Abstract
During the Ebola outbreak, mortality reduction was attributed to multiple improvements in supportive care delivered in Ebola treatment units (ETUs). We aimed to identify high-priority supportive care measures, as well as perceived barriers and facilitators to their implementation, for patients with Ebola Virus Disease (EVD). We conducted a cross-sectional survey of key stakeholders involved in the response to the 2014–2016 West African EVD outbreak. Out of 57 email invitations, 44 responses were received, and 29 respondents completed the survey. The respondents listed insufficient numbers of health workers (23/29, 79%), improper tools for the documentation of clinical data (n = 22/28, 79%), insufficient material resources (n = 22/29, 76%), and unadapted personal protective equipment (n = 20/28, 71%) as the main barriers to the provision of supportive care in ETUs. Facilitators to the provision of supportive care included team camaraderie (n in agreement = 25/28, 89%), ability to speak the local language (22/28, 79%), and having treatment protocols in place (22/28, 79%). This survey highlights a consensus across various stakeholders involved in the response to the 2014–2016 EVD outbreak on a limited number of high-priority supportive care interventions for clinical practice guidelines. Identified barriers and facilitators further inform the application of guidelines.
Highlights
Ebola Virus Disease (EVD) is a febrile illness that often leads to gastrointestinal fluid losses and complications of hypovolemia, including renal dysfunction, metabolic acidosis, and organ dysfunction [1,2,3,4,5]
Between January and June of 2016, 57 individuals received an invitation to participate in the survey, and 44 replied to at least one email for a response rate of 77%
Out of 28 respondents, 14 (50%) disagreed that health workers in Ebola treatment units (ETUs) knew and 13/28 (46%) disagreed
Summary
Ebola Virus Disease (EVD) is a febrile illness that often leads to gastrointestinal fluid losses and complications of hypovolemia, including renal dysfunction, metabolic acidosis, and organ dysfunction [1,2,3,4,5]. The optimal clinical care of these patients includes supportive care to prevent and manage organ dysfunction [2,3], which in turn requires adequately staffed and resourced Ebola treatment units (ETUs) with appropriate infection prevention and control protocols. The observed mortality reduction has been attributed to earlier patient presentation, and to multiple gradual improvements in supportive care delivered in ETUs as staff expertise and material resources increased [2]. Based on this observation, we launched a program of research that culminated in the publication of evidence-based guidelines for the supportive care of patients with EVD [9]. A secondary objective was to collect information on perceived barriers and facilitators to the provision of supportive care during the outbreak
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