Major Article| Volume 48, ISSUE 4, P375-379, April 2020

An update on US Ebola treatment center personnel management and training

Published:February 06, 2020DOI:


      • Ebola treatment centers are facing competing demands for resources and staffing.
      • Dedicated Ebola-care units require cadre of highly trained staff.
      • US preparedness capabilities for highly hazardous communicable diseases are reduced.
      • Research and support is needed to sustain US high-level isolation capabilities.


      In 2014, 56 US hospitals were designated as Ebola treatment centers (ETCs). ETCs had minimum augmented capability requirements for Ebola virus disease care, including for staffing and training. We sought to identify current ETC staffing challenges and frequency of staff retraining.


      In May 2019, an electronic survey was distributed to representatives of the 56 ETCs.


      Sixty-six percent (37/56) of ETCs responded. Registered nurses comprised the majority of ETC staff. All responding units required orientation training (average = 15.21 hours) and all but one required retraining. Among the top challenges that ETCs reported to maintaining high-level isolation capabilities were staff training time, staff recruitment, staff retention, and training costs.


      Five years after ETC designation, units face staffing challenges. Research is lacking on the effective number of hours and optimal frequency of staff training. ETCs reported smaller staffing teams compared to our 2016 assessment, but team composition remains similar. As units continue to maintain capabilities with decreasing external support and attention, the need for retraining must be balanced with logistical constraints and competing demands for staff time.


      Our study shows that US preparedness capabilities are reduced. More research, support, and funding are needed to sustain the unique knowledge and proficiency acquired by ETC teams to ensure domestic preparedness for highly hazardous communicable diseases.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention (CDC)
        Interim guidance for U.S. hospital preparedness for patients under investigation (PUIs) or with confirmed Ebola virus disease (EVD): a framework for a tiered approach.
        Ebola Virus Dis. 2018; (Available at:) (Accessed September 8, 2019)
      1. US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response. Regional treatment network for Ebola and other special pathogens. 2017. Available at: Accessed January 30, 2020.

        • Herstein J.J.
        • Biddinger P.D.
        • Kraft C.S.
        • et al.
        Initial costs of Ebola treatment centers in the united states.
        Emerg Infect Dis. 2016; 22: 350-352
      2. World Health Organization (WHO). Ebola in the democratic Republic of Congo: health emergency update. Available at: 2019. Accessed September 5, 2019.

      3. World Health Organization (WHO). As Ebola cases reach 3000 in DRC, WHO calls on partners to fulfill promises to communities. Available at: 2019. Accessed September 4, 2019.

        • Global Preparedness Monitoring Board
        World at Risk: Annual Report on Global Awareness for Health Emergencies.
        World Health Organization, Geneva2019 (Licence: CC BY-NC-SA 3.0 IGO)
        • Park B.J.
        • Peck A.J.
        • Kuehnert M.J.
        • et al.
        Lack of SARS transmission among healthcare workers, United States.
        Emerg Infect Dis. 2004; 10: 244-248
      4. World Health Organization. Health worker Ebola infections in Guinea, Liberia, and Sierra Leone. 2015. Available at: 2015. Accessed September 5, 2019.

      5. World Health Organization (WHO). Ebola health worker infections. Available at: 2019. Accessed August 30, 2019.

      6. World Health Organization (WHO). Ebola virus disease—democratic republic ofthe congo. Available at: 2019. Accessed September 5, 2019.

      7. Centers for Disease Control and Prevention (CDC). 2014-2016 Ebola outbreak in West Africa. Available at: 2019. Accessed August 29, 2019.

        • Herstein J.J.
        • Biddinger P.D.
        • Gibbs S.G.
        • et al.
        Personnel management and biosecurity of US high-level isolation units.
        J Nurs Admin. 2018; 48: 553-560
      8. Centers for Disease Control and Prevention (CDC). Interim guidance for preparing Ebola treatment centers. Available at: 2019. Accessed September 1, 2019.

        • Kratochvil C.J.
        • Evans L.
        • Ribner B.S.
        • et al.
        The national Ebola training and education center: preparing the united states for ebola and other special pathogens.
        Health Secur. 2017; 15: 253-260
        • Mohan G.M
        • Susman T
        • Hennessy-Fiske M
        Nurses at Dallas hospital describe poor safety measures with Ebola victim.
        LA Times. October 14, 2014; (World & Nation. Available at:) (Accessed August 30, 2019)
        • US Health and Human Services Office of Inspector General
        Hospitals Reported Improved Preparedness for Emerging Infectious Diseases After the Ebola Outbreak.
        2018 (OEI-06-15-00230; Available at:) (Accessed September 5, 2019)
        • NSI Nursing Solutions I
        National Health Care Retention and RN Staffing Report.
        2019 (Available at:) (Accessed January 30, 2020)
        • Hewlett A.L.
        • Varkey J.B.
        • Smith P.W.
        • Ribner B.S.
        Ebola virus disease: preparedness and infection control lessons learned from two biocontainment units.
        Curr Opin Infect Dis. 2015; 28: 343-348
        • Popescu S.
        • Leach R.
        Identifying gaps in frontline healthcare facility high-consequence infectious disease preparedness.
        Health Secur. 2019; 17: 117-123
        • Herstein J.J.
        • Biddinger P.D.
        • Gibbs S.G.
        • et al.
        Sustainability of high-level isolation capabilities among US Ebola treatment centers.
        Emerg Infect Dis. 2017; 23: 965-967
        • Herstein J.J.
        • Biddinger P.D.
        • Gibbs S.G.
        • et al.
        High-level isolation unit infection control procedures.
        Health Secur. 2017; 15: 519-526