title: Clinical documentation and data transfer from Ebola and Marburg virus disease wards in outbreak settings: health care workers' experiences and preferences.
abstract: Understanding human filovirus hemorrhagic fever (FHF) clinical manifestations and evaluating treatment strategies require the collection of clinical data in outbreak settings, where clinical documentation has been limited. Currently, no consensus among filovirus outbreak-response organisations guides best practice for clinical documentation and data transfer. Semi-structured interviews were conducted with health care workers (HCWs) involved in FHF outbreaks in sub-Saharan Africa, and with HCWs experienced in documenting and transferring data from high-risk areas (isolation wards or biosafety level 4 laboratories). Methods for data documentation and transfer were identified, described in detail and categorised by requirement for electricity and ranked by interviewee preference. Some methods involve removing paperwork and other objects from the filovirus disease ward without disinfection. We believe that if done properly, these methods are reasonably safe for certain settings. However, alternative methods avoiding the removal of objects, or involving the removal of paperwork or objects after non-damaging disinfection, are available. These methods are not only safer, they are also perceived as safer and likely more acceptable to health workers and members of the community. The use of standardised clinical forms is overdue. Experiments with by sunlight disinfection should continue, and non-damaging disinfection of impregnated paper, suitable tablet computers and underwater cameras should be evaluated under field conditions.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. silja.buehler@ifspm.uzh.ch.
authors.forename: Silja
authors.initials: S
authors.lastname: Bühler
authors.affiliation: Médecins Sans Frontières - Spain, Nou de la Rambla, 26, Barcelona 08001, Spain. paul.roddy@barcelona.msf.org.
authors.forename: Paul
authors.initials: P
authors.lastname: Roddy
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. enolte@rand.org.
authors.forename: Ellen
authors.initials: E
authors.lastname: Nolte
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Matthias.Borchert@charite.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Borchert
mesh_terms: D017954:Africa South of the Sahara; D000818:Animals; D001291:Attitude of Health Personnel; D004196:Disease Outbreaks; D004203:Disinfection / Q000379:methods*; D057286:Electronic Health Records; D006282:Health Personnel / Q000523:psychology*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008379:Marburg Virus Disease / Q000453:epidemiology / Q000628:therapy*; D010356:Patient Isolation