Skip to main content Accessibility help

Ebola Preparedness Resources for Acute-Care Hospitals in the United States: A Cross-Sectional Study of Costs, Benefits, and Challenges

  • Michael A. Smit (a1) (a2), Kenneth A. Rasinski (a3), Barbara I. Braun (a3), Linda L. Kusek (a3), Aaron M. Milstone (a4) (a5), Daniel J. Morgan (a6) (a7) and Leonard A. Mermel (a1) (a2)...



To assess resource allocation and costs associated with US hospitals preparing for the possible spread of the 2014–2015 Ebola virus disease (EVD) epidemic in the United States.


A survey was sent to a stratified national probability sample (n=750) of US general medical/surgical hospitals selected from the American Hospital Association (AHA) list of hospitals. The survey was also sent to all children’s general hospitals listed by the AHA (n=60). The survey assessed EVD preparation supply costs and overtime staff hours. The average national wage was multiplied by labor hours to calculate overtime labor costs. Additional information collected included challenges, benefits, and perceived value of EVD preparedness activities.


The average amount spent by hospitals on combined supply and overtime labor costs was $80,461 (n=133; 95% confidence interval [CI], $56,502–$104,419). Multivariate analysis indicated that small hospitals (mean, $76,167) spent more on staff overtime costs per 100 beds than large hospitals (mean, $15,737; P<.0001). The overall cost for acute-care hospitals in the United States to prepare for possible EVD cases was estimated to be $361,108,968. The leading challenge was difficulty obtaining supplies from vendors due to shortages (83%; 95% CI, 78%–88%) and the greatest benefit was improved knowledge about personal protective equipment (89%; 95% CI, 85%–93%).


The financial impact of EVD preparedness activities was substantial. Overtime cost in smaller hospitals was >3 times that in larger hospitals. Planning for emerging infectious disease identification, triage, and management should be conducted at regional and national levels in the United States to facilitate efficient and appropriate allocation of resources in acute-care facilities.

Infect Control Hosp Epidemiol 2017;38:405–410


Corresponding author

Address correspondence to Dr Leonard Mermel, Department of Epidemiology and Infection Control, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (


Hide All

PREVIOUS PRESENTATION: The preliminary results of this work were presented at the 2016 Society for Healthcare Epidemiology of America National Conference, Atlanta, Georgia, May 18–21, 2016.



Hide All
1. Ebola Situation Report, 10 June 2016. World Health Organization website. Published 2016. Accessed August 31, 2016.
2. Chevalier, MS, Chung, W, Smith, J, et al. Ebola virus disease cluster in the United States—Dallas County, Texas, 2014. Morb Mortal Wkly Rep 2014;63:10871088.
3. CDC telebriefing: CDC update on first Ebola case diagnosed in the United States. Centers for Disease Control website. Published 2014. Accessed August 31, 2016.
4. Daly, R. Hospitals’ Ebola preparation costs can vary widely. Healthc Financ Manage 2014;68(60–62):64.
5. Steinhauer, J. In U.S., Fear of Ebola Closes Schools and Shapes Politics. The New York Times website. Published October 19, 2014. Accessed August 31, 2016.
6. Narasimhulu, DM, Edwards, V, Chazotte, C, Bhatt, D, Weedon, J, Minkoff, H. Healthcare workers’ attitudes toward patients with Ebola virus disease in the United States. Open Forum Infect Dis 2016;3:ofv192.
7. Polgreen, PM, Santibanez, S, Koonin, LM, Rupp, ME, Beekmann, SE, Del Rio, C. Infectious disease physician assessment of hospital preparedness for Ebola virus disease. Open Forum Infect Dis 2015;2:ofv087.
8. Haverkort, JJ, Minderhoud, AL, Wind, JD, Leenen, LP, Hoepelman, AI, Ellerbroek, PM. Hospital preparations for viral hemorrhagic fever patients and experience gained from admission of an Ebola patient. Emerg Infect Dis 2016;22:184191.
9. 35 U.S. hospitals designated as Ebola treatment centers. Department of Health and Human Services website. Published December 2, 2014. Accesssed June 28, 2016.
10. Morgan, DJ, Braun, B, Milstone, AM, et al. Lessons learned from hospital Ebola preparation. Infect Control Hosp Epidemiol 2015;36:627631.
11. APIC survey finds US healthcare facilities are more prepared to confront Ebola compared to last year: staffing and infection control resources remain issues. Am J Infect Control 2016;44:1.
12. Herberg, JA, Emonts, M, Jacobs, M, Riordan, A. UK preparedness for children with Ebola infection. Arch Dis Child 2015;100:421423.
13. de Jong, MD, Reusken, C, Horby, P, et al. Preparedness for admission of patients with suspected Ebola virus disease in European hospitals: a survey, August–September 2014. Euro Surveill 2014;19:20980.
14. Herstein, JJ, Biddinger, PD, Kraft, CS, et al. Current capabilities and capacity of Ebola treatment centers in the United States. Infect Control Hosp Epidemiol 2016;37:313318.
15. Cummings, KJ, Choi, MJ, Esswein, EJ, et al. Addressing infection prevention and control in the first U.S. community hospital to care for patients with Ebola virus disease: context for national recommendations and future strategies. Ann Intern Med 2016;165:4149.
Type Description Title
Supplementary materials

Smit supplementary material
Smit supplementary material 1

 PDF (347 KB)
347 KB

Ebola Preparedness Resources for Acute-Care Hospitals in the United States: A Cross-Sectional Study of Costs, Benefits, and Challenges

  • Michael A. Smit (a1) (a2), Kenneth A. Rasinski (a3), Barbara I. Braun (a3), Linda L. Kusek (a3), Aaron M. Milstone (a4) (a5), Daniel J. Morgan (a6) (a7) and Leonard A. Mermel (a1) (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed