Assessing Viral Transfer During Doffing of Ebola-Level Personal Protective Equipment in a Biocontainment Unit

Casanova, Lisa M.; Erukunuakpor, Kimberly; Kraft, Colleen S.; Mumma, Joel M.; Durso, Francis T.; Ferguson, Ashley N.; Gipson, Christina L; Walsh, Victoria L.; Zimring, Craig; DuBose, Jennifer; Jacob, Jesse T

doi:10.1093/cid/cix956

Cited by 36 publications

(44 citation statements)

References 30 publications

(43 reference statements)

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“…[35] Hands-on training can provide real-time feedback to correct behaviors in the moment with observer interventions or surrogates for contamination. [36,37] In this sample, skills maintenance training was limited and primarily occurred at ETCs. A barrier identified was debate over the appropriate frequency of training, though surveyed trainees who wanted refresher training, wanted it to occur 1-2 times annually.…”

Section: Discussionmentioning

confidence: 99%

Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

Bleasdale

Sikka

Moritz

et al. 2019

Journal of Occupational and Environmental Hygiene

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During the 2014-2015 Ebola virus disease (EVD) outbreak, hospitals in the United States selected personal protective equipment (PPE) and trained healthcare personnel (HCP) in anticipation of receiving EVD patients. To improve future preparations for high-consequence infectious diseases, it was important to understand factors that affected PPE selection and training in the context of the EVD outbreak. Semistructured interviews were conducted with HCP involved with decision-making during EVD preparations at acute care hospitals in the Chicago, IL area to gather information about the PPE selection and training process. HCP who received training were surveyed about elements of training and their perceived impact and overall experience by email invitation. A total of 28 HCP from 15 hospitals were interviewed, and 55 HCP completed the survey. Factors affecting PPE selection included: changing guidance, vendor supply, performance evaluations, and perceived risk and comfort for HCP. Cost did not affect selection. PPE acquisition challenges were mitigated by: sharing within hospital networks, reusing PPE during training, and improvising with existing PPE stock. Selected PPE ensembles were similar across sites. Training included hands-on activities with trained observers, instructional videos, and simulations/drills, which were felt to increase HCP confidence. Many felt refresher training would be helpful. Hands-on training was perceived to be effective, but there is a need to establish the appropriate frequency of refresher training frequency to maintain competence. Lacking confidence in the CDC guidance, interviewed trainers described turning to other sources of information and developing independent PPE evaluation and selection. Response to emerging and/or high consequence infectious diseases would be enhanced by transparent, risk-based guidance for PPE selection and training that addresses protection level, ease of use, ensembles, and availability. KEYWORDSEbola virus disease; healthcare personnel training; high-consequence infections; occupational health; personal protective equipment; qualitative research; standard precautions

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Section: Discussionmentioning

confidence: 99%

Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

Bleasdale

Sikka

Moritz

et al. 2019

Journal of Occupational and Environmental Hygiene

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“…Although few studies have utilized both FP and MS2 as surrogate markers, some have also reported higher rates of FP compared to MS2 detections. 17,31 Others have reported similar detection rates 19,32 or more frequent MS2 detections. 21 This lack of agreement may indicate that neither marker performs significantly 8 room-exit observations were missing because room exit could not be observed.…”

Section: Discussionmentioning

confidence: 89%

Assessment of antibiotic-resistant organism transmission among rooms of hospitalized patients, healthcare personnel, and the hospital environment utilizing surrogate markers and selective bacterial cultures

Kwon

Reske²,

O’Neil³

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:To assess potential transmission of antibiotic-resistant organisms (AROs) using surrogate markers and bacterial cultures.Design:Pilot study.Setting:A 1,260-bed tertiary-care academic medical center.Participants:The study included 25 patients (17 of whom were on contact precautions for AROs) and 77 healthcare personnel (HCP).Methods:Fluorescent powder (FP) and MS2 bacteriophage were applied in patient rooms. HCP visits to each room were observed for 2–4 hours; hand hygiene (HH) compliance was recorded. Surfaces inside and outside the room and HCP skin and clothing were assessed for fluorescence, and swabs were collected for MS2 detection by polymerase chain reaction (PCR) and selective bacterial cultures.Results:Transfer of FP was observed for 20 rooms (80%) and 26 HCP (34%). Transfer of MS2 was detected for 10 rooms (40%) and 15 HCP (19%). Bacterial cultures were positive for 1 room and 8 HCP (10%). Interactions with patients on contact precautions resulted in fewer FP detections than interactions with patients not on precautions (P < .001); MS2 detections did not differ by patient isolation status. Fluorescent powder detections did not differ by HCP type, but MS2 was recovered more frequently from physicians than from nurses (P = .03). Overall, HH compliance was better among HCP caring for patients on contact precautions than among HCP caring for patients not on precautions (P = .003), among nurses than among other nonphysician HCP at room entry (P = .002), and among nurses than among physicians at room exit (P = .03). Moreover, HCP who performed HH prior to assessment had fewer fluorescence detections (P = .008).Conclusions:Contact precautions were associated with greater HCP HH compliance and reduced detection of FP and MS2.

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“…Debate continues over whether UV-fluorescent markers or various viral surrogates are best-suited for testing PPE. [14][15][16] However, UV-fluorescence has advantages of both cost and the training benefit of visual reinforcement of contamination, which was a key consideration for this work. The method aimed to provide realistic exposure events in terms of quantity and means of contamination.…”

Section: Limitationsmentioning

confidence: 99%

A unified personal protective equipment ensemble for clinical response to possible high consequence infectious diseases: A consensus document on behalf of the HCID programme

Poller

Tunbridge

Hall

et al. 2018

Journal of Infection

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The importance of appropriate personal protective equipment (PPE) as a component of healthcare worker (HCW) protection was highlighted during the Ebola virus disease (EVD) outbreak in West Africa. The large number of HCW deaths in Africa was in part due to lack of resources or prior training in PPE usage. As part of the Ebola legacy, the High Consequence Infectious Disease (HCID) programme was initiated by NHS England and Public Health England (PHE) to improve preparedness for Ebola and other infections that not only endanger the life of the patient, but also pose particular dangers to HCWs. A systematic review identified national standardisation of PPE protocols as a priority, but recognised that a lack of safety data limited the ability to mandate any one protocol. A simulation-based exercise was developed to assess the safety of PPE ensembles in use in the UK during first assessment of a patient with a possible HCID. A mannequin was adapted to expose volunteer HCWs to synthetic bodily fluids (vomit, sweat, diarrhoea and cough), each with a different coloured fluorescent tracer, invisible other than under ultraviolet (UV) light. After exposure, HCWs were examined under UV lights to locate fluorescent contamination, and were screened again after removing PPE (doffing) to detect any personal contamination. The exercise was videoed, allowing retrospective analysis of contamination events and user errors. The simulation testing identified significant HCW contamination events after doffing, related to protocol failure or complications in PPE doffing, providing conclusive evidence that improvements could be made. At a workshop with an expert stakeholder group, the data were examined and a unified PPE ensemble agreed. This ensemble was then tested in the same simulation exercise and no evidence of any HCW contamination was seen after doffing. Following further review by the working group, a consensus agreement has been reached and a unified 'HCID assessment PPE' ensemble, with accompanying donning and doffing protocols, is presented here.

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Assessing Viral Transfer During Doffing of Ebola-Level Personal Protective Equipment in a Biocontainment Unit

Cited by 36 publications

References 30 publications

Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

Assessment of antibiotic-resistant organism transmission among rooms of hospitalized patients, healthcare personnel, and the hospital environment utilizing surrogate markers and selective bacterial cultures

A unified personal protective equipment ensemble for clinical response to possible high consequence infectious diseases: A consensus document on behalf of the HCID programme

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