Diseases In Healthcare Facilities Research Articles

Clinical characteristics of community-onset Clostridioides difficile infections at a tertiary hospital in mainland China: A fourteen-year (2010–2023) retrospective study

BackgroundClostridioides difficile infection (CDI) is an increasingly common disease in healthcare facilities and community settings. However, there are limited reports of community-onset CDI (CO-CDI) in China. MethodsWe collected diarrheal stool samples from 3885 patients who went to outpatient department or emergency department in a tertiary hospital in China during 2010–2023, analyzed the correlation between patients’ basic information and the detection rate of CDI. Besides, all stool samples from 3885 outpatients included were tested by culturing. Moreover, we randomly selected 89 patients’ stools during the 14 years and isolated 126 C. difficile strains from them. The presence of toxin genes (tcdA, tcdB, cdtA, and cdtB) were confirmed by PCR. Toxigenic strains were typed using multilocus sequence typing (MLST). Susceptibility to 9 antimicrobials was evaluated using the E-test. Results528 of 3885 patients (13.6 %) with diarrhea were finally diagnosed as CDI. The median age of patients included was 51 years (6 months-95 years), while the median of patients with CDI was older than patients with negative results [55.5 years (6 months-93 years) vs. 50 years (9 months −95 years), p < 0.001]. In winter, patients with diarrhea might be more likely to have CDI. The detection rate of CDI of patients in emergency department was much higher than those in other outpatients (20.7 % vs. 12.4 %, p < 0.001), and did differ from each outpatient departments (p < 0.05). There were 95 isolated strains detected as toxigenic C. difficile. Among these strains, 82 (86.3 %) had the tcdA and tcdB genes (A+B+) and 5 of these 82 strains were positive for the binary toxin genes (cdtA and cdtB) (A+B+CDT+). There were 15 different sequence types (STs) by multilocus sequence typing (MLST), while the most ST was ST-54 (23.2 %). ST types composition was relatively stable over the time span of this study. Some strains had high resistance to ciprofloxacin, clindamycin, and erythromycin. Twenty-three isolates (24.2 %) were multidrug-resistant. ConclusionsOutpatients with CDI were common among patients having diarrhea during this period in our hospital. Elderly patients and patients went to emergency department may be susceptible to CDI. Based on MLST, the result revealed that the C. difficile isolates had high genetic diversity and maintained stability in this period. All isolates were susceptible to metronidazole and vancomycin, and nearly one quarter of all isolates had multidrug resistance.

Cost-Consequence Analysis of Levofloxacin Compared to Ceftriaxone in Community-Acquired Pneumonia of Adult Inpatients at X Hospital Surakarta

Background: Community-acquired pneumonia is still a significant cost-burden disease in healthcare facilities. Pharmacoeconomic analysis using the cost-consequence analysis (CCA) method of ceftriaxone compared to levofloxacin as a first-line empirical antibiotic has never been carried out. Objective: to model the clinical and economic impact of administering ceftriaxone as a first-line empirical antibiotic compared to its comparator levofloxacin for community-acquired pneumonia therapy in hospitalized adult inpatients from the perspective of healthcare facilities. Methods: This research is a retrospective observational study that collects medical records and patient billing data in X Hospital Surakarta from January to December 2022 period. The study was conducted from June to July 2023. Subjects were adult inpatients aged ≥ 18 years with community-acquired pneumonia and were given levofloxacin or ceftriaxone as first-line empiric antibiotics. The data taken included patient profile, antibiotic effectiveness and direct medical costs. Cost-consequence analysis (CCA) was used to compare levofloxacin to ceftriaxone to assess their impact on length of stay, antibiotic effectiveness, and direct medical costs based on a healthcare perspective. Results: The antibiotic effectiveness for levofloxacin was 75.00%, and ceftriaxone was 93.33%. The average length of stay for levofloxacin was 3.39 days, and ceftriaxone was 3.00 days. The total direct medical costs for levofloxacin were IDR 2,056,799, and ceftriaxone was IDR 1,969,627. Conclusion: The administration of ceftriaxone to levofloxacin as a first-line empirical antibiotic for community-acquired pneumonia in hospitalized adult patients had the consequence of increasing antibiotic effectiveness, reducing the length of stay and saving total direct medical costs by IDR 87,172.

Validation of quantitative real-time polymerase chain reaction for detection of Legionella pneumophila in hospital water networks

Rapid monitoring of Legionella pneumophila (Lp) is essential to reduce the risk of Legionnaires' disease in healthcare facilities. However, culture results take at least eight days, delaying the implementation of corrective measures. Here, we assessed the performance of a qPCR method and determined qPCR action thresholds for the detection of Lp in hospital hot water networks (HWNs). Hot water samples (N= 459) were collected from a hospital HWN. Lp were quantified using iQ-Check® Quanti real-time PCR Quantification kits (Bio-Rad) and the results were compared with those of culture. qPCR thresholds corresponding to the culture action thresholds of 10 and 1000cfu/L were determined on a training dataset and validated on an independent dataset. Lp concentrations measured by culture and qPCR were correlated for both the training dataset (Spearman's correlation coefficient ρ= 0.687, P<0.0001) and the validation dataset (ρ= 0.661, P<0.0001). Lp qPCR positivity thresholds corresponding to culture action thresholds of 10cfu/L was 91 genome units (gu) per litre (sensitivity, 86.4%; negative predictive value - NPV, 93.3%) and that corresponding to culture action thresholds of 1000cfu/L was 1048 gu/L (sensitivity, 100%; NPV, 100%). Detection of Lp by qPCR could be implemented with confidence in hospitals as a complement to culture in the monitoring strategy to speed up the implementation of corrective measures.

Seroprevalence of Varicella-Zoster Virus and Measles among Healthcare Workers in a Tertiary Medical Center in Korea.

Measles and varicella still occur in the general population despite the widespread vaccination against them, and healthcare workers (HCWs) are still at risk of exposure to these diseases. Here, we evaluated the seroprevalence of measles and varicella-zoster virus (VZV) in HCWs and the trend of seroprevalence according to age, birth year, and occupational group. The serostatuses of measles and VZV of HCWs during new employee medical examinations between October 2015 and October 2021 were included. Thereafter, the trends of seroprevalence according to age, birth year, and occupational groups were evaluated. Overall, 2070 and 1827 HCWs were evaluated for VZV and measles serostatus, respectively. The seroprevalences of VZV and measles were 91% (1884/2070) and 70% (1284/1827), respectively. Younger HCWs had a significantly lower seroprevalence of measles (p = 0.02, age) and VZV (p = 0.003, birth year and p &lt; 0.001, age). The seroprevalence of measles and VZV was significantly higher among doctors and nursing assistants than among nurses and other HCWs (p &lt; 0.001 in both). In conclusion, the seroprevalence of measles and VZV significantly decreased in younger HCWs. Additionally, monitoring the serostatus of measles and VZV and the immunization of susceptible HCWs are required to prepare and control infectious diseases in healthcare facilities.

Vented Individual Patient (VIP) Hoods for the Control of Infectious Airborne Diseases in Healthcare Facilities.

By providing a means of separating the airborne emissions of patients from the air breathed by healthcare workers (HCWs), vented individual patient (VIP) hoods, a form of local exhaust ventilation (LEV), offer a new approach to reduce hospital-acquired infection (HAI). Results from recent studies have demonstrated that, for typical patient-emitted aerosols, VIP hoods provide protection at least equivalent to that of an N95 mask. Unlike a mask, hood performance can be easily monitored and HCWs can be alerted to failure by alarms. The appropriate use of these relatively simple devices could both reduce the reliance on personal protective equipment (PPE) for infection control and provide a low-cost and energy-efficient form of protection for hospitals and clinics. Although the development and deployment of VIP hoods has been accelerated by the coronavirus disease 2019 (COVID-19) pandemic, these devices are currently an immature technology. In this review, we describe the state of the art of VIP hoods and identify aspects in need of further development, both in terms of device design and the protocols associated with their use. The broader concept of individual patient hoods has the potential to be expanded beyond ventilation to the provision of clean conditions for individual patients and personalized control over other environmental factors such as temperature and humidity.

Diagnostic sensitivity of direct wet mount microscopy for soil-transmitted helminth infections in Jimma Town, Ethiopia.

Soil-transmitted helminthiasis (STH) remains a major public health problem in school children in Ethiopia. Although direct wet mount microscopy (DWMM) is the means to diagnose parasitic diseases in health care facilities in Ethiopia, it remains unclear what its diagnostic performance is for STH. A cross-sectional study was performed in Jimma Town (Ethiopia) and included 600 children from 10 primary schools. The diagnostic sensitivity of DWMM was compared to a composite reference standard (CRS) consisting of Kato-Katz, McMaster and Mini-FLOTAC. We also explored the impact of intensity of infection (the highest faecal egg counts (FECs; expressed as eggs per gram of stool (EPG)) across the CRS) on the diagnostic sensitivity of DWMM. Based on the CRS, there were 210 Ascaris (35.0%), 312 Trichuris (52.0%) and 102 hookworm cases (17.0%). The median intensity of infections equalled 2,057 EPG for Ascaris, 200 EPG for Trichuris and 110 EPG for hookworms. The sensitivity of DWMM was 73.8% for Ascaris, but was around 17% for both Trichuris and hookworms. The sensitivity significantly increased with intensity of STH. For Ascaris, the odds for detecting an infection intensity of 1,000 EPG was 6.2 times higher than detecting an infection of 100 EPG. For Trichuris and hookworms, these odds ratios were 7.1 and 14. The diagnostic sensitivity of DWMM is low for STH, but it is able to detect those subjects that are in the highest need of treatment, and hence contributes to the global goal to eliminate STH as a public health problem.

Non-COVID area of a tertiary care hospital: A major source of nosocomial COVID-19 transmission.

COVID-19 pandemic has spread to all corners of the world where infection control measures are being implemented. There is now a resurgence of the disease in health care facilities with documented in-hospital transmission and cases becoming positive in areas designated to cater for COVID-19 negative patients. We encountered such an event at our institution where fourteen patients (including health care workers) in the non-COVID zone were found to be COVID-19 positive. This highlights the loopholes in the system and the need for better and systematic infection control measures in hospitals that deal with infectious diseases with high infectivity. Findings also suggests the failure of government's criteria for suspected COVID-19 cases, and therefore needs a rethinking.

Characterization of Aerosol Emission from Single-film Rupture in a Tube

ABSTRACT The generation of aerosols during “silent” tidal breathing via the bronchiole fluid film burst (BFFB) mechanism, which involves the rupturing of mucus meniscus or film in terminal bronchioles, has been described in recent studies. To replicate the BFFB mechanism and identify the characteristics of aerosol generation during normal breathing, this study set up a single-film generation system employing tubes ranging from 0.7 to 2.94 cm in diameter that simulated the bronchioles. A liquid film of artificial mucus or soap solution was applied on the bottom of each tube and moved upward by filtered carrier air, which eventually led to the rupturing of the film. The resultant airborne particles (> 7 nm) were then counted with a condensation particle counter, and the number size distributions (0.6–20 µm) were measured with an Aerodynamic Particle Sizer. The experimental results show that the film’s rising velocity, rise distance and surface tension in addition to the tube diameter all affected the total particle count and the size distribution. The total particle count increased with the rising velocity until the latter reached 3 cm s–1 and then decreased as the velocity continued growing—a phenomenon that was mainly due to the curvature of the film increasing with the velocity. Moreover, the larger the tube diameter, the higher the particle count. When a 0.9% NaCl solution was added to increase the surface tension of the film, the total particle count decreased as the surface tension increased, regardless of whether artificial mucus or soap solution was used. This approach to reducing the propagation of infectious diseases in healthcare facilities seems to merit further exploration.

Outbreaks of infectious diseases in healthcare facilities: Issues of epidemiological diagnostics and preanalytical stage

Background. The issue of outbreaks of infectious diseases in healthcare facilities is not often discussed in the scientific community. Several years ago, the primary etiological agents of outbreaks in hospitals were bacteria, whereas in most cases under modern conditions, outbreak incidence is caused by viruses.&#x0D; Aim. Based on the analysis of research materials on outbreaks of infectious diseases in healthcare facilities of Ural and Siberian Federal Districts, this work aimed to characterize infectious diseases under contemporary conditions and identify problematic issues of the preanalytical stage of epidemiological diagnostics and the organization of preventive and anti-epidemic measures.&#x0D; Methods. The data of federal statistical monitoring form No. 23 Information on outbreaks of infectious diseases (18 units of information) and the copy of the Acts of an epidemiological investigation of foci of infectious (parasitic) diseases with the establishment of a causal relationship (14 units of information) were analyzed. The work used epidemiological and statistical methods of information processing. The significance of differences between the indices of independent samples was evaluated using Fishers exact test.&#x0D; Results. In 2018, 14 outbreaks of infectious diseases were recorded in healthcare facilities in 7 out of 18 subjects in Ural and Siberian Federal Districts. The total number of victims was 183 people (97 (53.0%) children and 86 (47.0%) adults). Most of the outbreaks (12 of 14; 85.7%) were of viral etiology. One outbreak was of bacterial, and one was of fungal origin.&#x0D; Discussion. Viruses played a key role in the formation of foci with multiple diseases in the healthcare facilities of Ural and Siberian Federal Districts in 2018. Most of the foci of infection with an aerogenic transmission mechanism were caused by varicella-zoster virus, and those with fecaloral transmission mechanism were etiologically associated with Norwalk virus. Children were the most vulnerable contingents in outbreaks in the healthcare facilities. In all the situations analyzed, the prerequisites for an outbreak include the untimely isolation of the source of infection, hospital overload, and inadequate financial and logistical support. Anti-epidemic measures were conducted to the fullest extent during outbreaks of acute intestinal infections in comparison with outbreaks of a different etiology.&#x0D; Conclusion. Most outbreaks registered in the hospitals could be prevented by vaccination of the related population.

Analisis Biaya Penyakit Stroke Pasien Jaminan Kesehatan Nasional di RSUD Blambangan Banyuwangi

Cost analysis of chronic diseases in health care facilities during JKN is needed as quality and cost control. Stroke is a high cost, volume, and risk, catastrophic disease that can cause an increase in medical expenses, which requires special attention. The purpose of this study is to provide an overview of real costs and cost components, providing an overview of the direct medical costs and tariff packages of INA-CBGs based on the type of stroke, and the factors that affect direct medical costs. This study is a descriptive-analytic observational study according to the hospital perspective. Data was taken retrospectively. The subjects of the study were adult JKN patients who were aged ≥18 years old with a stroke diagnosis that entered the inclusion criteria. The research variables included age, gender, type of stroke, comorbidity, hospitalization class, length of stay (LOS), and real costs. Data analysis used univariate, bivariate and multivariate analysis. The research results obtained total real costs of Rp. 1,525,236,503 with an average cost of Rp. 4,872,960, the largest cost component was the cost of drugs and BMHP Rp. 402,248,555 (27.21%). The real cost of hemorrhagic strokes is Rp. 572,969,865 and the INA-CBGs tariff package is Rp. 483,804,000, the real cost of ischemic stroke is Rp. 1,107,055,700. There were significant differences in real cost from class factors and length of stay (p-value &lt;0.005). The concluded that the INA-CBGs tariff package is insufficient to finance hospitalized patients with hemorrhagic strokes (-Rp89.165,865), but sufficient for ischemic stroke (+Rp.154,789,069).

Water, Sanitation, and Hygiene in Rural Health-Care Facilities: A Cross-Sectional Study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia.

Safe and sufficient water, sanitation, and hygiene (WaSH) prevent the spread of disease in health-care facilities (HCFs). Little research has been conducted on WaSH in HCF in sub-Saharan Africa. We carried out a cross-sectional study of WaSH in 1,318 randomly selected rural HCF (hospitals, health centers, health posts, and clinics) in regions throughout Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Methods included questionnaires with head doctors and nurses to document WaSH access, continuity, quality, quantity and reliability, and analysis of drinking water samples for Escherichia coli. We found that fewer than 50% of rural HCFs had access to improved water sources on premises, improved sanitation, and consistent access to water and soap for handwashing (Ethiopia [7%), Kenya [30%], Mozambique [29%], Rwanda [50%], Uganda [30%], and Zambia [21%]). Adequate hand hygiene reduces disease transmission and health-care-acquired infections, but fewer than 25% of HCF in each country reported that a combination of water, soap, and hand-drying materials were always available. Our research points to a lack of basic WaSH services in rural HCFs in regions of sub-Saharan Africa, which poses a threat to the health of patients and health-care workers in these settings.

Highlighting the need for more infection control practitioners in low- and middle-income countries.

Background: Many low- and middle-income countries struggle to implement, monitor and evaluate the efficacy of infection control (IC) measures within health care facilities. This hampers their ability to prevent nosocomial infections, identify emerging pathogens and rapidly alert officials to possible outbreaks. The lack of dedicated and trained IC practitioners (ICPs) is a serious deficit in the health care workforce, and is worsened by the lack of institutions that offer IC training. Discussion: While no single individual can entirely eliminate the risk of nosocomial transmission, there is literature to support the value of designated IC persons. Recommendations from the World Health Organization in 2008 and 2009 describe the need for this specialized cadre of workers, but many countries lack the national regulations to authorize, train and manage such professionals at the national or local level. This article provides an overview of how ICPs are trained and credentialed in several countries, and discusses approaches countries can use to train ICPs. Conclusion: Trained ICPs can help prevent future outbreaks and control nosocomial transmission of diseases in health care facilities. For this to occur, supportive national policies, availability of training institutions and local administrative support will be required.

Rates of Hospital‐Acquired Respiratory Illness in Bangladeshi Tertiary Care Hospitals: Results from a Low‐Cost Pilot Surveillance Strategy

Patients hospitalized in resource-poor health care settings are at increased risk for hospital-acquired respiratory infections due to inadequate infrastructure. From 1 April 2007 through 31 March 2008, we used a low-cost surveillance strategy to identify new onset of respiratory symptoms in patients hospitalized for >72 h and in health care workers in medicine and pediatric wards at 3 public tertiary care hospitals in Bangladesh. During 46,273 patient-days of observation, we recorded 136 episodes of hospital-acquired respiratory disease, representing 1.7% of all patient hospital admissions; rates by ward ranged from 0.8 to 15.8 cases per 1000 patient-days at risk. We identified 22 clusters of respiratory disease, 3 of which included both patients and health care workers. Of 226 of heath care workers who worked on our surveillance wards, 61 (27%) experienced a respiratory illness during the study period. The cost of surveillance was US$43 per month per ward plus 30 min per day in data collection. Patients on these study wards frequently experienced hospital-acquired respiratory infections, including 1 in every 20 patients hospitalized for >72 h on 1 ward. The surveillance method was useful in calculating rates of hospital-acquired respiratory illness and could be used to enhance capacity to quickly detect outbreaks of respiratory disease in health care facilities where systems for outbreak detection are currently limited and to test interventions to reduce transmission of respiratory pathogens in resource-poor settings.

The effectiveness of stress and anxiety management interventions for adults diagnosed with cardiovascular disease in healthcare facilities: A systematic review

Objectives The overall objective of this review is to synthesise the best available evidence regarding the effectiveness of stress and anxiety management interventions in relieving stress and anxiety among adult patients diagnosed with cardiovascular disease in healthcare facilities. Question What is the effectiveness of stress and anxiety management interventions for adults diagnosed with cardiovascular disease in healthcare facilities? Inclusion Criteria Types of participants The review will consider studies with participants who; • are adult patients of any gender between 18- 65 years of age; • have been diagnosed with cardiovascular disease (namely; degenerative changes of the blood vessels, extraneous infections and congenital heart diseases) with no specifications to the stage or severity of the disease or presence of co-morbidities; and • are hospitalised/have regular visits at healthcare facilities, including hospitals and community based settings, such as; rehabilitation centres, nursing homes, outpatient clinics. Types of interventions The review will consider studies that examine any stress and anxiety management interventions that affect stress and anxiety levels among adult patients with cardiovascular disease. Studies can be either individual or group and unlimited to the number, duration, timing or intensity of the sessions. No preference is set on the type of personnel delivering the intervention or the presence of other co-interventions. Stress and anxiety management interventions include, but are not limited to, behavioural therapy, meditation and relaxation training. Types of outcomes This review will consider studies that quantitatively measured as outcomes the levels of stress and anxiety by any standardised measurements instruments/scales.

The effectiveness of stress and anxiety management interventions for adults diagnosed with cardiovascular disease in healthcare facilities: A systematic review

The effectiveness of stress and anxiety management interventions for adults diagnosed with cardiovascular disease in healthcare facilities: A systematic review

Nosocomial Infections Caused by Acinetobacter baumannii A Major Threat Worldwide

From the Unite des Rickettsies, Faculte de Medecine, Universite de la Mediterranee, Marseille, France (both authors). Received May 15, 2006; accepted May 15, 2006; electronically published June 23, 2006. Infect Control Hosp Epidemiol 2006; 27:645-646 2006 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2006/2707-0001$15.00. Currently, Acinetobacter baumannii is considered to be an important and emerging hospital-acquired pathogen worldwide. It is responsible for 2%-10% of all gram-negative bacterial infections in intensive care units in Europe and the United States. However, despite the importance of this organism as a public health problem, several shadow areas persist regarding its virulence, antimicrobial resistance, reservoirs, and epidemiology. Several articles published in this issue of ICHE shed some light on this fascinating bacterium. Some of the uncertainties surrounding A. baumannii are related to the fact that bacteria classified as members of the genus Acinetobacter have a long history of taxonomic changes, moving from the family Neisseriaceae to the family Moraxellaceae. Within the genus Acinetobacter, studies based on DNA-DNA hybridization have described 25 “genomic species” that fulfilled the criteria to be considered as distinct species, and 17 of these have officially been validated to date. This situation has led contributors to the Manual of Clinical Microbiology to state that the majority of the genomic species cannot be reliably distinguished by phenotypic tests. Despite that, and because of the difficulties in differentiating the isolates according to their phenotypic characteristics, the term Acinetobacter calcoaceticus–Acinetobacter baumannii complex is often used. It is important to note, and this may be a limitation of the studies we comment on in this editorial, that in 3 of the 4 studies, species identification was performed using phenotypic methods only, and the isolates were named either A. baumannii or A. baumannii-calcoaceticus. In the study in this issue of the journal by Griffith et al., ribotyping, which could have been used to identify the isolates, was used to compare the isolates but not to identify them, and the isolates were also classified as A. baumanniicalcoaceticus. One of the main concerns about A. baumannii is a characteristic that makes it a major threat to public health, namely, its remarkable ability to rapidly develop antibiotic resistance, mostly by acquisition of gene clusters carried by plasmids, transposons, or integrons, sometimes arranged in resistance islands within the genome. This phenomenon led to multidrug resistance in this species within a few decades. With the emergence of increasingly resistant strains, the management of A. baumannii infection has become a public health problem in many countries. To date, some strains of A. baumannii have become resistant to almost all currently available antibacterial agents, including carbapenems, which were once considered the drug of choice for treatment of A. baumannii infection. In this issue, Peleg et al. describe the frightening emergence of carbapenem resistance in A. baumannii isolates over a 3-year period in an Australian hospital, significantly linked to an increased used of meropenem. They demonstrated, by pulsed-field gel electrophoresis, the clonal origin of these multidrug-resistant strains, but they failed to identify the mechanism associated with carbapenem resistance. The latter point is of particular interest, because Peleg et al. screened strains for the presence of the genes for carbapenemhydrolyzing b-lactamases most commonly found in other countries. However, although Peleg et al. suggested that there may be a nonenzymatic mechanism of resistance or a new b-lactamase, they did not search all currently described genes coding for carbapenem-hydrolyzing b-lactamases. The identification of the mechanism involved in carbapenem resistance in this clonal population of A. baumannii should warrant further investigation to determine whether the bacterium has acquired a resistance gene that is spreading around the world or a gene “made in Australia.” Finally, this article by Peleg et al. emphasizes the risk of misuse of antibiotics, because of the extremely rapid emergence of antibiotic resistance in A. baumannii, and the consequent need for strict rules for prescription of carbapenems. In addition to its propensity to acquire antibiotic resistance, A. baumannii is feared for its ability to cause outbreaks of disease in healthcare facilities. Such outbreaks may take particular forms, such as those that involve multiple facilities. In France, the AYE strain, which produces an extended-spectrum b-lactamase, spread throughout 54 healthcare facilities in 8 administrative regions during an 11-month period. In their study, Fillaux et al. used pulsed-field gel electrophoresis to compare 1,277 A. baumannii strains, including 148 mul-

A hospital contingency plan for exotic communicable diseases.

The exotic communicable diseases are highly virulent, transmissible, conditions which occur most often in tropical areas. Since the late 1960s, there have been occasions when these diseases have been exported to the US and Canada. Advance planning will facilitate the care of patients infected with these diseases in health care facilities. Hospitals should develop a contingency plan which addresses the management of patients that present themselves to the emergency department as well as patients diagnosed after admission. The plan should address such topics as the isolation room, protective clothing, disinfection of the environment and equipment as well as the management of waste and handling of corpses. A well thought out plan will prevent subsequent transmission of infection to attending personnel, other patients and the surrounding community.