Jocelyn J. Herstein

Current capabilities and capacity of Ebola treatment centers in the United States

OBJECTIVE To describe current Ebola treatment center (ETC) locations, their capacity to care for Ebola virus disease patients, and infection control infrastructure features. DESIGN A 19-question survey was distributed electronically in April 2015. Responses were collected via email by June 2015 and analyzed in an electronic spreadsheet. SETTING The survey was sent to and completed by site representatives of each ETC. PARTICIPANTS The survey was sent to all 55 ETCs; 47 (85%) responded. RESULTS Of the 47 responding ETCs, there are 84 isolation beds available for adults and 91 for children; of these pediatric beds, 35 (38%) are in childrens hospitals. In total, the simultaneous capacity of the 47 reporting ETCs is 121 beds. On the basis of the current US census, there are 0.38 beds per million population. Most ETCs have negative pressure isolation rooms, anterooms, and a process for category A waste sterilization, although only 11 facilities (23%) have the capability to sterilize infectious waste on site. CONCLUSIONS Facilities developed ETCs on the basis of Centers for Disease Control and Prevention guidance, but specific capabilities are not mandated at this present time. Owing to the complex and costly nature of Ebola virus disease treatment and variability in capabilities from facility to facility, in conjunction with the lack of regulations, nationwide capacity in specialized facilities is limited. Further assessments should determine whether ETCs can adapt to safely manage other highly infectious disease threats.

U.S. Ebola Treatment Center Clinical Laboratory Support

ABSTRACT Fifty-five hospitals in the United States have been designated Ebola treatment centers (ETCs) by their state and local health authorities. Designated ETCs must have appropriate plans to manage a patient with confirmed Ebola virus disease (EVD) for the full duration of illness and must have these plans assessed through a CDC site visit conducted by an interdisciplinary team of subject matter experts. This study determined the clinical laboratory capabilities of these ETCs. ETCs were electronically surveyed on clinical laboratory characteristics. Survey responses were returned from 47 ETCs (85%). Forty-one (87%) of the ETCs planned to provide some laboratory support (e.g., point-of-care [POC] testing) within the room of the isolated patient. Forty-four (94%) ETCs indicated that their hospital would also provide clinical laboratory support for patient care. Twenty-two (50%) of these ETC clinical laboratories had biosafety level 3 (BSL-3) containment. Of all respondents, 34 (72%) were supported by their jurisdictional public health laboratory (PHL), all of which had available BSL-3 laboratories. Overall, 40 of 44 (91%) ETCs reported BSL-3 laboratory support via their clinical laboratory and/or PHL. This survey provided a snapshot of the laboratory support for designated U.S. ETCs. ETCs have approached high-level isolation critical care with laboratory support in close proximity to the patient room and by distributing laboratory support among laboratory resources. Experts might review safety considerations for these laboratory testing/diagnostic activities that are novel in the context of biocontainment care.

Initial Costs of Ebola Treatment Centers in the United States.

To the Editor: The 2014–2015 outbreak of Ebola virus disease (EVD) in West Africa was unprecedented in scale and scope. During the outbreak, 11 patients with EVD were cared for in the United States (1). Safely caring for patients with suspected EVD requires specialized protocols and training for hospital staff in the use of personal protective equipment (PPE) and isolation precautions (2,3). The care of a hospitalized patient with confirmed EVD in high-level isolation units requires large specialized teams of nurses, physicians, laboratory technologists, environmental service workers, and waste management specialists, and inpatient care may continue for weeks (3,4). The staff-to-patient ratio necessary to care for a patient with EVD in high-level isolation is much higher than that in a typical intensive care unit because of the extensive PPE used and the need for partners to assist with PPE donning and doffing. In response to preparedness challenges in the United States, the Centers for Disease Control and Prevention recommended a multitiered framework of hospitals with advanced capabilities for Ebola care: frontline facilities, Ebola assessment hospitals, and Ebola treatment centers (ETCs) (2). Within this federal framework, 55 hospitals in the United States have been designated by their states as ETCs, which have the advanced capabilities required to provide medical care to patients with confirmed EVD throughout their illness (5). Although the cost of preparing these healthcare facilities to care for EVD patients was believed to be substantial (5–7), we aimed to directly survey the ETCs to determine the costs incurred to prepare their facilities to manage and treat EVD patients. In April 2015, we sent a 19-question electronic survey to all 55 ETCs, including the 3 preexisting biocontainment patient care units (Technical Appendix). Participation was voluntary, and individual responses were confidential. The survey assessed the ETCs’ general organization and the costs incurred to establish the ETC. Of the ETCs, 45 indicated interest in participating in the establishment of the United States Highly Infectious Diseases Network to establish infection control metrics and competencies for high-level patient isolation centers. The Institutional Review Board of the University of Nebraska Medical Center declared this study exempt. Of the 55 ETCs, 47 (85.5%) responded to the survey; 45/47 reported the total costs incurred to establish their ETC, and 43/47 provided a detailed assessment of costs. The 45 ETCs reporting total costs incurred a cumulative total of

US State Public Health Departments Special Pathogen Planning

53,909,701 (mean

Sustainability of High-Level Isolation Capabilities among US Ebola Treatment Centers

1,197,993/ETC) to establish the ETCs (Table). The most costly activity was facility construction and modifications. Costs incurred to provide initial training for staff averaged

Communicable Diseases and Emerging Pathogens: The Past, Present, and Future of High-Level Containment Care

267,075 (range

A Gap Analysis Survey of US Aircraft Rescue and Fire Fighting (ARFF) Members to Determine Highly Infectious Disease Training and Education Needs

10,000–

Ebola Virus Disease Preparations Do Not Protect the United States Against Other Infectious Outbreaks

1,624,639). Each ETC spent

U.S. High-Level Isolation Unit Clinical Laboratory Capabilities Update

172,581 (mean per facility; range

A needs assessment of infection control training for American Red Cross personnel working in shelters

3,000–