3.1. Clinical Documentation inside Filovirus Disease Wards
“Almost all of these data were eventually destroyed [when the paper-based clinical records] were sprayed with chlorine” (note: chlorine solution destroys paper-based records).
3.2. Data Transfer from Filovirus Disease Wards
3.2.1. Data Transfer Methods from Sub-Saharan Africa
- Some methods avoided taking any objects out of the filovirus disease ward: Clinical notes were recorded by memory once outside the ward (n = 6 interviewees); clinical notes were dictated to a HCW on the other side of the fence (6); clinical notes were held up at the fence and then photographed (5), manually copied (2), or entered into a laptop computer (1) by a HCW standing outside the fence.
- Other methods avoided taking paper forms out of the filovirus disease ward but involved taking other objects out after disinfection: Patient records were photographed inside the ward with a digital camera wrapped in a plastic bag, which was disinfected by chlorine before taking it out (1); a designated laptop was used inside the ward for data entry, sprayed with chlorine solution, and taken out at the end of the day (1).
- Again other methods involved taking paperwork out of the filovirus disease ward: without disinfection (5), after exposing it to sun light (UV radiation; 1) or after disinfecting it with chlorine solution after wrapping it in plastic (1) or without doing so (1); data were copied from patient files into forms without touching anything else, and these forms were then taken out without disinfection (1); ward rounds were conducted by two HCWs, one providing patient care, the other taking clinical notes without touching anything on the ward so that records were considered uncontaminated and taken out without disinfection (2); following a patient’s death, the single-patient room including the patient records was sealed and fumigated with formaldehyde, the records then taken out (1).
3.2.2. Methods used in BSL-4 Laboratories in Europe
3.2.3. Suggested Methods for the Future
- Enter data or scan records into a laptop computer left inside, and transmit data via Internet, a cable, or a USB stick disinfected with chlorine to another computer outside (n = 8 interviewees)
- Have a person entering the filovirus disease ward and photographing the clinical records without touching anything else and taking the camera out without disinfection (5)
- Enter data with a Personal Digital Assistant (PDA) kept inside a plastic cover, disinfect it with chlorine before taking it out, or transmit data via Bluetooth or email (3)
- Make carbon copies or photocopies of the clinical records, wrap them in a plastic cover, disinfect the cover and take only the copies out (2)
- Print patient forms on transparencies, use a permanent marker to fill them out and spray them with chlorine (2).
- Use a voice recorder inside the ward and transfer the audio cassette or minidisc to the outside (2)
- Use a walkie-talkie or a cell phone to dictate clinical data to the outside (2)
- Transmit data with a fax machine inside connected via cable to another fax machine outside (2)
- Place documents in a container after the outbreak, leave them inside until the virus is considered unviable, or fumigate the container with formaldehyde (1)
- Have a video camera pointing at the table where data are documented (1)
3.3. Perceived Advantages and Disadvantages of Present and Future Methods
3.3.1. General Aspects
“Who knows if there are odd chances and somebody might get Ebola from a microscopic bit of virus somewhere that escaped notice”.(HCW 15)
“If you take something out of the isolation ward and then the epidemic flairs up in the community again, [there would be trouble]. I mean that is an environment where there are a lot of rumours and perhaps … the risk is not really there, but you don’t even want to be seen as taking risks”.(HCW 14)
3.3.2. Detailed Advantages and Disadvantages of Methods
“At the very beginning you don’t have … many resources and you might want to use … a very simple method … and as your team increases … you could do more sophisticated things”.(HCW 2)
3.4. Ranking of Methods
5. Recommendations and Conclusions
Conflicts of Interest
References and Notes
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