HIGH CONSEQUENCE INFECTIOUS DISEASE:
WHAT NURSES NEED TO KNOW By Toby Hatton, MA, RN, BSN, BS, CHSP and Ellen Martin, PhD, RN, CPHQ
NURSES AT THE SHARP END of healthcare are at increased risk during an infectious disease outbreak. As we learned during the Ebola outbreak three years ago, the stakes are highest when the infectious disease is lethal. High consequence infectious diseases (HCID) are defined by the Centers for Disease Control and Prevention (CDC) as those diseases that have epidemic or pandemic potential, have the potential to spread rapidly through a population, or have a high mortality rate. The Texas Department of State Health Services (DSHS) defines HCID as diseases that: “presents an immediate threat, poses a high risk of death or serious long-term disability to a large number of people; and creates a substantial risk of public exposure because of the disease’s high level of contagion or the method by which the disease is transmitted.” This definition is closely tied to the Texas Health and Safety Code definition of a public health disaster.
HCID PREPAREDNESS The potential severity of HCID makes preparedness and response planning a vital public health priority with significant policy implications at the federal, state,
The federal priority is mitigating the effects of HCID through training, preparedness, response, investigation, monitoring, and controlling so that a constant state of readiness exists within both public health and healthcare delivery systems. health system, and facility level. The federal priority is mitigating the effects of HCID through training, preparedness, response, investigation, monitoring, and controlling so that a constant state of readiness exists within both public health and healthcare delivery systems. In response to the Ebola outbreak in 2014, Texas received $13.3 M in new state funds and $15.5 M in one-time federal funding to support high consequence infectious disease projects. The Texas Department of State Health Services and the Health and Human Services Commission address HCID in their strategic plans. The two main priorities are to develop and sustain an HCID response system and build an infrastructure within the existing healthcare delivery system of hospitals and Emergency Medical Services (EMS) to ensure facilities and healthcare providers are prepared to safely transport and treat patients with HCID.
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Hospital priorities include development of internal processes and procedures so that staff can safely receive and treat patients with HCID. Nurses will provide direct care to the patient with a HCID until they can be safely transferred to a CDCapproved HCID Treatment Center. From a public health perspective, collaboration is the priority as all entities work together to build a stronger and better prepared community. This includes providing education, monitoring, and supporting the HCID response. The CDC and Center for Health Security at the Johns Hopkins Bloomberg School of Public Health have developed resources including a health sector resilience checklist to help support public health preparedness and response efforts.
HCID RESPONSE In Texas, we have a system of disaster responders known as the Emergency Medical Task Force (EMTF). The EMTF is broken