Just as We Can Learn From the Art of Pandemics Past, so too can hospitals and healthcare organizations. The consensus is that given world overcrowding, global climate change and the high level of world travel, global pandemics aren't going away. So, what lessons do recent outbreaks such as Ebola in 2014 and SARS in 2003 offer and how might healthcare technology come to the rescue? Here are eight hospital preparedness lessons that come to mind.
8 Lessons for Hospital Preparedness from Past Pandemics
1. Hand Hygiene Is a No-Brainer So Ensure It Happens
In case you haven't received the memo, don't ever underestimate the power of proper hand hygiene. According to We learned four valuable lessons from Ebola. They can help us fight the coronavirus, the very first lesson had to do with hand washing. In fact, the very first line of defense against not only Ebola and coronavirus is hand washing. As soon as proper hand washing was in place, new Ebola cases dropped drastically.
From The lessons of SARS in Hong Kong, you learn that,
"Despite all the technical advances in recent years, we have now gone back to basics in infection control routines and emphasise commonsense behaviour, like frequent hand washing and avoidance of touching the face, etc."
Strategy and technology to prevent hospital-acquired infections: Lessons from SARS, Ebola, and MERS in Asia and West Africa highlights a sobering realization:
"Studies reviewed herein show that HAIs of these 3 fatal diseases can be prevented by using basic prevention strategies, such as hand hygiene protocols. Many nurses and doctors were infected because of the lax attitude toward daily precautions and standard operating procedures. ...
However, there are relationships among these human factors. Most HCWs that lack knowledge about infection sources and transmission routes of the Ebola virus, MERS coronavirus, and SARS coronavirus, usually pay no attention to the use of PPE and hand hygiene practices."
If ensuring good hand hygiene is so difficult, then shouldn't technology help make it happen?
With RTLS, it's possible.
2. Don't Underestimate the Value of Ongoing Pandemic Preparedness
A theme that comes up repeatedly is the value of preparing for unexpected healthcare situations and particularly infectious ones. Preparation means understanding protocols, how to use PPE, how to handle patient surges, and more. Here are specific examples from past pandemics.
Dallas' brush with Ebola holds lessons for hospitals recommends adding Infectious-disease episodes to the list of emergency preparedness drills, and having public relations teams ready ahead of time with protocols and training.
"It is critical that the medical community learns from the previous mistakes so that emphasis in the fight against Ebola can shift toward preparing healthcare systems and organizations, establishing better disease surveillance systems, and restoring the trust in health services across affected communities."
The author of Ebola Lessons from Sweden: Health Care Preparedness is Vital writes,
“Since the EVD [Ebola virus disease] cases in Dallas, Texas, the continuity of hospital preparedness has been questionable. While certain hospitals were designated as EVD treatment facilities, the readiness of most American hospitals remains unknown. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the existing US health care system.”
"The truth is that we should see what happened in Sweden as a not-so-gentle reminder to continue training for basic infection prevention efforts, by asking travel-screening questions and using proper isolation precautions, while also working to re-educate staff on Ebola personal protective equipment and processes."
Drills prepare healthcare workers so the focus can be on patient care and staying safe during the real emergency. As Nurses Prep for Coronavirus, Lessons from the Ebola Outbreak details how,
"When the head nurse of the Nebraska Biocontainment Unit (NBU) donned protective equipment to meet her first patient with Ebola, she had practiced the ritual for nine years. She and fellow nurses even picked the equipment and designed the protocol."
That practice is critical.
"The 2014–15 Ebola outbreak proved to be a cautionary tale for our nation’s response to new infectious diseases... The nation learned that some hospitals and regions are better prepared than others to address infectious disease epidemics; that nurses are on the front lines of care; and that, without adequate training and protection, nurses put their own health and safety in jeopardy to care for the public."
Can technology help with ongoing pandemic preparedness?
Is this a situation where 3-D simulations can play a role? What about tracking whether a healthcare worker has completed PPE training on a regular basis?
3. Follow Standard Safety Precautions Rigorously
What makes infectious outbreaks so challenging is how they affect not just patients but also the front-line healthcare workers who care for them. That in turn requires paying close attention to standard safety precautions.
"Patients infected with EBOV, who seek emergency care, expose ‘front-line’ healthcare workers to significant risk of contracting the infection. Considering the highly contagious nature of the body fluids from individuals with symptomatic infection, dealing with Ebola mandates that healthcare workers follow standard safety precautions rigorously in order to safeguard themselves and the people with whom they interact."
Perhaps that seems self-evident. However, as As Nurses Prep for Coronavirus, Lessons from the Ebola Outbreak points out, the U.S. is used to having readily available vaccines or cures:
"For decades our nation has felt isolated from infectious diseases that prevail in other parts of the world, but the arrival of Zika on the heels of the Ebola crisis brought home our vulnerability, and the advent of coronavirus adds to it."
Without that ready vaccine, hospitals and healthcare workers require new systems to manage the situation.
"As a first step, she recommended nurses and other health care personnel maintain their skill in standard (once called “universal”) precautions—protocols for handling blood and bodily fluids as if they were infectious."
As with hand hygiene, can't technology help ensure that standard safety precautions are indeed followed?
4. Educate About Infection Protocols and Implications
Education and training are a running theme. They are part of following proper procedures and preparing for the unexpected. You can't ignore them. For example, according to The Emergence of Ebola as a Global Health Security Threat: From ‘Lessons Learned’ to Coordinated Multilateral Containment Efforts,
"Employing adequate screening protocols and ensuring that the ‘front-line’ personnel are familiar with pertinent policies is of special importance. In order to contain the spread of Ebola, it is of paramount importance to ensure that the medical staff in the Emergency Departments is prepared, that appropriate screening and isolation policies are in place, and that vigilance and clinical suspicion are sufficient enough to readily identify individuals who have recently traveled to EBOV-affected areas or who may have been in contact with an actively symptomatic Ebola patient, keeping in mind the pertinent incubation periods and other key information about the characteristics of the virus."
Here's another perspective from Strategy and technology to prevent hospital-acquired infections: Lessons from SARS, Ebola, and MERS in Asia and West Africa:
"Lack of knowledge can cause delayed response to suspected cases, poor triaging, and incorrect use of PPE. HCWs are more easily infected by suspected patients at the early stage of an outbreak before most HCWs have the necessary knowledge about case definitions and transmission methods of the pathogen. This highlights the importance of timely education and training of hospital staff. The safety of HCWs is based on the assumption that they have been trained to adopt appropriate behaviors in infectious and non-infectious conditions...
Without special training, HCWs may miss important details and steps when using PPE or washing hands. For example, HCWs may forget to remove personal items (such as jewelry, watches, and pens) before putting on PPE, forget to put on a second pair of gloves over the cuff, forget to perform hand hygiene on gloved hands before taking off PPE, or forget to perform hand washing after dealing with contaminated laundry."
Can you embed educational modules in your clinical software solutions?
Education and training need to be ongoing.
5. Ensure Robust Means of Communication
Communication is another critical element for hospital pandemic preparedness and comes up as a separate section in The coronavirus playbook: How 12 health systems are responding to the pandemic. Good communication ensures collaboration As Nurses Prep for Coronavirus, Lessons from the Ebola Outbreak describes:
"But preparation was just one factor that helped Nebraska Medicine and Emory University Hospital safely and effectively treat patients with Ebola. NBU’s clinical care was shaped by a deliberate culture of collaboration. Team members shared information at shift-change huddles. Nurses, doctors, and respiratory therapists spoke up if they saw something troubling and avoided traditional hierarchies that hamper open communication."
The other important aspect to communication is how it affects staff, patients and patient families especially during an infectious outbreak when person-to-person communication is neither possible nor advisable.
Can you enable mobile communications?
Imagine being able to use mobile devices to send text updates to family members and patients, or to check on patients. What about using mobile communications to helps with tracking assets and confirming that rooms are ready?
Telehealth plays a role here in screening patients and keeping them out of Emergency Departments until necessary.
6. Isolation Protocols Work
The CDC recommends "Identify, Isolate, Inform" in the case of Ebola. According to We learned four valuable lessons from Ebola. They can help us fight the coronavirus,
"One of the most important and lifesaving measures international responders put in place was to divide Ebola treatment centres into zones, with infected patients isolated in the high-risk zones. Proper zoning is a matter of life and death during epidemics, so it’s concerning to read reports of coronavirus hotspots where people are moving freely between red and green zones."
Isolation, though, is more than just separating the infected from the non-infected. It requires technology and equipment - including PPE - as well as effective triaging. Here's how Strategy and technology to prevent hospital-acquired infections: Lessons from SARS, Ebola, and MERS in Asia and West Africa describes the situation:
"A well-designed isolation area should have at least 3 regions: heavily contaminated, lowly contaminated, and non-contaminated. Isolation wards with a single bed are most suitable for preventing transmission through droplets... Another basic feature of isolation ward is the regulation of airflow, which can reduce the cross contamination of airborne pathogens. Architectural design of compartments including the locations of windows and doors can ensure the natural airflow. Exhaust ventilators of the isolation rooms should be located far from the intakes of other areas to avoid contamination. Ventilation facilities can improve bio-security by maintaining air pressure.
For isolation wards of highly infectious diseases, environments with negative pressure are required. In contrast, positive pressure should be provided to operating rooms, intensive care unit (ICU), and other important places. The regulation of airflow is especially important for the prevention of pathogens such as SARS-CoV, which can not be filtered through a high-efficiency particulate air (HEPA) filter."
Consider implementing technology to support isolation protocols.
7. Tracking the Spread of Infectious Diseases
Unless you track the spread of the disease, you can't easily contain it. Tracking includes patient tracking and contact tracing. Another aspect includes keeping track of any people or equipment that come into contact with infected patients in healthcare facilities to ensure that they are protected and/or disinfected.
In a low-tech environment such as the Democratic Republic of Congo, tracking included creative approaches as Using Lessons Learned From Ebola, Experts Are Preparing for a Coronavirus Outbreak in Africa describes:
"...The center monitored indicators like school attendance and pharmacy sales to track the spread of the disease. They deployed satellite mapping technology to figure out where to send emergency response teams. Venczel believes that measures like these made a big difference in preventing the spread of the disease—the outbreak finally appears to be under control, with no new cases for nearly a month. Now, says Venczel, the team is readying the center to respond to COVID-19. With the mapping tools, “we zoom into areas that we know are at risk,” she says. “That really helps for planning.”
Imagine implementing RTLS and mobile solutions.
Asset tracking and ensuring that cleaning protocols already address some of these issues. Mobile devices can also play an important role in contact tracing.
8. How Can You Help Reduce ED Patient Density?
The best way to reduce ED patient density is by staying home and flattening the curve. However, once infected what possibilities are there for managing the process?
Strategy and technology to prevent hospital-acquired infections: Lessons from SARS, Ebola, and MERS in Asia and West Africa recommends appointments and effective triaging to ease overcrowding.
"Guiding services and information desks can save time for patients by providing basic information, such as the locations of examination rooms, the dispensary, and the laboratory. Importantly, online systems of patient appointments and information queries can efficiently reduce the patient density of some areas of a hospital."
Triage can start before the hospital with telemedecine, online appointments, and drive-through testing from the patient's car as we're seeing happening now.
What other technology-based triage systems come to mind?
How is Your Hospital Preparing for the COVID-19 Pandemic?
What would you add to this list? How do you see technology helping valuable healthcare workers stay safe as they deliver the care that patients need during this challenging pandemic?
Thanks for reading.
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