Addressing Staffing Challenges in Global High-Level Isolation Units 

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In November 2022, NETEC’s International Partnerships and Programs hosted a Global Rounds virtual session with global high-level isolation unit (HLIU) representatives to discuss HLIU staffing challenges and approaches.  

Read the meeting report, published in Open Forum Infectious Diseases. 

Sustaining a Special Pathogens Health Care Workforce 

Recruiting and retaining health care workers amid unprecedented global staffing shortages is a top priority for health care institutions. It is especially important in HLIUs, where the readiness of a unit and its staff to respond to a special pathogen has serious consequences. These facilities are equipped with specialized engineering and administrative controls and run by highly trained teams to care for patients with high-consequence infectious diseases.  

Identifying challenges and testing solutions for sustaining a health care workforce that is highly capable and highly trained in special pathogens prior to a real-world disease surge can help prevent system failure, protect health care workers, and enhance the safety of patients and the community. 

Takeaways from the Global Rounds 

Increasing Institutional Support and Buy-in 

Maintaining HLIU readiness is highly influenced by the parent institution’s support and how leadership perceives the unit’s importance, especially in times when the unit is not active. Ideas for increasing institutional support and buy-in for a unit dedicated to high-consequence infectious disease cases that may never actually admit a patient include: 

• Identify HLIU “champions” to advocate on behalf of the unit, emphasizing the importance of preparedness and limiting the burden on the institution. 
• Find ways to utilize the HLIU space in times of peace without interfering with readiness and activation including the use of the space for training and education with partners such as nursing programs. 
• Partner with the Emergency Department to emphasize the overlap of highly trained professionals and build relationships. 

Improving Staff Retention and Recruitment  

Recruitment of new staff and the retention of skilled staff have both presented problems for HLIUs, where a high-stress working environment is common and the stakes are high. While some organizations have staff dedicated to the HLIU, others rely on volunteers. Each set up has its own challenges to motivating staff to serve in HLIUs. Solutions to recruiting and sustaining a HLIU workforce include: 

• Implement team-building activities to make participation in the unit fun and to build comaraderie. For example, turning activation simulations into timed races against team members or offering opportunities to discuss current and recent outbreaks. 
• Offer monetary or other incentives such as educational and professional development courses. 
• Work with institutional marketing and communications to develop a strong recruitment plan that includes meetings with nurse managers from departments that may have strong candidates and encouraging current HLIU staff to identify peers that may be a good fit. 
• Target the hiring of young professionals who have not experienced burnout and may be excited by the prospect of treating patients with high-consequence infectious diseases. 
• Highlight the strengths and benefits of being on an HLIU team by recognizing the niche as having high recognition, opportunities for professional development and research, and engagement with external partners. 

Adapting Staffing Models 

HLIUs often rely on unique staffing models to secure and maintain a workforce available for activation. While mandatory staffing (i.e., serving on the HLIU team is part of the contract/job responsibilities) ensures a team of trained staff, it can be difficult to motivate people if they do not want to perform HLIU activities. Additionally, many units rely on dual staffing models with teams centered around infectious disease and critical care specialists. However, burnout and turnover of medical professionals has forced institutions to adapt their staffing models. Alternative approaches to diversifying and strengthening staffing models include: 

• Recruit and train certified nursing assistants who are capable of filling many roles and are often nursing students who may transition into permanent HLIU positions upon graduating. 
• Ask HLIU team members that have left for prolonged periods (e.g., for maternity leave) and no longer want to work in the HLIU on their return to serve as trained observers or trainers, since they are familiar with personal protective equipment and the unit’s operating procedures. 

Providing Just-in-time Training 

An important facet to ensuring a competent HLIU workforce is the provision of just-in-time training educational resources and exercises. It can be challenging to provide these trainings when space, time, and trainers are allocated to other purposes. Additionally, requests for HLIU staff to lead just-in-time training for non-HLIU systems can put further strain on resources. To address these challenges, consider solutions including: 

• Avoid just-in-time training issues by setting a regular training schedule, especially trainings on personal protective equipment. 
• Develop just-in-time training videos that can be posted on YouTube or the staff intranet. Supplement these videos with additional education such as pathogen-specific lectures. 
• Maintain a library of just-in-time training resources that emphasize core principles and are at the ready to send to peers when requested. 

NETEC’S Global Rounds on staffing and just-in-time training provided an opportunity for practitioners from around the world to discuss the challenges faced in maintaining a highly trained workforce. Many of the takeaways from discussions are relevant to health care institutions and programs around the world seeking solutions to recruit and retain their workforce amongst a global shortage of health care workers. Global Rounds participants were able to discuss shared challenges and solutions to recruiting and retaining highly trained teams. 

Read the meeting report: “Challenges and Approaches to High-Level Isolation Unit Staffing and Just-in-Time Training” 

Learn More About Past Global Rounds

Global Rounds: Response to the 2022 Mpox Outbreak