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The two recently discharged Ebola patients treated at Emory Hospital in Atlanta were the source of much misinformation and fear upon admission, with many people questioning the wisdom of bringing the deadly virus into the country. In response, Susan Mitchell Grant, RN and chief nurse at Emory wrote a thoughtful op-ed piece for the Washington Post. 1
"The purpose of any hospital is to care for the ill and advance knowledge about human health," Grant noted. "At Emory, our education, research, dedication and focus on quality — essentially everything we do — is in preparation to handle these types of cases. Further, Americans stand to benefit from what we learn by treating these patients. Ebola won’t become a threat to the general public from their presence in our facility, but the insight we gain by caring for them will prepare us to better treat emergent diseases that may confront the United States in the future."
Grant took the ethical high ground, calling out those who would abandon care givers who selflessly came to the aid of others in grave need. "We are caring for these patients because it is the right thing to do," she writes. "These Americans generously went to Africa on a humanitarian mission to help eradicate a disease that is especially deadly in countries without our health-care infrastructure. They deserve the same selflessness from us. To refuse to care for these professionals would raise enormous questions about the ethical foundation of our profession."
Grant closed with the raison d’etre, the very essence of the personal mission of those who wear the white. It’s like asking the mountain climber why, but instead of "Because it’s there," the answer is "Because I’m here."
"As health-care professionals, this is what we have trained for," she writes. "People often ask why we would choose to care for such high-risk patients. For many of us, that is why we chose this occupation — to care for people in need. Every person involved in the treatment of these two patients volunteered for the assignment. At least two nurses canceled vacations to be a part of this team. We can either let our actions be guided by misunderstandings, fear and self-interest, or we can lead by knowledge, science and compassion. We can fear, or we can care."
"People say, Sign me up I want to do this,’" she says. "It’s a professional development opportunity and they see it as an opportunity to enhance their skills in other ways."
Schwedhelm doesn’t hire every person who applies. First, she speaks with their managers to learn more about their clinical skills, energy, and ability to be self-directed.
"We want rock stars on this unit," Schwedhelm says. "We teach them how to care for highly infectious patients."
Volunteers have to be experts in their disciplines because they’ll need to learn special skills involving high level of infection control, notes Kate Boulter, RN, lead nurse of the biocontainment unit in Nebraska.
The ideal employee of a biocontainment unit is someone who is very detail oriented and a critical thinker, she says. Employees have to follow rules and instructions precisely, as shortcuts and mistakes could lead to exposures and injuries. Teamwork is a top priority.
"Each person has a partner who watches them put on their personal protective equipment and take it off," Schwedhelm says. "They hold each other accountable."
From an employee health perspective, the biocontainment team functions as one unit, and everyone involved agrees on decisions and steps taken, says Uriel Sandkovsky, MD, an infectious disease physician and medical director for employee health for Nebraska Medical Center.
Biocontainment team volunteers also have to be eligible to receive the smallpox vaccination in the event of an exposure.
"With smallpox you have a four-day window to get vaccinated after exposure, so if we had a smallpox or monkeypox case we could vaccinate them," Smith adds.
Emory University employee health professionals developed a comprehensive surveillance program consistent with CDC guidelines to monitor physicians and staff caring for Ebola patients, Feistritzer says.
"Inclusion criteria were defined as individuals who were involved in direct patient care or those involved in the handling of contaminated blood or body fluids," she says.
The surveillance protocol includes taking employees temperature twice daily for 21 days the outer limits of the incubation period after their last episode of care for Ebola patients. Also, each employee tracks their symptoms, including headache, joint or muscle aches, weaknesses, diarrhea, vomiting, stomach pain, or lack of appetite. They use a log to document and track results and follow a protocol to report any symptoms.
Emory also addressed concerns among patients and other employees through hospital-wide education and communication.
"The entire Emory Healthcare community received a series of emails designed to inform and educate throughout the hospitalization," Feistritzer says.
The hospital also educated staff about infection control practices and the Ebola protocols. They held town hall meetings to provide accurate information and to have clinical experts and hospital leaders answer any questions staff might have, she explains.
"Physician and nurse executive teams rounded on each patient care unit to answer questions staff or patients might have had," she adds.
The Emory website posted educational material with frequently asked questions and regular updates, available to both staff and patients.
Hospital employee health departments across the country could learn strategies for handling epidemics and even more common infectious diseases from the experiences of the Nebraska and Emory biocontainment units, Sandkovsky emphasizes.
Hospitals should ask employees to notify employee health before taking an overseas trip. There might be vaccinations they’ll need. And when they return, they should be warned to watch for symptoms of illness, he says.
"They could be exposed to malaria or typhoid," Sandkovsky says.
It is a good idea to have employees regularly trained on the use of isolation and personal protection equipment.
"One of our colleagues in the [Nebraska] unit has an innovative educational approach where people get into gowns and take care of mock patients," Smith says. "It’s recorded, and supervisors go over the video with employees to reinforce compliance."