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Gary Evans writes Hospital Infection Control & Prevention (HIC), Hospital Employee Health (HEH) and contributes to IRB Advisor (IRB). As senior writer at AHC, Evans has written numerous articles on infectious disease threats to both patients and health care workers, including pandemic influenza, MERS and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.
With an ongoing ebola outbreak in West Africa, Phillip Fischer, MD, board member of Infectious Disease Alert, fields some clinical questions in the May 2014 issue of IDA.
A middle aged man arrived at a small mission hospital in Guinea with signs suggestive of Ebola virus disease. The hospital has no isolation rooms. Should they care for the patient or refer him elsewhere?
Faced with a patient who is sick with a possible viral hemorrhagic fever, a care team has several goals:
1) compassionately care for the patient while seeking a favorable medical outcome (cure),
2) protect health care workers and other patients at the facility from becoming infected, and,
3) collaborate with governmental and non-governmental groups to identify, track, and abort outbreaks.
Currently, there is no curative treatment for human Ebola virus disease. Care is supportive with institution of comfort measures, fluid management, provision of blood products as needed, and management of whatever super-infections and complications arise.
Isolation measures center on keeping the patient and his or her secretions and blood away from direct contact with other people. All persons involved in the care of the patient suspected of harboring Ebola virus should use protective masks, gowns, and gloves. Linens, and medical equipment contaminated with blood and secretions should be sterilized or discarded. Similarly, bodies of patients who succumb to Ebola should be handled without direct contact.
During the current outbreak, government health ministries and non-governmental groups are collaborating effectively to ensure that sampling and testing are available and that isolation supplies are distributed to health centers and hospitals in endangered areas. Hospitals should ensure that space and equipment are available should the need arise.
The non-hypothetical situation that prompted this question took place early in the outbreak when the hospital in question was not yet confident that they had the staff, space, and supplies to manage the patient. The patient was referred to a government hospital a few miles farther down the road but then reportedly left against medical advice during the first night at that facility – before testing could confirm the diagnosis.
For more this story see the next issue of IDA.