1
|
Figi CE, Herstein JJ, Beam EL, Le AB, Hewlett AL, Lawler JV, Lowe JJ, Gibbs SG. Literature review of physiological strain of personal protective equipment on personnel in the high-consequence infectious disease isolation environment. Am J Infect Control 2023; 51:1384-1391. [PMID: 37182761 DOI: 10.1016/j.ajic.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Heat strain and dehydration can affect an individual's physical and mental performance. The purpose of this review was to examine the literature for the impact of heat strain on health care workers (HCWs) who care for patients with high-consequence infectious diseases (HCIDs) while wearing personal protective equipment (PPE), discuss the risks of impaired safety caused by heat strain and dehydration in HCID environments, identify attempts to combat PPE-related heat strain, recognize limitations, and provide suggestions for further research. METHODS A literature search was performed in PubMed or MEDLINE and Google Scholar. Authors screened abstracts for inclusion criteria and reviewed articles if the abstracts were considered to include information relevant to the aim. RESULTS The search terms yielded 30 articles that were sorted based on environment setting, physiological impact, and interventions. DISCUSSION The safety of the HCWs and patients can be enhanced through the development and usage of cooler, more comfortable PPE materials and ensembles to help slow the rate of dehydration and support the regulation of core body temperature. CONCLUSIONS Heat strain caused by wearing PPE is an occupational health concern for HCWs in the high-risk environment, that is, HCID care. Future studies are needed to develop innovative PPE ensembles that can reduce heat strain and improve well-being.
Collapse
Affiliation(s)
- Claire E Figi
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX.
| | - Jocelyn J Herstein
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, College of Public Health, 985110 Nebraska Medical Center, Omaha, NE.
| | - Elizabeth L Beam
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE.
| | - Aurora B Le
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI.
| | - Angela L Hewlett
- Global Center for Health Security, University of Nebraska Medical Center, 986161 Nebraska Medical Center, Omaha, NE; Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, 983332 Nebraska Medical Center, Omaha, NE.
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, 986161 Nebraska Medical Center, Omaha, NE.
| | - John J Lowe
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, College of Public Health, 985110 Nebraska Medical Center, Omaha, NE; Global Center for Health Security, University of Nebraska Medical Center, 986161 Nebraska Medical Center, Omaha, NE.
| | - Shawn G Gibbs
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX.
| |
Collapse
|
2
|
Lukowski J, Vasa A, Arguinchona C, ElRayes W, Frank MG, Galdys AL, Garcia MC, Garland JA, Kline S, Persson C, Ruby D, Sauer LM, Vasistha S, Carrasco S, Herstein JJ. A narrative review of high-level isolation unit operational and infrastructure features. BMJ Glob Health 2023; 8:e012037. [PMID: 37423621 DOI: 10.1136/bmjgh-2023-012037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 07/11/2023] Open
Abstract
High-level isolation units (HLIUs) are specially designed facilities for care and management of patients with suspected or confirmed high-consequence infectious diseases (HCIDs), equipped with unique infrastructure and operational features. While individual HLIUs have published on their experiences caring for patients with HCIDs and two previous HLIU consensus efforts have outlined key components of HLIUs, we aimed to summarise the existing literature that describes best practices, challenges and core features of these specialised facilities. A narrative review of the literature was conducted using keywords associated with HLIUs and HCIDs. A total of 100 articles were used throughout the manuscript from the literature search or from alternate methods like reference checks or snowballing. Articles were sorted into categories (eg, physical infrastructure, laboratory, internal transport); for each category, a synthesis of the relevant literature was conducted to describe best practices, experiences and operational features. The review and summary of HLIU experiences, best practices, challenges and components can serve as a resource for units continuing to improve readiness, or for hospitals in early stages of developing their HLIU teams and planning or constructing their units. The COVID-19 pandemic, a global outbreak of mpox, sporadic cases of viral haemorrhagic fevers in Europe and the USA, and recent outbreaks of Lassa fever, Sudan Ebolavirus, and Marburg emphasise the need for an extensive summary of HLIU practices to inform readiness and response.
Collapse
Affiliation(s)
- Joseph Lukowski
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Christa Arguinchona
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Wael ElRayes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria G Frank
- School of Medicine, University of Colorado, Denver, Colorado, USA
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Alison L Galdys
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Mary C Garcia
- Department of Laboratory Services, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jennifer A Garland
- Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Susan Kline
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Caroline Persson
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Darrell Ruby
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Lauren M Sauer
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sami Vasistha
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sharon Carrasco
- Serious Communicable Disease Program, Emory University, Atlanta, Georgia, USA
| | - Jocelyn J Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
3
|
Frank MG, Croyle C, Beitscher A, Price C. The Role of Hospitalists in Biocontainment Units: A Perspective. J Hosp Med 2020; 15:375-377. [PMID: 32195660 DOI: 10.12788/jhm.3402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/23/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Maria G Frank
- Division of Hospital Medicine, Denver Health Hospital Authority, Denver, Colorado
- Biocontainment Unit, Denver Health Hospital Authority, Den-ver, Colorado
- Department of Medicine, Denver Health Hospital Authority, Denver, Colorado
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Caroline Croyle
- Biocontainment Unit, Denver Health Hospital Authority, Den-ver, Colorado
- Department of Patient Safety & Quality, Denver Health and Hospital Authority, Denver, Colorado
| | - Adam Beitscher
- Division of Hospital Medicine, Denver Health Hospital Authority, Denver, Colorado
- Biocontainment Unit, Denver Health Hospital Authority, Den-ver, Colorado
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Connie Price
- Biocontainment Unit, Denver Health Hospital Authority, Den-ver, Colorado
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
4
|
Beam EL, Schwedhelm MM, Boulter KC, Vasa AM, Larson L, Cieslak TJ, Lowe JJ, Herstein JJ, Kratochvil CJ, Hewlett AL. Ebola Virus Disease: Clinical Challenges, Recognition, and Management. Nurs Clin North Am 2019; 54:169-180. [PMID: 31027659 PMCID: PMC7096726 DOI: 10.1016/j.cnur.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The 2014 to 2016 Ebola outbreak response resulted in many lessons learned about biocontainment patient care, leading to enhanced domestic capabilities for highly infectious and hazardous communicable diseases. However, additional opportunities for improvement remain. The article identifies and describes key considerations and challenges for laboratory analysis, clinical management, transportation, and personnel management during the care of patients infected with Ebola or other special pathogens. Dedication to maintaining preparedness enables biocontainment patient care teams to perform at the highest levels of safety and confidence.
Collapse
Affiliation(s)
- Elizabeth L. Beam
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198, USA,Corresponding author
| | - Michelle M. Schwedhelm
- Emergency Management and Biopreparedness, Nebraska Medicine, 987422 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kathleen C. Boulter
- Nebraska Biocontainment Unit, Nebraska Medicine, 982470 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Angela M. Vasa
- Nebraska Biocontainment Unit, Nebraska Medicine, 982470 Nebraska Medical Center, Omaha, NE 68198, USA
| | - LuAnn Larson
- University of Nebraska Medical Center, 986814 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Theodore J. Cieslak
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198, USA
| | - John J. Lowe
- College of Public Health, University of Nebraska Medical Center, 984388 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Jocelyn J. Herstein
- Global Center for Health Security, University of Nebraska Medical Center, 984388 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Christopher J. Kratochvil
- University of Nebraska Medical Center, Nebraska Medicine, 987878 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Angela L. Hewlett
- Division of Infectious Diseases, Nebraska Biocontainment Unit, Nebraska Medicine, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA
| |
Collapse
|
5
|
Hewlett A, K. Murthy AR. Designing Medical Facilities to Care for Patients with Highly Hazardous Communicable Diseases. BIOEMERGENCY PLANNING 2018. [PMCID: PMC7120841 DOI: 10.1007/978-3-319-77032-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Certain highly hazardous communicable diseases (HHCD), including viral hemorrhagic fevers, the Middle East respiratory syndrome coronavirus (MERS-CoV), and severe acute respiratory syndrome virus (SARS), have caused nosocomial outbreaks in unprepared facilities. Consequently, biocontainment units have been constructed to protect caregivers, patients, and family members, in addition to providing optimal care of the infected patient. Biocontainment units have adopted many of the design features originally found in biocontainment laboratories and can serve as national referral facilities for the most severe and highly hazardous infections. Although a patient with a HHCD can show up at any healthcare facility unannounced, not every hospital can or should attempt to establish a biocontainment unit. Nevertheless, there are design features or management principles found in biocontainment units that can be adopted in most facilities. Awareness of the potential risk, in addition to adopting structural and policy control measures, can do a lot to prepare a facility for the next unexpected infectious disease outbreak.
Collapse
Affiliation(s)
- Angela Hewlett
- Division of Infectious Diseases, Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha, NE USA
| | - A. Rekha K. Murthy
- Division of Infectious Diseases, Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA USA
| |
Collapse
|
6
|
The Creation of a Biocontainment Unit at a Tertiary Care Hospital. The Johns Hopkins Medicine Experience. Ann Am Thorac Soc 2017; 13:600-8. [PMID: 27057583 DOI: 10.1513/annalsats.201509-587ps] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In response to the 2014-2015 Ebola virus disease outbreak in West Africa, Johns Hopkins Medicine created a biocontainment unit to care for patients infected with Ebola virus and other high-consequence pathogens. The unit team examined published literature and guidelines, visited two existing U.S. biocontainment units, and contacted national and international experts to inform the design of the physical structure and patient care activities of the unit. The resulting four-bed unit allows for unidirectional flow of providers and materials and has ample space for donning and doffing personal protective equipment. The air-handling system allows treatment of diseases spread by contact, droplet, or airborne routes of transmission. An onsite laboratory and an autoclave waste management system minimize the transport of infectious materials out of the unit. The unit is staffed by self-selected nurses, providers, and support staff with pediatric and adult capabilities. A telecommunications system allows other providers and family members to interact with patients and staff remotely. A full-time nurse educator is responsible for staff training, including quarterly exercises and competency assessment in the donning and doffing of personal protective equipment. The creation of the Johns Hopkins Biocontainment Unit required the highest level of multidisciplinary collaboration. When not used for clinical care and training, the unit will be a site for research and innovation in highly infectious diseases. The lessons learned from the design process can inform a new research agenda focused on the care of patients in a biocontainment environment.
Collapse
|
7
|
Vasa A, Smith PW, Schwedhelm M, Cieslak TJ, Lowe J, Kratochvil CJ, Beam EL, Boulter K, Hewlett A. Advancing Preparedness for Highly Hazardous Contagious Diseases: Admitting 10 Simulated Patients with MERS-CoV. Health Secur 2017; 15:432-439. [PMID: 28805464 DOI: 10.1089/hs.2017.0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Ebola outbreak of 2014-2016 highlighted the need for the development of a more robust healthcare infrastructure in the United States to provide isolation care for patients infected with a highly hazardous contagious disease. Routine exercises and skills practice are required to effectively and safely prepare care teams to confidently treat this special population of patients. The Nebraska Biocontainment Unit (NBU) at Nebraska Medicine in Omaha has been conducting exercises since 2005 when the unit was opened. Previous activities and exercises conducted by the Nebraska Biocontainment Unit have focused on transporting and caring for up to 3 patients with Ebola virus disease or other special pathogens. Changes in regional and national mandates, as well as the increased potential for receiving multiple patients at once, at a single location, have resulted in a greater demand to exercise protocols for the treatment of multiple patients. This article discusses in detail the planning, execution, and outcomes of a full-scale exercise involving 10 simulated patients with a highly infectious pathogen transmitted by the airborne route.
Collapse
|
8
|
Yu S, Cole JS. A 48-year-old man with severe shortness of breath. Air Med J 2014; 33:231-234. [PMID: 25179957 DOI: 10.1016/j.amj.2014.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 04/16/2014] [Accepted: 05/02/2014] [Indexed: 06/03/2023]
Abstract
A 48-year-old man was found by his neighbor unconscious on the floor at his residence. Earlier in the day, his neighbor reported noticing the patient was becoming more short of breath and having some trouble speaking. The neighbor alerted EMS. Upon EMS arrival, the patient was tachypneic with a room air O2 saturation in the 60s. A LifeFlight helicopter responded to transfer this patient to a tertiary care center from his home in a rural farming community.
Collapse
Affiliation(s)
- Sammy Yu
- Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA
| | - John S Cole
- Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA.
| |
Collapse
|