After a succession of emerging infections from SARS to Ebola in this young century, healthcare epidemiologists are trying to shift the response from reacting to a single pathogen to a more all-hazards approach. As with natural disaster planning, preparing for infectious disease outbreaks must prioritize protection and accommodations for healthcare workers if facilities expect to remain open for business.
The Society for Healthcare Epidemiology of America (SHEA) is partnering with the CDC to provide training and resources to infectious disease doctors to respond to hospital outbreaks and public health emergencies, says Louise Dembry, MD, MS, MBA, president of SHEA Board of Trustees.
“This type of training is really to focus on hospital epidemiologists and give them a breadth of background on emergency preparedness using the hospital incident command system, as well as how they interface with public health at their facility,” she says. “It is applying an all-hazards approach to infectious disease, which has not been done a lot and certainly not on a big scale. It tends to be that we need to prepare, for example, a SARS response plan, and then prepare an Ebola response plan. Really, we should be looking at this more globally.”
Common factors include the need for personal protective equipment (PPE), though that may vary to some degree with the emerging infection.
“There are key steps involved in preparing the facility for the next ‘high-consequence pathogen,’” Dembry says. “The type of PPE might be slightly different, but you’ve got to be thinking ahead of time. What type of PPE do we need and what type of training to people need? How is that going to be done [with forethought] versus doing it on the fly? We learn with each one of these, and we certainly learned more about PPE with Ebola. And we were probably a little more prepared for Ebola after dealing with SARS. There are a lot of common themes that we need to always be thinking ahead.”
For example, healthcare epidemiologists have been primarily in a reactive disease-specific mode. As part of a broader view, they need to be brought into disaster and emergency management training, she notes.
“Understanding how a hospital incident command systems works is very helpful,” Dembry says. “We want to be careful to not be in silos with this. We need to work together and decide, where do we hand off the majority of [this particular] responsibility? We are trying to get all healthcare epidemiologists on the same basic level of understanding of how these things work — how they might unfold, and how to prepare and hopefully prevent [outbreaks].”
One issue that has been underscored time and again with natural disasters and emergency events is that hospitals will find it very difficult to stay open if planning does not include accommodations and reassurance for healthcare workers and their families. Thus, occupational health must be brought into the discussions very early on if an infectious threat is identified.
“There is a part of it that is occupational health and a part that is infection prevention — it is a team approach and collaboration,” Dembry says. “And that’s why understanding how a hospital incident command system works is very helpful. There will be somebody there who takes on the majority of occupational health [issues], but I think we as hospital epidemiologists and ID physicians are also the content experts about the infectious disease [threat]. When it comes to protecting healthcare personnel, this is where we can help our occupational health colleagues understand the risks of transmission depending on the person’s job [and other factors].”
Similarly, the type of PPE and its proper use must be determined.
“They are going to come to us and say, ‘Tell us more about this,’” she says. “What are the things we need to be concerned about for staff? Do we have the right things in our PPE stockpile? Should we be beefing up our PPE stockpile? So that takes ongoing communication and working together.”
Ultimately, the training program could create a standardized response across infection control and healthcare epidemiology, moving away from the reactive mode healthcare is typically in with an emerging infectious disease.