Hospital preparedness and operational adaptation for the safe management of Crimean–Congo haemorrhagic fever patients

BACKGROUND: The Ebola virus health emergency in 2014 highlighted the urgent need to establish a hospital network in Spain for the management of high-risk infectious diseases. Currently, the only autochthonous high-risk infectious disease in Spain is Crimean-Congo hemorrhagic fever virus (CCHFV). Until 2025, 10 of the 20 nationally reported cases (50%) had occurred in Salamanca province. In response, the University Hospital of Salamanca (Complejo Asistencial Universitario de Salamanca [CAUSA]) implemented an adaptation process to optimize the safe care of CCHFV-infected patients. METHODS: We conducted a retrospective descriptive study of the adaptation process at the CAUSA covering the period up to 2025. Structural, organizational, procedural and training-related measures were analysed, as well as the acquisition of specialized equipment. FINDINGS: CAUSA established a comprehensive response model for CCHFV management, incorporating specific protocols for clinical care, diagnostics, therapeutic interventions, and infection prevention and control. Adaptations included infrastructure modifications, management reorganization, continuous staff training, and integration of specialized resources. No cases of nosocomial transmission associated with the management of CCHFV patients have been documented to date. CONCLUSION: The CAUSA experience demonstrates that a general hospital can be adapted to safely manage Crimean-Congo hemorrhagic fever patients. Strong institutional leadership, multi-disciplinary collaboration and continuous training were key enablers. These measures strengthen overall hospital preparedness and infection control, and the model may be applicable to other non-reference hospitals in Europe.