Abstract
The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital's preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery.
Highlights
The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms
Following the request of the Ministry of Health, Welfare, and Sport to prepare for the admission of EBOV-infected patients, all previously developed procedures were revised for the treatment of patients with viral hemorrhagic fever (VHF)
We present an overview of the preparations made at the MIH in the fall of 2014, pending a possible VHF outbreak, and the experience gained from the admission of an EBOV-infected patient
Summary
Scenario Description and Routing Flowcharts were developed that described 3 scenarios for routing a patient with suspected or confirmed VHF: 1) self-referral, 2) external referral, and 3) in-hospital referral from another ward. Security staff and a nurse would guide the patient to the MIH via a designated cleared route. An emergency department nurse would open the MIH, activate the negative pressure system, and alert a team of trained nurses and an infectious disease specialist, all of whom would perform triage and assess the need to scale up the response. VHF patients arriving by ambulance would enter the MIH through a separate entrance in the MIH. At this entrance, a 3-zone area was drawn on the floor to indicate the safe zone and potentially contaminated zones and to delineate doffing zones (where potentially contaminated clothing and gear are removed) for ambulance and disinfection personnel (Figure 2). Personnel from the appointed ambulance services were trained in accordance with the revised protocols
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