Wednesday, November 19, 2014

Protecting the hospital

                                                  Me in full PPE, it gets pretty steamy inside

Connaught is the largest hospital in Sierra Leone and houses a nursing college and the only medical school. Whilst Ebola might be the word on everyones’ lips it doesn’t mean that all the other illnesses have gone away, far from it. It’s not practical for everyone in the hosptial to wear full PPE the entire time so it's vital to screen and isolate any patient who might have Ebola before they get to the rest of the hospital. This is where the isolation unit comes in.

Every patient attending the hospital for any reason at all is now screened by dedicated team just outside the main gates. Screening is based on basic symtoms, measurement of fever and history of contact with known or suspected Ebola cases. To protect hospital staff screening must pick up 100% of Ebola cases but many other illnesses share symptoms so many non-Ebola patients also screen positive. Perhaps a third of patients admitted to the isolation ward test negative for Ebola.

The screening tent outside the hospital gates
This creates 2 problems, the obvious one is that negative and positive patients must share a ward. While great care is taken to prevent cross infection,  a small risk must still remain. The second is that negative patients might not get treatment for  their actual problem. It isn’t possible to do routine blood tests or X-rays because of exposure risks so we are often left in the dark. All patients are treated for malaria and common bacterial infections which hopefully covers some of the bases but clearly not all. The result is that a knock on effect of the Ebola epidemic is that peope with unrelated illnesses are also suffering, partly because the hospital is not running at full steam but also because of the need to protect the hospital staff by isolating them in a ward that cannot provide all the care they need.

This scenario makes the turn around time for Ebola tests absolutely critical. These issues would evapourate if there was a point of care test giving results in a few minutes or even hours. As it stands however, test results take between 1 and 7 days to come back and improving this is a high priority. If point of care testing became a reality there would be no need for an isolation ward at all as patients could immediately be directed to the hospital itself or a self contained Ebola treatment centre.

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