Advancing Preparedness for Highly Hazardous Contagious Diseases: Admitting 10 Simulated Patients with MERS-CoV

Abstract

The Ebola outbreak of 2014-2016 highlighted the need for the development of a more robust healthcare infrastructure in the United States to provide isolation care for patients infected with a highly hazardous contagious disease. Routine exercises and skills practice are required to effectively and safely prepare care teams to confidently treat this special population of patients. The Nebraska Biocontainment Unit (NBU) at Nebraska Medicine in Omaha has been conducting exercises since 2005 when the unit was opened. Previous activities and exercises conducted by the Nebraska Biocontainment Unit have focused on transporting and caring for up to 3 patients with Ebola virus disease or other special pathogens. Changes in regional and national mandates, as well as the increased potential for receiving multiple patients at once, at a single location, have resulted in a greater demand to exercise protocols for the treatment of multiple patients. This article discusses in detail the planning, execution, and outcomes of a full-scale exercise involving 10 simulated patients with a highly infectious pathogen transmitted by the airborne route.

A narrative review of high-level isolation unit operational and infrastructure features

“…To date, several surveys have evaluated deficiencies, standards and staff competencies related to the Centers for Disease Control and Prevention Identify, Isolate and Inform algorithm for a patient with EVD or another HCID, with emphasis on the value of standardised processes across the healthcare sector 31 33 34 36. The paradigm created by New York Health and Hospitals, ‘Ready or not, patients will present’, highlights the importance of HCID readiness for all healthcare entry points 33…”

“…A 2018 survey of select HLIUs found consensus among respondents that VHFs and smallpox would be managed in an HLIU, but HLIU uses varied for other diseases 6. Unsurprisingly, multiple simultaneous patient admissions require altered HLIU patient intake procedures and considerations for escalated staffing, waste management and PPE use; exercises and drills are effective in testing and revising these procedures 5 6 12 31…”

The Special Pathogens Research Network: Enabling Research Readiness

“…The SPRN couples testing and assessment of research readiness with field exercises for special pathogens research. 28 Exercises serve as a cornerstone of the all-hazards approach to preparedness, including for infectious diseases, and are incorporated into local, regional, and national drills. The concept of integrating special pathogens research in the field has not been implemented widely, and much of Table 3.…”

Obstetric simulation for a pandemic

“…From prior pandemics and disasters, it is evident that simulation is one of the most effective ways to practice new protocols and identify gaps in knowledge and preparation. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Communication, teamwork, and process efficiency are dramatically increased with simulations, which is why they are quickly being adapted as an essential part of medical training for small team events like codes and postpartum hemorrhages and large-scale, multi-hospital emergencies, disasters, and pandemics.…”

“…The Ebola outbreak in 2014–2016 was the most recent event that demonstrated a need for pandemic and disaster preparedness throughout the country, as hospitals quickly realized they did not have plans for admitting, transporting, and caring for these highly contagious patients. 5 , 7 , 14 , 15 This was also one of the first times that simulations focused on protecting the providers from disease and not just improving patient care. Simulations initially focused only on donning and doffing personal protective equipment (PPE), as this was noted to be one of the most critical aspects of readiness for this threat.…”