Preparing for patients with high-consequence infectious diseases: Example of a high-level isolation unit

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: 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.

Fig 1. Plan of the high-level isolation unit (HLIU).

A small version with two patient rooms, B large version with twelve patient rooms. Red bars denote doors, which seal the isolation area (marked by light colors) from other areas, arrows denote entry and exit of the isolation area, + denotes patient room with anteroom. In the small and large version of the HLIU, door (1) and (2) are closed, respectively (see A and B).

Fig 2. Perceived competence depending on the number of trainings attended.

Box plot of points on the 5-point Likert scale (with extremes labelled as “I do not agree at all” at the lower and “I fully agree” at the higher end). The lower bound of the box indicates the first quartile, the thick line indicates the median, and the upper bound of the box indicates the third quartile. The lower and upper whisker indicate minimum and maximum values, respectively. The circle represents outliers (i.e. < first quartile– 1.5*IQR). 0–1, 2–3, and ≥ 4 trainings had been attended by 43, 40, and 33 participants, respectively. Results show overall agreement with 13 questions addressing competence (e.g. “I feel competent with airway management in the HLIU”) from participants who had so far participated in 0–1, 2–3, and ≥ 4 training sessions.