Kristin J. Cummings, MD, MPH; Mary J. Choi, MD, MPH; Eric J. Esswein, MSPH, CIH; Marie A. de Perio, MD; Joshua M. Harney, MS, CIH; Wendy M. Chung, MD, MS; David L. Lakey, MD; Allison M. Liddell, MD; Pierre E. Rollin, MD
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Acknowledgment: The authors thank Nicole Edwards of the National Institute for Occupational Safety and Health for her assistance with the figures and Sean Faulkner of Texas Health Presbyterian Hospital Dallas for his assistance with the donning and doffing posters.
Financial Support: By the Centers for Disease Control and Prevention.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2944.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Requests for Single Reprints: Kristin J. Cummings, MD, MPH, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, MS 2800, Morgantown, WV 26505.
Current Author Addresses: Dr. Cummings: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, MS 2800, Morgantown, WV 26505.
Dr. Choi: Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333.
Mr. Esswein: Western States Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver Federal Center, PO Box 25226, Denver, CO 80225.
Dr. de Perio: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1090 Tusculum Avenue, R-10, Cincinnati, OH 45226.
Mr. Harney: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1090 Tusculum Avenue, R-11, Cincinnati, OH 45226.
Dr. Chung: Dallas County Health and Human Services, 2377 North Stemmons Freeway, #502, Dallas, TX 75207.
Dr. Lakey: Department of State Health Services, 601 Colorado Street, Suite 201, Austin, TX 78701.
Dr. Liddell: Texas Health Presbyterian Hospital Dallas, 8230 Walnut Hill Lane, Suite 308, Dallas, TX 76231.
Dr. Rollin: Viral Special Pathogens Branch, MS G-14, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333.
Author Contributions: Conception and design: K.J. Cummings, M.J. Choi, E.J. Esswein, M.A. de Perio, W.M. Chung, P.E. Rollin.
Analysis and interpretation of the data: K.J. Cummings, M.J. Choi, E.J. Esswein, M.A. de Perio, W.M. Chung, A.M. Liddell, P.E. Rollin.
Drafting of the article: K.J. Cummings, M.J. Choi, E.J. Esswein, M.A. de Perio, J.M. Harney, W.M. Chung, P.E. Rollin.
Critical revision of the article for important intellectual content: K.J. Cummings, M.J. Choi, E.J. Esswein, M.A. de Perio, J.M. Harney, W.M. Chung, A.M. Liddell, P.E. Rollin.
Final approval of the article: K.J. Cummings, M.J. Choi, E.J. Esswein, M.A. de Perio, J.M. Harney, W.M. Chung, D.L. Lakey, A.M. Liddell, P.E. Rollin.
Provision of study materials or patients: A.M. Liddell.
Administrative, technical, or logistic support: J.M. Harney, W.M. Chung, D.L. Lakey.
Collection and assembly of data: K.J. Cummings, M.J. Choi, E.J. Esswein, M.A. de Perio, J.M. Harney, W.M. Chung, D.L. Lakey, A.M. Liddell, P.E. Rollin.
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.
Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection.
While providing care to a patient with EVD and to 2 nurses who became infected while caring for him, a U.S. community hospital strengthened a system of controls aimed at preventing disease transmission, including engineering and administrative controls and personal protective equipment (PPE).
Changes to the hospital's physical layout, procedures for handling clinical specimens and waste, job duties of HCP, and PPE ensembles required substantial investments of time, personnel, and resources.
This experience contributed to informing national policies for preparedness for EVD and has implications for other high-consequence emerging infectious diseases.
Timeline of events at the first U.S. community hospital to care for patients with EVD in Dallas, Texas, September to October 2014.
ED = emergency department; EVD = Ebola virus disease; MICU = medical intensive care unit.
The original (top) and final (bottom) layouts of a section of the medical intensive care unit used for care of patients with Ebola virus disease at a community hospital in Dallas, Texas, September to October 2014.
The unnamed rooms in the final layout were not used. PAPR = powered air-purifying respirator; PPE = personal protective equipment.
Table 1. Final PPE Ensembles Used for Care of Patients With Ebola Virus Disease and Handling Clinical Specimens in a Community Hospital in Dallas, Texas, in October 2014
Table 2. Types and Examples of Key Hazard Control Measures Implemented for Care of Patients With Ebola Virus Disease in a Community Hospital in Dallas, Texas, Between September and October 2014
Posters developed to facilitate donning (left) and doffing (right) of specialized personal protective equipment.
After the training courses, the posters were displayed for reference in areas of the hospital where specialized personal protective equipment would be used. PAPR = powered air-purifying respirator.
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Cummings KJ, Choi MJ, Esswein EJ, et al. 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. Ann Intern Med. 2016;165:41–49. [Epub ahead of print 10 May 2016]. doi: https://doi.org/10.7326/M15-2944
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© 2019
Published: Ann Intern Med. 2016;165(1):41-49.
DOI: 10.7326/M15-2944
Published at www.annals.org on 10 May 2016
Hospital Medicine, Infectious Disease.
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