Nurses treating an ebola patient in Dallas had to use medical tape to secure openings in their protective outfits, a nursing union has claimed, as a second hospital worker tested positive for the disease.
Thomas Eric Duncan, who died at Texas Health Presbyterian Hospital on 8 October, was also left in an open area of the emergency room for several hours before being put in isolation, Deborah Burger of National Nurses United said in a statement.
An unnamed female health worker from the hospital was placed in isolation 90 minutes after reporting she had a fever on Tuesday.
She was the second person of the 77 that came into contact with Mr Duncan to have caught ebola.
A "breach of protocol" was initially blamed after nurse Nina Pham, who is reported to be in stable condition, tested positive.
Miss Pham was wearing the CDC-outlined protective gear when she treated Mr Duncan and officials have yet to identify any lapse in procedures, although experts say the mask, shield, gloves and gown can be difficult to put on and remove safely.
The nurses' union statement said hospital workers interacted with Mr Duncan "with whatever protective equipment was available" while he produced "a lot of contagious fluids".
It added that those who treated the Liberian were also caring for other patients in the hospital and were concerned their heads and necks were exposed.
"There was no advance preparedness on what to do with the patient, there was no protocol, there was no system," Ms Burger said.
She warned that even now, some hospital staff do not have the necessary equipment to deal with the disease.
"Hospital managers have assured nurses that proper equipment has been ordered but it has not arrived yet," she said.
The nurses at Texas Health Presbyterian Hospital are not represented by Nurses United or any other union and it was not immediately clear if the nurses making the allegations were among those caring for Mr Duncan.
Officials are working to identify anybody who may have had contact with the newly infected health worker and are continuing to monitor all of those who may have been exposed to either Mr Duncan or Miss Pham.
In a news conference, Dallas County judge Clay Jenkins said: "At the hospital we have a situation involving 77 people. Two of them have tested positive for ebola. We are preparing contingencies for more and that is a very real possibility.
"You can imagine the anxieties of those 77 families."
Dallas Fire and Rescue have begun decontaminating the apartment building where the health worker lives.
The third case to be reported in the US was identified before world leaders were due to hold a video conference on how to tackle the disease that has killed more than 4,400 people, almost all of them in West Africa.
US President Barack Obama said he planned to pressure some countries into taking firmer action to slow the spread of the disease, which health experts have warned could infect 10,000 people a week within two months.
British, French, German and Italian leaders will be involved in the talks with Mr Obama.
Meanwhile, NBC's chief medical editor has apologised for a breaching voluntary quarantine that she and her team were placed in after cameraman Ashoka Mukpo caught ebola in Liberia.
Dr Nancy Snyderman and two members of her crew were reportedly seen collecting a takeaway order.
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