U.S. and Nebraska hospitals consider readiness for contagious virus outbreaks

Ebola patient arrives at Nebraska Medical Center. (Photo courtesy of UNMC)
UNMC staff check protective clothing in biocontainment unit. (Photo courtesy of UNMC)
Sample of protective gear worn by medical team treating infectious diseases. (Photo by Bill Kelly, NET News)
December 16, 2015 - 6:45am

A year after American hospitals treated their first cases of Ebola a new study finds the United States “has sufficient capacity for treating another outbreak.”


Dr. Philip Smith approaches the mobile unit used to transport infectious disease patients. (Photo by Bill Kelly, NET News)

Dr. Philip Smith, University of Nebraska Medical Center. (Photo by Bill Kelly, NET News)

The study, written by researchers at the University of Nebraska Medical Center (UNMC), cautions “financial, staffing and resource challenges remain a hurdle” for many hospitals maintaining dedicated treatment centers established to treat the deadly virus.

The findings come after a year in which many hospitals reevaluated their ability to recognize and respond to patients presenting symptoms of a dangerously communicable disease.

The online journal Infection Control & Hospital Epidemiology published the study under the review of the Society for Healthcare Epidemiology of America.

John Lowe, Ph.D., the lead researcher on the UNMC study, cautions in some ways treating Ebola could be easier than some of the other diseases spread by coughing and sneezing.

“We have strengthened our nation’s ability to properly contain a highly unlikely outbreak of Ebola,” Lowe is quoted as saying in a statement released with the report. “However, the ability to treat outbreaks of other infectious viruses which are airborne, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) would be challenging.”

Fifty-five sites in the U.S. have the ability to treat Ebola, including those established since the 2014 cases brought to American hospitals for care.  The centers house 120 beds in specified areas able to contain highly contagious patients. UNMC in Omaha used its biocontainment ward, established more than ten years ago, for the first time when the first of the patients arrived last year.

With UNMC appearing on “the world stage” treating Ebola patients, Elizabeth Beam, the director of education for the school’s biocontainment unit said the spotlight “allows us to really start spreading that knowledge” about how to effectively respond to these types of cases.

(Visit the Centers for Disease Control's website on Ebola)

Dr. Jonathan Morgan, the chief medical officer at Regional West Medical Center in Scottsbluff, Nebraska, recalls viewing coverage of the specially-trained medical team and “watching with keen interest to see what we learn and apply to our situation here in western Nebraska.”

Regional West Medical Center in Scottsbluff, Nebraska. (Photo by Bill Kelly, NET News)

Dr. Jonathan Morgan (Courtesy Photo)

While Ebola may be an unlikely risk in the Panhandle, there are many other threats to public health, both known and yet to be discovered.

Dr. Phillip Smith of the University of Nebraska Medical Center believes the MERS is a genuine threat. “The second would be avian flu,” Smith said.  “That's been percolating for over ten years and if this becomes human to human contagious, with a high mortality rate, it could be a very devastating epidemic.”

Smith heads the Bio-containment Unit that treated the Ebola patients in 2014.

A recent study by the Centers for Disease Control determined “bird flu viruses are unlikely to easily… spread between people in their current form” however poultry populations in the Midwest and Asia were decimated by the disease this year and public health professionals are still watchful for human crossover.

Morgan of Regional West says it’s understood we live in a world where exotic and frightening diseases are only an international flight away.

In the case of Ebola, press coverage and social media hype made a once distant tropical disease a raging concern for physicians and their patients everywhere in the country.

“We got the lay public coming to the hospital and saying, ‘Are you guys ready for Ebola?’” Morgan said.  “That was a little unusual.”

Morgan and those responsible for hospital procedures at Regional West recognized they needed to ask themselves if they were in fact ready, leading the facility to reexamine whether staff were prepared to detect and address a serious outbreak.

“The first learning moment was one of concern,” Morgan said. His initial reaction, before reexamining the hospital’s resources was, "Oh my gosh.  We don't have the resources to do something like this!"

Regional West, like a number of Nebraska hospitals across Nebraska evaluated internal response plans.

Morgan said periodic reviews of procedures are “the first step in determining any sort of a plan” to handle cases where some level of containment may be necessary.

“You have to have a realistic assessment audit of what are your resources" he said, including the facility's staffing, training, and equipment needed to deal with these extreme cases.

Scenarios faced by regional or local clinics would differ dramatically from those which unfolded at the Nebraska Medical Center’s fully-equipped biocontainment unit. The facility had been set up expressly to handle unusual but highly dangerous cases.  The Omaha patients arrived with plenty of notice, delivered by aircraft along with supporting medical teams.

 

Elizabeth Beam talks to a Scottsbluff audience about bio-containment procedures.

Samples of protective gear worn by biocontainment staff at UNMC. (Photo by Bill Kelly, NET News)

“We were getting patients from literally from the (United States) State Department, (asking) ‘can we bring a patient to you?’” recalls Beam, with the Med Center’s biocontainment unit. “It’s a very odd way for a patient to come in your hospital.”

In smaller hospitals a carrier could walk through the front entrance of any clinic in Nebraska, potentially unaware they carry a contagion, thus endangering other patients and health care workers.

“Regardless of whether it's urban or rural, it's that initial provider who cares for that patient,” Beam said. “It's the details that we attend to in preparing for patients like that and then applying that to patients who come in with an unknown illness and so, yeah, the emphasis on that is huge and so necessary.

Beam and others on the UNMC biocontainment staff found interest in Ebola provided an opportunity to preach preparation to anyone who might face a worst-case scenario of infectious diseases. In the past year its doctors and nurses have been popular speakers, as well as authors of numerous articles for scholarly journals outlining the unit's best practices. Health care professionals from all over the world routinely seek guidance from the Nebraska-based Ebola team, considering their methods to be the model in safety and effectiveness.

Beam says she tells doctors, nurses and anyone else in the field their approach is very basic, even while the cases being treated are “scary.” After health care workers at other hospitals became exposed to the virus, the Nebraska team reconsidered every aspect of procedures used to protect staff tending to a patient at every stage.

“We want to have that initial provider awareness that (if a) patient’s coughing. I should put a mask on that patient (and) put a mask on myself.”

Beam often reminds health care professionals about basic precautions like reacting to coughing and sneezing patients. At a time when the risk of pandemic is taken seriously, “that should trigger an immediate response” Beam says. 

“We have to work really hard with our health care providers to teach them to do this stuff very carefully and systematically so they are not spreading disease,” Beam said.

EBOLA EDUCATION MATERIALS

UNMC makes available to the public many of the same Ebola educational materials used to train health care professionals. CLICK HERE to check out their online resources.

“It's the details that we attend to in preparing for patients,” Beam said. “The emphasis on that is huge and so necessary.” 

Dr. Morgan, Chief of Medicine at Regional West, said “that was part of our plan as well.”

Morgan is especially mindful of circumstances where a worsening patient without an obvious diagnosis might show up at one of the regional clinics in Nebraska’s Panhandle.

“If this patient should present to Oshkosh, Sidney, Alliance Chadron, Kimball, etc., what would be (the local doctor's) role and how would we respond when our health care partners in the Panhandle would ask us for help?”

Regional West has been drilling staff in basic skills, like donning and doffing the protective gear crucial to dealing with airborne viruses or dangerous bodily fluids.  

Staff also take part in more complex drills and exercises, testing the decision-making which occurs in real-time if the hospital was presented with one or more patients carrying a seriously infectious disease.

According to the study of the capability of U.S. centers to treat Ebola a sizable majority of health care facilities were “inadequately prepared to care for patients with suspected or confirmed Ebola.” The Centers for Disease Control provided substantial resources to upgrade their capabilities under the direction of CDC, sites have expanded their capabilities, yet remain “limited” in overall capacity.

"In the past year, the United States saw an intense effort across the country to rapidly expand the capacity for high-level isolation patient care,” Dr. Lowe of UNMC said. “Our study shows an unprecedented increase in the number of high-level isolation beds across the country and found a variety of approaches to achieving this capability.”

“The processes are fairly simple,” Morgan said, “but they need to be accomplished just right, with great detail to minimize risk to the patient (and) minimize risk to the health care health care provider.”

In his new research study, Lowe writes that since 2014 the United States rapidly expanded its capabilities to handle “high-level isolation patient care.”

Lowe, an assistant professor in the College of Public Health, added in a prepared statement released with the study, the research “shows an unprecedented increase in the number of high-level isolation beds across the country and found a variety of approaches to achieving this capability.”

When factoring the cost of a major outbreak, the study cautions it’s important to factor in the potentially high price of necessities such as bio-hazard waste disposal, intense staffing needs, and the potential for more costly treatment factors like treating children or multiple patients at once.

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