Department for Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
PLoS One. 2022 Mar 3;17(3):e0264644. doi: 10.1371/journal.pone.0264644. eCollection 2022.
Patients with high-consequence infectious diseases (HCID) are rare in Western Europe. However, high-level isolation units (HLIU) must always be prepared for patient admission. Case fatality rates of HCID can be reduced by providing optimal intensive care management. We here describe a single centre's preparation, its embedding in the national context and the challenges we faced during the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic.
Ten team leaders organize monthly whole day trainings for a team of doctors and nurses from the HLIU focusing on intensive care medicine. Impact and relevance of training are assessed by a questionnaire and a perception survey, respectively. Furthermore, yearly exercises with several partner institutions are performed to cover different real-life scenarios. Exercises are evaluated by internal and external observers. Both training sessions and exercises are accompanied by intense feedback.
From May 2017 monthly training sessions were held with a two-month and a seven-month break due to the first and second wave of the SARS-CoV-2 pandemic, respectively. Agreement with the statements of the questionnaire was higher after training compared to before training indicating a positive effect of training sessions on competence. Participants rated joint trainings for nurses and doctors at regular intervals as important. Numerous issues with potential for improvement were identified during post processing of exercises. Action plans for their improvement were drafted and as of now mostly implemented. The network of the permanent working group of competence and treatment centres for HCID (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger (STAKOB)) at the Robert Koch-Institute (RKI) was strengthened throughout the SARS-CoV-2 pandemic.
Adequate preparation for the admission of patients with HCID is challenging. We show that joint regular trainings of doctors and nurses are appreciated and that training sessions may improve perceived skills. We also show that real-life scenario exercises may reveal additional deficits, which cannot be easily disclosed in training sessions. Although the SARS-CoV-2 pandemic interfered with our activities the enhanced cooperation among German HLIU during the pandemic ensured constant readiness for the admission of HCID patients to our or to collaborating HLIU. This is a single centre's experience, which may not be generalized to other centres. However, we believe that our work may address aspects that should be considered when preparing a unit for the admission of patients with HCID. These may then be adapted to the local situations.
在西欧，患有高后果传染病（HCID）的患者较为罕见。然而，高等级隔离单位（HLIU）必须随时准备接收患者。通过提供最佳的重症监护管理，可降低 HCID 的病死率。本文介绍了单一中心的准备情况，以及其在国家背景下的嵌入情况，还描述了在严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）大流行期间我们所面临的挑战。
10 名团队负责人每月为 HLIU 的医生和护士团队组织一整天的培训，重点是重症监护医学。通过问卷调查和感知调查分别评估培训的影响和相关性。此外，我们还与多个合作机构进行年度演习，以涵盖不同的现实场景。演习由内部和外部观察员进行评估。培训课程和演习均伴有密集的反馈。
自 2017 年 5 月以来，由于 SARS-CoV-2 大流行的第一波和第二波，每月培训课程分别中断了两个月和七个月。培训后，参与者对问卷调查的回答比培训前更一致，表明培训课程对能力有积极影响。参与者定期对护士和医生的联合培训进行评分，认为其非常重要。在演习的后期处理过程中发现了许多存在改进潜力的问题。针对这些问题，制定了改进计划，截至目前，这些计划大多已得到实施。罗伯特·科赫研究所（RKI）高致病性病原体疾病的常设工作小组和治疗中心网络（Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger (STAKOB)）在 SARS-CoV-2 大流行期间得到了加强。
为 HCID 患者的入院做充分准备具有挑战性。我们表明，医生和护士的联合定期培训受到了欢迎，并且培训课程可能会提高感知技能。我们还表明，现实场景演习可能会揭示培训课程中不易发现的其他缺陷。尽管 SARS-CoV-2 大流行干扰了我们的活动，但德国 HLIU 之间的合作得到了加强，这确保了我们或合作 HLIU 对 HCID 患者的入院始终保持准备就绪。这是一个单一中心的经验，可能无法推广到其他中心。然而，我们相信，我们的工作可以解决为 HCID 患者入院做准备时应考虑的方面。然后，可以根据当地情况进行调整。
