Ebola: Safely Managing Patients Infected with Highly Contagious Diseases

1. Introduction

Highly contagious diseases with epidemic potential require a coordinated, continuous response that involves all levels of government and partners internationally. Nurses working in different phases of an outbreak need to be knowledgeable, flexible, and prepared to adapt to ever-changing situations. Continuing education and training, along with comprehensive preparedness and readiness plans, are essential to protect both healthcare workers and the public. However, ongoing and continuous education and preparedness for Ebola and other highly contagious diseases are challenges that the healthcare system and nursing profession currently face.Highly contagious diseases like Ebola present unique challenges to nurses in the healthcare setting, as both the patients and healthcare workers are at risk of infection. Nurses, especially those who work in critical care units and emergency departments, play a key role in identifying, managing, and preventing the spread of Ebola. Successful containment of outbreaks and prevention of further transmission depend on early diagnosis, isolation of infected patients, appropriate infection control practices, and the use of personal protective equipment.Ebola is a rare and deadly disease caused by infection with one of the Ebola virus strains. It was first discovered near the Ebola River in 1976 in what is now the Democratic Republic of Congo. Since then, outbreaks have appeared sporadically in Africa. The 2014-2016 outbreak in West Africa was the largest Ebola outbreak since the virus was first discovered, with multiple countries affected. The outbreak was associated with more than 28,000 cases and over 11,000 deaths. Twelve cases of Ebola have been reported in the United States to date, with two of those being transmissions within the healthcare setting.The world has experienced several infectious disease outbreaks in the past, such as the Spanish flu in 1918, the severe acute respiratory syndrome (SARS) in 2003, the H1N1 influenza in 2009, and the Ebola outbreak in West Africa in 2014-2016. Safely managing patients infected with highly contagious diseases is of utmost importance to prevent the spread of infection within the healthcare facility and the community. This is especially crucial given the global nature of healthcare and the ease and frequency of international travel today.

1.1. Importance of Safely Managing Highly Contagious Diseases

First and foremost, safely managing highly contagious diseases like Ebola is important to minimize the risk of transmission, both for healthcare workers and other patients in the healthcare setting. Ebola is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. The Ebola virus is a member of a family of RNA viruses known as Filoviridae. These viruses exist as parasites of several organisms, including humans, and cause a number of hemorrhagic fevers. The Ebola virus is named after the Ebola River in the Democratic Republic of Congo (formerly Zaire), where one of the first recorded outbreaks occurred. Since then, there have been numerous outbreaks of Ebola in Africa. The first documented human case of Ebola virus was in 1976, and since that time, the virus has been a health threat in Africa. The natural reservoir host of the Ebola virus is not confirmed, but scientists believe that the virus is animal-borne and that bats are the most likely reservoir. In general, highly contagious diseases have the potential to cause sudden, widespread illness and death, and they can also cause a high degree of public fear and social disruption. Therefore, it is essential that there is a coordinated and well thought out plan for managing such diseases effectively. Severe acute respiratory syndrome (SARS), for example, led to considerable disruption to international air travel and business in 2003, and had serious economic implications for affected countries. Even more seriously, the “Black Death,” now known to be caused by the bacterium Yersinia pestis, killed an estimated 25 million people in Europe between 1347 and 1351 and had far-reaching social and economic effects. Highly contagious diseases like Ebola are transmitted through contact with blood or body fluids of a person who is sick with or has died from Ebola, or through exposure to contaminated objects, such as needles. Some highly contagious diseases may be airborne, transmitting through particles of moisture that are coughed or sneezed into the air. It is also possible for some diseases to be transmitted through the water or food supplies. Therefore, taking appropriate measures for safely managing such patients with highly contagious diseases is vital. Such measures help to control the spread of these diseases and minimize the risk of infections to both patients and healthcare workers. In addition, having appropriate procedures for managing patients with highly contagious diseases in place can give assurance to healthcare workers, who are the first line of response, and also avoid unnecessary panic among the public. Sudden outbreaks of highly contagious diseases can cause substantial stress and worry. People may worry about catching the disease for themselves or for their loved ones, what treatments are available or what will happen to their jobs or businesses. By having good plans in place for managing patients with highly contagious diseases and by effectively and appropriately implementing those plans, public fear and social disruption can be minimized.

1.2. Overview of Ebola Virus

The first symptoms of Ebola infection are very similar to those of many other infections, such as fever, muscle pain, headache, and sore throat. These early nonspecific symptoms, along with adequate knowledge of the transmission pathway, are believed to be important in the recognition and containment of potential outbreaks. These symptoms, however, are eventually overpowered by the later signs of severe damage to the vascular system, such as widespread bruising, bloody feces, vomiting blood, and spontaneous bleeding from various orifices. If the patient makes it past this critical stage and has a robust immune system, they can recover from the virus. Long-term complications of Ebola infection may include joint pain, muscle pain, and fatigue. However, the survival rate depends on the exact strain of Ebola virus and medical care. For some outbreaks, live rates have varied from 25% to 90%.The Ebola virus primarily targets the immune system and vascular system in the human body. After initial contact and entry into the body, the virus first invades local macrophages and dendritic cells, then travels within infected cells through the lymphatic system. The virus ultimately disrupts the vascular system and induces abnormal blood clotting, which can lead to a variety of bleeding disorders. In fact, it is the multifaceted damage to the vascular system which ultimately results in the severe and often fatal hemorrhagic fever that has made Ebola virus infections notorious. The cellular response to Ebola infection, known as “cytokine storm,” greatly enhances inflammation and vascular permeability, further adding to the lethal nature of the virus.The Ebola virus, named after the Ebola River in the Democratic Republic of Congo, where it was first detected in 1976, is a member of the family Filoviridae. There are five known Ebola virus species, four of which can cause disease in humans and the fifth in nonhuman primates. While the natural reservoir for Ebola virus remains unknown, it is believed that fruit bats are likely the hosts for the virus and that the infection is transmitted to humans and other animals through bat secretions. Upon infection, the virus can be secreted in many different body fluids, such as saliva, vomit, feces, sweat, and blood, and can be transmitted to others through direct contact with the skin or mucous membranes.

1.3. Challenges Faced by Nurses in Managing Ebola Patients

Nurses working with Ebola patients face many challenges. These challenges may encompass the provision of direct care and the structural, administrative, and cultural issues that are part of an outbreak response in a healthcare facility. Most significantly, the high mortality rates and the absence of a proven vaccine and a clear-cut treatment for Ebola may cause fear and extensive distress for nurses who are responsible for providing nursing care to the patients. Studies have identified that there is an existence of cognitive, emotional, and physical challenges experienced by the nurses. The cognitive challenges include high workload, situational awareness, and decision-making process in managing the safety of both nurses and the patients. Emotional challenges mainly refer to the psychological demand, anxiety, burnout, and stress due to the unpredictable disease trajectory and death of the patients while physical challenges are related to the adherence of the infection prevention and control practices and use of personal protective equipment (PPE) in the workplace. Also, maintaining a safe environment with high infectious agents such as the providing of adequate spacing from other patients, segregation or isolation plans, and the reduction in unnecessary transportation to other places can be challenging. This may entail the alteration of the healthcare customs of allowing visitations and the accommodation of patient’s preference on the comprehensive healthcare options. Nurses not only have to maintain the functional requirements in treating the patients but also to implement the structural changes. Mitigation strategies include more staffing and the training of healthcare workers to have a better understanding of the pathogen and the infection prevention. The ongoing Ebola weighs heavy on the nurses both mentally and physically. The continuous exposure to the trauma and suffering of the patients can lead to distress response and other types of psychological impacts on the nurses, not to mention potential stigmatization and shunning by the public. It is important for the nurses to have an additionally reinforced training on stress and emotional management during the outbreak of such high-risk infectious diseases. In essence, it is an educational and support intervention strategy which can aid in diabetes prevention and improve the holistic health in the safety work environment for the nurses. Also, empowering the nurses on the decision-making process and work safety confidence with more isolation on the structural overcome will promote a positive and healthy workforce when encountered with an infectious outbreak. Finally, with the increased involvement in the research profession and rapid advancements in the laboratory technologies, it aims to develop better treatments of Ebola and potential cures. Nonetheless, it is vital for the nurses to have a strong drive in the engagement of the academic opportunities to have a deeper understanding of biomedical research so as to equip themselves to face the challenges in dealing with such infectious diseases in the long run.

2. Personal Protective Equipment (PPE)

2.1. Importance of PPE in Ebola Management

2.2. Types of PPE Used by Nurses

2.3. Proper Donning and Doffing of PPE

3. Infection Prevention and Control Measures

3.1. Hand Hygiene Practices

3.2. Disinfection and Sterilization Procedures

3.3. Waste Management in Ebola Units

4. Patient Assessment and Monitoring

4.1. Initial Assessment of Ebola Patients

4.2. Vital Signs Monitoring

4.3. Symptom Management

5. Safe Patient Handling and Movement

5.1. Techniques for Safe Patient Transfers

5.2. Proper Use of Medical Equipment

5.3. Preventing Patient Falls

6. Communication and Collaboration

6.1. Effective Communication Strategies in Ebola Units

6.2. Interprofessional Collaboration in Managing Ebola Patients

6.3. Family and Community Engagement

7. Emotional and Psychological Support

7.1. Providing Emotional Support to Ebola Patients

7.2. Self-Care for Nurses in High-Stress Environments

7.3. Dealing with Stigma and Discrimination

8. Emergency Preparedness and Response

8.1. Disaster Planning for Ebola Outbreaks

8.2. Rapid Response Teams and Emergency Protocols

8.3. Lessons Learned from Previous Ebola Outbreaks

9. Training and Education

9.1. Ebola-specific Training for Nurses

9.2. Continuous Professional Development in Ebola Management

9.3. Simulation and Drills for Preparedness

10. Conclusion