Dodging the Ebola Bullet

November 11th, 2015

By Gary Evans, Senior Staff Writer

More than a year out from the emergence of Ebola, many infection preventionists report they received no additional resources to deal with the crisis, still lack adequate supplies of personal protective equipment (PPE) and remain uncertain about how frequently health care workers need to be trained to ensure they are donning and doffing PPE correctly.

The troubling trends appear in a national survey of 981 hospital-based IPs conducted by the Association for Professionals in Infection Control and Epidemiology (APIC). Ebola revealed that the nation’s infection control programs are not adequately funded and have little surge capacity. Unfortunately, that still seems to be the case in many hospitals. Despite the most highly publicized and publicly feared infectious disease since the emergence of HIV in 1981, 55% of APIC survey respondents said they never received any additional resources from their hospitals to deal with the many issues raised by Ebola. While 75% reported they now have adequate supplies of PPE, that still leaves a quarter of hospitals with insufficient stock.

Ebola also exposed longstanding problems with PPE use that have probably been contributing to infection transmission between hospital patients for some time. New studies continue to show workers lack training and frequently contaminate themselves removing the equipment.^1,2 The issue is the subject of ongoing confusion, as evidenced by 33% of the respondents in the APIC survey answering “we have not made that determination yet” when asked what frequency of retraining is needed to maintain PPE competency.

It is tempting to conclude that some hospitals simply gambled that they would not have to deal with a case of Ebola and avoided expenditures to prepare for an unlikely event. Those that did so may have dodged a deadly bug, but one could certainly argue that they are now less prepared for the next emerging infection. With global travel and continuing encroachment on animal habitats, we are in age of pandemics where zoonotic viruses can find a fast track into human populations. Consider that these dangerous pathogens all emerged in the last dozen years: Severe Acute Respiratory Syndrome (SARS), H1N1 pandemic influenza A, Middle East Respiratory Syndrome (MERS) and Ebola.

In the recent APIC survey, 92% of respondents said their facility is more prepared for Ebola than it was a year ago. A positive response to be sure, but with the notable exception of highly-trained containment teams like those at Emory Hospital and the University of Nebraska, it is questionable how many hospitals were really prepared in 2014 to deal with an emerging virus that had never been transmitted in the U.S. The Centers for Disease Control and Prevention originally took the position that any hospital could handle an Ebola case, but dropped that assumption in favor of dispatching response teams after two nurses were infected by a dying patient in a Dallas hospital.

Meanwhile, the Ebola outbreak in West Africa is almost over in a conventional sense, though recent reports that the virus could survive in semen for nine months may lead to sporadic cases if the viral RNA discovered in the study is capable of sexual transmission.³ As of Nov. 1, 2015, the World Health Organization reported a total 28,571 Ebola cases with 11,299 deaths. A total of 881 healthcare workers have been infected and 513 of them died -- a mortality rate of 58%. Contributing factors in the healthcare infections were a shortage of PPE and improper use of the equipment when it was available, the WHO said.

References

1. John A, Tomas M, Cadum J, et al. Are Healthcare Personnel Trained in correct Use of Personal Protective Equipment? IDWeek.Session 53: HAI: Occupational Health. San Diego, CA.Oct.7-11, 2015.

2. .Deen GF, Knust B, Broutet, et al. Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors — Preliminary Report. New Engl J Med October 14, 2015 DOI: 10.1056/NEJMoa1511410.

3. Tomas ME, Kundrapu S, Thota P, et al. Contamination of Health Care Personnel During Removal of Personal Protective Equipment. JAMA Intern Med Published online Oct.12, 2015.doi:10.1001/jamainternmed.2015.4535.