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Kociolek LK, Shane AL, Simonsen KA, Zerr DM. Infection Prevention and Control Implications of Special Pathogens in Children. Pediatr Clin North Am 2024; 71:431-454. [PMID: 38754934 DOI: 10.1016/j.pcl.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Special pathogens are broadly defined as highly transmissible organisms capable of causing severe disease in humans. Children's hospital healthcare personnel (HCP) should be prepared to identify patients possibly infected with a special pathogen, isolate the patient to minimize transmission, and inform key infection prevention, clinical, and public health stakeholders. Effective preparedness requires resources and practice with attention to education, policies and procedures, drills and training, and supplies. Successfully preparing for special pathogens is an important measure toward keeping communities, HCP, and patients and families safe in this global age that brings pathogens from across the world to our doorstep.
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Affiliation(s)
- Larry K Kociolek
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 20, Chicago, IL 60611, USA.
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Emory Children's Center, 2015 Uppergate Drive Northeast, Room 504A, Atlanta, GA 30322, USA
| | - Kari A Simonsen
- Department of Pediatrics, University of Nebraska Medical Center, 982162 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Danielle M Zerr
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Mailstop MA7.226, 4800 Sand Point Way, Seattle, WA 98105, USA
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Matić Z, Sala MFW, Tonetto LM, Campiglia GC, Morgan J, DuBose JR, Zimring CM, Kraft CS. Understanding Experience of Patients With Highly Infectious Diseases During Extended Isolation: A Design Perspective. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:97-112. [PMID: 36164757 DOI: 10.1177/19375867221128916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study aimed to develop a better understanding of the unique needs of patients with highly infectious diseases and their perceptions of being placed in isolation. We explore the subjective experiences of patients treated for Ebola in a biocontainment unit (BCU) and the healthcare personnel who cared for them. BACKGROUND The 2014 Ebola outbreak and the COVID-19 pandemic have brought to focus some major challenges of caring for patients with serious infectious diseases. Previous studies on BCU design have looked at ways to prevent self- and cross-contamination, but very few have examined how the built environment can support an improved patient experience. METHOD A qualitative study was conducted with four patients treated for Ebola and two critical care nurses who provided direct care to them at a single BCU in the U.S. Data were collected through in-depth semi-structured interviews to capture the actual patients' perception and experience of isolation. The interviews were analyzed using the thematic analysis approach. RESULTS The Ebola patients placed in source isolation perceived the BCU as an artificial environment where they lacked control, agency, autonomy, and independence. The physical separation from other patients, visitor restrictions, and staff wearing PPE contributed to feelings of social and emotional isolation, and loneliness. CONCLUSIONS The isolation can take a toll on physiological and psychological well-being. A thoughtful design of isolation units may improve patients' experience by supporting human and social interactions, empowering patients through space flexibility and personalization of space, and supporting a more holistic approach to isolation care.
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Affiliation(s)
| | - Maria F Wong Sala
- SimTigrate Design Lab, Georgia Institute of Technology, Atlanta, GA, USA
| | | | | | | | - Jennifer R DuBose
- SimTigrate Design Lab, Georgia Institute of Technology, Atlanta, GA, USA
| | - Craig M Zimring
- SimTigrate Design Lab, Georgia Institute of Technology, Atlanta, GA, USA
| | - Colleen S Kraft
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Vasa A, Pacino V, Vasistha S, ElRayes W, Lowe JJ. COVID-19 Response Among US Hospitals with Emerging Special Pathogen Programs. Health Secur 2022; 20:S31-S38. [PMID: 35584272 DOI: 10.1089/hs.2021.0193] [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: 11/12/2022] Open
Abstract
In February 2015, the US Department of Health and Human Services developed a tiered hospital network to deliver safe and effective care to patients with Ebola virus disease (EVD) and other special pathogens. The tiered network consisted of regional special pathogen treatment centers, state- or jurisdiction-designated treatment centers, assessment hospitals able to safely isolate a patient until a diagnosis of EVD was confirmed and transfer the patient, and frontline healthcare facilities able to identify and isolate patients with EVD and facilitate transport to higher-tier facilities. The National Emerging Special Pathogens Training and Education Center (NETEC) was established in tandem to support the development of healthcare facility special pathogen management capabilities. In August 2020, 20 hospitals that previously received an onsite readiness consultation by NETEC were surveyed to assess how special pathogen programs were leveraged for COVID-19 response. All surveyed facilities indicated their programs were leveraged for COVID-19 response in at least 1 of the following ways: NETEC-sponsored resources and training, utilization of patient isolation spaces, specially trained staff, and supplies. Personal protective equipment shortages were experienced by 95% of facilities, with 80% of facilities reporting that special pathogens program personal protective equipment was used to support facility response to COVID-19 admissions. More than half of facilities (63%) reported leveraging biocontainment unit staff to provide training and education to frontline staff during initial response to COVID-19. These findings have implications for planning and investments to avoid the panic-then-forget cycle that hinders sustained preparedness for future special pathogens.
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Affiliation(s)
- Angela Vasa
- Angela Vasa, MSN, RN, is Director of Isolation and Quarantine Services, Nebraska Medicine; and Director of Readiness Consultations and Metric Development, National Emerging Special Pathogens Training and Education Center (NETEC), University of Nebraska Medical Center, Omaha, NE
| | - Valerie Pacino
- Valerie Pacino, MPH, is a Graduate Assistant, College of Public Health, University of Nebraska Medical Center, and NETEC, Omaha, NE
| | - Sami Vasistha
- Sami Vasistha, MS, is a Program Manager, NETEC, and a Program Manager, Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE
| | - Wael ElRayes
- Wael ElRayes, MBBCh, PhD, MS, FACHE, is an Evaluator, NETEC, and an Assistant Professor, Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - 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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Billman CL, Flinn J, Gadala A, Bowman C, McIlquham T, Sulmonte CJ, Garibaldi BT. Creating a Safety Officer Program to Enhance Staff Safety During the Care of COVID-19 Patients. Health Secur 2022; 20:S54-S59. [PMID: 35483094 DOI: 10.1089/hs.2021.0182] [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: 11/12/2022] Open
Abstract
Staff safety is paramount when managing an infectious disease event. However, early data from the COVID-19 pandemic suggested that staff compliance with personal protective equipment and other safety protocols was poor. In response to patient surges, many hospitals created dedicated "biomode" units to provide care for patients infected with SARS-CoV-2, the virus that causes COVID-19. To enhance staff safety on biomode units and during patient transports, our hospital created a safety officer/transport safety officer (SO/TSO) program. The first SOs/TSOs were nurses, clinical technicians, and other support staff who were redeployed from their home units when the units closed during the initial surge. During subsequent COVID-19 surges, dedicated SOs/TSOs were hired to maintain the program. SOs/TSOs provided just-in-time personal protective equipment training and helped staff safely enter and exit COVID-19 clinical units. SOs/TSOs participated in the transport of over 1,000 COVID-19 patients with no safety incidents reported. SOs/TSOs conducted safety audits throughout the hospital and observed 86% compliance with COVID-19 precautions across 32,500 activities. During contact tracing of frontline staff who became infected with SARS-CoV-2, potential deviations from COVID-19 precautions were identified in only 7.7% of cases. The SO/TSO program contributed to a culture of safety in the biomode units and helped to enhance infection prevention throughout the hospital. This program can serve as a model for other health systems during the response to the current pandemic and during future infectious disease threats.
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Affiliation(s)
- Carrie L Billman
- Carrie L. Billman, RN, BSN, CIC, is a Senior Infection Control Epidemiologist, Hospital Epidemiology and Infection Control, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Jade Flinn
- Jade Flinn, MSN, RN, is a Nurse Educator, Johns Hopkins Biocontainment Unit, Department of Medicine, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Avinash Gadala
- Avinash Gadala, PhD, MS, BPharm, is a Clinical Analytics Systems Architect, Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD
| | - Chad Bowman
- Chad Bowman, MSN, RN, CFRN, NR-P, is Lead Clinical Nurse, Lifeline Critical Care Transport Team, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Taylor McIlquham
- Taylor McIlquham, MPH, CIC, is an Infection Control Epidemiologist, Hospital Epidemiology and Infection Control, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Christopher J Sulmonte
- Christopher J. Sulmonte, MHA, is a Project Administrator, Johns Hopkins Biocontainment Unit, Department of Medicine, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEPH, is Medical Director, Johns Hopkins Biocontainment Unit, Department of Medicine, all at The Johns Hopkins Hospital, Baltimore, MD
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Grein JD, Garland JA, Arguinchona C, Frank MG, Garibaldi BT, Grindle A, Hewlett A, Kline S, Levine CB, Mehta A, Mukherjee V, Sauer LM, Searle EF, Vanairsdale S, Vasa A. Contributions of the Regional Emerging Special Pathogen Treatment Centers to the US COVID-19 Pandemic Response. Health Secur 2022; 20:S4-S12. [PMID: 35483049 DOI: 10.1089/hs.2021.0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Emerging Special Pathogens Training and Education Center (NETEC) was established in 2015 to improve the capabilities of healthcare facilities to provide safe and effective care to patients with Ebola and other special pathogens in the United States. Through NETEC, a collaborative network of 10 Regional Emerging Special Pathogen Treatment Centers (RESPTCs) undertook readiness activities that included potential respiratory pathogens. These preparations, which took place before the COVID-19 pandemic, established a foundation of readiness that enabled RESPTCs to play a pivotal role in the US COVID-19 pandemic response. As initial COVID-19 cases were detected in the United States, RESPTCs provided essential isolation capacity, supplies, and subject matter expertise that allowed for additional time for healthcare systems to prepare. Through the Special Pathogen Research Network, RESPTCs rapidly enrolled patients into early clinical trials. During periods of high community transmission, RESPTCs provided educational, clinical, and logistical support to a wide range of healthcare and nonhealthcare settings. In this article, we describe how NETEC and the RESPTC network leveraged this foundation of special pathogen readiness to strengthen the national healthcare system's response to the COVID-19 pandemic. NETEC and the RESPTC network have proven to be an effective model that can support the national response to future emerging special pathogens.
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Affiliation(s)
- Jonathan D Grein
- Jonathan D. Grein, MD, is Director, both in Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer A Garland
- Jennifer A. Garland, RN-BC, PhD, CIC, is Special Pathogens Clinical Program Manager, both in Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Christa Arguinchona
- Christa Arguinchona, MSN, RN, CCRN, is Manager, Special Pathogens/Infection Prevention, Providence Sacred Heart Medical Center, Spokane, WA
| | - Maria G Frank
- Maria G. Frank, MD, is a Hospitalist, Division of Hospital Medicine, Denver Health and Hospital Authority, and an Associate Professor of Medicine, School of Medicine, University of Colorado; both in Denver, CO
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Director, Johns Hopkins Biocontainment Unit, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Grindle
- Amanda Grindle, RN, MSN, CNL, CPN, CCRN, is Clinical Program Manager, Special Care Unit, Children's Healthcare of Atlanta, Atlanta, GA
| | - Angela Hewlett
- Angela Hewlett, MD, MS, is an Associate Professor, Division of Infectious Diseases, Department of Internal Medicine; the George W. Orr MD and Linda Orr Chair in Health Security; and Medical Director, Nebraska Biocontainment Unit; all at the University of Nebraska Medical Center, Omaha, NE
| | - Susan Kline
- Susan Kline, MD, MPH, is Executive Medical Director for Infection Prevention, University of Minnesota Medical Center, and a Professor of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School; both in Minneapolis, MN
| | - Corri B Levine
- Corri B. Levine, PhD, MS, MPH, is Program Manager for Emerging and Special Pathogens Program, University of Texas Medical Branch, Galveston, TX
| | - Aneesh Mehta
- Aneesh Mehta, MD, is an Associate Professor of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Vikramjit Mukherjee
- Vikramjit Mukherjee, MD, FRCP(Edin), is an Assistant Professor, NYU School of Medicine; and is Director, Medical Intensive Care Unit, and Director, Special Pathogens Program, Bellevue Hospital Center; all in New York, NY
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director, Special Pathogens Research Network, and is an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, Global Center for Health Security; both at the University of Nebraska Medical Center, Omaha, NE
| | - Eileen F Searle
- Eileen F. Searle, PhD, RN, CCRN, is Biothreats Program Director, Center for Disaster Medicine, Massachusetts General Hospital, Boston, MA
| | - Sharon Vanairsdale
- Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN, is an Associate Professor, Clinical Track, Nell Hodgson Woodruff School of Nursing, Emory University; Program Director for Serious Communicable Diseases, Emory University Hospital; and Director of Education and Resources, National Emerging Special Pathogens Training and Education Center, Emory University; all in Atlanta, GA
| | - Angela Vasa
- Angela Vasa, MSN, RN, is Director of Isolation and Quarantine Services and Director, Readiness Consultations and Metrics Development, National Emerging Special Pathogens Training and Education Center; both at Nebraska Medicine, Omaha, NE
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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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The utility and sustainability of US Ebola treatment centers during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2022; 44:643-650. [PMID: 35189995 PMCID: PMC10019924 DOI: 10.1017/ice.2022.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We sought to determine the ongoing sustainability of ETCs and to identify how ETC capabilities have affected hospital, local, and regional coronavirus disease 2019 (COVID-19) readiness and response. DESIGN An electronic survey included both qualitative and quantitative questions and was structured into 2 sections: operational sustainability and role in the COVID-19 response. SETTING AND PARTICIPANTS The survey was distributed to site representatives from the 56 originally designated ETCs, and 37 (66%) responded. METHODS Data were coded and analyzed using descriptive statistics. RESULTS Of the 37 responding ETCs, 33 (89%) reported that they were still operating, and 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but 1 ETC reported that existing capabilities (eg, trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (eg, ETC trained staff, donated supplies, and shared developed protocols). CONCLUSIONS Existing high-level isolation capabilities and expertise developed following the 2014-2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and to support responses by other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.
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Kinlay SH, Whiting J, Audain P, Conrad P, Kulma A, Agus MSD, Sandora TJ. Novel Deployment of Pediatric Biocontainment Unit Nurses in Response to COVID-19. Am J Nurs 2021; 121:53-58. [PMID: 34673694 DOI: 10.1097/01.naj.0000799008.92892.b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Most existing biocontainment units (BCUs) in U.S. hospitals are designed to care for a limited number of patients infected with epidemiologically significant pathogens. The COVID-19 pandemic presented substantial challenges to hospital preparedness and operations because of its high incidence rate and the high risk of transmission to staff members. This article describes a novel practice innovation: a hospital-wide deployment of nurses on a trained BCU team to support hospital staff in safely caring for patients with COVID-19. Their responsibilities included assisting in the development of guidelines and providing training on safety protocols and the appropriate use of personal protective equipment. The authors show how this deployment contributed significantly to staff education and support during the pandemic.
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Affiliation(s)
- Stephanie Heather Kinlay
- Stephanie Heather Kinlay is an RN in the biocontainment unit (BCU) and medical ICU (MICU) at Boston Children's Hospital, where Pascale Audain is an RN in the BCU and MICU and the MICU-based infection prevention coordinator, Paula Conrad is an infection preventionist, Michael S. D. Agus is the co-medical director of the BCU and chief of the division of medical critical care, and Thomas J. Sandora is the co-medical director of the BCU and a pediatric infectious diseases physician. At the time of this writing, Amy Kulma was an RN in the BCU and MICU and Jon Whiting was director of nursing in the MICU; Whiting is now vice president and associate chief nurse of clinical and patient care operations at Boston Children's Hospital. Contact author: Stephanie Heather Kinlay, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Long CM, Marzi A. Biodefence research two decades on: worth the investment? THE LANCET. INFECTIOUS DISEASES 2021; 21:e222-e233. [PMID: 34331891 DOI: 10.1016/s1473-3099(21)00382-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
For the past 20 years, the notion of bioterror has been a source of considerable fear and panic worldwide. In response to the terror attacks of 2001 in the USA, extensive research funding was awarded to investigate bioterror-related pathogens. The global scientific legacy of this funding has extended into the present day, highlighted by the ongoing COVID-19 pandemic. Unsurprisingly, the surge in biodefence-related research and preparedness has been met with considerable apprehension and opposition. Here, we briefly outline the history of modern bioterror threats and biodefence research, describe the scientific legacy of biodefence research by highlighting advances pertaining to specific bacterial and viral pathogens, and summarise the future of biodefence research and its relevance today. We sought to address the sizeable question: have the past 20 years of investment into biodefence research and preparedness been worth it? The legacy of modern biodefence funding includes advancements in biosecurity, biosurveillence, diagnostics, medical countermeasures, and vaccines. In summary, we feel that these advances justify the substantial biodefence funding trend of the past two decades and set a precedent for future funding.
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Affiliation(s)
- Carrie M Long
- Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Andrea Marzi
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA.
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Gerber JE, Geller G, Boyce A, Maragakis LL, Garibaldi BT. Genomics in Patient Care and Workforce Decisions in High-Level Isolation Units: A Survey of Healthcare Workers. Health Secur 2021; 19:318-326. [PMID: 33826422 DOI: 10.1089/hs.2020.0182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The impact of host genomics on an individual's susceptibility, immune response, and risk of severe outcomes for a given infectious pathogen is increasingly recognized. As we uncover the links between host genomics and infectious disease, a number of ethical, legal, and social issues need to be considered when using that information in clinical practice or workforce decisions. We conducted a survey of the clinical staff at 10 federally funded Regional Ebola and Other Special Pathogen Treatment Centers to understand their views regarding the ethical, legal, and social issues related to host genomics and the administrative and clinical functions of high-level isolation units. Respondents overwhelmingly agreed that genomics could provide valuable information to identify patients and employees at higher risk for poor outcomes from highly infectious diseases. However, there was considerable disagreement about whether such data should inform the allocation of scarce resources or determine treatment decisions. While most respondents supported a confidential employer-based genomic testing system to inform individual employees about risk, respondents disagreed about whether such information should be used in staffing models. Respondents who thought genomic information would be valuable for patient treatment were more willing to undergo genetic testing for staffing purposes. Most respondents felt they would benefit from additional training to better interpret results from genetic testing. Although this study was completed before the COVID-19 pandemic, the responses provide a baseline assessment of provider attitudes that can inform policy during the current pandemic and in future infectious disease outbreaks.
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Affiliation(s)
- Jennifer E Gerber
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
| | - Gail Geller
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
| | - Angie Boyce
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
| | - Lisa L Maragakis
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
| | - Brian T Garibaldi
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
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