Material Educativo

Outbreak Preparedness and Response: The Essentials

EXECUTIVE SUMMARY

In any disaster or other crisis, how you react depends largely on how well prepared you are. Over the years, ECRI
has witnessed a number of catastrophic events—such as outbreaks of severe acute respiratory syndrome (SARS)
and Ebola—and has learned lessons that are pertinent for dealing for current crises such as the COVID-19
coronavirus outbreak that is happening now, in early 2020. While no two emergencies are the same, we can gain
vital insights from previous events.

In a crisis, normal processes must often be modified to ensure that the best possible care is provided while
ensuring the safety of patients and personnel despite limited resources. We have collected many ECRI
publications that include preparation checklists, patient handling checklists, equipment lists, lists of alternative
suppliers, recommendations for patient care equipment such as ventilators, and recommendations for infection
control.

In keeping with its mission to advance effective, evidence-based healthcare globally, ECRI is making this
compendium of resources freely available to the public—no membership or other payment is required to access
it.

TABLE OF CONTENTS

COVID-19: Interim Guidance from CDC
– Lessons from SARS
– Lessons from Ebola
– Equipment Needs
– Respiratory Equipment
– Alternative Suppliers
– Cleaning and Disinfection
– IT Concerns
– Other ECRI Emergency Preparedness Resources
– Relevant Essentials Pages for ECRI Members

COVID-19: INTERIM GUIDANCE FROM CDC

The U.S. Centers for Disease Control and Prevention (CDC) has issued Interim Infection Prevention and Control
Recommendations to address the COVID-19 coronavirus outbreak. CDC specifies that its “cautious approach will be
refined and updated as more information becomes available and as response needs change in the United States.”

LESSONS FROM SARS

Like the current (early 2020) COVID-19 outbreak, the 2003 epidemic of severe acute respiratory syndrome (SARS)
was a public health crisis worldwide, causing hundreds of deaths. Dealing with that outbreak provided vital lessons
in how hospitals should protect against, and cope with, disasters involving airborne pathogens.
Preparation Is the Best Protection
Learn what part the healthcare facility, its surrounding community, clinicians, and facilities and clinical engineering
staff can play in preparing for an outbreak.
Protecting against Infectious Disease Transmission during Equipment Maintenance
This article provides guidance for clinical engineering, respiratory therapy, and other personnel involved in
maintaining potentially SARS-exposed equipment.
Mechanical Ventilation of SARS Patients
ECRI recommends that breathing-circuit filters be incorporated in the exhalation limb of any ventilator used on a
patient with SARS, since the virus can be carried by droplets that exit from the limb. In this article, we review the
issues behind our recommendations and describe steps hospitals can take to prevent any adverse effects on
ventilation.
Selecting Respiratory Protection for Equipment Servicers and Other Hospital Personnel
This article addresses the advantages and limitations of the N95 respirator for respiratory protection against
infectious diseases and offers recommendations for further protection.

LESSONS FROM EBOLA
In 2014 and 2015, an outbreak of the Ebola virus spread from Guinea to seven more countries, killing over 10,000
people. ECRI’s Ebola-related publications at that time placed a heavy emphasis on preparedness.
Ebola Preparedness Survey: Results and Commentary
Here are responses to our survey asking hospitals to assess the status of their Ebola preparedness planning. Find
out what challenges facilities have encountered in selecting equipment that might be needed to treat an Ebola
patient.
Webinar: Ebola: Medical Device and Personal Protective Equipment Preparedness
With so much for hospitals to manage related to Ebola preparedness, efforts to manage the details of technology
may get lost in the shuffle. This 90-minute interactive webinar, which took place in December 2014, gave an
overview of Ebola equipment preparedness.
Checklist: Equipment-Related Preparedness for Ebola
If your hospital has to treat patients with Ebola, there are a host of equipment-related issues to address to keep
your staff and patients safe. Here’s a look at the most important ones.

EQUIPMENT NEEDS
In any disease outbreak or other public health crisis, a key need is for equipment to defend staff and patients
against infections and to help affected individuals breathe. Here are resources that help explain which devices to
use and provide alternative sources for such equipment in times of shortage.

Respiratory Equipment
Automatic Gas-Powered Resuscitators: What Is Their Role in Mass Critical Care?
Although automatic gas-powered resuscitators may seem like a wise choice for ventilating patients in mass critical
care scenarios, ECRI recommends against stockpiling the devices for this purpose. Find out why in our Evaluation.
Evaluation: Portable/Transport Ventilators
Today’s portable ventilators often have advanced features rivaling full-size units. But sometimes a simpler design is
better. This article will help you find a model that meets your needs.
MaxAir CAPR System (Syntech International) for Preventing Infectious Agent Transmission
The MaxAir CAPR (Controlled Air-Purifying Respirator) System is a loose-fit, powered air-purifying respirator (PAPR)
intended to be worn (e.g., by healthcare workers) to prevent transmission of infectious agents (e.g., anthrax,
bacterial meningitis, influenza, tuberculosis) to patients or medical staff.

Alternative Suppliers
As the number of patients diagnosed with COVID-19 rises rapidly, hospitals in the hardest-hit areas of China are
looking for alternate suppliers of certain personal protective equipment (PPE), such as goggles, masks, and gowns.
Although it was mandated after the SARS outbreak in 2012 that facilities have adequate supplies of items such as
these on hand for an infectious outbreak, in reality there seems to be a shortage.
The following are comprehensive directories of go-to sources to supplement the usual suppliers.
Alternate Supplier List: Personal Protective Equipment—Organized by equipment type: respirators, shoe covers,
masks, etc.
Emergency Preparedness Device List—Organized according to ECRI’s Universal Medical Device Nomenclature
System (UMDNS) device terms.

CLEANING AND DISINFECTION
Disinfectant Concentrations and Contact Times for EPA’s List of Products Effective against Novel
Coronavirus SARS-CoV-2, the Cause of COVID-19

This table lists disinfectant concentrations and contact times for EPA’s List N, which covers antimicrobial products
effective against novel coronavirus SARS-CoV-2. This will help you ensure you’re using an effective disinfectant at a
sufficient concentration and contact time to kill SARS-CoV-2, the cause of COVID-19.

IT CONCERNS
Management Checklist for Teleworking Surge During COVID-19 Response (may not display properly in
Internet Explorer)
A checklist and related resources from the Healthcare and Public Health Sector Coordinating Council intended to
ensure that bandwidth and cybersecurity needs are met during a teleworking surge resulting from wide-scale public
emergencies such as COVID-19.

OTHER ECRI EMERGENCY PREPAREDNESS RESOURCES

Coronavirus Outbreak Preparedness Center
A collection of infection control and outbreak preparedness resources for hospitals and healthcare providers.
Emergency Preparedness: Planning and Mitigation
Emergency preparedness includes planning, preparation, mitigation, response, and recovery. This guidance article
discusses planning and mitigation. Organizations should take an all-hazards approach to planning for facility- and
community-based natural and human-made disasters. Participation in annual community-based drill exercises is
mandatory.

RELEVANT ESSENTIALS PAGES FOR ECRI MEMBERS
The following resources are available to ECRI members and provide Evaluations and Guidance on respiratory care
and infection control. They are just two of many Essentials pages linking to a vast array of ECRI product
Evaluations, safety guidance, and purchasing advice. Members of certain ECRI programs have access to all of our
Essentials pages and the content they provide.
Infection Reduction Technologies: The Essentials
This is a collection of resources on devices and systems designed to reduce healthcare-associated infections,
including product Evaluations and ratings, purchasing guidance, and safety information.
Ventilators: The Essentials
This is a collection of resources on ventilators, including product Evaluations and ratings, selection and purchasing
guidance, safety information, and help in understanding the technology.

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