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The handful of specialized biocontainment units in U.S. hospitals remain on high alert as the Ebola outbreak continues in West Africa and the first two American health care workers were successfully treated and released from Emory Hospital in Atlanta.
In addition, the Centers for Disease Control and Prevention recently issued infection control precautions for any U.S. hospital admitting a suspected or confirmed case of Ebola. The agency also posted Ebola guidelines for environmental cleaning and protection of housekeeping personnel. (See related story, p. 114.)
The two U.S. Ebola cases involved care workers who very nearly gave their lives to helping patients in Liberia during the worst Ebola outbreak in history. A Texas physician and a North Carolina missionary were flown to Atlanta in August, spending several weeks in Emory University Hospital’s biocontainment unit. They received hydration, experimental drug treatment, and other care. By late August, each patient had recovered and was discharged.
The Emory Healthcare team’s experience in treating the two Ebola patients showed how well-trained, well-staffed, and well-equipped hospital units can provide high quality care while ensuring staff remains safe.
"Staff involved in the direct care of these patients received extensive training with demonstrated competency verification," says Nancy R. Feistritzer, DNP, RN, vice president of patient care services at Emory.
But the high profile nature of the rare and dangerous disease has raised concern among the public and health care workers.
"There is anxiety amongst hospital staff in ordinary hospitals about handling Ebola cases," says Philip W. Smith, MD, professor in the division of infectious diseases at the Nebraska Medical Center in Omaha, NE, which houses the nation’s largest biocontainment care unit. The 10-bed Nebraska unit remains prepared to admit Ebola patients should the need arise.
"Before we have a crisis, we have people volunteer to work in the unit and to receive special training," Smith explains. "They’re mentally prepared for something like this, whereas other people are not necessarily ready for Ebola in a hospital ward bed."
The biocontainment units at Emory and Nebraska have had years to train and prepare staff to handle infectious disease cases that might overwhelm the typical hospital. They were designed according to federal guidelines for handling CDC category A diseases, which include Ebola, plague, anthrax, hemorrhagic fever and smallpox.
Since the units are very rarely needed, they are staffed by hospital professionals who are on call 24/7 to shift from their main job when needed.
"Members of the Emory Healthcare team all volunteered to care for these patients," Feistritzer says. "Even so, care of acutely ill patients at their most vulnerable can be stressful under any circumstances."
Emory provided staff and physicians caring for the Ebola patients with support through daily team huddles, leader rounding, and hospital chaplains.
"The staff support team was present throughout these challenging and stressful times in order to provide emotional and spiritual support for staff," she says.
When the Nebraska biocontainment unit sought volunteers from hospital staff before the unit was ready for cases, more than enough health care workers applied.
In fact, even during the ongoing Ebola outbreak, more hospital staff have applied to join the unit, notes Shelly Schwedhelm, MSN, RN, director of emergency department trauma and emergency preparedness.