Page 162 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

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(12). We conclude that the multisectoral approach for EVD preparedness has been experienced widely.
Although the likelihood for patients with actual EVD in the Netherlands was considered low, first responders were occasionally confronted with patients with potential EVD. While the CID was consulted on 96 patients with potential EVD, this number is likely higher at regional level. As every first responder could be confronted with a potential EVD patient, given the nonspecific symptoms in the early stage of illness and number of travellers to Ebola endemic areas visit- ing relatives and friends, the CID developed additional triage standards for early detection for first responders. The CID also stimulated regional coordination for referral and isolation procedures (3, 6, 13). We conclude that in the Netherlands the intensity of preparedness for EVD was at a high level. Nevertheless, the high mortality rate and risk of contamination by contact with symptomatic patients triggered fear amongst first responders. This finding was reflected in the results of the focus groups’ sessions, in which the need for more extensive and explicit guidelines was emphasized, especially regarding the type and use of PPE and specific referral procedures.
In October 2014, the decision was made to centralize prolonged care of EVD patients in 4 of 8 academic hospitals, in line with other countries (14, 15). The anticipated lower burden of preparedness for the 4 not selected hospitals was not achieved, as they all still needed to be able to assess, isolate, and per- form laboratory testing of suspected patients. Further centralization, including patient assessments, must be explored.
Participants requested national and interorganizational standardization of type and use of PPE. While national guidelines provided minimum standards, during the course of the Ebola epidemic, several hospitals increased the safety level of PPE. Health care workers did not feel safe when other institutes installed higher PPE standards. In the United Kingdom, it was also observed that clinical staff preferred to use higher levels of PPE than recommended in the guidelines of the Advisory Committee on Dangerous Pathogens (7). Although it is difficult to monitor the implementation of PPE guidelines, the CID can facilitate better exchange of best practices.
The timeliness of detection and referral of potential EVD patients varied. None of them fully complied with the case definition of a probable case when strictly applying the clinical, epidemiological, and high-risk exposure criteria (3). Only 1 patient had high exposure contact with a patient with confirmed EVD. Absence of high-risk exposure influences the sense of urgency among patient and physician, affecting the delay between first date of illness and CID consul-