Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T08:41:45.522Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  15 February 2021

Madeline A. DiLorenzo Open the ORCID record for Madeline A. DiLorenzo [Opens in a new window] ,
Christoph A. Baker ,
Jocelyn J. Herstein ,
Laura Evans ,
John J. Lowe ,
Shawn G. Gibbs  and
Nahid Bhadelia
Madeline A. DiLorenzo*
Affiliation:
Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts
Christoph A. Baker
Affiliation:
Tufts University School of Medicine, Boston, Massachusetts
Jocelyn J. Herstein
Affiliation:
Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska
Laura Evans
Affiliation:
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington
John J. Lowe
Affiliation:
Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska
Shawn G. Gibbs
Affiliation:
School of Public Health, Texas A&M University, College Station, Texas
Nahid Bhadelia
Affiliation:
Special Pathogens Unit, National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, Massachusetts
*
Author for correspondence: Madeline A. DiLorenzo, E-mail: madeline.dilorenzo@bmc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

In response to the 2013–2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF).

Design:

A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care.

Setting and participants:

The questionnaire was sent to 82 ETCs.

Methods:

We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not.

Results:

Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication.

Conclusions:

There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 11 , November 2021 , pp. 1307 - 1312
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ebola situation report. World Health Organization website. https://apps.who.int/ebola/sites/default/files/atoms/files/who_ebola_situation_report_30-12-2015.pdf?ua=1&ua=1. Accessed July 28, 2020.Google Scholar
Viral hemorrhagic fevers (VHFs). Centers for Disease Control and Prevention website. https://www.cdc.gov/vhf/index.html. Accessed June 6, 2020.Google Scholar
World Health Organization. Laboratory Safety Biomanual, 3rd edition. Geneva: World Health Organization; 2004.Google Scholar
Uyeki, TM, Mehta, AK, Davey, RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med 2016;374:636–646.10.1056/NEJMoa1504874CrossRefGoogle ScholarPubMed
2014–2016 Ebola virus outbreak in West Africa. Centers for Disease Control and Prevention website. https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html. Accessed July 27, 2020.Google Scholar
Bell, BP, Damon, IK, Jernigan, DB, et al. Overview, control strategies, and lessons learned in the CDC response to the 2014–2016 Ebola epidemic. MMWR Suppl 2016;65 suppl 3:4–11.CrossRefGoogle ScholarPubMed
Ebola virus disease for clinicians. Centers for Disease Control and Prevention website. https://www.cdc.gov/vhf/ebola/clinicians/index.html. Accessed May 25, 2020.Google Scholar
Edelson, PJ. Don’t categorically refuse CPR to Ebola patients. The Hastings Center website. https://www.thehastingscenter.org/dont-categorically-refuse-cpr-to-ebola-patients. Accessed May 25, 2020.Google Scholar
Kramer, DB, Lo, B, Dickert, NW. CPR in the COVID-19 era—an ethical framework. N Engl J Med 2020;383(2):e6.10.1056/NEJMp2010758CrossRefGoogle ScholarPubMed
2018 annual report. National Ebola Training and Education Center website. https://netec.org/wp-content/uploads/2019/01/NETEC-Annual-Report-FY2018.pdf. Published 2019. Accessed May 8, 2020.Google Scholar
NETEC webinar series: COVID-19 education and training. National Ebola Training and Education Center website. https://netec.org/education-and-training/. Accessed June 5, 2020.Google Scholar
Herstein, JJ, Le, AB, McNulty, LA, et al. Update on Ebola treatment center costs and sustainability, United States, 2019. Emerg Infect Dis 2020;26:1007–1009.10.3201/eid2605.191245CrossRefGoogle ScholarPubMed
Herstein, JJ, Le, AB, McNulty, LA, et al. An update on US Ebola treatment center personnel management and training. Am J Infect Control 2020;48:375–379.10.1016/j.ajic.2019.12.005CrossRefGoogle ScholarPubMed
Murthy, S. Ebola and provision of critical care. Lancet 2015;385:1392–1393.10.1016/S0140-6736(15)60712-7CrossRefGoogle Scholar
Blais, C, White, J. Bioethics in practice—a quarterly column about medical ethics. Ebola and medical ethics: ethical challenges in the management of contagious infectious diseases. Ochsner J 2015;15:5–7.Google ScholarPubMed
Connor, MJ Jr, Kraft, C, Mehta, AK, et al. Successful delivery of RRT in Ebola virus disease. J Am Soc Nephrol 2015;26:31–37.CrossRefGoogle ScholarPubMed
Torabi-Parizi, P, Davey, RT, Suffredini, AF, Chertow, DS. Ethical and practical considerations in providing critical care to patients with Ebola virus disease. Chest 2015;147:1460–1466.10.1378/chest.15-0278CrossRefGoogle ScholarPubMed
Belfroid, E, Van Steenbergen, J, Timen, A, et al. Preparedness and the importance of meeting the needs of healthcare workers: a qualitative study on Ebola. J Hosp Infect 2018;98:212–218.CrossRefGoogle ScholarPubMed
Mulangu, S, Dodd, LE, Davey, RT, et al. A randomized controlled trial of Ebola virus disease therapeutics. N Engl J Med 2019;381:2293–2303.CrossRefGoogle ScholarPubMed
Farrow, R, Becherer-Bailey, G, Mantuani, D, Nagdev, A. Early multiorgan point-of-care ultrasound evaluation of respiratory distress during SARS-CoV-2 outbreak: case report. Clin Pract Cases Emerg Med 2020;4:129–133.Google ScholarPubMed
Scoppettuolo, G, Biasucci, DG, Pittiruti, M. Vascular access in COVID-19 patients: smart decisions for maximal safety. J Vasc Access 2020;21:408–410.10.1177/1129729820923935CrossRefGoogle ScholarPubMed
Garibaldi, BT, Chertow, DS. High-containment pathogen preparation in the intensive care unit. Infect Dis Clin North Am 2017;31:561–576.10.1016/j.idc.2017.05.008CrossRefGoogle ScholarPubMed
Gossen, A, Mehring, B, Gunnell, BS, et al. The isolation communication management system. A telemedicine platform to care for patients in a biocontainment unit. Ann Am Thorac Soc 2020;17:673–678.10.1513/AnnalsATS.202003-261IPCrossRefGoogle Scholar