In 2014, the United States experienced its first known cases of Ebola virus disease transmission between a patient and health care workers. While treating a patient who had contracted the disease in another country, two Texas nurses developed the illness, prompting medical centers across the country to evaluate and improve their protocols for dealing with similar fatal, serious communicable diseases.
While the COVID-19 pandemic brought a greater awareness to personal protective equipment (PPE) and some of the safety protocols used for infectious diseases, the requirements to safely care for viral hemorrhagic fevers like Ebola, Marburg virus, hantavirus, dengue virus and others are much more intensive. Because these diseases are so deadly — for example, up to 90% of untreated Ebola cases are fatal — extra equipment, protocols and precautions are required when admitting a patient suspected of being ill.
Last Wednesday, multiple groups across UK HealthCare worked together with Lexington Fire and EMS, the Kentucky Department for Public Health, the National Emerging Special Pathogens Training and Education Center (NETEC) and representatives from Emory University and the University of North Carolina to execute an in-person simulation of treating a patient with a viral hemorrhagic fever.
“Given how deadly these infections are, there's a big push in the U.S. to have more centers able to care for patients who could have these infections until we get test results back that would say otherwise,” said Nicholas Van Sickels, M.D., medical director for UK HealthCare Infection Prevention and Control. “And that’s why we do these drills, to find errors. If you practice, you’re less likely to make mistakes.”
The drill followed the scenario of a patient who had returned from a country with an Ebola outbreak and was experiencing Ebola-like symptoms. From the patient arriving in an ambulance, to being evaluated inside UK Chandler Hospital’s Emergency Department, to being transported to an isolated section of UK’s medical ICU, participants practiced building antechambers to provide more protection in the ED, donning and doffing PPE, proper waste disposal for the biohazardous materials, getting an X-ray and “treating” the patient, and figuring out the best way to communicate through closed doors while wearing extensive protective gear.
Led by UK HealthCare Infection Prevention and Control, employees from UK HealthCare security, emergency medicine, critical care, environmental services, laboratory services and more participated in the simulation.
“With viruses like Marburg or Ebola, the bodily fluids are so infectious that you have to be very careful when you put on PPE, when you take it off, how to dispose of it, and how to communicate in and out of the rooms,” Van Sickels said. “There’s a lot of steps involved, and a lot of challenges. Today in our simulation, we found places where we could make refinements to make this process safer for our staff and our patients.”
In January, UK HealthCare received a $500,000 Special Pathogen Treatment, Assessment, and Network Development (STAND) award from NETEC to support improvements to UK’s processes, training and equipment for dealing with serious communicable diseases. NETEC is the congressionally designated Coordinating Body of the National Special Pathogen System (NSPS), a network of hospitals tiered by their ability to isolate, test, stabilize and/or care for a patient with a serious communicable disease. With help from this grant, UK HealthCare is working toward becoming a NSPS Level 2 Special Pathogen Treatment Center (SPTC), allowing UK to provide care for patients through the duration of their illness instead of stabilizing and referring them to another hospital.
UK HealthCare is the only hospital in Kentucky to receive this funding and expects to officially become a Level 2 SPTC facility this summer. This designation would also make UK HealthCare a referral site from Level 3 and 4 facilities not only in Kentucky, but other neighboring states.
During the drill, reps from Emory and UNC — both NSPS Level 1 Regional Emerging Special Pathogen Treatment Centers (RESPTCs) for Region 4 — were on-site to evaluate and offer specific feedback and suggestions for improvement for UK HealthCare. As RESPTCs, these centers provide regional leadership, training, and technical expertise to support facilities across the region.
“I think, overall, our simulation went very well, and the goal of having Emory and UNC here on site was to help guide us and show us where we had some areas of improvement,” Van Sickels said. “We were so fortunate today to have them here to answer questions and help UK HealthCare be a lot better prepared for any of these high-consequence pathogens that come throughout our doors.”
While viral hemorrhagic fevers are rare in the United States, these types of training drills also improve health care worker readiness for other serious infectious diseases that occur more frequently, such as measles. Measles is one of the most contagious infectious diseases and spreads through airborne particles released when an infected person coughs, sneezes, or even speaks. These particles can remain suspended in the air and are infectious for hours after the patient has left the area. In populations without immunity, a single infected person can transmit the virus to 10 or more people.
“Although the level of personal protective equipment required for diseases such as Ebola is much more intensive, many of the core principles practiced in these drills apply to other pathogens,” said Takaaki Kobyashi, M.D., senior medical director for UK HealthCare Infection Prevention and Control. “For example, while measles does not require the same contact precautions used for viral hemorrhagic fevers, it still requires strict airborne precautions, including the use of N95 respirators and negative-pressure isolation rooms. The workflows we practiced during the simulation — early recognition of a potentially serious infection, rapid patient isolation, proper use of PPE and coordination among clinical and public health teams — can therefore strengthen preparedness for more common infectious diseases such as measles.”
As part of the NETEC grant, UK HealthCare will continue its training and preparation, including performing at least two simulations per year to continuously practice and evaluate the process.
“If you don't practice and you don't do it, then when the real-life scenario happens, everybody's anxiety level goes way up, and people start to make mistakes,” Van Sickels said. “So it’s cliché, but practice makes perfect.”