Outbreak Response

Preparedness is key for hospitals and health systems when responding to an infectious disease outbreak

The novel coronavirus (2019-nCoV) is not the first, nor will it be the last, infectious disease outbreak to make global headlines.

“There have been a number of outbreaks that have taught us that routine healthcare infection prevention is not enough when dealing with a novel infectious disease or an infection that has potential for causing a lot of morbidity and mortality,” said Jennifer Anne Hanrahan, DO, an infection disease specialist from the University of Toledo.

SARS, MERS-CoV and Ebola have been transmitted in healthcare facilities and preventing the spread of infection in hospitals is critical to containing these infections worldwide.

“These outbreaks have shown that emerging pathogen outbreaks can occur with little forewarning and cause disruption to hospitals and their ability to care for patients and keep healthcare workers safe,” Dr. Hanrahan said.

Being prepared

The Society for Healthcare Epidemiology of America (SHEA) emphasizes the importance of supporting novel Coronavirus (2019-nCoV) preparedness efforts with rigorous commitment to infection prevention and science-based decision making. SHEA members – healthcare epidemiologists and other experts in infection prevention and infectious diseases working in collaboration with public health – are experienced in outbreak management, having overseen preparedness and management of 2019-nCoV, SARS, MERS-CoV, H1N1, influenza and other infectious diseases, and are working diligently to ensure safety.

SHEA works closely with the Centers for Disease Control and Prevention (CDC), and over the past several years has given particular focus and investment to strengthen the infection prevention and control infrastructure for preparedness and response to emerging pathogens. The SHEA/CDC Outbreak Response Training Program (ORTP), created from 2016 to 2018, is a comprehensive program for hospital epidemiologists to be maximally effective to protect their patients, colleagues and community from facility-level outbreaks to emerging pathogens, such as 2019-nCoV. The ORTP provides expert-authored and selected resources in incident management, with tools and trainings for development and implementation of policies and identification of resources.

“The ORTP was developed to make sure that those working in infection prevention, specifically healthcare epidemiologists and infection preventionists, are knowledgeable in incident management and the structures, frameworks and resources that help limit facility disruption, supplement resources, and prevent the spread of the pathogen,” said Hanrahan. “These outbreaks showed that education in incident management and preparation to work within an emergency response framework is essential in stopping an emerging pathogen crisis.”

Being prepared takes time, Hanrahan said.“It can feel overwhelming when starting from scratch, and these tools help make preparation manageable.”

There are several different things that hospitals and healthcare workers have to think about in terms of their process for taking care of patients. For example, these outbreaks have demonstrated that training in proper donning and doffing techniques for personal protective equipment (PPE) is critical in order to decrease risk of infection to healthcare workers and other patients, Hanrahan said. The ORTP guides healthcare workers in the components of preparedness and response, including successful implementation of policies, and provides quick, direct access to resources and tools selected by experts as the most important and useful. The ORTP was created so the experts tasked with preparedness and response can apply their expertise to stopping the outbreak, rather than spending precious time tracking down resources and navigating new or unpracticed roles.

“Every outbreak has taught us a little bit more and it is important to incorporate these lessons into future planning,” said Hanrahan.

For more information on the SHEA/CDC Outbreak Response Training Program (ORTP), visit https://learningce.shea-online.org/content/sheacdc-outbreak-response-training-program-ortp#group-tabs-node-course-default4

Identifying gaps

Both Ebola and SARS demonstrated that routine personal protective equipment (PPE) was not sufficient to prevent infection in healthcare workers, said Jennifer Anne Hanrahan, DO, from the University of Toledo. “Learning how to don and doff the personal protective equipment properly takes time and practice and is specific to the type of equipment being used. Training is critical to properly donning and doffing PPE.”

A number of other issues have also been identified and these are outlined in the SHEA Expert Guidance: Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals https://doi.org/10.1017/ice.2017.212

Tool kits: https://ortp.guidelinecentral.com/