In August 2014, fear struck the globe, when the Ebola epidemic breached the continent of Africa’s borders and reached the United States. While proving to be a formidable opponent, the Ebola crisis was ultimately contained, but not before infecting two unsuspecting health care workers in Texas and claiming the lives of two others; both of whom contracted the virus outside of the U.S.
The epidemic tested the agility, resilience and capabilities of the country’s health care system in ways similar to the manner in which Hurricane Katrina exposed structural vulnerabilities in certain parts of the country, yet it also helped to inform how hospital’s respond to future disasters, such as Hurricane Harvey.
Historically, biohazard protocols have been included in hospital disaster plans, yet the Ebola outbreak exposed significant gaps in diagnosis and containment procedures for this particular virus in the U.S.
Now, with new incident cases and deaths attributed to the Ebola virus being reported in the Democratic Republic of the Congo (DRC), it’s important to reflect on what we learned and what has changed since 2014 to ensure the utmost level of preparedness in the event of a second outbreak.
With Ebola, a systematic breakdown began even before afflicted individuals arrived on American soil. To start, there was a lack of awareness about the epidemiology, detection, prevention and treatment of the virus. Compounding the problem was a lack of adequate resources to address a potential or actual outbreak, and knowledge of how to properly contain and manage any person, object or equipment exposed to Ebola.
Today we can best position ourselves to handle another outbreak of the virus in our country by capitalizing on our 2014 learnings, including:
- Assessment and screening. Health care organizations have worked to develop assessment and screening documents to assist in identifying patients who may have been exposed to the virus. For example, the CDC published infographics to educate emergency department personnel on how to identify Ebola exposure or risk.
- Testing: There are now enhanced diagnostic testing methods, with results in hours versus days or weeks, which was the case in 2014. These improvements in turnaround times are one of the Ebola virus transmission containment variables in the DRC. As those infected are confirmed more quickly, they can be more rapidly isolated and health care officials are able to trace the activity of the infected person and identify other potential cases and initiate treatment plans. There is even testing currently being conducted by the World Health Organization (WHO) on an antigen rapid test for the virus, producing with a high degree of accuracy within 15 minutes, those infected with the Ebola virus and identifying those not infected with Ebola.
- Education and training: Education and training of the epidemiology of the Ebola virus is imperative. Health care personnel should rely on thought leaders such as the CDC and WHO for specific guidance and the development of facility-specific protocols. Documents currently available include the CDC’s “Infection Prevention and Control Recommendations for Hospitalized Patients under Investigations (PUIs) for Ebola Virus Disease in U.S. Hospitals” and the WHO’s “Ebola Response Key Technical Documents.”
- Infection control and Ebola: The CDC’s Interim Guidance for Environmental Infection Control in Hospitals for the Ebola virus provides the most relevant direction to caregivers and staff in the health care setting who are caring for patients being investigated or patients with confirmed Ebola virus disease. The CDC recommendations also address the use of proper personal protective equipment against direct exposure to the virus and the recommended use of a U.S. Environmental Protection Agency-registered hospital disinfectant, with specific label claims, to disinfect surfaces.
- Supply management: Access to adequate inventory of supplies and personal protective equipment (PPE) guidelines are available and it’s imperative that health care leaders, risk managers and others ensure the proper items are readily available and that all relevant caregivers and stakeholders are properly trained and educated on their use. PPE supplies include but are not limited to gowns, gloves and masks. The CDC is also a great source of information for patient care equipment and recommendations, cleaning and decontamination guidance as well as a PPE calculator to assist in determining the amount of PPE to have on hand to provide care for those with suspected or confirmed Ebola.
Hospitals often serve as a beacon of safety and security in our communities. With that comes the responsibility to conduct thorough analyses of what can be done better and what must be done differently during emergencies.
We have learned from extreme experiences before with this virus. If we work to address these vulnerabilities now, we can ensure greater public health and safety in the event of an Ebola reoccurrence in our country.
