The 2014 West Africa Ebola outbreak is the most recent highly publicized viral outbreak to challenge the healthcare community, but Ebola Virus Disease (EVD) has not been our first challenge and it will not be the last. Infectious diseases have always carried risks for healthcare providers, and there have always been dedicated healers ready to face the fight.
A roadside marker near Elliston, VA, testifies that neither outbreaks nor their effects on those who bravely step forward to care for the sick are new. The marker’s inscription reads, “Near here stood Montgomery White Sulphur Springs, popular resort area of 19th century America. During the Civil War the resort was converted into a military hospital staffed by Catholic nuns. Several hundred victims of smallpox including nurses and soldiers are buried nearby” (VA Historical Markers).
Today, we might do well to take a moment to contemplate the sacrifices of contemporary health workers on the West African frontlines who also have been buried alongside patients they sought to save (Mark, 2014). Of course, these kinds of outbreaks are of particular concern to critical care providers because a relatively large proportion of patients affected have become critically ill. Caring for these patients involves risk of exposure and transmission to others.
Because outbreaks involve novel pathogens, they challenge our thinking. Although experience serves as an initial rough guide for responses to outbreaks, novel pathogens are unpredictable and often defy conventional wisdom.
Outbreaks reinforce the importance of critical care knowledge, skill, and teamwork in uncertain situations. Prevention and supportive therapy, which seem simple, require high levels of infrastructure and of provider knowledge and skills. These elements are already part of the critical-care tool kit, but outbreaks highlight the importance of the basics as a foundation for clinical practice.
For example, infection control practices are one of the first skill sets that nurses and physicians learn, but they are also some of the most difficult skills to perform well and consistently. Containing the spread of diseases like EVD, Middle Eastern Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), and influenza requires standard and contact precautions. Airborne infection isolation is recommended for MERS, SARS, and influenza; and although EVD is not spread by airborne transmission, it can be spread by aerosolized secretions. In order to be effective, infection control measures must begin at the first point of contact with a potentially infected person.
The recent Ebola outbreak reminds us that hand washing, personal protective equipment, and pristine technique are essential. Practice makes perfect. Safety requires both individual effort and exceptional teamwork, including taking accountability for helping each other adhere to infection control protocols.
The very nature of clinical care brings nurses, physicians, and other members of the healthcare team into close proximity with patients at the most infectious period of their illness. Today’s risks are mitigated by better understanding of pathogenesis and transmission, by the availability of personal protective equipment, and by the exceptional knowledge and skills of critical-care providers. But caring for outbreak victims will never be completely free of risk. Our duty is to use all our knowledge and skills to protect our patients, the public, and ourselves, and to be ready for the next challenge. History has shown there will always be dedicated healthcare providers ready to take evidence-based practice and basic human compassion to the frontlines of these battles.
American Association of Critical-Care Nurses (AACN) Critical Care Webinar Series presents:
The Nurses’ Perspective: Caring for an Ebola Patient
(Free to AACN members and nonmembers)
In the aftermath of the Ebola Virus Disease (EVD) cases in the U.S. this fall, nurses working in acute and critical care units around the country continue to be concerned about the implications of caring for patients with serious communicable illnesses – for themselves, their patients and their workplace.
This American Association of Critical-Care Nurses (AACN) webinar features a panel of nurses from Emory University Hospital in Atlanta, volunteers in the Serious Communicable Disease Unit (SCDU), who describe first-hand their daily experience caring for the recent patients with EVD. The nurses describe their unit, a typical day while caring for EVD patients, issues that emerged, and their interactions with the patient and family. They also addressed how nurses are trained to monitor their practice – and each other – during isolation procedures.
Virginia Historical Markers. Retrieved from: http://www.waymarking.com/waymarks/WM7H83_Montgomery_White_Sulphur_Springs. Accessed October 29, 2014.
Mark, M. (October, 2014). Ebola crisis: how health workers on west African frontline are paying with their lives. The Guardian. Retrieved from: http://www.theguardian.com/world/2014/oct/08/-sp-ebola-west-africa-health-workers. Accessed November 11, 2014.
Excerpt from “Viral Outbreaks in an Age of Global Citizenship,” by Cindy L. Munro, RN, PhD, ANP, and Richard H. Savel, MD, American Journal of Critical Care. January 2015, Volume 24, No. 1, pp. 4-6. http://ajcc.aacnjournals.org/content/24/1/4.full.
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