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

Abstract

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

Personal protective equipment doffing practices of healthcare workers

“…Hands-on training in PPE was commonly used with enhanced PPE ensembles during the Ebola Virus Disease outbreak of 2014-2015, and trainees identified hands-on training as has having the greatest influence on their confidence to care for Ebola Virus Disease patients. [15] Such training could be integrated into HCWs' clinical competency skills tests. Clearly, the evidence in this and other work demonstrate that the current approaches are inadequate to obtaining the desired PPE doffing behaviors from HCWs.…”

Characteristics of personal protective equipment training programs in Australia and New Zealand hospitals: A survey

“…Maintaining a skilled workforce in the use of high-level PPE is an important part of pandemic preparedness, particularly for hospitals with biocontainment capacity. Research from the USA showed that HCWs expect PAPRs to be available for them to use with EVD patients [43]. However, PAPR components are relatively expensive and the cost of maintaining an in-date stock of PAPR components between HCID events or outbreaks may be a deterrent to using them for training, especially if the risk of an actual case is very low.…”

A systematic risk-based strategy to select personal protective equipment for infectious diseases

“…This issue was apparent in the changing guidelines for PPE during the 2014-2015 EVD. 5 The risk-based approach we propose in this study enables transparent decisionmaking, even in the face of uncertainty or disagreement, because each step of the approach can be documented, allowing review (and critique) by others.…”

“…For example, in the Chicago area, HCP used visual inspection and colored liquids (eg, Kool-Aid [The Kraft-Heinz Co]) to evaluate dermal coverage and fluid impermeability of PPE, respectively, to increase confidence in PPE selection decisions during EVD preparations. 5 Implementation of a systematic risk-based process for selection of a PPE ensemble to protect HCP from infectious diseases benefits from a team with expertise in occupational health, infectious diseases, human factors, and health care activities. The questions in Table 1 are intended to help ensure that PPE ensembles are evaluated holistically, but may not be complete.…”

“…2 However, HCP consistently fail to select appropriate PPE in this context, citing time, difficulty, and lack of perceived risk as reasons for noncompliance. 3,4 During the 2014-2015 Ebola Virus Disease (EVD) outbreak, we found that many acute care hospitals used the standard precautions framework to select PPE, 5 but that this process was challenging in part because HCP lack both the knowledge and information about how, and how well, the pieces of PPE and PPE ensemble protected HCP.…”