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Al Dowaiki SS, Morley D, Agreiter I, Herstein JJ, Vincent H, Woo J. Implementation of a High-Level Isolation Unit Readiness Checklist in the Irish Setting. Health Secur 2024. [PMID: 39178107 DOI: 10.1089/hs.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024] Open
Abstract
A high-level isolation unit (HLIU) is a specially designed biocontainment unit for suspected or confirmed high-consequence infectious diseases. For most HLIUs, maintaining readiness during times of inactivity is a challenge. In this case study, we describe a checklist approach to assess HLIU readiness to rapidly operate upon activation. This checklist includes readiness criteria in several domains, such as infrastructure, human resources, and material supplies, that are required to safely activate the unit at any time. The checklist audit tool was derived from a novel activation readiness checklist published by the biocontainment unit at The Johns Hopkins Hospital in Baltimore, Maryland. It was then adapted for the Irish healthcare setting and implemented at the Mater Misericordiae University Hospital, Ireland's current isolation facility. Results from the audit were also used to inform recommendations for the construction of a new HLIU to open in 2025. The audit tool is user friendly, practical, and focuses on the essential elements of readiness to ensure a successful rapid operation.
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Affiliation(s)
- Samata Salim Al Dowaiki
- Samata Salim Al Dowaiki, MD, MRCP (UK), is an Internist and Infectious Diseases Specialist, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Deirdre Morley
- Deirdre Morley, MBBCh, JFICMI, EDIC, is a Clinical Lead, National Isolation Unit, and a Consultant in Infectious Disease and Intensive Care Medicine
| | - Iris Agreiter
- Iris Agreiter, MSN, RN, is a Clinical Nurse Specialist, National Isolation Unit
| | - Jocelyn J Herstein
- Honey Vincent, RN, RNP, is a Staff Development Facilitator, National Isolation Unit; and
| | - Honey Vincent
- James Woo, MBBCh, MRCPI, is Deputy Clinical Lead, National Isolation Unit, and a Consultant in Infectious Diseases; all at Mater Misericordiae University Hospital, Dublin, Ireland
| | - James Woo
- Jocelyn J. Herstein, PhD, MPH, is an Assistant Professor, Department of Environmental, Agricultural and Occupational Health, College of Public Health, and Director, National Emerging Special Pathogens Training and Education Center International Partnerships and Programs; both at University of Nebraska Medical Center, Omaha, NE
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Uhrig A, Rwagasore E, Liebau LD, Villinger D, Gertler M, Masaisa F, Bitunguhari L, Piening T, Paerisch T, Cronen T, Nkeshimana M, Muvunyi CM, Stegemann MS. Building a High-Level Isolation Unit in Rwanda and Establishing a Training Program for the Medical Management of Patients With High-Consequence Infectious Diseases. Health Secur 2024. [PMID: 39178149 DOI: 10.1089/hs.2023.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024] Open
Abstract
Rwanda is a country in East Africa, a region characterized by highly mobile populations and outbreaks of high-consequence infectious diseases occurring on a regular basis. To increase the level of outbreak preparedness in the region, the Rwandan government and the German Ministry of Health signed a joint agreement to construct a new high-level isolation unit in Rwanda, the first in East Africa, and implement a training program for Rwandan healthcare workers to equip them with the necessary skills and knowledge for medical management of patients under high-level isolation conditions, including intensive care treatment. To better understand the scope and format of the planned training program, a needs assessment was performed based on findings from a standardized survey of 4 intensive care units in Rwanda as well as observations from 2 members of a German high-level isolation unit who completed clinical internships at Rwandan hospitals. In this case study, we describe the necessary steps to promote the sustainability and capabilities of the new high-level isolation unit in Kigali and ensure the successful implementation of the training program.
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Affiliation(s)
- Alexander Uhrig
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Edson Rwagasore
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Laura Dorothea Liebau
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - David Villinger
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Maximilian Gertler
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Florence Masaisa
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Leopold Bitunguhari
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Turid Piening
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Thomas Paerisch
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Thomas Cronen
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Menelas Nkeshimana
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Claude Mambo Muvunyi
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
| | - Miriam Songa Stegemann
- Alexander Uhrig, MD, is Medical Director, Medical Intensive Care Unit, and Director, Critical Care Medicine, Berlin High-Level Isolation Unit, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; Maximilian Gertler, MD, is a Tropical Medicine Consultant, Institute of Tropical Medicine, and International Health, Charité Center for Global Health; Thomas Cronen, MD, is an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine; and Miriam Songa Stegemann, MD, is a Training Coordinator, Berlin High-level Isolation Unit, an Infectious Disease Consultant, Department of Infectious Diseases, Pulmonary and Critical Care Medicine, and Director of Antimicrobial Stewardship Program; all at Charité - Universitätsmedizin Berlin, Berlin, Germany. Edson Rwagasore, MD, MSc, is Division Manager, Division of Public Health Surveillance and Emergency Preparedness and Response, and Claude Mambo Muvunyi, MD, PhD, MSc, is Director General; both at the Rwanda Biomedical Centre, Kigali, Rwanda. Laura Dorothea Liebau, MSc, and David Villinger, MD, are Consultants, Medmissio Institute for Global Health Würzburg, Germany. Florence Masaisa, MD, is an Associate Professor and Chair, Department of Internal Medicine, University of Rwanda, and a Physician, Hematologist, and Head of Clinical Education and Research, University Teaching Hospital of Kigali; all in Kigali, Rwanda. Leopold Bitunguhari, MD, is a Senior Lecturer of Medicine, University of Rwanda, and a Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; both in Kigali, Rwanda. Turid Piening is a Training Coordinator, EFFO-COE Project, and a Research Associate, and Thomas Paerisch, MD, is Project Coordinator, EFFO-COE Project, and a Research Associate; both at the Center of Biological Risks and Special Pathogens, Robert Koch Institute, Berlin, Germany. Menelas Nkeshimana, MD, is Head, Department of Health Workforce Development, Ministry of Health; a Consultant Physician, Department of Internal Medicine, University Teaching Hospital of Kigali; and a Lecturer, University of Rwanda; all in Kigali, Rwanda
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Herstein JJ, Lukowski J, ElRayes W, Lowe JJ, Mehta AK, Mukherjee V, Stern KL, Carrasco SV, Vasa A, Vasistha S, Sauer LM. High-Level Isolation: A Landscape Analysis of Global Capabilities and Opportunities to Advance the Field. Health Secur 2024. [PMID: 39101827 DOI: 10.1089/hs.2023.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
High-level isolation units (HLIUs) have been established by countries to provide safe and optimal medical care for patients with high-consequence infectious diseases. We aimed to identify global high-level isolation capabilities and determine gaps and priorities of global HLIUs, using a multiple method approach that included a systematic review of published and gray literature and a review of Joint External Evaluations and Global Health Security Index reports from 112 countries. A follow-up electronic survey was distributed to identified HLIUs. The landscape analysis found 44 previously designated/self-described HLIUs in 19 countries. An additional 33 countries had potential HLIUs; however, there were not enough details on capabilities to determine if they fit the HLIU definition. An electronic survey was distributed to 36 HLIUs to validate landscape analysis findings and to understand challenges, best practices, and priorities for increased networking with a global HLIU cohort; 31 (86%) HLIUs responded. Responses revealed an additional 30 confirmed HLIUs that were not identified in the landscape analysis. To our knowledge, this was the first mapping and the largest ever survey of global HLIUs. Survey findings identified major gaps in visibility of HLIUs: while our landscape analysis initially identified 44 units, the survey unveiled an additional 30 HLIUs that had not been previously identified or confirmed. The lack of formalized regional or global coordinating organizations exacerbates these visibility gaps. The unique characteristics and capabilities of these facilities, coupled with the likelihood these units serve as core components of national health security plans, provides an opportunity for increased connection and networking to advance the field of high-level isolation and address identified gaps in coordination, build an evidence base for HLIU approaches, and inform HLIU definitions and key components.
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Affiliation(s)
- Jocelyn J Herstein
- Jocelyn J. Herstein, PhD, MPH, is an Assistant Professor, Department of Environmental, Agricultural and Occupational Health, College of Public Health, and Director, National Emerging Special Pathogens Training and Education Center (NETEC) International Partnerships and Programs
| | - Joseph Lukowski
- Joseph Lukowski, MPH, is a Data Coordinator II, Lymphoma Study Group-Tissue Bank/Consent, Oncology/Hematology, Department of Internal Medicine
| | - Wael ElRayes
- Wael ElRayes, MBBCh, PhD, MS, FACHE, is Faculty, Department of Health Services Research and Administration, and Co-Director, Center for Global Health and Development, College of Public Health
| | - John J Lowe
- John J. Lowe, PhD, is Director, Global Center for Health Security, Professor and Chair, Department of Environmental, Agricultural and Occupational Health, College of Public Health, and Assistant Vice Chancellor for Health Security Training and Education, Office of the Vice Chancellor for Academic Affairs
| | - Aneesh K Mehta
- Aneesh K. Mehta, MD, FIDSA, FAST, is Professor of Medicine and of Surgery, Assistant Director of Transplant Infectious Diseases, and Chief of Infectious Diseases Services, Emory University Hospital, Emory University School of Medicine, Atlanta, GA
| | - Vikramjit Mukherjee
- Vikramjit Mukherjee, MD, FRCP, is Director, Critical Care, and Director, Special Pathogens Program, NYC Health + Hospitals/Bellevue, and Associate Professor, NYU School of Medicine, New York, NY
| | - Katie L Stern
- Katie L. Stern, MPH, is a Program Evaluation Specialist, Global Center for Health Security
| | - Sharon Vanairsdale Carrasco
- Sharon Vanairsdale Carrasco, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN, FNAP, is an Associate Clinical Professor, Nell Hodgson Woodruff School of Nursing, Director of Training and Education, NETEC, and Director, Regional Emerging Special Pathogen Treatment Center, Region IV, Emory University, Atlanta, GA
| | - Angela Vasa
- Angela Vasa, MSN, RN, is Director, Readiness Consultations and Metrics Development, NETEC, and Director, Biopreparedness and Special Pathogen Programs, Nebraska Medicine, Omaha, NE
| | - Sami Vasistha
- Sami Vasistha, MS, is Lead Program Manager, NETEC, and Program Manager, Global Center for Health Security; and
| | - Lauren M Sauer
- Lauren M. Sauer, MSc, is Associate Director of Research, Global Center for Health Security, Director, Special Pathogens Research Network, and Associate Professor, Department of Environmental, Agricultural and Occupational Health, College of Public Health; all at the University of Nebraska Medical Center, Omaha, NE
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4
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Zweers LN, Tingen-Wieland M, Bowles E, van Tricht J, Velers J, Tostmann A, Rovers CP. Improving Safety and Comfort of Healthcare Workers Caring for Patients With High-Consequence Infectious Diseases in a High-Level Isolation Unit Using Innovative Approaches. Health Secur 2024. [PMID: 39051065 DOI: 10.1089/hs.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Patients with high-consequence infectious diseases (HCIDs) require high-quality care by specially trained staff in a high-level isolation unit (HLIU) that follows strict infection prevention and control (IPC) measures. Caring for patients with (suspected) HCID is challenging, mainly because of the strict personal protective equipment (PPE) and IPC protocols healthcare workers (HCW) must adhere to for protection. The Radboud University Medical Center, located in Nijmegen, the Netherlands, has been a dedicated HLIU facility since 2008. A newly built HLIU opened in May 2022, and encouraged us to review the existing PPE selection, IPC protocols, and HCID training program to improve safety and comfort for HCWs working in the HLIU. Based on a systematic search through (inter)national HCID PPE guidelines and semistructured interviews with end users, we selected an improved, more comfortable set of PPE. Additionally, we developed a more concise and easier-to-use patient care process flow and implemented a new teaching strategy. The new way of working was tested in October 2022 when the first 2 patients with suspected HCID were admitted to our unit. We used surveys to evaluate the experiences of HCWs involved in this care to further improve the workflow of the unit. When optimizing safety and comfort for HCWs, it is important to consider (inter)national guidelines as well as user preferences. By systematically evaluating recent experiences of patient admission to the HLIU and then adjusting protocols and training, we can ensure that the quality of provided healthcare and the safety of HCWs working in the HLIU remains high.
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Affiliation(s)
- Luca N Zweers
- Luca N. Zweers, MSc, is a PhD Candidate and Project Team Member, and Chantal P. Rovers, MD, PhD, is an Infectious Diseases Specialist, Full Professor, and Medical Manager; both in the High-Level Isolation Unit, Department of Internal Medicine, Radboudumc Community for Infectious Diseases. Manon W. M. Tingen-Wieland is an Infection Prevention and Control Expert, Edmée C. Bowles, MD, is a Clinical Microbiologist and Unit Head, and Alma Tostmann, PhD, is an Infectious Diseases Epidemiologist and Deputy Unit Head; all in the Infection Prevention and Control Unit, Department of Medical Microbiology, Radboudumc Community for Infectious Diseases. Jacqueline M. van Tricht and Jos Velers are Learning and Development Advisors, Radboudumc Health Academy. All authors are at the Radboud University Medical Center, Nijmegen, the Netherlands
| | - Manon Tingen-Wieland
- Luca N. Zweers, MSc, is a PhD Candidate and Project Team Member, and Chantal P. Rovers, MD, PhD, is an Infectious Diseases Specialist, Full Professor, and Medical Manager; both in the High-Level Isolation Unit, Department of Internal Medicine, Radboudumc Community for Infectious Diseases. Manon W. M. Tingen-Wieland is an Infection Prevention and Control Expert, Edmée C. Bowles, MD, is a Clinical Microbiologist and Unit Head, and Alma Tostmann, PhD, is an Infectious Diseases Epidemiologist and Deputy Unit Head; all in the Infection Prevention and Control Unit, Department of Medical Microbiology, Radboudumc Community for Infectious Diseases. Jacqueline M. van Tricht and Jos Velers are Learning and Development Advisors, Radboudumc Health Academy. All authors are at the Radboud University Medical Center, Nijmegen, the Netherlands
| | - Edmée Bowles
- Luca N. Zweers, MSc, is a PhD Candidate and Project Team Member, and Chantal P. Rovers, MD, PhD, is an Infectious Diseases Specialist, Full Professor, and Medical Manager; both in the High-Level Isolation Unit, Department of Internal Medicine, Radboudumc Community for Infectious Diseases. Manon W. M. Tingen-Wieland is an Infection Prevention and Control Expert, Edmée C. Bowles, MD, is a Clinical Microbiologist and Unit Head, and Alma Tostmann, PhD, is an Infectious Diseases Epidemiologist and Deputy Unit Head; all in the Infection Prevention and Control Unit, Department of Medical Microbiology, Radboudumc Community for Infectious Diseases. Jacqueline M. van Tricht and Jos Velers are Learning and Development Advisors, Radboudumc Health Academy. All authors are at the Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jacqueline van Tricht
- Luca N. Zweers, MSc, is a PhD Candidate and Project Team Member, and Chantal P. Rovers, MD, PhD, is an Infectious Diseases Specialist, Full Professor, and Medical Manager; both in the High-Level Isolation Unit, Department of Internal Medicine, Radboudumc Community for Infectious Diseases. Manon W. M. Tingen-Wieland is an Infection Prevention and Control Expert, Edmée C. Bowles, MD, is a Clinical Microbiologist and Unit Head, and Alma Tostmann, PhD, is an Infectious Diseases Epidemiologist and Deputy Unit Head; all in the Infection Prevention and Control Unit, Department of Medical Microbiology, Radboudumc Community for Infectious Diseases. Jacqueline M. van Tricht and Jos Velers are Learning and Development Advisors, Radboudumc Health Academy. All authors are at the Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos Velers
- Luca N. Zweers, MSc, is a PhD Candidate and Project Team Member, and Chantal P. Rovers, MD, PhD, is an Infectious Diseases Specialist, Full Professor, and Medical Manager; both in the High-Level Isolation Unit, Department of Internal Medicine, Radboudumc Community for Infectious Diseases. Manon W. M. Tingen-Wieland is an Infection Prevention and Control Expert, Edmée C. Bowles, MD, is a Clinical Microbiologist and Unit Head, and Alma Tostmann, PhD, is an Infectious Diseases Epidemiologist and Deputy Unit Head; all in the Infection Prevention and Control Unit, Department of Medical Microbiology, Radboudumc Community for Infectious Diseases. Jacqueline M. van Tricht and Jos Velers are Learning and Development Advisors, Radboudumc Health Academy. All authors are at the Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alma Tostmann
- Luca N. Zweers, MSc, is a PhD Candidate and Project Team Member, and Chantal P. Rovers, MD, PhD, is an Infectious Diseases Specialist, Full Professor, and Medical Manager; both in the High-Level Isolation Unit, Department of Internal Medicine, Radboudumc Community for Infectious Diseases. Manon W. M. Tingen-Wieland is an Infection Prevention and Control Expert, Edmée C. Bowles, MD, is a Clinical Microbiologist and Unit Head, and Alma Tostmann, PhD, is an Infectious Diseases Epidemiologist and Deputy Unit Head; all in the Infection Prevention and Control Unit, Department of Medical Microbiology, Radboudumc Community for Infectious Diseases. Jacqueline M. van Tricht and Jos Velers are Learning and Development Advisors, Radboudumc Health Academy. All authors are at the Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chantal P Rovers
- Luca N. Zweers, MSc, is a PhD Candidate and Project Team Member, and Chantal P. Rovers, MD, PhD, is an Infectious Diseases Specialist, Full Professor, and Medical Manager; both in the High-Level Isolation Unit, Department of Internal Medicine, Radboudumc Community for Infectious Diseases. Manon W. M. Tingen-Wieland is an Infection Prevention and Control Expert, Edmée C. Bowles, MD, is a Clinical Microbiologist and Unit Head, and Alma Tostmann, PhD, is an Infectious Diseases Epidemiologist and Deputy Unit Head; all in the Infection Prevention and Control Unit, Department of Medical Microbiology, Radboudumc Community for Infectious Diseases. Jacqueline M. van Tricht and Jos Velers are Learning and Development Advisors, Radboudumc Health Academy. All authors are at the Radboud University Medical Center, Nijmegen, the Netherlands
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Persson C, Levine CB, Marshall K, Shea S, Arguinchona C, Carrasco SV, Sauer LM, Herstein JJ. Building a biocontainment unit: Infrastructure and organizational experiences of the 13 regional biocontainment units in the United States. Am J Infect Control 2024:S0196-6553(24)00584-4. [PMID: 38969069 DOI: 10.1016/j.ajic.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
In the United States, the system for special pathogen patient care incorporates a network of federally funded US biocontainment units that maintain operational readiness to care for patients afflicted by high-consequence infectious diseases (HCIDs). This network has expanded in number of facilities and in scope, serving as a regional resource for special pathogen preparedness. Lessons learned for maintaining these units are shared with the intent of informing new and existing biocontainment units.
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Affiliation(s)
- Caroline Persson
- Administration Department, Denver Health Medical Center, Denver, CO.
| | - Corri B Levine
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX
| | - Kara Marshall
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX
| | - Sophia Shea
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE
| | - Christa Arguinchona
- Special Pathogens, Providence Sacred Heart Medical Center & Children's Hospital, Spokane, WA
| | | | - Lauren M Sauer
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Jocelyn J Herstein
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; College of Public Health, University of Nebraska Medical Center, Omaha, NE
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6
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Lukowski J, Vasa A, Arguinchona C, ElRayes W, Frank MG, Galdys AL, Garcia MC, Garland JA, Kline S, Persson C, Ruby D, Sauer LM, Vasistha S, Carrasco S, Herstein JJ. A narrative review of high-level isolation unit operational and infrastructure features. BMJ Glob Health 2023; 8:e012037. [PMID: 37423621 DOI: 10.1136/bmjgh-2023-012037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 07/11/2023] Open
Abstract
High-level isolation units (HLIUs) are specially designed facilities for care and management of patients with suspected or confirmed high-consequence infectious diseases (HCIDs), equipped with unique infrastructure and operational features. While individual HLIUs have published on their experiences caring for patients with HCIDs and two previous HLIU consensus efforts have outlined key components of HLIUs, we aimed to summarise the existing literature that describes best practices, challenges and core features of these specialised facilities. A narrative review of the literature was conducted using keywords associated with HLIUs and HCIDs. A total of 100 articles were used throughout the manuscript from the literature search or from alternate methods like reference checks or snowballing. Articles were sorted into categories (eg, physical infrastructure, laboratory, internal transport); for each category, a synthesis of the relevant literature was conducted to describe best practices, experiences and operational features. The review and summary of HLIU experiences, best practices, challenges and components can serve as a resource for units continuing to improve readiness, or for hospitals in early stages of developing their HLIU teams and planning or constructing their units. The COVID-19 pandemic, a global outbreak of mpox, sporadic cases of viral haemorrhagic fevers in Europe and the USA, and recent outbreaks of Lassa fever, Sudan Ebolavirus, and Marburg emphasise the need for an extensive summary of HLIU practices to inform readiness and response.
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Affiliation(s)
- Joseph Lukowski
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Christa Arguinchona
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Wael ElRayes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria G Frank
- School of Medicine, University of Colorado, Denver, Colorado, USA
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Alison L Galdys
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Mary C Garcia
- Department of Laboratory Services, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jennifer A Garland
- Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Susan Kline
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Caroline Persson
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Darrell Ruby
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Lauren M Sauer
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sami Vasistha
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sharon Carrasco
- Serious Communicable Disease Program, Emory University, Atlanta, Georgia, USA
| | - Jocelyn J Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
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7
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Xia H, Yuan Z. High-containment facilities and the role they play in global health security. JOURNAL OF BIOSAFETY AND BIOSECURITY 2022. [DOI: 10.1016/j.jobb.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Bessis S, Dinh A, Gautier S, Davido B, Levy J, Lawrence C, Lot AS, Bensmail D, Rech C, Farcy-Afif M, Bouchand F, de Truchis P, Herrmann JL, Barbot F, Orlikowski D, Moine P, Perronne C, Josseran L, Prigent H, Annane D. A Restructured Hospital Into a One-Building Organization for COVID-19 Patients: A Resilient and Effective Response to the Pandemic. Front Public Health 2022; 10:709848. [PMID: 35685762 PMCID: PMC9170938 DOI: 10.3389/fpubh.2022.709848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/15/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is a unique crisis challenging healthcare institutions as it rapidly overwhelmed hospitals due to a large influx of patients. This major event forced all the components of the healthcare systems to adapt and invent new workflows. Thus, our tertiary care hospital was reorganized entirely. During the cruising phase, additional staff was allocated to a one-building organization comprising an intensive care unit (ICU), an acute care unit, a physical medicine and rehabilitation unit, and a COVID-19 screening area. The transfer of patients from a ward to another was more efficient due to these organizations and pavilion structure. The observed mortality was low in the acute care ward, except in the palliative unit. No nosocomial infection with SARS-CoV-2 was reported in any other building of the hospital since this organization was set up. This type of one-building organization, integrating all the components for comprehensive patient care, seems to be the most appropriate response to pandemics.
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Affiliation(s)
- Simon Bessis
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Aurélien Dinh
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- *Correspondence: Aurélien Dinh
| | - Sylvain Gautier
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Public Health, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Benjamin Davido
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Jonathan Levy
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christine Lawrence
- Microbiology Laboratory and Hygiene, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne-Sophie Lot
- Department of Medical Informatics, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Djamel Bensmail
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Célia Rech
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Muriel Farcy-Afif
- Department of Pharmacy, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Frédérique Bouchand
- Department of Pharmacy, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre de Truchis
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Louis Herrmann
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Microbiology Laboratory and Hygiene, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Frédéric Barbot
- INSERM CIC1429, Clinical Investigation Center, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - David Orlikowski
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- INSERM CIC1429, Clinical Investigation Center, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Moine
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Intensive Care Unit, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christian Perronne
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Loïc Josseran
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Public Health, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Hélène Prigent
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Physiology, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Djillali Annane
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Intensive Care Unit, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
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9
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Andalib E, Faghani M, Zia Ziabari SM, Shenagari M, Salehiniya H, Keivanlou MH, Rafat Z. The Effectiveness of the Anteroom (Vestibule) Area on Hospital Infection Control and Health Staff Safety: A Systematic Review. Front Public Health 2022; 10:828845. [PMID: 35558527 PMCID: PMC9086672 DOI: 10.3389/fpubh.2022.828845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/22/2022] [Indexed: 01/22/2023] Open
Abstract
The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well.
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Affiliation(s)
- Elham Andalib
- Department of Design, Faculty of Fine Art, Music and Design, University of Bergen, Bergen, Norway.,Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoumeh Faghani
- Department of Anatomy, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyyed Mahdi Zia Ziabari
- Department of Emergency Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Shenagari
- Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Zahra Rafat
- Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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10
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Herstein JJ, Vasa A, Sauer LM, Vanairsdale S, ElRayes W, Vasistha S, Herzog C, Leo YS, Vasoo S, Jacobs M, Lowe JJ. Increasing International Collaboration and Networking Among High-level Isolation Units and Programs. Health Secur 2022; 20:S85-S89. [PMID: 35475686 DOI: 10.1089/hs.2021.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jocelyn J Herstein
- Jocelyn J. Herstein, PhD, MPH, is Director, International Programs and Engagement, National Emerging Special Pathogens Training and Education Center (NETEC), and an Assistant Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health; all at the University of Nebraska Medical Center, Omaha, NE
| | - Angela Vasa
- Angela Vasa, MSN, RN, is Director, Readiness Consultations and Metrics Development, NETEC, and Director, Isolation and Quarantine, Nebraska Medicine; all at the University of Nebraska Medical Center, Omaha, NE
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director, Special Pathogens Research Network, NETEC, and an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health; all at the University of Nebraska Medical Center, Omaha, NE
| | - Sharon Vanairsdale
- Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN, is Director of Education and Resources, NETEC; an Associate Professor, Clinical Track, School of Nursing, Emory University; and Program Director for Serious Communicable Diseases, Emory University Hospital, all in Atlanta, GA
| | - Wael ElRayes
- Wael ElRayes, MBBCh, PhD, MS, FACHE, is an Assistant Professor, Department of Health Services Research and Administration, College of Public Health; all at the University of Nebraska Medical Center, Omaha, NE
| | - Sami Vasistha
- Sami Vasistha, MS, is a Program Manager, NETEC, and a Program Manager, Global Center for Health Security; all at the University of Nebraska Medical Center, Omaha, NE
| | - Christian Herzog
- Christian Herzog, PhD, is Head, Strategy and Incidence Response, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Yee Sin Leo
- Yee Sin Leo, MBBS, M Med, MPH, MRCP, FRCP, FAMS, is Executive Director, National Centre for Infectious Diseases; Senior Consultant, Department of Infectious Diseases, Tan Tock Seng Hospital; and Adjunct Professor, Saw Swee Hock School of Public Health; all in Singapore
| | - Shawn Vasoo
- Shawn Vasoo, MBBS, MRCP, is Clinical Director, National Centre for Infectious Diseases, and a Senior Consultant, Department of Infectious Diseases, Tan Tock Seng Hospital; both in Singapore
| | - Michael Jacobs
- Michael Jacobs, MA, PhD, FRCP, FRCP Edin, DTM&H, is a Consultant and Honorary Associate Professor of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - John J Lowe
- John J. Lowe, PhD, is Co-Principal Investigator, NETEC, a Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, and Assistant Vice Chancellor for Health Security Training and Education; all at the University of Nebraska Medical Center, Omaha, NE
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11
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Pfäfflin F, Stegemann MS, Heim KM, Achterberg S, Pfitzner U, Götze L, Oesterhelweg L, Suttorp N, Herzog C, Stadtmann B, Uhrig A. Preparing for patients with high-consequence infectious diseases: Example of a high-level isolation unit. PLoS One 2022; 17:e0264644. [PMID: 35239726 PMCID: PMC8893674 DOI: 10.1371/journal.pone.0264644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Patients with high-consequence infectious diseases (HCID) are rare in Western Europe. However, high-level isolation units (HLIU) must always be prepared for patient admission. Case fatality rates of HCID can be reduced by providing optimal intensive care management. We here describe a single centre’s preparation, its embedding in the national context and the challenges we faced during the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic.
Methods
Ten team leaders organize monthly whole day trainings for a team of doctors and nurses from the HLIU focusing on intensive care medicine. Impact and relevance of training are assessed by a questionnaire and a perception survey, respectively. Furthermore, yearly exercises with several partner institutions are performed to cover different real-life scenarios. Exercises are evaluated by internal and external observers. Both training sessions and exercises are accompanied by intense feedback.
Results
From May 2017 monthly training sessions were held with a two-month and a seven-month break due to the first and second wave of the SARS-CoV-2 pandemic, respectively. Agreement with the statements of the questionnaire was higher after training compared to before training indicating a positive effect of training sessions on competence. Participants rated joint trainings for nurses and doctors at regular intervals as important. Numerous issues with potential for improvement were identified during post processing of exercises. Action plans for their improvement were drafted and as of now mostly implemented. The network of the permanent working group of competence and treatment centres for HCID (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger (STAKOB)) at the Robert Koch-Institute (RKI) was strengthened throughout the SARS-CoV-2 pandemic.
Discussion
Adequate preparation for the admission of patients with HCID is challenging. We show that joint regular trainings of doctors and nurses are appreciated and that training sessions may improve perceived skills. We also show that real-life scenario exercises may reveal additional deficits, which cannot be easily disclosed in training sessions. Although the SARS-CoV-2 pandemic interfered with our activities the enhanced cooperation among German HLIU during the pandemic ensured constant readiness for the admission of HCID patients to our or to collaborating HLIU. This is a single centre’s experience, which may not be generalized to other centres. However, we believe that our work may address aspects that should be considered when preparing a unit for the admission of patients with HCID. These may then be adapted to the local situations.
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Affiliation(s)
- Frieder Pfäfflin
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Miriam Songa Stegemann
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katrin Moira Heim
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Stephan Achterberg
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ursula Pfitzner
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Louise Götze
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lars Oesterhelweg
- Institute of Legal Medicine and Forensic Sciences, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Norbert Suttorp
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Christian Herzog
- Centre for Biological Threats, Strategy and Incident Response, Robert Koch-Institute, Berlin, Germany
| | - Benjamin Stadtmann
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Alexander Uhrig
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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12
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Capabilities of global high-level isolation units: A pre-workshop survey. Infect Control Hosp Epidemiol 2021; 43:1679-1685. [PMID: 34847983 DOI: 10.1017/ice.2021.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
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13
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Jung J, Song KH, Jeong H, Ham SY, Kim ES, Kim HB. Are coveralls required as personal protective equipment during the management of COVID-19 patients? Antimicrob Resist Infect Control 2021; 10:164. [PMID: 34838123 PMCID: PMC8626720 DOI: 10.1186/s13756-021-01017-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/01/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Few studies have investigated the contamination of personal protective equipment (PPE) during the management of patients with severe-to-critical coronavirus disease (COVID-19). This study aimed to determine the necessity of coveralls and foot covers for body protection during the management of COVID-19 patients. METHODS PPE samples were collected from the coveralls of physicians exiting a room after the management of a patient with severe-to-critical COVID-19 within 14 days after the patient's symptom onset. The surface of coveralls was categorized into coverall-only parts (frontal surface of the head, anterior neck, dorsal surface of the foot cover, and back and hip) and gown-covered parts (the anterior side of the forearm and the abdomen). Sampling of the high-contact surfaces in the patient's environment was performed. We attempted to identify significant differences in contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between the coverall-only and gown-covered parts. RESULTS A total of 105 swabs from PPEs and 28 swabs from patient rooms were collected. Of the PPE swabs, only three (2.8%) swabs from the gown-covered parts were contaminated with SARS-CoV-2. However, 23 of the 28 sites (82.1%) from patient rooms were contaminated. There was a significant difference in the contamination of PPE between the coverall-only and gown-covered parts (0.0 vs 10.0%, p = 0.022). CONCLUSIONS Coverall contamination rarely occurred while managing severe-to-critical COVID-19 patients housed in negative pressure rooms in the early stages of the illness. Long-sleeved gowns may be used in the management of COVID-19 patients.
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Affiliation(s)
- Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Hyeonju Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.,Ansung Hospital, Gyeonggi Provincial Medical Center, Ansung, Gyeonggi-do, Republic of Korea
| | - Sin Young Ham
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.,Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
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14
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Optimizing Highly Infectious Disease Isolation Unit Management: Experiences From the Infectious Diseases Isolation and Research Unit, Fort Portal, Uganda. Disaster Med Public Health Prep 2021; 17:e72. [PMID: 34819204 PMCID: PMC8886060 DOI: 10.1017/dmp.2021.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infectious disease outbreaks on the scale of the current coronavirus disease 2019 (COVID-19) pandemic are a new phenomenon in many parts of the world. Many isolation unit designs with corresponding workflow dynamics and personal protective equipment postures have been proposed for each emerging disease at the health facility level, depending on the mode of transmission. However, personnel and resource management at the isolation units for a resilient response will vary by human resource capacity, reporting requirements, and practice setting. This study describes an approach to isolation unit management at a rural Uganda Hospital and shares lessons from the Uganda experience for isolation unit managers in low- and middle-income settings.
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15
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Herstein JJ, Lowe JJ, Wolf T, Vasoo S, Leo YS, Chin B, Shen Y, Hewlett AL, Lawler JV. Leveraging a preexisting global infectious disease network for local decision-making during a pandemic. Clin Infect Dis 2021; 74:729-733. [PMID: 34318871 PMCID: PMC8406886 DOI: 10.1093/cid/ciab660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Indexed: 12/15/2022] Open
Abstract
Emerging infectious disease epidemics require a rapid response from health systems; however, evidence-based consensus guidelines are generally absent early in the course of events. Formed in 2017 by five high-level isolation units spanning three continents, the experience of the Global Infectious Disease Preparedness Network (GIDPN) early in the course of COVID-19 provides a model for accelerating best practice development and improving decision-making in health emergencies. The network served as a platform for real-time, open and transparent information-sharing during unknowns of an active outbreak by clinicians caring for patients, by researchers conducting clinical trials and transmission and infection prevention studies, and by teams advising local and national policymakers. Shared knowledge led to earlier adoption of some treatment modalities as compared to most peer institutions and to implementation of protocols prior to incorporation into national guidelines. GIDPN and similar networks are integral in enhancing preparedness for and response to future epidemics/pandemics.
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Affiliation(s)
- Jocelyn J Herstein
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - John J Lowe
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Timo Wolf
- Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Yinzhong Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Angela L Hewlett
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - James V Lawler
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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16
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Levine MM, Abdullah S, Arabi YM, Darko DM, Durbin AP, Estrada V, Jamrozik E, Kremsner PG, Lagos R, Pitisuttithum P, Plotkin SA, Sauerwein R, Shi SL, Sommerfelt H, Subbarao K, Treanor JJ, Vrati S, King D, Balasingam S, Weller C, Aguilar AO, Cassetti MC, Krause PR, Restrepo AMH. Viewpoint of a WHO Advisory Group Tasked to Consider Establishing a Closely-monitored Challenge Model of Coronavirus Disease 2019 (COVID-19) in Healthy Volunteers. Clin Infect Dis 2021; 72:2035-2041. [PMID: 32857836 PMCID: PMC7499532 DOI: 10.1093/cid/ciaa1290] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Indexed: 12/16/2022] Open
Abstract
WHO convened an Advisory Group (AG) to consider the feasibility, potential value, and limitations of establishing a closely-monitored challenge model of experimental severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) in healthy adult volunteers. The AG included experts in design, establishment, and performance of challenges. This report summarizes issues that render a COVID-19 model daunting to establish (the potential of SARS-CoV-2 to cause severe/fatal illness, its high transmissibility, and lack of a "rescue treatment" to prevent progression from mild/moderate to severe clinical illness) and it proffers prudent strategies for stepwise model development, challenge virus selection, guidelines for manufacturing challenge doses, and ways to contain SARS-CoV-2 and prevent transmission to household/community contacts. A COVID-19 model could demonstrate protection against virus shedding and/or illness induced by prior SARS-CoV-2 challenge or vaccination. A limitation of the model is that vaccine efficacy in experimentally challenged healthy young adults cannot per se be extrapolated to predict efficacy in elderly/high-risk adults.
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Affiliation(s)
- Myron M Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | | | - Anna P Durbin
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vicente Estrada
- Medical School, Complutense University, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Peter G Kremsner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Gabon
| | - Rosanna Lagos
- Centro para Vacunas en Desarrollo (CVD-Chile), Santiago, Chile
| | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Stanley A Plotkin
- Department of Pediatrics, University of Pennsylvania, Doylestown, Pennsylvania, USA
| | - Robert Sauerwein
- Medical Parasitology Department, Radboud University, Nijmegen, The Netherlands
| | - Sheng-Li Shi
- Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Wuhan, China
| | - Halvor Sommerfelt
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, and Norwegian Institute of Public Health, Oslo, Norway
| | - Kanta Subbarao
- WHO Collaborating Centre for Reference and Research on Influenza and Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute, Melbourne, Australia
| | - John J Treanor
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Sudhanshu Vrati
- Regional Centre for Biotechnology, Haryana (NCR Delhi), India
| | - Deborah King
- Vaccines Priority Area, Wellcome Trust, London, United Kingdom
| | | | - Charlie Weller
- Vaccines Programme, Wellcome Trust, London, United Kingdom
| | - Anastazia Older Aguilar
- Global Health Discovery & Translational Sciences, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - M Cristina Cassetti
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Philip R Krause
- Office of Vaccines Research and Review, CEBR, FDA, Silver Spring, Maryland, USA.,Chair, WHO R&D Blueprint COVID-19 Vaccines Working Group
| | - Ana Maria Henao Restrepo
- Office of the Executive Director (WHE), WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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17
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Ramírez-Cervantes KL, Romero-Pardo V, Pérez-Tovar C, Martínez-Alés G, Quintana-Diaz M. A medicalized hotel as a public health resource for the containment of Covid-19: more than a place for quarantining. J Public Health (Oxf) 2021; 43:89-97. [PMID: 32776147 PMCID: PMC7454785 DOI: 10.1093/pubmed/fdaa129] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background To describe the implementation of a medicalized hotel in the community of Madrid as a public health resource for the containment of coronavirus disease (COVID-19) and to describe the characteristics of population benefitted. Methods A descriptive study of the implementation of the Via Castellana Medicalised Hotel (VCMH) was conducted. The average monthly household income, educational level and occupational social class of the subjects admitted were obtained through a survey conducted during their stay. Results There was no guidance for launching; however the hotel was coordinated by a tertiary referral hospital and attended the preventive medicine regulations and the decrees of legal regimes and authorization of health services in Madrid. Between 19 March and the 9 May 2020, 399 patients were admitted; 59% (235) were migrant; the main reason for referral (58%) was a lack of house conditions for quarantining, including overcrowding, which when compared with the migrant status a positive correlation was found. Some other reasons for referral were homelessness and eviction. Most of the survey participants had low monthly household income, educational level and social class. Conclusions This medicalized hotel provided medical care and offered housing to a subgroup of vulnerable population who could not afford a safe quarantine.
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Affiliation(s)
| | - V Romero-Pardo
- Hospital Universitario La Paz, Department of Psychiatry, Madrid 28046, Spain
| | - C Pérez-Tovar
- Hospital Universitario La Paz, COVID@HULP group, Madrid 28046, Spain
| | - G Martínez-Alés
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY 10032, USA
| | - M Quintana-Diaz
- Hospital Universitario La Paz, Intensive Care Unit, Madrid 28046, Spain
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18
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Luo Z, Zhang Y, Zheng Y, MacIntyre CR, Liang Y, Wang Q, Ma Y. Prevention of SARS-CoV-2 transmission from international arrivals: Xiaotangshan Designated Hospital, China. Bull World Health Organ 2021; 99:374-380. [PMID: 33958825 PMCID: PMC8061664 DOI: 10.2471/blt.20.265918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 01/10/2023] Open
Abstract
A surge in the number of international arrivals awaiting coronavirus disease 2019 (COVID-19) screening overwhelmed health-care workers and depleted medical resources in designated hospitals in Beijing, China in March 2020. The People’s Government of Beijing Municipality therefore issued a policy which required the mandatory transfer of all asymptomatic passengers arriving from a foreign country to designated quarantine hotels, and the transfer of passengers with fever or respiratory symptoms to designated hospitals. Xiaotangshan Designated Hospital, a severe acute respiratory syndrome hospital in 2003, was rapidly renovated and put into operation with the main tasks of screening and isolating symptomatic international arrivals at Beijing Capital International Airport, providing basic medical care for mild to moderate COVID-19-positive cases, and rapidly referring severe to critical COVID-19-positive cases to higher-level hospitals. During the month-long period of its operation, 2171 passengers were screened and 53 were confirmed as having COVID-19 (six severe to critical). We describe how the use of Xiaotangshan Designated Hospital in this way enabled the efficient grouping and assessment of passengers arriving from a foreign country, the provision of optimal patient care without compromising public safety and the prioritization of critically ill patients requiring life-saving treatment. The designated hospital is a successful example of the World Health Organization’s recommendation to renovate existing medical infrastructures to improve the COVID-19 response capacity. The flexible design of Xiaotangshan Designated Hospital means that it can be repurposed and reopened at any time to respond to the changing pandemic conditions.
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Affiliation(s)
- Zujin Luo
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing 100043, China
| | - Yi Zhang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yue Zheng
- Department of Surgical Intensive Care Unit, Beijing Chao-Yang Hospital, Beijing, China
| | | | - Ying Liang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, China
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yingmin Ma
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing 100043, China
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19
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Borromeo Flinn J, Benza JJ, Sauer LM, Sulmonte C, Hynes NA, Garibaldi BT. The Risk of Not Being Ready: A Novel Approach to Managing Constant Readiness of a High-Level Isolation Unit During Times of Inactivity. Health Secur 2020; 18:212-218. [PMID: 32559152 DOI: 10.1089/hs.2019.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The biocontainment unit at Johns Hopkins Hospital is a specially designed, inactive high-level isolation unit designated to care for patients infected with high-consequence pathogens. The unit team designed a facility-specific readiness scale and checklist that focus on infrastructure, consumable supplies, and staffing to assess activation readiness of the biocontainment unit. Over a period of 50 days and 14 days, these tools were used as part of a routine risk assessment to first identify barriers and then tier the impact of these barriers into activation categories of "Ready," "Ready with Considerations," and "Not Ready." The assessment identified the greatest risks to activation readiness were staffing and waste management capabilities. Assessing threats to activation readiness and the risk of not being ready should be a priority for maintaining facility, regional, and national capacity to safely isolate and care for patients infected with high-consequence pathogens while maintaining healthcare worker safety.
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Affiliation(s)
- Jade Borromeo Flinn
- Jade Borromeo Flinn, MSN, RN, CCRN, CNRN, is Nurse Educator, Department of Medicine and Department of Neurosciences, Johns Hopkins Hospital, Johns Hopkins University School of Medicine
| | - Jesse J Benza
- Jesse J. Benza, MHA, is Business Service Analyst, Department of Medicine, Johns Hopkins University School of Medicine
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director of Operations and Assistant Professor, Department of Emergency Medicine, Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins University School of Medicine
| | - Christopher Sulmonte
- Christopher Sulmonte, Jr., MHA, is Project Administrator, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine
| | - Noreen A Hynes
- Noreen A. Hynes, MD, MPH, is Associate Professor/Geographic Medicine Center Director, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, and Departments of Environmental Health and Engineering and International Health, Johns Hopkins Bloomberg School of Public Health
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Medical Director of Biocontainment Unit, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
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20
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Elective Surgery During the SARS-CoV-2 Pandemic (COVID-19): A Morbimortality Analysis and Recommendations on Patient Prioritisation and Security Measures. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2020. [PMCID: PMC7305868 DOI: 10.1016/j.cireng.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction The spread of the SARS-CoV-2 infection (COVID-19) has required adaptation by hospitals affected by the pandemic, which has caused a reduction in elective surgical activity. Methods Retrospective study of patients operated on in the previous month and during the peak of the pandemic. We analysed the COVID-19 infection rate, the severity of respiratory infection according to the Brescia respiratory COVID-19 severity scale, the adopted therapeutic measures and the overall postoperative complications. Results From 17th February to 31st March 2020, there was a progressive decrease in surgical activity, with only 213 patients operated on. This comprised 59 (27.8%) elective operations for oncological diseases, 97 (45.5%) elective operations for benign diseases and 57 (26.7%) as urgent procedures. There was a progressive increase in the rate of infection by COVID-19, with a total of 15 cases (7%). This included 10 patients (16.9%) in the elective group for oncological disease, 1 (1%) in the elective surgery group for benign disease and 4 (7%) in the urgent surgery group (P<.001). Five patients presented with a severe respiratory infection, of which 4 were affected by oncological disease. There were 3 deaths (1.4%), which were all due to the worsening of a respiratory infection. Conclusions The patients undergoing the surgical procedures showed high rates of COVID-19 infection and postoperative complications, especially the patients with oncological diseases. Local resumption of surgical activity must be based on the prioritisation of the cases to be operated on, respecting certain premises of security and optimisation of the available resources.
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Di Martino M, García Septiem J, Maqueda González R, Muñoz de Nova JL, de la Hoz Rodríguez Á, Correa Bonito A, Martín-Pérez E. [Elective surgery during the SARS-CoV-2 pandemic (COVID-19): a morbimortality analysis and recommendations on patient prioritisation and security measures]. Cir Esp 2020; 98:525-532. [PMID: 32408995 PMCID: PMC7188649 DOI: 10.1016/j.ciresp.2020.04.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The spread of the SARS-CoV-2 infection (COVID-19) has required adaptation by hospitals affected by the pandemic, which has caused a reduction in elective surgical activity. METHODS Retrospective study of patients operated on in the previous month and during the peak of the pandemic. We analysed the COVID-19 infection rate, the severity of respiratory infection according to the Brescia respiratory COVID-19 severity scale, the adopted therapeutic measures and the overall postoperative complications. RESULTS From 17th February to 31st March 2020, there was a progressive decrease in surgical activity, with only 213 patients operated on. This comprised 59 (27.8%) elective operations for oncological diseases, 97 (45.5%) elective operations for benign diseases and 57 (26.7%) as urgent procedures.There was a progressive increase in the rate of infection by COVID-19, with a total of 15 cases (7%). This included 10 patients (16.9%) in the elective group for oncological disease, 1 (1%) in the elective surgery group for benign disease and 4 (7%) in the urgent surgery group (p < 0.001). Five patients presented with a severe respiratory infection, of which 4 were affected by oncological disease. There were 3 deaths (1.4%), which were all due to the worsening of a respiratory infection. CONCLUSIONS The patients undergoing the surgical procedures showed high rates of COVID-19 infection and postoperative complications, especially the patients with oncological diseases. Local resumption of surgical activity must be based on the prioritisation of the cases to be operated on, respecting certain premises of security and optimisation of the available resources.
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Affiliation(s)
- Marcello Di Martino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, España.
| | - Javier García Septiem
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, España
| | - Rocío Maqueda González
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, España
| | - Jose Luis Muñoz de Nova
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, España
| | | | - Alba Correa Bonito
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, España
| | - Elena Martín-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, España
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Ferguson C, Fletcher R, Ho P, MacLeod E. Should Australian states and territories have designated COVID hospitals in low community transmission? Case study for Western Australia. AUST HEALTH REV 2020; 44:728-732. [PMID: 32854819 DOI: 10.1071/ah20199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022]
Abstract
This case study describes the process of selecting the most appropriate state-wide hospital system to manage COVID-19 cases in a setting of low community transmission of COVID-19 infection. A rapid review of the literature was conducted of the advantages and disadvantages of having designated COVID hospitals. This led to three different options being presented for discussion. Following consultation, the option chosen was for all hospital facilities to remain prepared to care for COVID-19 patients where they present rather than having specified designated hospitals because this was considered the most practical option currently.
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Affiliation(s)
- Chantal Ferguson
- Western Australia Department of Health, State Health Incident Coordination Centre, COVID-19 Health Operations, PO Box 8172, Perth Business Centre, WA 6849, Australia.
| | - Robert Fletcher
- Western Australia Country Health Service, Safety and Quality, PO Box 6680, East Perth Business Centre, WA 6892, Australia.
| | - Portia Ho
- Western Australia Department of Health, State Health Incident Coordination Centre, COVID-19 Health Operations, PO Box 8172, Perth Business Centre, WA 6849, Australia. ; and Corresponding author.
| | - Elizabeth MacLeod
- East Metropolitan Health Service, GPO Box X2213,Perth, WA 6847, Australia.
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An JAR, Song KH, Kim ES, Kwak R, Jung J, Park JY, Park JS, Lee H, Shin MJ, Lee HY, Lim S, Park KU, Kim JH, Bitton A, Kim HB. Pandemic preparedness of an academic medical centre in the Republic of Korea. Clin Microbiol Infect 2020; 26:1595-1599. [PMID: 32891767 PMCID: PMC7470819 DOI: 10.1016/j.cmi.2020.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Julia Ah-Reum An
- Ariadne Labs, Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital, Boston, MA, USA
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea.
| | - Ruby Kwak
- Harvard Medical School, Boston, MA, USA
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Ji Young Park
- Department of Paediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Hyunju Lee
- Department of Paediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Myoung Jin Shin
- Infection Control Office, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hee Young Lee
- Centre for Preventive and Public Health, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea; Gyeonggi Infectious Disease Control Center, Seongnam, Gyeonggi-do, Republic of Korea
| | - Seungkwan Lim
- Ansung Hospital, Gyeonggi Provincial Medical Center, Ansung, Gyeonggi-do, Republic of Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - June-Ho Kim
- Ariadne Labs, Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital, Boston, MA, USA
| | - Asaf Bitton
- Ariadne Labs, Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital, Boston, MA, USA
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
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Dattari R, Garg R. Need of guidelines for safe transport of patients with COVID-19. J Anaesthesiol Clin Pharmacol 2020; 36:S139-S141. [PMID: 33100665 PMCID: PMC7574019 DOI: 10.4103/joacp.joacp_447_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Rohini Dattari
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
- Address for correspondence: Dr. Rakesh Garg, Room No 139, First Floor, Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
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Pandey N, Kaushal V, Puri GD, Taneja S, Biswal M, Mahajan P, Guru RR, Malhotra P, Sehgal IS, Dhooria S, Muthu V, Agarwal R. Transforming a General Hospital to an Infectious Disease Hospital for COVID-19 Over 2 Weeks. Front Public Health 2020; 8:382. [PMID: 32850601 PMCID: PMC7399037 DOI: 10.3389/fpubh.2020.00382] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022] Open
Abstract
Pandemics like the coronavirus disease (COVID)-19 can cause a significant strain on the healthcare system. Healthcare organizations must be ready with their contingency plans for managing many patients with contagious infectious disease. Ideally, every large hospital should have a facility that can function as a high-level isolation unit. An isolation unit ensures that the healthcare staff and the hospital are equipped to deal with infectious disease outbreaks. Unfortunately, such facilities do not exist in several hospitals, especially in resource-limited settings. In such a scenario, healthcare setups need to convert their existing general structure into an infectious disease facility. Herein, we describe our experience in transforming a general hospital into a functional infectious disease isolation unit.
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Affiliation(s)
- Navin Pandey
- Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vipin Kaushal
- Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anesthesia and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranay Mahajan
- Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Ranjan Guru
- Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Frank MG, Croyle C, Beitscher A, Price C. The Role of Hospitalists in Biocontainment Units: A Perspective. J Hosp Med 2020; 15:375-377. [PMID: 32195660 DOI: 10.12788/jhm.3402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/23/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Maria G Frank
- Division of Hospital Medicine, Denver Health Hospital Authority, Denver, Colorado
- Biocontainment Unit, Denver Health Hospital Authority, Den-ver, Colorado
- Department of Medicine, Denver Health Hospital Authority, Denver, Colorado
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Caroline Croyle
- Biocontainment Unit, Denver Health Hospital Authority, Den-ver, Colorado
- Department of Patient Safety & Quality, Denver Health and Hospital Authority, Denver, Colorado
| | - Adam Beitscher
- Division of Hospital Medicine, Denver Health Hospital Authority, Denver, Colorado
- Biocontainment Unit, Denver Health Hospital Authority, Den-ver, Colorado
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Connie Price
- Biocontainment Unit, Denver Health Hospital Authority, Den-ver, Colorado
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Albrecht R, Knapp J, Theiler L, Eder M, Pietsch U. Transport of COVID-19 and other highly contagious patients by helicopter and fixed-wing air ambulance: a narrative review and experience of the Swiss air rescue Rega. Scand J Trauma Resusc Emerg Med 2020; 28:40. [PMID: 32410706 PMCID: PMC7222521 DOI: 10.1186/s13049-020-00734-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background The current COVID-19 pandemic highlights the challenges air ambulance services are facing when transporting highly infectious patients for several hours in enclosed spaces. This overview provides an example of a standard operating procedure (SOP) for infection prevention measures in HEMS missions during the COVID-19 pandemic. Furthermore, we describe different methods used by several organizations in Europe and the experience of the Swiss air rescue organization Rega in transporting these patients. Possible benefits of the use of small patient isolation units (PIU) are discussed, including the fact that accompanying medical personnel do not need to wear personal protective equipment (PPE) during the transport but can still maintain full access to the patient. Rega has developed and patented its own PIU. This device allows spontaneously breathing or mechanically ventilated patients to be transported in pressurized jet cabins, small helicopters and ambulance vehicles, without the need to change between transport units. This PIU is unique, as it remains air-tight even when there is a sudden loss of cabin pressure. Conclusion A wide variety of means are being used for the aeromedical transport of infectious patients. These involve isolating either the patient or the medical crew. One benefit of PIUs is that the means of transport can be easily changed without contaminating the surroundings and while still allowing access to the patient.
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Affiliation(s)
- Roland Albrecht
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland. .,Swiss Air Rescue, Rega, Zurich, Switzerland.
| | - Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Theiler
- Swiss Air Rescue, Rega, Zurich, Switzerland.,Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Urs Pietsch
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
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Chen S, Zhang Z, Yang J, Wang J, Zhai X, Bärnighausen T, Wang C. Fangcang shelter hospitals: a novel concept for responding to public health emergencies. Lancet 2020; 395:1305-1314. [PMID: 32247320 PMCID: PMC7270591 DOI: 10.1016/s0140-6736(20)30744-3] [Citation(s) in RCA: 400] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/15/2022]
Abstract
Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zongjiu Zhang
- National Health Commission of the People's Republic of China, Beijing, China
| | - Juntao Yang
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jian Wang
- National Center for Medical Service Administration, Beijing, China
| | - Xiaohui Zhai
- National Center for Medical Service Administration, Beijing, China
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Chen Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Chinese Academy of Engeering, Beijing, China.
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29
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Kiiza P, Adhikari NKJ, Mullin S, Teo K, Fowler RA. Principles and Practices of Establishing a Hospital-Based Ebola Treatment Unit. Crit Care Clin 2020; 35:697-710. [PMID: 31445614 DOI: 10.1016/j.ccc.2019.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Outbreaks of Ebola virus disease and high-risk transmissible infections are increasing and pose threats to health care workers and global health systems. Previous outbreaks offer lessons for health system preparedness and response, including establishment of hospital-based high-risk pathogen treatment units. Their creation demands early preparation and interprofessional coordination; infection prevention and control; case management training; prepositioning of supplies; conversion of existing structures to treatment units; and strengthening communication and research platforms. Hospital-based Ebola and high-risk pathogen treatment units may improve case detection, interrupt transmission, and improve staff safety and patient care.
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Affiliation(s)
- Peter Kiiza
- Sunnybrook Research Institute, Sunnybrook Hospital, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Neill K J Adhikari
- Sunnybrook Research Institute, Sunnybrook Hospital, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Mullin
- Sunnybrook Research Institute, Sunnybrook Hospital, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Koren Teo
- Canadian Forces Health Services Group, Toronto, 10 Yukon Ln, North York, Ontario M3K 0A1, Canada
| | - Robert A Fowler
- Sunnybrook Research Institute, Sunnybrook Hospital, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
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Ray S, Goyal S, Roy K, Chawla N, Singh RJ. Not the last pandemic – Investing in a safe navy for the future pandemic. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_144_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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US State Public Health Departments Special Pathogen Planning. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:E28-E33. [PMID: 29227420 DOI: 10.1097/phh.0000000000000714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT US state public health departments played key roles in planning for and responding to confirmed and suspected cases of Ebola virus disease (EVD) during the 2014-2016 outbreak, including designating select hospitals as high-level isolation units (HLIUs) for EVD treatment in conjunction with the Centers for Disease Control and Prevention. OBJECTIVE To identify existing guidelines and perspectives of state health departments pertaining to the management and transport of patients with EVD and other highly hazardous communicable diseases (HHCDs). DESIGN An electronic 8-question survey with subquestions was administered as a fillable PDF. SETTING The survey was distributed to publicly accessible e-mails of state health department employees. PARTICIPANTS State epidemiologists, emergency preparedness directors, or chief medical officers from each of the 50 states and the District of Columbia were contacted; a representative from 36 states and the District of Columbia responded (73%). MAIN OUTCOME MEASURES Descriptive statistics were used to identify the proportion of state health departments with various existing protocols. RESULTS A majority of states reported that they would prefer patients confirmed with viral hemorrhagic fevers (eg, EVD, Marburg fever) and smallpox be transported to an HLIU for treatment rather than remain at the initial hospital of diagnosis. While most (89%) states had written guidelines for the safe transportation of patients with HHCDs, only 6 (16%) had written protocols for the management of accidents or other travel disruptions that may occur during HHCD transport within the state. Twenty-two state health departments (59%) had operationally exercised transport of a patient to an HLIU. CONCLUSIONS Nearly half of states in the United States lack an HLIU, yet most prefer to have patients with HHCDs treated in high-level isolation. Recent budget cuts and uncertainty of future funding threaten the abilities of health departments to devote the necessary resources and staff to prepare for and deliver the desired care to HHCD cases. The lack of HLIUs in some states may complicate transport to a geographically proximate HLIU. Moreover, limited guidance on diseases that warrant high-level isolation may cause disagreement in HHCD patient placement between health departments, diagnosing facilities, and HLIUs.
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Gibbs SG, Herstein JJ, Le AB, Beam EL, Cieslak TJ, Lawler JV, Santarpia JL, Stentz TL, Kopocis-Herstein KR, Achutan C, Carter GW, Lowe JJ. Review of Literature for Air Medical Evacuation High-Level Containment Transport. Air Med J 2019; 38:359-365. [PMID: 31578975 PMCID: PMC7128392 DOI: 10.1016/j.amj.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Aeromedical evacuation (AE) is a challenging process, further complicated when a patient has a highly hazardous communicable disease (HHCD). We conducted a review of the literature to evaluate the processes and procedures utilized for safe AE high-level containment transport (AE-HLCT) of patients with HHCDs. METHODS A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019). Authors screened abstracts for inclusion criteria and full articles were reviewed if the abstract was deemed to contain information related to the aim. RESULTS Our search criteria yielded 14 publications and were separated based upon publication dates, with the natural break point being the beginning of the 2013-2016 Ebola virus disease epidemic. Best practices and recommendations from identified articles are subdivided into pre-flight preparations, inflight operations, and post-flight procedures. CONCLUSIONS Limited peer-reviewed literature exists on AE-HLCT, including important aspects related to healthcare worker fatigue, alertness, shift scheduling, and clinical care performance. This hinders the sharing of best practices to inform evacuations and equip teams for future outbreaks. Despite the successful use of different aircraft and technologies, the unique nature of the mission opens the opportunity for greater coordination and development of consensus standards for AE-HLCT operations.
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Affiliation(s)
- Shawn G Gibbs
- Department of Environmental and Occupational Health, Indiana University School of Public Health, Bloomington, IN
| | - Jocelyn J Herstein
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE.
| | - Aurora B Le
- Department of Environmental and Occupational Health, Indiana University School of Public Health, Bloomington, IN; Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN
| | - Elizabeth L Beam
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Theodore J Cieslak
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, NE; National Strategic Research Institute, Omaha, NE
| | - Joshua L Santarpia
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; National Strategic Research Institute, Omaha, NE; Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE
| | - Terry L Stentz
- Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE; The Charles W. Durham School of Architectural Engineering and Construction, University of Nebraska-Lincoln, Lincoln, NE
| | - Kelli R Kopocis-Herstein
- The Charles W. Durham School of Architectural Engineering and Construction, University of Nebraska-Lincoln, Lincoln, NE
| | - Chandran Achutan
- Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | | | - John J Lowe
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE
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Conserved B and T cell epitopes prediction of ebola virus glycoprotein for vaccine development: An immuno-informatics approach. Microb Pathog 2019; 132:243-253. [PMID: 31075428 PMCID: PMC7270928 DOI: 10.1016/j.micpath.2019.05.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/19/2022]
Abstract
Ebola virus (EBOV), a non-segmented single-stranded RNA virus, is often-most transmitted through body fluids like sweat, tears, saliva, and nasal secretions. Till date, there is no licensed vaccine of EBOV is available in the market; however, the world is increasingly vulnerable to this emerging threat. Hence, it is the need of time to develop a vaccine for EBOV to hinder its dissemination. The current study has been designed for identification and characterization of the potential B and T-cell epitopes using the Immuno-informatics tools, and it helped in finding the potent vaccine candidates against EBOV. Prediction, antigenicity and allergenicity testing of predicted B and T cells' epitopes was done as well to identify their potential as a vaccine candidate and to measure their safety level respectively. Among B-cell epitopes "WIPAGIGVTGVIIA" showed a high antigenicity score and it would play an important role in evoking the immune response. In T-cell epitopes, peptides "AIGLAWIPY" and "IRGFPRCRY" presented high antigenicity score, which binds to MHC class-I and MHC class-II alleles respectively. All predicted epitopes were analyzed and compared with already reported peptides carefully. Comparatively, Peptides predicted in the present study showed more immunogenicity score than already reported peptides, used as positive control, and are more immunogenic as compared to them. Peptides reported in the present study do not target only Zaire EBOV (ZEBOV), as in previous studies, but also other species, i.e. Tai Forest EBOV (TAFV), Sudan EBOV (SUDV), Bundibugyo EBOV (BDBV), and Reston EBOV (RESTV) and would bring the promising results as potent vaccine candidates.
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Dean CL, Hill CE. Caring for patients with Ebola virus disease: Are U.S. biocontainment centers ready for the next outbreak? Semin Diagn Pathol 2019; 36:160-163. [PMID: 31010606 DOI: 10.1053/j.semdp.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The 2014 West African Ebola virus disease (EVD) outbreak is the largest and deadliest EVD epidemic to date, resulting in fivefold more cases than all other outbreaks combined. This outbreak was particularly devastating to healthcare workers in West Africa and resulted in several EVD patients being medically evacuated for treatment in the U.S. and Europe. Governmental agencies provide recommendations for triaging and testing patients with EVD, however best laboratory practices are still unknown and are very resource dependent.
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Affiliation(s)
- Christina L Dean
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Room H-185D, Atlanta, GA 30322, USA.
| | - Charles E Hill
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Room H-185D, Atlanta, GA 30322, USA
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Kortepeter MG, Cieslak TJ. Biocontainment Units: Moving to the Next Phase of Evolution. Health Secur 2019; 17:74-76. [PMID: 30724617 DOI: 10.1089/hs.2018.0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The concept and belief in the idea of "biocontainment" has undergone significant evolution during the past 20 years. The authors believe that the time is right to move to the next phase of this evolution to reassess establishment of formal standards for what constitutes a biocontainment unit and what diseases might be considered for admission to a biocontainment unit.
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Affiliation(s)
- Mark G Kortepeter
- Mark G. Kortepeter, MD, MPH, is Professor of Epidemiology, Department of Epidemiology, College of Public Health, University of Nebraska, Omaha, Nebraska
| | - Theodore J Cieslak
- Theodore J. Cieslak, MD, MPH, is Associate Professor of Epidemiology and Co-Medical Director, Nebraska Biocontainment Unit, College of Public Health, University of Nebraska, Omaha, Nebraska
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36
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Singh SK, Kuhn JH. Clinical Management of Patients Infected with Highly Pathogenic Microorganisms. DEFENSE AGAINST BIOLOGICAL ATTACKS 2019. [PMCID: PMC7123672 DOI: 10.1007/978-3-030-03053-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The clinical management of high consequence infectious diseases (HCID) poses an immense challenge, seen largely varying standards in terms of infection prevention control (IPC) as well as in quality of clinical care. This chapter gives an overview of possible treatment as well as IPC options. Lessons learned within the German Permanent Working Group of Competence and Treatment Centres for highly infectious, life-threatening diseases (STAKOB) are taken into account.
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Affiliation(s)
- Sunit K. Singh
- Molecular Biology Unit, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jens H. Kuhn
- NIH/NIAID, Division of Clinical Research, Integrated Research Facility at Fort Detrick, Frederick, MD USA
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Abstract
OBJECTIVE To describe strategies used by US high-level isolation units (HLIUs) to recruit, train, and sustain a full team of multidisciplinary staff and identify how units are secured. BACKGROUND Fifty-six US hospitals have been designated HLIUs, capable of providing safe care to patients with highly infectious disease. METHODS An electronic survey was administered to the 56 HLIUs in spring of 2016. Responses were collected via a fillable PDF and analyzed using descriptive statistics. RESULTS Thirty-six HLIUs (64%) responded; 33 completed surveys, and 3 reported no longer being a designated HLIU. HLIUs reported large numbers of multidisciplinary staff, primarily consisting of RNs and critical care clinicians. Nearly all HLIUs (94%) required orientation training, although hours varied. CONCLUSIONS Over a short period, HLIUs recruited and trained significant numbers of staff with little guidance. Costs of ongoing trainings are considerable, and it remains unclear how HLIUs will continue funding these activities.
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de la Calle-Prieto F, Martín-Quirós A, Trigo E, Mora-Rillo M, Arsuaga M, Díaz-Menéndez M, Arribas JR. Therapeutic management of Crimean-Congo haemorrhagic fever. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2018. [PMCID: PMC7270944 DOI: 10.1016/j.eimce.2017.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Crimean-Congo haemorrhagic fever has been reported in more than 30 countries in Africa, Asia, the Middle East and Eastern Europe, with an increasing incidence in recent years, especially in Europe. Because no specific treatments have demonstrated efficacy, supportive treatment is essential, as well as the provision of a centre with the appropriate means to guarantee the safety of its healthcare professionals. Laboratory monitoring of thrombocytopenia, severe coagulopathy or liver failure is of critical importance. Patients with Crimean-Congo haemorrhagic fever should be admitted to High Level Isolation Units where appropriate biocontainment procedures can prevent nosocomial transmission through infected fluids or accidents with contaminated material. In case of high-risk exposures, early administration of ribavirin should be considered.
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de la Calle-Prieto F, Martín-Quirós A, Trigo E, Mora-Rillo M, Arsuaga M, Díaz-Menéndez M, Arribas JR. Therapeutic management of Crimean-Congo haemorrhagic fever. Enferm Infecc Microbiol Clin 2018; 36:517-522. [PMID: 28669587 PMCID: PMC7103311 DOI: 10.1016/j.eimc.2017.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 02/03/2023]
Abstract
Crimean-Congo haemorrhagic fever has been reported in more than 30 countries in Africa, Asia, the Middle East and Eastern Europe, with an increasing incidence in recent years, especially in Europe. Because no specific treatments have demonstrated efficacy, supportive treatment is essential, as well as the provision of a centre with the appropriate means to guarantee the safety of its healthcare professionals. Laboratory monitoring of thrombocytopenia, severe coagulopathy or liver failure is of critical importance. Patients with Crimean-Congo haemorrhagic fever should be admitted to High Level Isolation Units where appropriate biocontainment procedures can prevent nosocomial transmission through infected fluids or accidents with contaminated material. In case of high-risk exposures, early administration of ribavirin should be considered.
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Affiliation(s)
| | | | - Elena Trigo
- Unidad de Aislamiento de Alto Nivel, Hospital La Paz-Carlos III, Idipaz, Madrid, España
| | - Marta Mora-Rillo
- Unidad de Aislamiento de Alto Nivel, Hospital La Paz-Carlos III, Idipaz, Madrid, España
| | - Marta Arsuaga
- Unidad de Aislamiento de Alto Nivel, Hospital La Paz-Carlos III, Idipaz, Madrid, España
| | - Marta Díaz-Menéndez
- Unidad de Aislamiento de Alto Nivel, Hospital La Paz-Carlos III, Idipaz, Madrid, España
| | - José Ramón Arribas
- Unidad de Aislamiento de Alto Nivel, Hospital La Paz-Carlos III, Idipaz, Madrid, España
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Highly infectious diseases in the Mediterranean Sea area: Inventory of isolation capabilities and recommendations for appropriate isolation. New Microbes New Infect 2018; 26:S65-S73. [PMID: 30402245 PMCID: PMC6205579 DOI: 10.1016/j.nmni.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/16/2022] Open
Abstract
Epidemics such as viral haemorrhagic fevers, severe acute respiratory syndrome, Middle East respiratory syndrome coronavirus or yet unknown ones have few chances of disappearing. Globalization, worldwide travel, climate change, social conflicts and wars, among others, are likely to favor the emergence of epidemics. Preparedness of hospitals to prevent the spread of these outbreaks is among the prioritized political programmes of many countries. The EuroNHID network has in the past drawn a map of features and equipment of hospitals across Europe to take care of highly contagious patients. We update the data regarding isolation capabilities and recommendations, with an emphasis on Mediterranean countries.
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Herstein JJ, Biddinger PD, Gibbs SG, Le AB, Jelden KC, Hewlett AL, Lowe JJ. High-Level Isolation Unit Infection Control Procedures. Health Secur 2018; 15:519-526. [PMID: 29058966 DOI: 10.1089/hs.2017.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The 2014-2016 Ebola outbreak in West Africa prompted a select group of US hospitals to establish high-level isolation units equipped with advanced engineering controls, trained staff, and stringent protocols to safely treat highly infectious disease patients. This survey details the comprehensive infection control protocols developed by these units, including for decontamination of units, post-mortem management, liquid waste disposal, and personal protective equipment (PPE) use. In spring 2016, a survey was electronically distributed to the 56 original Centers for Disease Control and Prevention (CDC)-designated high-level isolation units. Responses were collected via a fillable PDF and analyzed using descriptive statistics. Thirty-six (64%) high-level isolation units responded; 33 completed the survey, and 3 reported they no longer maintained high-level isolation unit capabilities. Nearly all responding units had written procedures for decontamination, liquid waste disposal, and PPE use; however, infection control protocols varied between units. High-level isolation units implemented multiple strategies in promoting hand hygiene among staff and in monitoring correct PPE use. Maximum time allowed in full PPE was restricted in all but 2 units (average of 3.45 hours per shift). Almost all (94%) had written procedures for the management of human remains, although only 2 units had written protocols for an autopsy of a patient with a highly infectious disease. While the vast majority of high-level isolation units reported having written protocols for infection control practices, staff compliance and procedural application are the true indicators of the state of preparedness. Therefore, rigorous training and staff adherence to infection control practices is critical to minimizing exposure risks.
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Horton S, Sullivan R, Flanigan J, Fleming KA, Kuti MA, Looi LM, Pai SA, Lawler M. Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action. Lancet 2018; 391:1953-1964. [PMID: 29550030 DOI: 10.1016/s0140-6736(18)30460-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/28/2017] [Accepted: 12/08/2017] [Indexed: 11/17/2022]
Abstract
Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.
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Affiliation(s)
- Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | | | - John Flanigan
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth A Fleming
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Green Templeton College, University of Oxford, Oxford, UK
| | - Modupe A Kuti
- Department of Chemical Pathology, College of Medicine, University of Ibadan, and University Hospital, Ibadan, Nigeria
| | - Lai Meng Looi
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay A Pai
- Columbia Asia Referral Hospital, Bangalore, India
| | - Mark Lawler
- Faculty of Medicine, Health and Life Sciences and Centre for Cancer Research and Cell Biology, Queens University, Belfast, UK
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Abstract
The idea of building hospitals to fight contagion was born with the lazarettos. At the time when the microorganisms were not yet known, the mechanisms of transmission of contagion were already well apprehended. Based on the same knowledge but thanks to new technologies, such hospitals have now been built downtown, next to the most highly performing technological plateau. Regrouping patient care, diagnostics, research, and development, the University Hospital Institute Méditerranée Infection building offers a wonderful tool to contain and understand contagion, in a well-designed setting, creating excellent working conditions that are attractive for interested scientists.
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Affiliation(s)
| | - Philippe Brouqui
- University Hospital Institute Méditerranée Infection, Marseille, France
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44
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Le AB, Biddinger PD, Smith PW, Herstein JJ, Levy DA, Gibbs SG, Lowe JJ. A Highly Infectious Disease Care Network in the US Healthcare System. Health Secur 2018. [PMID: 28636444 DOI: 10.1089/hs.2016.0073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During the 2014-15 Ebola outbreak in West Africa, the United States responded by stratifying hospitals into 1 of 3 Centers for Disease Control and Prevention (CDC)-designated categories-based on the hospital's ability to identify, isolate, assess, and provide care to patients with suspected or confirmed Ebola virus disease (EVD)-in an attempt to position the US healthcare system to safely isolate and care for potential patients. Now, with the Ebola epidemic quelled, it is crucial that we act on the lessons learned from the EVD response to broaden our national perspective on infectious disease mitigation and management, build on our newly enhanced healthcare capabilities to respond to infectious disease threats, develop a more cost-effective and sustainable model of infectious disease prevention, and continue to foster training so that the nation is not in a vulnerable position once more. We propose the formal creation of a US Highly Infectious Disease Care Network (HIDCN) modeled after 2 previous highly infectious disease consensus efforts in the United States and the European Union. A US Highly Infectious Disease Care Network can provide a common platform for the exchange of training, protocols, research, knowledge, and capability sharing among high-level isolation units. Furthermore, we envision the network will cultivate relationships among facilities and serve as a means of establishing national standards for infectious disease response, which will strengthen domestic preparedness and the nation's ability to respond to the next highly infectious disease threat.
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45
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Herstein JJ, Biddinger PD, Gibbs SG, Le AB, Jelden KC, Hewlett AL, Lowe JJ. Sustainability of High-Level Isolation Capabilities among US Ebola Treatment Centers. Emerg Infect Dis 2018; 23:965-967. [PMID: 28518036 PMCID: PMC5443454 DOI: 10.3201/eid2306.170062] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
To identify barriers to maintaining and applying capabilities of US high-level isolation units (HLIUs) used during the Ebola virus disease outbreak, during 2016 we surveyed HLIUs. HLIUs identified sustainability challenges and reported the highly infectious diseases they would treat. HLIUs expended substantial resources in development but must strategize models of sustainability to maintain readiness.
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U.S. High-Level Isolation Unit Clinical Laboratory Capabilities Update. J Clin Microbiol 2018; 56:JCM.01608-17. [PMID: 29167287 DOI: 10.1128/jcm.01608-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/10/2017] [Indexed: 11/20/2022] Open
Abstract
In late 2014, 56 hospitals in the United States were designated by state and federal public health authorities as specially designed high-level isolation units (HLIUs) equipped with advanced infrastructure, laboratory capabilities, and trained staff to care for patients with highly hazardous communicable diseases (HHCDs), such as Ebola virus disease. This survey describes the clinical laboratory support capabilities of U.S. HLIUs, including the specific test menus that HLIUs have identified to safely manage HHCD patients and the locations where such testing would be performed. In spring 2016, a survey was electronically distributed, as a fillable pdf file, to the 56 U.S. HLIUs. Site representatives completed the surveys, and data were coded and analyzed in an electronic spreadsheet, using descriptive statistics. Thirty-six HLIUs (64%) responded, and 33 completed the laboratory capabilities section. Thirty-one HLIUs (94%) had performed risk analyses for all laboratory procedures and equipment. Twenty-nine (88%) had decontamination procedures specified for all laboratory equipment used for patients with suspected or confirmed HHCDs. On-site laboratories in 27 HLIUs (81%) had the capacity to inventory and to securely store HHCD patient specimens. Ten HLIUs (31%) had at least one test they would conduct within the patient isolation room. The high-risk nature of HHCDs and the occupational exposures that may occur in clinical laboratories demand advanced preparation and risk assessment of work practices, laboratory equipment, and instrumentation by HLIU laboratories. Although risk analyses of clinical laboratory testing and equipment that HLIUs have conducted have likely focused on those for Ebola virus, HLIUs must be prepared to revise their current procedures for other HHCDs.
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Hewlett A, K. Murthy AR. Designing Medical Facilities to Care for Patients with Highly Hazardous Communicable Diseases. BIOEMERGENCY PLANNING 2018. [PMCID: PMC7120841 DOI: 10.1007/978-3-319-77032-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Certain highly hazardous communicable diseases (HHCD), including viral hemorrhagic fevers, the Middle East respiratory syndrome coronavirus (MERS-CoV), and severe acute respiratory syndrome virus (SARS), have caused nosocomial outbreaks in unprepared facilities. Consequently, biocontainment units have been constructed to protect caregivers, patients, and family members, in addition to providing optimal care of the infected patient. Biocontainment units have adopted many of the design features originally found in biocontainment laboratories and can serve as national referral facilities for the most severe and highly hazardous infections. Although a patient with a HHCD can show up at any healthcare facility unannounced, not every hospital can or should attempt to establish a biocontainment unit. Nevertheless, there are design features or management principles found in biocontainment units that can be adopted in most facilities. Awareness of the potential risk, in addition to adopting structural and policy control measures, can do a lot to prepare a facility for the next unexpected infectious disease outbreak.
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Affiliation(s)
- Angela Hewlett
- Division of Infectious Diseases, Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha, NE USA
| | - A. Rekha K. Murthy
- Division of Infectious Diseases, Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA USA
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48
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Wolf T. Maintenance of Preparedness. BIOEMERGENCY PLANNING 2018. [PMCID: PMC7122287 DOI: 10.1007/978-3-319-77032-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The medical management of patients with highly hazardous communicable diseases (HHCD) will suddenly become important during public health emergencies of international concern but will receive little attention in between those events. It is very important to use those times to maintain and improve the level of preparedness and adjust it to advances in the field. The infrastructure provided needs to be regularly adjusted but also requires intensive maintenance. Every high-level isolation unit (HLIU) needs to plan individually and very precisely what kind of equipment, materials and medications need to be stockpiled and in what amount, in order to be able to provide adequate care. Providing HLIU treatment is a highly qualified and differentiated task, and training efforts should provide a multidisciplinary HLIU team with an intricate training schedule. The medical and psychological aspects of occupational health and safety need to be addressed as well in order to maintain preparedness.
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Bearman G, Munoz-Price S, Morgan DJ, Murthy RK. Viral Hemorrhagic Fever Preparedness. INFECTION PREVENTION 2018. [PMCID: PMC7122159 DOI: 10.1007/978-3-319-60980-5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 2014–2016 outbreak of Ebola virus disease (EVD) in West Africa marked the 25th such occurrence but was noteworthy in its massive scope, causing more human morbidity and mortality than the previous 24 recorded outbreaks combined. As of April 2016, there were 28,652 cases resulting in at least 11,325 deaths, nearly all in the three nations of Guinea, Liberia, and Sierra Leone (Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html. Accessed 2 June 2016). Moreover, the 2014–2016 outbreak was the first in which patients, albeit few in number, were afforded sophisticated intensive care in the United States and in Europe. This “high-level containment care” (HLCC) was provided in specially designed purpose-built biocontainment units (BCUs). In this chapter, we explore the history and evolution of biocontainment, discuss its unique engineering and infection control modalities, and offer recommendations for the clinical and operational management of Ebola and other viral hemorrhagic fevers (VHFs).
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Affiliation(s)
- Gonzalo Bearman
- VCUHS Epidemiology and Infection Control, North Hospital, Richmond, Virginia USA
| | | | | | - Rekha K. Murthy
- Department of Medical Affairs and Division of Infectious Diseases, Cedars-Sinai Health System, Los Angeles, California USA
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50
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Coignard-Biehler H, Rapp C, Chapplain JM, Hoen B, Che D, Berthelot P, Cazenave-Roblot F, Rabaud C, Brouqui P, Leport C. The French Infectious Diseases Society's readiness and response to epidemic or biological risk-the current situation following the Middle East respiratory syndrome coronavirus and Ebola virus disease alerts. Med Mal Infect 2017; 48:95-102. [PMID: 29169817 PMCID: PMC7125712 DOI: 10.1016/j.medmal.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/09/2017] [Accepted: 10/02/2017] [Indexed: 01/20/2023]
Abstract
CONTEXT In 2012, the French Infectious Diseases Society (French acronym SPILF) initiated the "Coordination of epidemic and biological risk" (SPILF-COREB - Emergences [SCE]) group to support the readiness and response of healthcare workers (HCWs) to new alerts. OBJECTIVE To present the SCE group, its functioning, and the main support it provided for frontline HCWs. METHODS A multidisciplinary group of heads of infectious disease departments from reference hospitals was created to build a network of clinical expertise for care, training, and research in the field of epidemic and biological risk (EBR). The network developed a set of standardized operational procedures (SOPs) to guide interventions to manage EBR-suspect patients. RESULTS A working group created the SOP aimed at frontline HCWs taking care of patients. Priority was given to the development of a generic procedure, which was then adapted according to the current alert. Five key steps were identified and hierarchized: detecting, protecting, caring for, alerting, and referring the EBR patient. The interaction between clinicians and those responsible for the protection of the community was crucial. The SOPs validated by the SPILF and its affiliates were disseminated to a wide range of key stakeholders through various media including workshops and the SPILF's website. CONCLUSION SPILF can easily adapt and timely mobilize the EBR expertise in case of an alert. The present work suggests that sharing and discussing this experience, initiated at the European level, can generate a new collective expertise and needs to be further developed and strengthened.
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Affiliation(s)
- H Coignard-Biehler
- Unité de coordination opérationnelle du risque épidémique et biologique, AP-HP, 75001 Paris, France; Service des maladies infectieuses et tropicales, hôpital Necker-Enfants malades, 75015 Paris, France; Samu 75, hôpital Necker-Enfants malades, 75015 Paris, France.
| | - C Rapp
- CMETE, 10, rue du Colonel-Driant, 75001 Paris, France; Hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé cedex, France
| | - J M Chapplain
- Unité de coordination opérationnelle du risque épidémique et biologique, AP-HP, 75001 Paris, France; Service des maladies infectieuses et tropicales, hôpital Pontchaillou, 35000 Rennes, France
| | - B Hoen
- Inserm CIC 14-24, faculté de médecine Hyacinthe-Bastaraud, université des Antilles, centre hospitalier universitaire, 97110 Pointe-à-Pitre, Guadeloupe
| | - D Che
- Santé publique France, 94410 Saint-Maurice, France
| | - P Berthelot
- Unité d'hygiène interhospitalière, service des maladies infectieuses et laboratoire des agents infectieux et hygiène, CHU de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - F Cazenave-Roblot
- Service des maladies infectieuses et tropicales, CHU de Poitiers, 86021 Poitiers, France
| | - C Rabaud
- Service des maladies infectieuses et tropicales, CHRU de Nancy, 54000 Nancy, France
| | - P Brouqui
- Service des maladies infectieuses et tropicales, hôpital Nord, 13000 Marseille, France
| | - C Leport
- Unité de coordination opérationnelle du risque épidémique et biologique, AP-HP, 75001 Paris, France; UMR 1137, Inserm, université Paris Diderot, 75018 Paris, France
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