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HHS Sponsors Largest Exercise for Moving Infectious-Disease Patients

The ability to move patients who are living with highly infectious diseases safely and securely to regional treatment centers was put to the test April 10-12, when the United States Department of Health & Human Services (HHS) hosted its largest patient-movement exercise in its history.

“Saving lives during crises requires preparation and training,” said Robert Kadlec, MD, HHS assistant secretary for preparedness and response. “A tremendous amount of coordination, synchronization, and skill is needed to move patients with highly infectious diseases safely. We have to protect the patients and the healthcare workers caring for those patients. This type of exercise helps ensure that everyone involved is ready for that level of complexity.” 

Coordinated by the HHS’ Office of the Assistant Secretary for Preparedness and Response, more than 50 organizations participated in the exercise, including the Department of State, Department of Transportation, designated regional Ebola treatment centers, local and state health and emergency management agencies, hospitals, airport authorities, and non-government organizations. Throughout the exercise, participants reacted as if the incident was real and were required to take the necessary actions while employing the appropriate resources to manage and protect the patients, the workforce, and the environment, according to HHS officials. 

The exercise focused on moving seven people acting as patients with Ebola symptoms in different regions of the country. The patients, including one pediatric patient, first presented themselves at one of the following healthcare facilities: CHI (Catholic Health Initiatives) St. Luke’s Health-The Woodlands Hospital, The Woodlands, TX; Medical University of South Carolina, Charleston; Norman (OK) Regional Hospital; St. Alphonsus Regional Medical Center, Boise, ID; and St. Luke’s Regional Medical Center, Boise. At each facility, healthcare workers collected and shipped samples for diagnostic tests to state laboratories, which in turn practiced running the necessary lab tests to diagnose the patients with Ebola. 

As part of the exercise, each patient received a positive diagnosis. Using appropriate isolation techniques and personal protective equipment, healthcare workers then took steps to have six of the patients transported by air to designated Ebola treatment centers. The treatment centers receiving the patients were Cedars-Sinai Medical Center, Los Angeles, CA; Emory University Hospital, Atlanta, GA; Providence Sacred Heart Medical Center, Spokane, WA; and University of Texas Medical Branch, Galveston. The pediatric patient was transported to Texas Children’s Hospital West Campus, Houston. The participating airports were Boise Airport, Charleston International Airport, DeKalb-Peachtree Airport in Atlanta, Ellington Field Airport in Houston, Los Angeles International Airport, Spokane International Airport, and Will Rogers World Airport in Oklahoma City, OK. 

Upon arrival, local emergency responders transferred the patients to ground ambulances for transportation from the airports to the treatment centers. HHS officials and the Department of State also previously collaborated on exercises to move Americans acting as Ebola patients from West African countries to Ebola treatment centers in the U.S. (In public health emergencies or disasters, the U.S. government orchestrates the return of Americans to the country, including Americans who are sick or injured.) Participants then gathered April 13 to assess the exercise, compare actions across the country, and share best practices for moving patients with highly infectious diseases, according to HHS officials. ■

CDC Says Unusual Antibiotic-Resistant Germs Widespread in U.S.

Health departments working with the Center for Disease Control and Prevention’s (CDC’s) Antibiotic Resistance Lab Network have found more than 220 instances of germs with “unusual” antibiotic resistance genes in the United States last year, according to CDC officials.

Germs with unusual resistance include those that cannot be killed by all or most antibiotics, are uncommon in a geographic area of the U.S., or have specific genes that allow them to spread their resistance to other germs. Rapid identification of the new or rare threats is the critical first step in the CDC’s containment strategy to stop the spread of antibiotic resistance. When a germ with unusual resistance is detected, facilities can quickly isolate patients and begin aggressive infection control and screening actions to discover, reduce, and stop transmission to others, officials said.

“[The] CDC’s study found several dangerous pathogens, hiding in plain sight, that can cause infections that are difficult or impossible to treat,” said Anne Schuchat, MD, CDC principal deputy director. “It’s reassuring to see that state and local experts, using our containment strategy, identified and stopped these resistant bacteria before they had the opportunity to spread.”

The CDC containment strategy calls for rapid identification of resistance, infection control assessments, testing patients without symptoms who may carry and spread the germ, and continued infection control assessments until spread is stopped, officials said. The strategy requires a coordinated response among healthcare facilities, labs, health departments, and the CDC through the Antibiotic Resistance Lab Network. Health departments using the approach have conducted infection control assessments and colonization screenings within 48 hours of finding unusual resistance and have reported no further transmission during follow-up over several weeks, according to officials. The strategy complements foundational CDC efforts, including improving antibiotic use and preventing new infections, and builds on existing detection and response infrastructure. New data suggest that the containment strategy can prevent thousands of difficult-to-treat or potentially untreatable infections, including high-priority threats such as Candida auris and carbapenem-resistant Enterobacteriaceae (CRE). 

Germs will continuously find ways to resist new and existing antibiotics; stopping new resistance from developing is not currently possible, according to CDC officials. Recent, nationwide infrastructure investments in laboratories, infection control, and response are enabling tailored, rapid, and aggressive investigations to keep resistance from spreading in healthcare settings.

Other study findings showed that one in four germ samples sent to the labs for testing had special genes that allow them to spread their resistance to other germs. 

Further investigation in facilities with unusual resistance revealed that about one in 10 screening tests, from patients without symptoms, identified a hard-to-treat germ that spreads easily, and the germ could have spread undetected in that healthcare facility, officials said.

For CRE alone, estimates show that the containment strategy would prevent as many as 1,600 new infections in three years in a single state — a 76% reduction. Visit www.cdc.gov/vitalsigns/containing-unusual-resistance to learn more about the containment strategy. ■