Monkeypox adds to the stakes for University of Minnesota special pathogen training

Monkeypox adds to the stakes for University of Minnesota special pathogen training
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Dr. Jeff Dichter has placed central venous catheters in the veins of hundreds of patients, but it was an extra challenge Wednesday when trying to do it while wearing puffy protective gowns, three pairs of gloves and a respirator on his head.

"It does limit your dexterity a little, your mobility a little, your vision a little," he said after threading the catheter into a block made from Metamucil and gelatin to simulate the feel of human tissue.

The veteran intensive care doctor was taking part in a drill at M Health Fairview's University of Minnesota Medical Center to practice providing routine care to patients with highly infectious diseases without getting exposed.

The quarterly training is routine for the U's special pathogens unit, which was created in 2014 amid concerns that an Ebola epidemic in Africa would reach the U.S.This week, amid the spread of monkeypox, it took on a sense of immediacy.

Ten monkeypox cases have been identified in Minnesota since late June as part of a global outbreak, according to the Minnesota Department of Health. None has produced severe illness or required hospital care, making the virus far less lethal than others such as Ebola, which had a death rate of about 40% among known cases in the 2014 outbreak.

Health officials are nonetheless concerned because the monkeypox virus, which historically spread from animals to humans in Africa, is capable of severe illness and is passing from person to person worldwide.

The 10 Minnesota cases mostly involved people infected during travel outside the state but included two people who lived together. Nine doses of monkeypox vaccine have been provided prophylactically to Minnesotans with potential exposure to these cases.

Transmission primarily occurs when people come in contact with bodily fluids or surfaces contaminated with the virus, making even routine surgical and medical procedures a risk for providers.

Donning of protective gear took as much time as Wednesday's practice placement of a catheter — a common procedure allowing critically ill patients to receive intravenous fluids or medication. The doctors put on gowns, then gloves that were then cinched to their gowns with masking tape, then hoodies attached to respirators, then aprons that tied around the air hoses running down their backs.

"This is why we have to do these trainings together, so that we're kind of comfortable looking out for each other," nurse Zuza Kuchta, a volunteer trainer, said as she tied an apron around one doctor's back.

So much emphasis over the past two years has been on preventing the airborne spread of COVID-19 that doctors need refreshers on how to protect themselves from viruses such as monkeypox that spread through contact with infected fluids or surfaces, said Dr. Susan Kline, a U infection prevention specialist.

The goal is to leave no skin exposed during the procedure or to come in contact with any protective gear afterward that has been contaminated.

"It's a very ritualistic process," Kline said.

Patients have been admitted to the special pathogens unit with suspicious symptoms of highly infectious disease over the past decade, but none tested positive. A severe case of monkeypox would qualify for treatment in the unit.

Dichter almost tripped as he took a foot cover off one leg and placed it outside the operating room, then sanitized his gloves before taking the cover off the other foot still inside the room.

The former medical director of Unity Hospital in Fridley recalled when it was designated as one of four Ebola treatment centers and took in a suspect patient who had just arrived by plane from West Africa. The intensity ratchets up when real cases occur, so practice helps to keep the treatment team focused and not miss any important steps, Dichter said.

"It just gives us experience doing different kind of things if we have a real patient," he said, "or when we have a real patient."