An Assessment of Preparations Made in the United States for Highly Hazardous Communicable Diseases Following the 2014-2016 Ebola Virus Disease Epidemic

The 2014-2016 Ebola virus disease (EVD) epidemic in West Africa was unprecedented in magnitude and scope. The threat of imported cases of EVD in the United States prompted the Centers for Disease Control and Prevention (CDC) to establish a tiered network of hospitals to enhance domestic isolation capacity, including the designation of select hospitals as Ebola treatment centers (ETCs). As of spring 2015, no information existed on the capacity, physical infrastructure, staffing models, or infection control protocols of these newly-established ETCs, nor was there information on other highly hazardous communicable diseases (HHCDs) these units would admit. Moreover, no documentation was available on the varying preparedness activities of state health departments related to HHCD transport and the treatment center network. The purpose of theses studies was to assess preparations made in the United States in response to the 2014-16 EVD epidemic; specifically, to determine costs incurred by CDC-designated ETCs in establishing their unit, capabilities developed by ETCs, and guidelines established by state health departments for the management and transportation of patients with EVD or another HHCD. Data were obtained through the distribution of three electronic national assessments; two administered to the 56 CDC-designated ETCs in 2015 and 2016 (85% and 64% response rate, respectively) and one to all state public health departments (73% response rate). On average, responding ETCs incurred $1.2 million in establishing their facility and are awaiting$650,000 in reimbursement. Cumulative capacity of reporting ETCs was 121 beds. Although nearly all facilities had written protocols for various infection control domains, procedures and capabilities varied. ETCs and state health departments differed in reports on diseases that would be treated in high-level isolation. The domestic preparedness efforts described in this dissertation are fundamental to the U.S. response to the next HHCD threat; however, questions on the sustainability and scalability of this network and the use of these units for a non-EVD HHCD outbreak remain

Using a Critical Safety Behavior Scoring Tool for N95 Respirator Use to Evaluate Training Interventions

Background: Hospitals struggle nationally to educate healthcare workers on the safe use of N95 respirators as part of their respiratory protection programs. Practical and effective interventions are needed to improve this clinical behavior which is critical to healthcare worker safety in airborne precautions, hazardous drug administration, and pandemic response. This analysis specifically investigated two just-in-time training interventions that would be practical to implement in a hospital setting. Method: A simulation approach was used to evaluate two interventions for N95 respirator use at a Midwestern Academy Hospital system (n=62, 32 control, 30 treatment). Healthcare workers were asked to don and doff an N95 respirator while being video recorded in an empty hospital corridor and room. After a randomized intervention was applied, they repeated the respirator donning and doffing while being video recorded. One intervention used an instructional video alone, while the other used the same instructional video but added a video reflection intervention. The video reflection intervention asked the participant to review and score their first performance of N95 donning and doffing using a Critical Safety Behavior Scoring Tool (CSBST). The research team used the same CSBST to score all performances of donning and doffing for comparison and evaluation. Result: This session will explain the critical safety behaviors at pre-test and post-test for the two intervention groups and describe the impact of the two types of just-in-time training on demonstrated N95 respirator skills. The video alone and video reflection scores were not significantly different at pretest. Scores were significantly higher on the post-test for the reflective practice intervention. Findings related to demographic information such as years in healthcare, frequency of use, history of needlestick, and fatigue will also be discussed. Conclusion: Video reflection may be one intervention that improves compliance with critical safety behaviors for just-in-time training on N95 respirator use. Further work should examine the video recorded findings for measurement elements that should be expanded in a scoring tool to include issues such as facial hair, hairstyle, and the quality of hand hygiene. Intervention studies should also examine how often the training must be repeated to maintain competency. This intervention may have implications for the training of other critical safety behaviors in infection control and other high-risk procedures

Need for Aeromedical Evacuation High-Level Containment Transport Guidelines

Circumstances exist that call for the aeromedical evacuation high-level containment transport (AE-HLCT) of patients with highly hazardous communicable diseases. A small number of organizations maintain AE-HLCT capabilities, and little is publicly available regarding the practices. The time is ripe for the development of standards and consensus guidelines involving AE-HLCT

Need for Aeromedical Evacuation High-Level Containment Transport Guidelines

Circumstances exist that call for the aeromedical evacuation high-level containment transport (AE-HLCT) of patients with highly hazardous communicable diseases. A small number of organizations maintain AE-HLCT capabilities, and little is publicly available regarding the practices. The time is ripe for the development of standards and consensus guidelines involving AE-HLCT

Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence inspecifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission

A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit

Although the concept of high-level containment care (HLCC or ‘biocontainment’), dates back to 1969, the 2014–2016 outbreak of Ebola virus disease (EVD) brought with it a renewed emphasis on the use of specialized HLCC units in the care of patients with EVD. Employment of these units in the United States and Western Europe resulted in a significant decrease in mortality compared to traditional management in field settings. Moreover, this employment appeared to significantly lessen the risk of nosocomial transmission of disease; no secondary cases occurred among healthcare workers in these units. While many now accept the wisdom of utilizing HLCC units and principles in the management of EVD (and, presumably, of other transmissible and highly hazardous viral hemorrhagic fevers, such as those caused by Marburg and Lassa viruses), no consensus exists regarding additional diseases that might warrant HLCC. We propose here a construct designed to make such determinations for existing and newly discovered diseases. The construct examines infectivity (as measured by the infectious dose needed to infect 50% of a given population (ID50)), communicability (as measured by the reproductive number (R0)), and hazard (as measured by morbidity and mortality). Diseases fulfilling all three criteria (i.e., those that are highly infectious, communicable, and highly hazardous) are considered candidates for HLCC management if they also meet a fourth criterion, namely that they lack effective and available licensed countermeasures

Sustainability of High-Level Isolation Capabilities among US Ebola Treatment Centers

To identify barriers to maintaining and applying capabilities of US high-level isolation units (HLIUs) used during the Ebola virus disease outbreak, during 2016 we surveyed HLIUs. HLIUs identified sustainability challenges and reported the highly infectious diseases they would treat. HLIUs expended substantial resources in development but must strategize models of sustainability to maintain readiness