1970. Management of Patients with Suspected or Confirmed Ebola Virus Disease at the National Institutes of Health Clinical Center
Session: Oral Abstract Session: Emerging Public Health Threats
Saturday, October 10, 2015: 3:00 PM
Room: 25--ABC
Background: The Ebola virus disease (EVD) epidemic in West Africa has infected more than 27,000 people and caused 11,000 deaths. Healthcare personnel (HCP) are at risk and account for 3.4% of cases. HCP exposed to or infected with EVD who were repatriated to the United States and Europe were cared for in isolation facilities capable of providing intensive care. Between September 2014 and March 2015, the NIH Clinical Center admitted four HCP with either high-risk exposure to, or known infection with, EVD. We describe the infection control challenges associated with their care.

Methods: Patients arrived via medical evacuation flights and were transported via ambulance in isolation pods. An all-volunteer staff provided care in an isolation unit specially designed to accommodate critical care interventions. We chose a conservative isolation approach, combining contact, droplet and airborne precautions, and only relaxing precautions when clinically appropriate. A multidisciplinary team of healthcare and ancillary personnel met daily to review patient care, infection control, and facility operations. Medical waste was autoclaved and incinerated, and human waste was disinfected prior to flushing. 

Results: Trained observers actively monitoring donning and doffing of personal protective equipment provided critical round-the-clock occupational safety support. Unanticipated challenges included: obstacles to maintaining effective isolation when established transportation algorithms could not be followed; anxiety about the adequacy of infection control interventions among uninvolved clinical staff; waste disposal bottlenecks; increased occupational safety vulnerability during transient periods of patient agitation; and a need for more than one trained observer during busy shifts and emergencies. We gained substantially from frequent communication with experienced colleagues, healthcare staff and public health authorities. Patient confidentiality was maintained to the maximum extent possible. 

Conclusion: Care of patients with EVD was complex, involved contributions from all members of the multidisciplinary team, necessitated flexibility, reassessment and adjustment, underscored precise communications, and required meticulous attention to infection control details.

Tara N. Palmore, M.D.1,2, Richard T. Davey Jr., M.D.2, Amanda M. Ramsburg, B.S.N.3, Angela V. Michelin, M.P.H.3, Robin T. Odom, M.S.1, Mary Ann Bordner, M.S.3 and David K. Henderson, M.D.3, (1)Hospital Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, MD, (2)National Institute of Allergy and Infectious Diseases, Bethesda, MD, (3)National Institutes of Health Clinical Center, Bethesda, MD

Disclosures:

T. N. Palmore, None

R. T. Davey Jr., None

A. M. Ramsburg, None

A. V. Michelin, None

R. T. Odom, None

M. A. Bordner, None

D. K. Henderson, None

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