Staff at Madrid’s Carlos III hospital say protective suits do not meet WHO standards as second nurse undergoes tests for virus

Health professionals in Madrid have blamed substandard equipment and a failure to follow protocol for the first case of Ebola to be contracted outside west Africa.

Health authorities announced on Monday that a Spanish nurse at Madrid’s Carlos III hospital who treated a patient repatriated from Sierra Leone had twice tested positive for Ebola.

Her husband had also been admitted to hospital and was in isolation, and a second nurse from the same team that treated both repatriated Ebola victims was also being tested. In this case, the nurse contacted the authorities on Monday complaining of a fever. She was in isolation in the Carlos III Hospital while authorities waited for the test results, a spokesperson for the Madrid regional government said.

A third person, a man recently arrived from Nigeria, was also under quarantine in Madrid but tested negative for Ebola in his first test.

Health authorities said they were monitoring more than 50 possible contacts of the nurse.

Staff at the hospital where she worked told El País that the protective suits they were given did not meet World Health Organisation (WHO) standards, which specify that suits must be impermeable and include breathing apparatus. Staff also pointed to latex gloves secured with adhesive tape as an example of how the suits were not impermeable and noted that they did not have their own breathing equipment.

The nurse was part of a team attending to missionary Manuel García Viejo, 69, who died four days after being brought to Carlos III hospital on 20 September. The same team, including the nurse, also treated missionary Miguel Pajares, 75, who was repatriated from Liberia in August and died five days later.

Staff at the hospital said waste from the rooms of both patients was carried out in the same elevator used by all personnel and, in the case of the second patient, the hospital was not evacuated.

The European commission said on Tuesday it had written to the Spanish health minister “to obtain some clarification” on how the nurse had become infected when all EU member states were supposed to have taken measures to prevent transmission.

“There is obviously a problem somewhere,” the commission spokesman Frédéric Vincent said.

Spanish health authorities have said that professionals treating Ebola patients in Spain always follow WHO protocols. The nurse would have entered García Viejo’s room just twice, said Antonio Alemany, from the regional government of Madrid, both times wearing protective equipment.

“We don’t know yet what failed,” Alemany said. “We are investigating the mechanism of infection.”

The regional director of the WHO in Europe said Ebola would “most likely” spread but the continent was well prepared to control it. Zsuzsanna Jakab told Reuters European health workers tasked with caring for the patients, as well as their families and close contacts, were most at risk of becoming infected.

“It will happen. But the most important thing in our view is that Europe is still at low risk and that the western part of the European region particularly is the best prepared in the world to respond to viral haemorrhagic fevers including Ebola,” she said.

The nurse had alerted the ministry of a slight fever on 30 September and been checked into a hospital in Alcorcón, on the outskirts of Madrid, with a high fever on Monday. She was transferred to Carlos III hospital early on Tuesday morning.

El Mundo reported that it was the nurse who asked to be tested for Ebola, having to insist repeatedly on being tested before it was done on Monday.

While staff at the Alcorcón hospital were waiting for the test results, the nurse remained in a bed in the emergency room, separated only by curtains from other patients, hospital staff told El Mundo. Their version of events clashes with that of health authorities, who have said the patient was isolated from the first moment.

The woman was on holiday at an unknown location when she began showing symptoms. “We are drawing up a list of all the people she may have been in contact with, including with health professionals at the Alcorcón hospital,” said Alemany, estimating that more than 30 people were being monitored for any sign of symptoms.

In August, Spain became the first European country in the current, fast-spreading outbreak to evacuate patients for treatment. The decision prompted concern among health professionals, who said Spanish hospitals were not adequately equipped to handle Ebola.