REDCap for Biocontainment Worker Symptom Monitoring
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The Ebola epidemic of 2014 demonstrated that outbreaks of high-consequence infectious diseases, even in remote parts of the world, can affect communities anywhere in the developed world and that every healthcare facility must be prepared to identify, isolate, and provide care for infected patients. The Nebraska Biocontainment Unit (NBU), located at Nebraska Medicine in Omaha, Nebraska, cared for 3 American citizens exposed in West Africa and confirmed with Ebola virus disease (EVD). Symptom monitoring of healthcare workers caring for these patients was implemented, which included twice daily contact to document the absence or presence of signs of fever or illness. This article describes the symptom monitoring experience of the NBU and local and state public health agencies. Based on lessons learned from that experience, we sought a more efficient solution to meet the needs of both the healthcare facility and public health authorities. REDCap, an open-source application used commonly by academic health centers, was used to develop an inexpensive symptom monitoring application that could reduce the burden of managing these activities, thus freeing up valuable time. Our pilot activities demonstrated that this novel use of REDCap holds promise for minimizing costs and resource demands associated with symptom monitoring while offering a more user-friendly experience for people being monitored and the officials managing the response.
This article describes the symptom monitoring experience of the Nebraska Biocontainment Unit and local and state public health agencies. REDCap was used to develop an inexpensive symptom monitoring application that could reduce the burden of managing these activities. The pilot activities demonstrated that this novel use of REDCap holds promise for minimizing costs and resource demands associated with symptom monitoring while offering a more user-friendly experience for people being monitored and the officials managing the response.
The Ebola epidemic of 2014-15 demonstrated that outbreaks of high-consequence infectious diseases, even in remote parts of the world, can have an impact on communities anywhere in the developed world and that every healthcare facility must be prepared to identify, isolate, and provide care for infected patients. Another outbreak in 2018 in the Democratic Republic of the Congo reminds us that the threat of future outbreaks continues.1
During the 2014-15 outbreak, the Centers for Disease Control and Prevention (CDC) developed guidance for preventing healthcare-associated Ebola transmission, including policies and processes for symptom monitoring and management of healthcare workers who care for infected patients.2 Symptom monitoring is defined as an assessment for symptoms at regular intervals of individuals who have cared for or been exposed to a patient with an infectious disease but are not yet ill. The individual is immediately isolated if symptoms are detected. Quarantine is the physical separation of an individual who was exposed to a communicable disease. Symptom monitoring and quarantine are important nonpharmaceutical interventions to prevent disease transmission, particularly if chemoprophylaxis, therapeutic medications, or vaccines are not available for a pathogen. Symptom monitoring, with or without quarantine, has been shown to be an effective strategy for containing emerging disease threats such as Ebola and SARS and will likely be a key intervention in the future.3
During 2014-15, symptom monitoring recommendations for healthcare workers caring for patients with Ebola virus disease (EVD) in US healthcare facilities included twice daily contact to monitor for symptoms and document fever checks throughout the care continuum and continuing 21 days after the last exposure. This article describes the administrative burden experienced by 1 US facility—the Nebraska Biocontainment Unit—in monitoring healthcare workers caring for patients with EVD and an inexpensive, efficient strategy to reduce this burden that meets the needs of the facility and public health authorities.
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