Hospitals and health systems preparing for and treating patients with Ebola Virus Disease (EVD) in the fall of 2015 faced unexpected challenges for ensuring safety of staff, patients and the community. The experiences are detailed in two studies published online in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA).
In a case study of the care of two patients with confirmed or suspected EVD at the National Institutes of Health (NIH) Clinical Center's Special Clinical Studies Unit, a multidisciplinary team detailed the challenges and surprises encountered in preparing and caring for patients with EVD. Although procedures for similar care had been long established, the reality of the patients' cases required flexibility and ability adjust procedures quickly.
"Years of planning and drills for care of a patient exposed or infected with Ebola could not anticipate the external scrutiny in which care was delivered," said Tara Palmore, MD, a lead author of the NIH case study and hospital epidemiologist in the NIH Clinical Center. "Many precautions were taken to prevent the spread of the virus, and some were taken to mitigate fear, even if science did not always support those fears. We were humbled by the commitment of healthcare providers and others to the mission of caring for these patients."
While the experiences of NIH staff illustrate the intensive and special efforts required for this care, a study detailing a survey of more than 250 SHEA members -- including hospital epidemiologists and infection preventionists in 41 states and the District of Columbia, including all of the U.S. centers that have cared for EVD -- demonstrates the extensive preparation underwent throughout the country. Survey respondents suggest that preparedness exercises, including institutional plan development, staff training in triage and personal protective equipment (PPE) use, and managing changing national and international guidelines, took up more than 80 percent of infection control staff time, leaving time for only 30 percent of routine infection prevention activities to be completed during this period.
Key themes include:
"Hospital Ebola preparations required extraordinary resources, which were diverted from routine infection prevention activities," said Daniel J. Morgan, MD, MS, an author of the SHEA survey and associate profession of epidemiology and public health at the University of Maryland School of Medicine. "Patients being evaluated for Ebola faced delays and potential limitations in the management of other diseases that are more common in travelers returning from West Africa."
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