An update on US Ebola treatment center personnel management and training

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Objective: In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We aimed to determine ongoing sustainability of ETCs and identify how ETC capabilities have impacted hospital, local, and regional COVID-19 readiness and response. Design: An electronic survey included both qualitative and quantitative questions and was structured into two sections: operational sustainability and role in the COVID-19 response. Setting and Participants: The survey was distributed to site representatives from the 56 originally designated ETCs; 37 (66%) responded. Methods: Data were coded and analyzed using descriptive statistics. Results: Of the 37 responding ETCs, 33 (89%) reported they were still operating while 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but one ETC reported that existing capabilities (e.g., trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (e.g., ETCs trained staff, donated supplies, and shared developed protocols). Conclusions: Existing high-level isolation capabilities and expertise developed following the 2014-2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and support response for other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.

Section: Discussionmentioning

confidence: 81%

The utility and sustainability of US Ebola treatment centers during the coronavirus disease 2019 (COVID-19) pandemic

Herstein

Biddinger

Gibbs

et al. 2022

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“…Not surprisingly, then, staff training was the most cited barrier in sustaining US high-level isolation capabilities in a 2019 survey. 18 Rigorous and sustained training is fundamental for HLIU operations because procedures are often different from routine practice and the consequences of inconsistent or incorrect implementation can be profound. In addition to well-developed protocols and procedures, units must ensure staff are trained and competent to think critically and assess risk, whatever the situation presents in these higher-risk environments.…”

Section: Discussionmentioning

confidence: 99%

Capabilities of global high-level isolation units: A pre-workshop survey

Herstein

Wolf

Nicastri

et al. 2021

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Objective: To assess experience, physical infrastructure, and capabilities of high-level isolation units (HLIUs) planning to participate in a 2018 global HLIU workshop hosted by the US National Emerging Special Pathogens Training and Education Center (NETEC). Design: An electronic survey elicited information on general HLIU organization, operating costs, staffing models, and infection control protocols of select global units. Setting and participants: The survey was distributed to site representatives of 22 HLIUs located in the United States, Europe, and Asia; 19 (86%) responded. Methods: Data were coded and analyzed using descriptive statistics. Results: The mean annual reported budget for the 19 responding units was US$484,615. Most (89%) had treated a suspected or confirmed case of a high-consequence infectious disease. Reported composition of trained teams included a broad range of clinical and nonclinical roles. The mean number of HLIU beds was 6.37 (median, 4; range, 2–20) for adults and 4.23 (median, 2; range, 1–10) for children; however, capacity was dependent on pathogen. Conclusions: Responding HLIUs represent some of the most experienced HLIUs in the world. Variation in reported unit infrastructure, capabilities, and procedures demonstrate the variety of HLIU approaches. A number of technical questions unique to HLIUs remain unanswered related to physical design, infection prevention and control procedures, and staffing and training. These key areas represent potential focal points for future evidence and practice guidelines. These data are important considerations for hospitals considering the design and development of HLIUs, and there is a need for continued global HLIU collaboration to define best practices.

“…Institutions were identified from their affiliation with NETEC, from previous participation in studies pertaining to ETCs, and from internet searches, e-mail exchanges, and telephone communication. 12,13 Participants were eligible to take part in the study if they were currently or previously had been part of the staff designated for care or planning the care of a PUI or a VHF patient at their institution.…”

Section: Inclusion Criteriamentioning

confidence: 99%

Institutional policies and readiness in management of critical illness among patients with viral hemorrhagic fever

DiLorenzo¹,

Baker²,

Herstein³

et al. 2021

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Objective: In response to the 2013–2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF). Design: A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care. Setting and participants: The questionnaire was sent to 82 ETCs. Methods: We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not. Results: Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication. Conclusions: There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.