187375 Hospital management success during an extreme diarrheal disease outbreak: Experience of the ICDDR,B following the 2007 monsoon season

Monday, October 27, 2008: 1:42 PM

Azharul I. Khan, MBBS, PhD , Clinical Sciences Division, International Centre for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh
Tracey L. P. Koehlmoos, PhD, MHA , Clinical Sciences Division, International Centre for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh
Megan A. Cohen, BS , Clinical Sciences Division, International Centre for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh
Alejandro Cravioto, Dr , ICDDR,B, Dhaka, Bangladesh
This work examines the International Center for Diarrheal Diseases Research, Bangladesh's (ICDDR,B) successful response to an extreme outbreak of diarrheal diseases in July- September 2007 following an intense monsoon season. We compared ICDDR,B's policies and practices during the recent outbreak with those of other facilities during a 1994 diarrheal disease crisis in Goma, Zaire. This project identified key factors accounting for ICDDR,B's lower mortality rate.

Of the 43,359 patients admitted to ICDDR,B from July to September 2007, 34% were culture-confirmed cholera cases, with 93% requiring IV fluid treatment. Individuals presenting with uncomplicated diarrhea had a 0% mortality rate. In contrast, Rwandan-staffed treatment centers during the 1994 Zaire outbreak reported case-fatality ratios as high as 14.5%.

Keys to ICDDR,B's success include the utilization of specialized management techniques such as cholera cots and on-site production of rice-based ORS; comprehensive training of all staff in the clinical assessment and treatment of diarrhea; logistical preparedness with full supply chains and pre-positioned supplies; and adaptive measures including the establishment of a one-way traffic emergency ward and patient fee waivers. On-going routine patient surveillance and antibiotic resistance trials ensured the prudent use of effective drugs supplementing fluid replacement therapy.

Based on this study's results, we recommend that diarrheal treatment centers prioritize adaptive management techniques focusing on quick patient resuscitation and subsequent fluid management. Allowing attendants to remain with admitted patients will ensure continuous monitoring of hydration status and ORS promotion. Management emphasizing flexibility, proper training and patient service delivery should prevent unnecessary deaths from diarrheal-associated dehydration.

Learning Objectives:
Develop an action plan for diarrheal disease epidemic management. List five characteristics of an efficient triage unit.

Keywords: Developing Countries, Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I (Dr. Azharul Islam Khan) is the Head of the Short Stay Unit which is the entry point of our Dhaka Hospital at ICDDR,B and we specialize in Diarrhoeal Diseases where we recieve around 250-300 patients daily and over 120,000 anually. In 2007 we recieved, treated and managed a record number of 43,359 patients from july through september following severe torrential rains leading to devastating floods which was associated with a major diarrhea outbreak. The highest number was 1045 in 24 hours on 14th August 2007. The management of these large number of patients were largely through the Short Stay Unit which houses the Triage and the emergency corner. Unprecedented patient visits necessitated changes in policy and establishment of coping mechanisms that resulted in zero deaths from diarrhea alone, i.e. those without any co-morbidity. ICDDR,B's successful management of the enourmous patients is largely attributable to its staff's unparallel experience and expertise, logistical preparedness, and adaptive health-management approach.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.