Addressing Infection Prevention and Control in the First U.S. Community Hospital to Care for Patients With Ebola Virus Disease: Context for National Recommendations and Future Strategies

Abstract

Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital's capacity to safely diagnose and treat patients with EVD. After admission of the first patient with EVD, a multidisciplinary team from the Centers for Disease Control and Prevention (CDC) joined the hospital's infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and managing regulated medical waste. Existing engineering and administrative controls were strengthened. The personal protective equipment (PPE) ensemble was standardized, HCP were trained on donning and doffing PPE, and a system of trained observers supervising PPE donning and doffing was implemented. Caring for patients with EVD placed substantial demands on a community hospital. The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for PPE, a rapid system for deploying CDC staff to assist hospitals ("Ebola Response Team"), and a framework for a tiered approach to hospital preparedness. The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for HCP to be prepared to safely care for patients with EVD and other high-consequence emerging infectious diseases.

Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

“…While there is a growing body of literature describing preparations for the 2014-2015 EVD outbreak, this study is unique because it allows comparison of experiences across different types of acute care hospitals (with different roles in the regional EVD plan), and between HCP who planned and received training. [6][7][8][9] The study objectives were achieved using semistructured interviews with HCP involved with EVD preparations, and surveying HCP who participated in training for the use of enhanced PPE ensembles for EVD.…”

Identification and Characterization of Failures in Infectious Agent Transmission Precaution Practices in Hospitals

“…4,5 Minimizing risks for health care personnel is also paramount, as illustrated by the self-contamination and subsequent illness of 2 nurses caring for a patient with Ebola virus disease. 6 Standard and transmission-based precautions are an infection-prevention mainstay for protecting patients and health care personnel. 7 These precautions include hand hygiene and the use of special clothing or equipment known as personal protective equipment (PPE).…”

Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006–2015

“…In 2014, the transmission of Ebola virus to 2 nurses who provided care to an Ebola-infected patient at a US hospital revealed the importance of directive PPE recommendations and standardized training efforts for healthcare personnel. Interventions included a system of trained observers supervising the donning and doffing of PPE (5,49). Even though the quality of evidence is low, the risk for contamination may be reduced by double-gloving, following directives for donning and doffing procedures, and instituting more active training (50).…”

“…More than 2,000 years ago, Hippocrates noted that "there are many handicrafts and arts which cause those who exercise them certain… plagues" (1). Recent experiences with anthrax, severe acute respiratory syndrome (SARS), influenza A(H1N1), and Ebola virus disease have highlighted the importance of focusing on workplaces not only to identify at-risk populations but also to understand mechanisms of disease propagation and to implement successful control and prevention measures (2)(3)(4)(5).…”