Ebola first arrived stateside last September, the Centers for Disease
Control and Prevention and the Department of Health and Human Services
launched a nationwide initiative to combat the virus at home — an
effort that included increasing the number of U.S. facilities
qualified to contain and treat Ebola from three to 51 and developing
countermeasures, like the first Ebola vaccine to progress to Phase 2
testing, to prevent and treat the virus. Domestic preparedness became
(and continues to remain) a top priority.
But how exactly
do these efforts trickle down to the local level? Is the Milwaukee
health care community prepared to handle a major outbreak? The last
epidemic to hit Cream City was 22 years ago — in 1993, when two
of the city’s water treatment plants became contaminated with
cryptosporidium. The parasitic disease infected more than 400,000
people, causing nearly 70 deaths. A 1994 report issued by the CDC
pronounced it the largest waterborne outbreak in U.S. history. And
what’s even more frightening? The cause of the contamination was
there is good news. Significant progress has been made locally over
the last two decades regarding disease control and prevention. All
parties, from private health care physicians to public health
officials, recognize that medical technology can only extend its reach
so far; staff training and education and the effective dissemination
of critical information are crucial to ensuring patient, public and
caregiver safety. Read on to learn just how prepared Milwaukee is to
handle a major outbreak.
Like many local
health care systems, Aurora Health Care employs infection
preventionists at each of its hospitals and outpatient clinics. Many
are nurses or have a microbiology background. "They do daily
surveillance — what are they seeing? How do we prevent them
(outbreaks)?" says Dr. Angela Tonozzi, director of infection
prevention for Aurora Health Care. "They also receive the alerts
to prevent a communicable disease outbreak." These alerts are
usually issued by the CDC or the state health department, and their
purpose is to keep the disease and the possibility of a subsequent
outbreak top of mind.
important is being aware of what is happening at the global level.
"What you see happening within our area is that we’re always on
the lookout for what’s happening at the local level, at the state
level, at the national level, and at the global level regarding
communicable diseases," says Tonozzi. "It’s important to
be aware of what’s going on and to anticipate and diagnose
director of disease control and environmental health for the City of
Milwaukee Health Department, says there are currently five influenza
candidates circulating in the world. "There are a number of small
clusters of influenza that we follow very closely globally," he
danger, says Biedrzycki, lies in their ease of transmissibility. The
global economy, which often demands frequent international travel, and
the abundance of air travel enhance the mobility of these viruses, and
many go undetected and unnoticed before becoming communicable. A
proactive and informed approach to global health is crucial. "We
need to be aware of disease emergence and surprise clusters of
outbreaks at the source and then engage the public in isolation or
quarantine," adds Biedrzycki.
Dr. Rita Hanson,
chief medical officer for Wheaton Franciscan Healthcare, oversees
patient safety and emergency preparedness for the health care system,
and she says routine preventative tactics, including wearing gowns and
gloves, are effective in dealing with less severe outbreaks like
influenza or measles. "With the exception of Ebola, all of the
things that we do routinely — the universal precautions for
protecting the staff and the public — are sufficient in protecting
people," she explains. "But with Ebola, the universal
precautions are insufficient. That’s what made it such a big thing,
plus the mortality of the virus. That combination of factors was
pretty unique, and in that instance, universal precautions and our
usual things would not get the job done."
guidelines are disseminated from the CDC or health departments,
Tonozzi and her team draft them into a usable document and strategize
how to put them into practice. "We as a group take those
guidelines and say, ‘How would this affect patients and caregivers?
How do we prepare and how do we protect safely?’" she explains.
"The main thing that you try to do when you get these types of
information is getting the right people at the table to flush through
the information, disseminate the information, and then practice.
Translating those guidelines into practice requires the best people to
Wheaton’s approach to preparing for an Ebola outbreak involved a
thorough risk analysis assessment. "Our approach — and I think
this is consistent with our colleagues — was to do a risk analysis
based on the nature of different roles and the likelihood of it
(Ebola) coming into contact," she says. "Our training
focused on: What is your role? And what is the risk to you as a
person? And what kind of training do you need in the context of your
role to contain and to protect yourself? We thought about all the
points of entry into our system and the people that would be there,
and we tailored education at that level."
assistant, for example, would need to be able to recognize the illness
but have little to no patient contact, so extensive response training
was unnecessary. Those engaged in direct patient care and therefore
exposed to a high-risk illness like Ebola, however, received much more
comprehensive training. "The number of people trained is pretty
small," Hanson adds. "This decreases the number of people
exposed, and the training is better and more concentrated."
the Medical College of Wisconsin’s designation as the only adult
Level 1 Trauma Center in eastern Wisconsin solidifed its status as
Milwaukee’s go-to hospital for Ebola cases last fall. A "Level
1" classification means the facility meets strict national
standards and is equipped to provide the highest level of specialty
expertise in the event of a trauma. Interestingly enough, Froedtert
even started preparing for an outbreak before the virus officially
(Ebola) hit the national news as an event, we received a call that a
traveler who was aggressively providing care (in West Africa)
identified Froedtert as a resource hospital if this person were to
become ill," recalls Susan Huerta, VP of quality, patient safety
& performance improvement at Froedtert & the Medical College
of Wisconsin. She says the system immediately went on high alert.
"As an academic medical center, we not only back up community
hospitals, but we have a commitment to our patient base to treat the
more unusual things they may experience." Once the first Ebola
case was later confirmed in Dallas, the system developed a more
sophisticated approach, involving the entire organization and its
Such an effort
requires the coordination of numerous individuals, from administrators
and physicians to public relations officials and emergency medical
technicians, and effective communication between all parties is
imperative. Tonozzi says it best: "Communicate, communicate,
communicate." Targeted informational brochures and materials are
dispersed to their intended audiences, approaches to care and
procedural rationals are communicated, and appropriate signage is
displayed throughout hospitals and clinics.
In the case of
Ebola, webinars carrying the same message were available to all health
care systems. Hanson was especially impressed by how the CDC and
health departments disseminated consistent information, ensuring all
systems were readily prepared and responding in sync. "There was
a great deal of effort to ensure we were up to date and to standardize
on what the guidelines were," she says.
Froedtert & the Medical College of Wisconsin made a concerted
effort to remain scientific in their approach. "Information, in
this case, was absolutely powerful in helping people work through what
was scary national press," she explains. "We sifted through
what made scientific sense — Is this based on science or is this
based on public opinion? I believe our staff, at the end of the day,
appreciated the fact that we stuck with science."
agrees that communication is key, but tailors his department’s
efforts from a public health standpoint. "We’re looking across
the board — at the entire population, including those that are
under-insured or not insured. Those individuals are typically not seen
by private health care individuals," he explains. His department
concentrates on actionable risk messaging, which builds public
awareness and engages the public in prevention. He cites "wash
your hands," "get a vaccination" and "take your
antibiotics" as examples.
In addition to
pharmaceutical-based messaging, Biedrzycki says non-pharmaceutical
efforts are just as important. His department practices a model of
voluntary compliance. "We tell people to quarantine themselves,
isolate themselves or observe good hygiene," he says.
"Mandatory (compliance) is impractical. We expect people to do
the right thing for the benefit of the community. It’s not about you
getting sick, it’s about you affecting others that might get very
Despite the fact
that many local health care systems compete with each other, their
primary goal is the same — to keep everyone safe. "It was
wonderful to see how well we collaborated because we’re all trying
to maintain that same patient and caregiver safety," says Tonozzi,
referring to how the systems banded together last fall to prepare for
a possible Ebola outbreak.
the nature of Ebola and how it might affect the community, for us to
be effective required an unusual level of cooperation and coordination
between the systems and administrators," adds Hanson. "Until
something happens, you don’t know how it’s going to play out. I
think we all felt gratified by the natural, immediate partnership
formed between the community systems and national and state health
to be impressed with the collaboration," says Huerta of the
relationship between public and private health care. "I think it’s
important to continue that. This (Ebola) is one infection, but there
are outbreaks every year. I think we formed some relationships that
will serve us well in the future."
formed between public and private health is not an entirely new
phenomenon, but one that’s improved significantly. "This
public/private health care relationship was jump-started by
9/11," says Biedrzycki, referring to the 2001 anthrax attacks.
"It was a defining moment for public health awareness."
(the early detection of disease in the community) is one example of
this partnership at work. "Since we’re a small organization, we
rely on the sublines of private health care through information
exchange and sharing to enhance our biosurveillance," explains
Biedrzycki. Private health care systems report what types of diseases
are circulating, lab diagnostics and results, and suspicious activity
or unusual clusters.
Electronic Disease Surveillance System (WEDSS) was designed to
facilitate this process. A web-based reporting system, WEDSS allows
clinicians, labs and state and local health departments to report,
record and analyze diseases and trend them. "(WEDSS) helps us in
understanding what diseases are prevalent and what diseases are
increasing and decreasing over time," says Biedrzycki. Strategy
and intervention can then be developed accordingly.
This exchange of
information also assists in practicing syndromic surveillance, which
involves analyzing symptoms of diseases before they occur. For
example, when crypto hit Milwaukee in 1993, anti-diarrheal medications
had been flying off the shelves for weeks. "Now, I can assure you
that if there’s a run toward any kind of medication in this
community, we’ll know about it," says Biedrzycki.
especially pivotal in changing the relationship between public and
private health care, says Biedrzycki. "It sent us on a trajectory
to improve infection control practices in both private health care and
in the community in a way that I’ve never seen in my 30 years."
mobility demanded a need for entry and exit screenings at airports,
requiring a new level of cooperation between airport staff, health
care professionals and third-party technology providers. "That
created a new model of infectious disease screening and created new
protocols for infectious control," Biedrzycki explains. "In
one short year, we’ve advanced this country. Ebola had a payoff in a
the pathways will stand up quickly in the future," says Huerta of
the virus’ impact on emergency preparedness and infection
prevention. "We’re in it for the long haul, for whatever comes
up next. The commitment to our patient population is very, very
Wisconsin Healthcare Emergency Readiness Coalition Inc.
Wisconsin Healthcare Emergency Readiness Coalition Inc. was
established to build a regional and diverse approach to health care.
The coalition covers nine Wisconsin counties and involves a variety of
health care professionals, from private and public health
administrators to animal health physicians.
sits on the organization’s board, says HERC hosted two summits
within the past year regarding Ebola and emergency preparedness. Each
summit featured a panel discussion that allowed attendees to speak
openly and honestly about the possibility of an outbreak. "I
would have to say that Milwaukee kind of took the bull by the horns,
if you will, with appropriate fear. This was not cavalier," says
Huerta of HERC’s responsive effort.
one mission of public health is to enhance community resilience, an
initiative he says has made considerable progress over the last five
years. "We have to engage communities to take responsibility and
control," he says. "Public health is not just a
He says public
health departments are there to "connect the dots," but all
institutions, from citizens and families to Corporate America, must
work together. "If you keep a community healthy economically and
socially, you have a much better chance of reducing illness and death.
The resources will flow, and the people will pull together,"
explains Biedrzycki. "That’s been the new thinking about how to
approach any type of preparedness."
is the innovators, the doers, the people that can build this community
resiliency," he stresses. "We’re trying to engage the
community and work with them to develop sustainable health models for