There are hospitals that spend years planning for and running drills around caring for a patient exposed to infected with Ebola, but the reality is much more challenging, according to a case study.
In one case study, a multidisciplinary team at the National Institutes of Health Clinical Center's Special Clinical Studies Unit outlined the challenges and surprises encountered in preparing and caring for patients with confirmed or suspected Ebola virus.
According to Tara Palmore, MD, a lead author of the NIH case study and hospital epidemiologist in the NIH Clinical Center, the training didn't take into account the external scrutiny with which the care for the patient was met.
"Many precautions were taken to prevent the spread of the virus, and some were taken to mitigate fear, even if science did not always support those fears," said Dr. Palmore.
In the study, the following six challenges, issues and themes emerged:
- Heightened interest from the media and the general public made preserving patient confidentiality and accommodating the high volume of calls to the unit from other medical centers and the public difficult.
- NIH compared the anxiety surrounding the admission of a patient with confirmed or suspected Ebola virus to the anxiety felt during the AIDS epidemic in the 1980s.
- Being transparent and communicating with the public and patients about Ebola and the infection control precautions in place didn't stop 40 patients from cancelling or rescheduling appointments at NIH. Between the scheduling issues and the numerous Ebola evaluations conducted, delays in patient care and patient anxiety became a challenge.
- Staffing was also an issue although, ultimately, the team at NIH was able to coordinate an all-volunteer frontline staff that included infectious disease specialists, nurses, intensivists, lab and radiology technologists, respiratory therapists and trained observers to monitor personal protective equipment dressing and removal.
- NIH had to conduct time- and labor-intensive training with a large corps of staff, including volunteers, while prioritizing training for staff that would provide direct care or handle patient specimens. Roughly 65 percent of respondents reported hosting drills or exercises to help staff prepare, but only 30 percent of frontline providers were trained in appropriate PPE use.
- Waste disposal was a huge challenge for NIH clinical leaders, who worked with trained contractors and state and local sanitation officials to develop a plan to adequately address concerns around waste disposal.
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