Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts.
Tufts University School of Medicine, Boston, Massachusetts.
Infect Control Hosp Epidemiol. 2021 Nov;42(11):1307-1312. doi: 10.1017/ice.2020.1416. Epub 2021 Feb 15.
In response to the 2013-2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF).
A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care.
The questionnaire was sent to 82 ETCs.
We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not.
Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication.
There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.
针对 2013-2016 年埃博拉病毒病疫情，美国政府指定了某些医疗机构为埃博拉治疗中心（ETC），以更好地为未来新发传染病疫情做好准备。本研究调查了 ETC 对病毒性出血热（VHF）患者的治疗经验和重症监护政策。
一份包含 58 个项目的问卷，就 9 项重症监护干预措施的政策、限制护理提供的因素以及为提供护理而开发的创新措施，向 82 个 ETC 收集信息。
问卷发给了 82 个 ETC。
我们分析了与 ETC 特征有关的有序和分类数据，以及关于其政策和感知挑战的描述性数据。统计分析评估了有 VHF 患者护理经验的 ETC 是否更有可能制定重症监护政策。
在 27 个做出回应的 ETC 中，有 17 个（63%）被纳入分析。其中，8 个（47%）报告了有对调查或确诊的 VHF 患者进行护理的经验。大多数 ETC 认为自己已为这些患者提供插管、胸外按压和肾脏替代治疗做好了准备。限制护理的最常见因素是工作人员的安全和临床无效。为更好地提供护理而开发的创新措施包括增加模拟培训和替代程序和沟通的技术。
各机构的重症监护政策和限制因素有广泛的相似之处。有几项干预措施，即 ECMO 和环甲膜切开术，很少有机构认为自己已经准备好提供这些干预措施。未来的研究可以确定提供这些干预措施的障碍，并在有了更多的新型传染病（如 COVID-19）经验后，探讨政策的变化。
