Thursday February 23rd 2017

Lessons learned from the 2014 Ebola epidemic

The 2014 Ebola epidemic was the largest in history and affected several countries in West Africa. The human toll was significant; laboratory confirmed cases exceeded 12,000, and a total of 6,482 people lost their lives to the disease, as reported by the Centers for Disease Control and Prevention in 2015.

In fall 2014, the Ebola virus was diagnosed in Texas and New York after two individuals traveled to the United States from West Africa following exposure to the disease. Two RNs contracted the virus after providing care for the patient with Ebola in Texas.

The emergence of the Ebola virus in the U.S. sparked widespread media coverage and a national dialogue about preparedness and response. Hospitals across the U.S. began rapidly preparing for the potential treatment of patients with the Ebola virus. There was much confusion about proper protocol and the efficacy of existing federal guidelines. Challenges identified included insufficient personal protective equipment; lack of knowledge regarding donning and, in particular, doffing, PPE; ineffective procedures to remove gross contaminants; inadequate donning and doffing areas; and an overall lack of training and monitoring of health care professionals potentially exposed to the Ebola virus.

CDC guidelines and regional treatment centers

The CDC responded by continually updating guidelines to include enhanced training and demonstrated competence, the use of more protective PPE and trained observers to supervise donning and doffing. Further, CDC offered guidance on the monitoring and movement of people exposed to Ebola. In response to public concern about the transmission of Ebola, CDC created several infographics and flyers in multiple languages. (For the latest information, visit the CDC’s website:

In addition, the U.S. Department of Health and Human Services in collaboration with health care stakeholders created a regional response plan by selecting 55 hospitals designated as Ebola treatment centers and nine regional facilities designated as “bio-containment units,” where an individual at high risk of transmitting a highly communicable disease can be effectively isolated.

ANA’s response

The American Nurses Association and other professional associations were important partners in this effort. ANA collaborated with many stakeholders including the CDC, ANA’s constituent and state nurses associations and organizational affiliates, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, the American Medical Association and others to ensure open channels of communication and dissemination of science-based information regarding Ebola. ANA also facilitated several just-in-time webinars attended by thousands of RNs, created an Ebola website to provide nurses with daily updates and critical clinical information related to appropriate use of PPE and more, and remained in communication with CDC throughout the duration of the outbreak.

Moving forward

Lessons learned from the Ebola epidemic were immediate and hard-hitting. The epidemic highlighted the importance of vigilance and the need to continuously improve infection prevention and control. Effective collaboration among federal and state agencies and nongovernmental organizations that work on public health, disease and infection prevention and control to solve problems and develop solutions demonstrated the importance of such relationships in creating significant and lasting change for the better.

To leverage lessons learned and continue working on infection control in the U.S., ANA and APIC have established a collaborative workgroup that is exploring issues and opportunities to develop evidence-based education to promote best infection prevention and control practices for nurses and other clinicians across the spectrum of care. ANA is also engaging in work with the CDC to ensure that nursing’s voice is heard as CDC continues to develop and revise guidelines, training and education materials.

— Jaime Murphy Dawson is senior policy advisor and
Holly Carpenter is policy associate in Nursing Practice
and Work Environment at ANA.


ANA’s Ebola Resources webpage:

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