Insight, best practice and strategic vision for infection prevention and control in high-level isolation units

A multi country collaboration of experts from across Europe promises improved hospital preparedness and response to high-consequence infectious diseases (HCID) with recommendations to strengthen clinical and biorisk management.

A map has been published of 47 high-level isolation units (HLIU) across 16 European countries where HCID patients will be attended.  The D10.1 Report identified good practices and the adequate facilities essential for the care of EVD patients. These facilities needed to be well-equipped to manage the disease and practices that prevent its spread to healthcare workers and other patients. However, gaps and inconsistencies in adequate Healthcare associated infections (HAI) capabilities and systems existed.  This scenario reduces the preparedness of EU member states for managing cross-border high-consequence infectious diseases (HCIDs).

The review also surveyed HLIU managers which disclosed challenges in patient management to both clinicians and infection prevention and control (IPC) personnel. This was primarily due to the lack of prior experience with highly infectious and deadly disease. 

This insight, plus familiarity with the guidance issued by different ministries of health across Europe, plus international bodies (especially ECDC, CDC and WHO) have enabled recommendations on a syndrome-based approach (D10.3).  This crystalises a syndromic-based operational protocol for patient management in the emergency room with a  practical pathway that can aid health workers to improve clinical and biorisk management, hospital preparedness and response to HCIDs.

The publication covers guidance for early detection and timely clinical management, comprising  identification of priority risks, surveillance of the exposure, definitions of different responsibilities and duties, a flowchart describing of appropriate response activities, and a checklist for procurement of the necessary supplies for HCID.   

This protocol has the flexibility for public health planners to apply to autochthonous (native to the area) or imported (i.e. transmitted by people entering an area) HCIDs in hospital emergency departments or other front-line health services.  It could also be adapted to situations such as a terrorist attack with a biological agent. 

The future?  A formal network of European clinicians with expertise in high consequence infectious diseases

The insight on current facilities and the introduction of a practical response pathway can be further strengthened by European-wide clinicians with expertise in high consequence infectious. 

A feasibility study makes the case for an expert clinical support service for high consequence infectious diseases (D10.2).  It considers the importance of shared expertise to guide others in providing care and implementing infection control measures.

The paper calls for the EU support for:

1. a formal network of European clinicians with expertise in high consequence infectious diseases be established

2. a digital platform meeting defined technical and legal criteria be made available to the network

3. the network be funded by the EU.

Improving clinical and biorisk management, as well as enhancing hospital preparedness and response to HCID within the EU, requires a multifaceted approach.

Given the potential impact of these HCID scenarios, and significant costs to society and healthcare systems, establishing a comprehensive plan of action is imperative. By implementing these recommendations and strategies, EU member states can significantly improve their preparedness and response capacities for managing high-consequence infectious diseases, thereby reducing the potential public health impact and enhancing overall infection prevention and control measures.

SHARP Joint Action work package 10 provides a structured approach for hospital preparedness and response to high-consequence infectious diseases (HCID) that can be followed to address the challenges.  The recommendations are justified as a priority in the joint action’s D4.2-Sustainability-report (PDF 609KB) and the proposals are included in a policy briefing D2.3 aimed at stimulating discussion and action at operational, national and regional policy level.

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