Infectious Disease Physician Assessment of Hospital Preparedness for Ebola Virus Disease

Preparedness of health care systems for Ebola outbreak response in Kasese and Rubirizi districts, Western Uganda

BACKGROUND

The level of preparedness of the health care workers, the health facility and the entire health system determines the magnitude of the impact of an Ebola Virus Disease (EVD) outbreak as demonstrated by the West African Ebola outbreak. The objective of the study was to assess preparedness of the health care facilities and identify appropriate preparedness measures for Ebola outbreak response in Kasese and Rubirizi districts in western Uganda.

METHODS

A cross sectional descriptive study was conducted by interviewing 189 health care workers using a structured questionnaire and visits to 22 health facilities to determine the level of health care system preparedness to EVD outbreak. District level infrastructure capabilities, existence of health facility logistics and supplies, and health care workers' knowledge of EVD was assessed. EVD Preparedness was assessed on infrastructure and logistical capabilities and the level of knowledge of an individual health work about the etiology, control and prevention of EVD.

RESULTS

Twelve out of the 22 of the health facilities, especially health center III's and IV's, did not have a line budget to respond to EVD when there was a threat of EVD in a nearby country. The majority (n = 13) of the facilities did not have the following: case definition books, rapid response teams and/or committees, burial teams, and simulation drills. There were no personal protective equipment that could be used within 8 h in case of an EVD outbreak in fourteen of the 22 health facilities. All facilities did not have Viral Hemorrhagic Fever (VHF) incident management centers, isolation units, guidelines for burial, and one-meter distance between a health care worker and a patient during triage. Overall, 54% (n = 102) of health care workers (HCWs) did not know the incubation period of EVD. HCWs who had tertiary education (aOR = 5.79; CI = 1.79-18.70; p = 0.003), and were Christian (aOR = 10.47; CI = 1.94-56.4; p = 0.006) were more likely to know about the biology, incubation period, causes and prevention of EVD.

CONCLUSIONS

Feedback on the level of preparedness for the rural districts helps inform strategies for building capacity of these health centers in terms of infrastructure, logistics and improving knowledge of health care workers.

Perceived Benefits and Challenges of Ebola Preparation Among Hospitals in Developed Countries: A Systematic Literature Review

The 2014–2016 Ebola epidemic in West Africa provided an opportunity to improve our response to highly infectious diseases. We performed a systematic literature review in PubMed, Cochrane Library, CINAHL, EMBASE, and Web of Science of research articles that evaluated benefits and challenges of hospital Ebola preparation in developed countries. We excluded studies performed in non-developed countries, and those limited to primary care settings, the public health sector, and pediatric populations. Thirty-five articles were included. Preparedness activities were beneficial for identifying gaps in hospital readiness. Training improved health-care workers’ (HCW) infection control practices and personal protective equipment (PPE) use. The biggest challenge was related to PPE, followed by problems with hospital infrastructure and resources. HCWs feared managing Ebola patients, affecting their willingness to care for them. Standardizing protocols, PPE types, and frequency of training and providing financial support will improve future preparedness. It is unclear whether preparations resulted in sustained improvements.

Prospero Registration. CRD42018090988.

Feasibility Assessment of a New Surveillance Tool for Respiratory Protective Devices Used in U.S. Healthcare

BACKGROUND

Respiratory protective devices (RPDs) are used for infection prevention in healthcare settings during routine patient care and public health emergencies. In recent years, healthcare systems have experienced shortages of RPDs during outbreaks of infectious diseases, in part due to a lack of information about their availability. New tools to track RPD inventories may improve accessibility during an emergency. Investigators at Vanderbilt University have identified four major themes that influence RPD use for infection prevention: hospital preparedness, responsiveness to airborne pathogens, potential exposure outcomes, and infection control practices related to respirator effectiveness. Based on these findings, an RPD surveillance tool (RST) was developed to collect and share near real-time data about RPD supplies in healthcare facilities. The objective of this study was to conduct a feasibility assessment of this RST.

METHODS

The new online surveillance tool was implemented at four large, urban, acute care U.S. hospitals in January 2014; data was collected about RPD inventory, tracking systems, hospital characteristics, and utility of gathered information.

RESULTS

The RST was implemented successfully and without difficulty at hospitals that had 78 to 90 percent occupancy rates. Participating hospitals reported that the RST (1) provided value for benchmarking their RPD supply, (2) promoted understanding about RPD accessibility among hospital systems engaged in infection control, and (3) served as a means to assess RPD program quality.

CONCLUSION

Implementation of this newly developed RST is feasible and appears to have utility in U.S. hospitals for tracking and understanding RPD use for routine healthcare delivery and public health emergencies.

Laboratory Processing of Specimens

Although not always the first topic discussed when preparing for a bioemergency, the availability of a competent clinical laboratory is vital for the optimal care of a patient with a risk group 4 (RG-4) high-consequence pathogen. The recent development of highly specialized facilities in the United States to assess and treat patients with highly hazardous communicable diseases has led to the design of dedicated laboratories or the redesign of laboratory space to safely process and test specimens that might contain one of these pathogens. For frontline and other acute care facilities to be prepared, safety practices need to be assessed and reviewed as necessary as pertaining to all laboratory activities, to include the pre-analytical (specimen collection and processing), analytical (specimen testing), and post-analytical (specimen disposal/waste management and reporting) processes. Laboratorians and administrative personnel need to consider the risks in handling specimens containing these pathogens and subsequently develop or revise processes to mitigate risks. In addition, issues such as scalability to handle large volume testing, the availability of trained staff, and long-term sustainability to meet the requirements of regulatory agencies need to be adopted within a fiscally responsible budget setting. This chapter provides generalized information on how clinical laboratories, from those supporting small frontline medical facilities to highly specialized laboratories supporting acute care treatment centers, can safely manage specimens from a patient known or potentially infected with a high-consequence pathogen.

Costs Associated with Ebola Preparedness at a Freestanding Pediatric Assessment Center

The 2014-2016 West Africa Ebola outbreak led US hospitals to prepare to treat Ebola patients, with significant attributable costs. A nationwide preparedness transition to a tiered approach allowed regional allocation of preparedness resources for Ebola frontline, assessment, and treatment hospitals. Preparedness costs for assessment centers were significant and largely uncompensated. Infect Control Hosp Epidemiol 2017;38:1367-1369.

Prevalence of Respiratory Protective Devices in U.S. Health Care Facilities: Implications for Emergency Preparedness

An online questionnaire was developed to explore respiratory protective device (RPD) prevalence in U.S. health care facilities. The survey was distributed to professional nursing society members in 2014 and again in 2015 receiving 322 and 232 participant responses, respectively. The purpose of this study was to explore if the emergency preparedness climate associated with Ebola virus disease changed the landscape of RPD use and awareness. Comparing response percentages from the two sampling time frames using bivariate analysis, no significant changes were found in types of RPDs used in health care settings. N95 filtering facepiece respirators continue to be the most prevalent RPD used in health care facilities, but powered air-purifying respirators are also popular, with regional use highest in the West and Midwest. Understanding RPD use prevalence could ensure that health care workers receive appropriate device trainings as well as improve supply matching for emergency RPD stockpiling.

Ebola Preparedness Resources for Acute-Care Hospitals in the United States: A Cross-Sectional Study of Costs, Benefits, and Challenges

OBJECTIVE

To assess resource allocation and costs associated with US hospitals preparing for the possible spread of the 2014–2015 Ebola virus disease (EVD) epidemic in the United States.

METHODS

A survey was sent to a stratified national probability sample (n=750) of US general medical/surgical hospitals selected from the American Hospital Association (AHA) list of hospitals. The survey was also sent to all children’s general hospitals listed by the AHA (n=60). The survey assessed EVD preparation supply costs and overtime staff hours. The average national wage was multiplied by labor hours to calculate overtime labor costs. Additional information collected included challenges, benefits, and perceived value of EVD preparedness activities.

RESULTS

The average amount spent by hospitals on combined supply and overtime labor costs was $80,461 (n=133; 95% confidence interval [CI], $56,502–$104,419). Multivariate analysis indicated that small hospitals (mean, $76,167) spent more on staff overtime costs per 100 beds than large hospitals (mean, $15,737; P<.0001). The overall cost for acute-care hospitals in the United States to prepare for possible EVD cases was estimated to be $361,108,968. The leading challenge was difficulty obtaining supplies from vendors due to shortages (83%; 95% CI, 78%–88%) and the greatest benefit was improved knowledge about personal protective equipment (89%; 95% CI, 85%–93%).

CONCLUSIONS

The financial impact of EVD preparedness activities was substantial. Overtime cost in smaller hospitals was >3 times that in larger hospitals. Planning for emerging infectious disease identification, triage, and management should be conducted at regional and national levels in the United States to facilitate efficient and appropriate allocation of resources in acute-care facilities.

Infect Control Hosp Epidemiol 2017;38:405–410

Preparation and Response to the 2014 Ebola Virus Disease Epidemic in Nigeria-The Experience of a Tertiary Hospital in Nigeria

INTRODUCTION

The 2014 Ebola Virus Disease (EVD) outbreak elicited global attention and challenged health systems around the world, Nigeria inclusive. We hereby report the preparation and response to the outbreak by a tertiary teaching hospital in Bayelsa State, Nigeria.

METHOD

Between 4th August and 31st October 2014, we conducted a mixed cross sectional and qualitative study to ascertain the EVD-related fear, myths and misconceptions among healthcare workers (HCWs), and to evaluate the plans, activities and challenges faced by the hospital during the outbreak. Data was collected using a self-administered questionnaire as well as by documented observations during the outbreak. HCWs were asked to rate their fear of EVD from 1 (no fear) to 10 (highest fear).

RESULTS

Out of 189 respondents, majority (>75%) reported uncertainty about the myth that EVD can be prevented by drinking salt water or eating Garcinia kola, while 82% of respondents believed that EVD can be prevented by avoiding crowded places. About 40% of respondents expressed fear ratings of EVD of ≥ 7 out of 10. In response to the outbreak, the hospital established an EVD response team, organised EVD-sensitization and training programmes and commenced routine EVD surveillance activities. An EVD-isolation ward was constructed from an existing ward, a field incinerator was designed, hand sanitizers were produced locally and personal protective equipment were procured. No case of EVD was reported in the hospital, although three false alarms caused panic. Some HCWs adopted overly protective and avoidance behaviours, but these behaviours were abandoned after the outbreak was declared over.

CONCLUSION

Our results suggest that the fear, myth and misconceptions were common among HCW during the outbreak. The EVD outbreak, however, helped to strengthen gaps in infection control and emergency preparedness in the hospital. Strategies to allay fear are required to contain future outbreaks of EVD in Nigeria hospitals.

Using Computer Vision and Depth Sensing to Measure Healthcare Worker-Patient Contacts and Personal Protective Equipment Adherence Within Hospital Rooms

This prospective study of cellulitis identified β-hemolytic streptococci as the dominating cause in all investigated subgroups. Group C/G streptococci were more frequently detected than group A streptococci. No single clinical feature substantially increased the probability of confirmed streptococcal etiology.

Background. We determined the feasibility of using computer vision and depth sensing to detect healthcare worker (HCW)-patient contacts to estimate both hand hygiene (HH) opportunities and personal protective equipment (PPE) adherence.

Methods. We used multiple Microsoft Kinects to track the 3-dimensional movement of HCWs and their hands within hospital rooms. We applied computer vision techniques to recognize and determine the position of fiducial markers attached to the patient's bed to determine the location of the HCW's hands with respect to the bed.

To measure our system's ability to detect HCW-patient contacts, we counted each time a HCW's hands entered a virtual rectangular box aligned with a patient bed. To measure PPE adherence, we identified the hands, torso, and face of each HCW on room entry, determined the color of each body area, and compared it with the color of gloves, gowns, and face masks. We independently examined a ground truth video recording and compared it with our system's results.

Results. Overall, for touch detection, the sensitivity was 99.7%, with a positive predictive value of 98.7%. For gowned entrances, sensitivity was 100.0% and specificity was 98.15%. For masked entrances, sensitivity was 100.0% and specificity was 98.75%; for gloved entrances, the sensitivity was 86.21% and specificity was 98.28%.

Conclusions. Using computer vision and depth sensing, we can estimate potential HH opportunities at the bedside and also estimate adherence to PPE. Our fine-grained estimates of how and how often HCWs interact directly with patients can inform a wide range of patient-safety research.