Clinical Documentation and Data Transfer from Ebola and Marburg Virus Disease Wards in Outbreak Settings: Health Care Workers’ Experiences and Preferences

Silja Bühler,Ellen Nolte,Paul Roddy,Matthias Borchert

doi:10.3390/v6020927

Abstract

Understanding human filovirus hemorrhagic fever (FHF) clinical manifestations and evaluating treatment strategies require the collection of clinical data in outbreak settings, where clinical documentation has been limited. Currently, no consensus among filovirus outbreak-response organisations guides best practice for clinical documentation and data transfer. Semi-structured interviews were conducted with health care workers (HCWs) involved in FHF outbreaks in sub-Saharan Africa, and with HCWs experienced in documenting and transferring data from high-risk areas (isolation wards or biosafety level 4 laboratories). Methods for data documentation and transfer were identified, described in detail and categorised by requirement for electricity and ranked by interviewee preference. Some methods involve removing paperwork and other objects from the filovirus disease ward without disinfection. We believe that if done properly, these methods are reasonably safe for certain settings. However, alternative methods avoiding the removal of objects, or involving the removal of paperwork or objects after non-damaging disinfection, are available. These methods are not only safer, they are also perceived as safer and likely more acceptable to health workers and members of the community. The use of standardised clinical forms is overdue. Experiments with by sunlight disinfection should continue, and non-damaging disinfection of impregnated paper, suitable tablet computers and underwater cameras should be evaluated under field conditions.

Highlights

Filoviruses, i.e., marburgviruses and ebolaviruses, are highly infectious and transmitted from person-to-person by direct contact with infected body fluids or by contaminated fomites [1,2]
This study aims to contribute to our understanding of potential approaches for documenting and transferring clinical filovirus hemorrhagic fever (FHF) data by conducting a survey among health care workers with relevant experience
Forty health care workers (HCWs) with experience in FHF outbreaks or data documentation and transfer from BSL-4 wards or isolation wards representing 15 organisations were initially contacted via e-mail for the first round of interviews

Summary

Introduction

Filoviruses, i.e., marburgviruses and ebolaviruses, are highly infectious and transmitted from person-to-person by direct contact with infected body fluids or by contaminated fomites [1,2]. The case fatality ratios of filovirus hemorrhagic fevers range from 25% to 90% [1]. In order to better understand human clinical manifestations of FHF and to inform treatment strategies, there is a need to systematically collect clinical data during outbreaks. Clinical documentation inside filovirus disease wards during FHF outbreaks has been limited [3,4,5,6,7,8]. Data collection has not always been systematic, and data have been lost as clinical records considered to be contaminated were destroyed. There is a lack of guidelines or standardised procedures for documenting clinical FHF data and transferring them from the FHF ward to the outside, and no consensus on the safest or easiest methods

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Methods

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Discussion

Conclusion