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Donovan SK, Herstein JJ, Le AB, Gibbs SG, Beam EL, Brown CK, Lowe AE, Lowe JJ, Lawler JV. The cardinal rules: Principles of personal protective equipment for high-consequence infectious disease events. Infect Control Hosp Epidemiol 2024; 45:785-787. [PMID: 38329022 DOI: 10.1017/ice.2023.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
In recognition of an increasing number of high-consequence infectious disease events, a group of subject-matter experts identified core safety principles that can be applied across all donning and doffing protocols for personal protective equipment.
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Affiliation(s)
- Sara K Donovan
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jocelyn J Herstein
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Aurora B Le
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
| | - Shawn G Gibbs
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas
| | - Elizabeth L Beam
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Christopher K Brown
- Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Abigail E Lowe
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Allied Health Professions Education, Research, and Practice, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - John J Lowe
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Herstein JJ, Figi CE, Le AB, Beam EL, Lawler JV, Schnaubelt ER, Carter GW, Lowe JJ, Gibbs SG. An Updated Review of Literature for Air Medical Evacuation High-Level Containment Transport During the Coronavirus Disease 2019 Pandemic. Air Med J 2023; 42:201-209. [PMID: 37150575 PMCID: PMC9808413 DOI: 10.1016/j.amj.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/27/2022] [Indexed: 05/09/2023]
Abstract
OBJECTIVE In 2019, our team conducted a literature review of air medical evacuation high-level containment transport (AE-HLCT) of patients infected with high-consequence pathogens. Since that publication, the coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous air medical evacuations. We re-examined the new literature associated with AE-HLCTs to determine new innovations developed as a result of the pandemic. METHODS A literature search was performed in PubMed/MEDLINE from February 2019 to October 2021. The authors screened abstracts for the inclusion criteria and reviewed full articles if the abstract was relevant to the aim. RESULTS Our search criteria yielded 19 publications. Many of the early transports of patients with COVID-19 used established protocols for AE-HLCT, which were built from the most recent transports of patients with Ebola virus disease. Innovations from the identified articles are subdivided into preflight considerations, in-flight operations, and postflight operations. CONCLUSION Lessons gleaned from AE-HLCTs of patients with COVID-19 in the early weeks of the pandemic, when little was known about transmission or the severity of the novel disease, have advanced the field of AE-HLCT. Teams that had never conducted such transports now have experience and processes. However, more research into AE-HLCT is needed, including research related to single-patient portable isolation units as well as containerized/multipatient transportation systems.
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Affiliation(s)
- Jocelyn J Herstein
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE; Global Center for Health Security, Omaha, NE.
| | - Claire E Figi
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX
| | - Aurora B Le
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Elizabeth L Beam
- Global Center for Health Security, Omaha, NE; College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - James V Lawler
- Global Center for Health Security, Omaha, NE; Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, NE
| | - Elizabeth R Schnaubelt
- Global Center for Health Security, Omaha, NE; Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, NE; United States Air Force School of Aerospace Medicine, Dayton, OH
| | | | - John J Lowe
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE; Global Center for Health Security, Omaha, NE
| | - Shawn G Gibbs
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX
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Le AB, Perez-Patron M, Ward LM, Comai A, Beam EL, Gibbs SG. Characteristics Associated With Consistent Handwashing and Satisfaction in the Workplace: A Pilot Survey of U.S. Workers. Workplace Health Saf 2022; 70:21650799221082305. [PMID: 35491860 DOI: 10.1177/21650799221082305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study seeks to determine what handwashing facilities are available to workers, predominantly in the manufacturing and service industries, to find out if their workplace has the appropriate resources to conduct proper handwashing and how that affects handwashing satisfaction. METHODS This cross-sectional study surveyed U.S. adult workers (N = 241) on their workplace handwashing equipment and facilities. The associations between demographic characteristics, consistent handwashing, and handwashing satisfaction were evaluated using Fisher's exact test. FINDINGS Eighty-eight percent of respondents reported consistent handwashing. Pulling a handle to exit the restroom was negatively associated with handwashing satisfaction (p = .004) and having difficulty with an automatic faucet or dispenser was negatively marginally significant in its association with handwashing consistency (p = .10). CONCLUSION/APPLICATIONS TO PRACTICE Greater understanding of the available equipment in workplace restroom facilities and how to improve selection and use of that equipment may improve workers' handwashing experiences.
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Affiliation(s)
- Aurora B Le
- Department of Environmental Health Sciences, School of Public Health, University of Michigan
| | - Maria Perez-Patron
- Department of Epidemiology and Biostatics, School of Public Health, Texas A&M University
| | - Lauren M Ward
- Department of Environmental Health Sciences, School of Public Health, University of Michigan
| | - Andrew Comai
- College of Nursing, University of Nebraska Medical Center
| | - Elizabeth L Beam
- Health and Safety Department, International Union, United Automobile, Aerospace and Agricultural Implement Workers of America
| | - Shawn G Gibbs
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University
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Herstein JJ, Abdoulaye AA, Jelden KC, Le AB, Beam EL, Gibbs SG, Hewlett AL, Vasa A, Boulter KC, Stentz TL, Kopocis-Herstein KR, ElRayes W, Wichman C, Lowe JJ. A pilot study of core body temperatures in healthcare workers wearing personal protective equipment in a high-level isolation unit. J Occup Environ Hyg 2021; 18:430-435. [PMID: 34383620 DOI: 10.1080/15459624.2021.1949459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8°F) during the 4-hr shift; core temperatures of half (n = 3) of the participants exceeded 38.5 °C (101.3 °F), the upper core temperature limit. Future investigations are needed to identify other heat stress risks both in and outside of controlled units. The ongoing COVID-19 pandemic offers unique opportunities for field-based research on risks of heat stress related to personal protective equipment in healthcare workers that can lead to both short- and long-term innovations in this field.
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Affiliation(s)
- Jocelyn J Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Aurora B Le
- School of Public Health, University of Michigan, Ann Arbor, Ann Arbor, Michigan
| | - Elizabeth L Beam
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Shawn G Gibbs
- School of Public Health, Texas A&M University, College Station, Texas
| | - Angela L Hewlett
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Terry L Stentz
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
- College of Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Kelli R Kopocis-Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
- College of Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Wael ElRayes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Chris Wichman
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - John J Lowe
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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Herstein JJ, Gibbs SG, Kupzyk KA, Beam EL. Using a Critical Safety Behavior Scoring Tool for Just-in-Time Training for N95 Respirator Use. Workplace Health Saf 2021; 70:31-36. [PMID: 34425725 DOI: 10.1177/21650799211031169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Historically, health care workers (HCWs) have exhibited marginal adherence to proper N95 respirator use. During the COVID-19 pandemic, HCWs with little to no prior training on N95 respirator use are relying on N95s as their primary respiratory protection. There is a need for simple, effective, and easily implementable just-in-time training (JITT) interventions to improve N95 respirator-related safety behavior. This study investigated two JITT interventions. METHODS A pilot experimental pretest posttest study design was used to evaluate two training interventions for N95 respirator donning/doffing performance at a Midwestern hospital system. HCW participants were randomly assigned to an intervention: one used a 4-minute instructional video alone, while the other used the same video but added a video reflection intervention (participant watched and scored a video of their own performance). All performances were scored using a 10-point Critical Safety Behavior Scoring Tool (CSBST). FINDINGS Sixty-two HCWs participated (32 video alone, 30 video reflection). The two groups' CSBST scores were not significantly different at pretest. Averaged participant scores on the CSBST improved immediately following both interventions. Scores were significantly higher on the posttest for the reflective practice intervention (p<.05). Years of experience and frequency of N95 respirator use did not predict pre or post scores. CONCLUSIONS/APPLICATIONS TO PRACTICE We provide evidence to support the use of a time-efficient JITT intervention to improve HCW N95 respirator donning/doffing practices during the COVID-19 pandemic and beyond. Hospital safety professionals should consider this type of training for HCWs required to wear respiratory protection.
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Beam EL, Herstein JJ, Kupzyk KA, Gibbs SG. A simulation approach to measure critical safety behaviors when evaluating training methods for respirator education in healthcare workers. Am J Infect Control 2020; 48:869-874. [PMID: 32407827 PMCID: PMC7214345 DOI: 10.1016/j.ajic.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/01/2022]
Abstract
N95 respirators are a common tool in healthcare for airborne isolation and pandemic response. Simulation can be used to train healthcare workers. Reflective practice may be a training intervention to improve N95 respirator use compared to video alone.
Background The N95 respirator is the most common safety tool used in hospitals to protect health care workers (HCW) from inhaling airborne particles. Focusing on HCW behavior related to respirator use is an effective route to improve HCW safety and respiratory health. Methods Participants were asked to perform the donning and doffing of an N95 respirator to camera. Then they were randomized to a video alone or a reflective practice intervention. After the intervention they repeated the donning and doffing to camera. A critical safety behavior scoring tool (CSBST) was developed to compare the performance of the participants over time at pretest, post-test and 1 month later for follow-up. Results The reflective practice intervention group was found to have significantly higher scores on the CSBST at post-test and follow-up than the video alone group. In the reflective practice intervention group, the participants perceived they were better at performing the N95 donning and doffing than the experts scored them. Conclusions The CSBST is a tool to measure the performance of HCWs on a specific targeted safety behaviors. The addition of a reflective practice intervention may result in a measurable and sustained improvement in the safety behaviors demonstrated when using the N95 respirator.
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Gibbs SG, Herstein JJ, Le AB, Beam EL, Cieslak TJ, Lawler JV, Santarpia JL, Stentz TL, Kopocis-Herstein KR, Achutan C, Carter GW, Lowe JJ. Review of Literature for Air Medical Evacuation High-Level Containment Transport. Air Med J 2019; 38:359-365. [PMID: 31578975 PMCID: PMC7128392 DOI: 10.1016/j.amj.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Aeromedical evacuation (AE) is a challenging process, further complicated when a patient has a highly hazardous communicable disease (HHCD). We conducted a review of the literature to evaluate the processes and procedures utilized for safe AE high-level containment transport (AE-HLCT) of patients with HHCDs. METHODS A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019). Authors screened abstracts for inclusion criteria and full articles were reviewed if the abstract was deemed to contain information related to the aim. RESULTS Our search criteria yielded 14 publications and were separated based upon publication dates, with the natural break point being the beginning of the 2013-2016 Ebola virus disease epidemic. Best practices and recommendations from identified articles are subdivided into pre-flight preparations, inflight operations, and post-flight procedures. CONCLUSIONS Limited peer-reviewed literature exists on AE-HLCT, including important aspects related to healthcare worker fatigue, alertness, shift scheduling, and clinical care performance. This hinders the sharing of best practices to inform evacuations and equip teams for future outbreaks. Despite the successful use of different aircraft and technologies, the unique nature of the mission opens the opportunity for greater coordination and development of consensus standards for AE-HLCT operations.
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Affiliation(s)
- Shawn G Gibbs
- Department of Environmental and Occupational Health, Indiana University School of Public Health, Bloomington, IN
| | - Jocelyn J Herstein
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE.
| | - Aurora B Le
- Department of Environmental and Occupational Health, Indiana University School of Public Health, Bloomington, IN; Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN
| | - Elizabeth L Beam
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Theodore J Cieslak
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, NE; National Strategic Research Institute, Omaha, NE
| | - Joshua L Santarpia
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; National Strategic Research Institute, Omaha, NE; Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE
| | - Terry L Stentz
- Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE; The Charles W. Durham School of Architectural Engineering and Construction, University of Nebraska-Lincoln, Lincoln, NE
| | - Kelli R Kopocis-Herstein
- The Charles W. Durham School of Architectural Engineering and Construction, University of Nebraska-Lincoln, Lincoln, NE
| | - Chandran Achutan
- Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | | | - John J Lowe
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Gibbs SG, Herstein JJ, Le AB, Beam EL, Cieslak TJ, Lawler JV, Santarpia JL, Stentz TL, Kopocis-Herstein KR, Achutan C, Carter GW, Lowe JJ. Need for Aeromedical Evacuation High-Level Containment Transport Guidelines. Emerg Infect Dis 2019; 25:1033-1034. [PMID: 30741629 PMCID: PMC6478225 DOI: 10.3201/eid2505.181948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Circumstances exist that call for the aeromedical evacuation high-level containment transport (AE-HLCT) of patients with highly hazardous communicable diseases. A small number of organizations maintain AE-HLCT capabilities, and little is publicly available regarding the practices. The time is ripe for the development of standards and consensus guidelines involving AE-HLCT.
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Beam EL, Hotchkiss EL, Gibbs SG, Hewlett AL, Iwen PC, Nuss SL, Smith PW. Observed variation in N95 respirator use by nurses demonstrating isolation care. Am J Infect Control 2018; 46:579-580. [PMID: 29329915 DOI: 10.1016/j.ajic.2017.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022]
Abstract
Video review and scoring was used to evaluate the behaviors of nurses wearing N95 filtering face piece respirators while providing isolation care in a simulated patient care environment. This study yielded a detailed description of behaviors related to N95 respirator use in a health care setting. Developing a more robust and systematic behavior analysis tool for use in demonstration, simulation, and clinical care would allow for improved respiratory protection of health care workers.
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Le AB, Buehler SA, Maniscalco PM, Lane P, Rupp LE, Ernest E, Von Seggern D, West K, Herstein JJ, Jelden KC, Beam EL, Gibbs SG, Lowe JJ. Determining training and education needs pertaining to highly infectious disease preparedness and response: A gap analysis survey of US emergency medical services practitioners. Am J Infect Control 2018; 46:246-252. [PMID: 29499788 PMCID: PMC7132664 DOI: 10.1016/j.ajic.2017.09.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/19/2022]
Abstract
Gap-analysis survey concerning HID preparedness among U.S. EMS was conducted. Knowledge deficits for exposure routes of notable select HIDs were identified. Results indicate practitioners could gain from updated HID training and education.
Background The Ebola virus disease outbreak highlighted the lack of consistent guidelines and training for workers outside of hospital settings. Specifically, emergency medical services (EMS) workers, who are frequently the first professionals to evaluate patients, often do not have advanced notice of patient diagnosis, and have limited time in their national curricula devoted to highly infectious disease (HID) identification and containment. All of these can place them at increased risk. To explore the depth of US EMS practitioners' HID training and education, a pilot gap analysis survey was distributed to determine where the aforementioned can be bolstered to increase occupational safety. Methods Electronic surveys were distributed to EMS organization members. The survey collected respondent willingness to encounter HID scenarios; current policies and procedures; and levels of knowledge, training, and available resources to address HIDs. Results A total of 2,165 surveys were initiated and collected. Eighty percent of frontline personnel were aware that their agency had an HID standard operating guideline. Almost 85% of respondents correctly marked routes of exposure for select HIDs. More than half of respondents indicated no maximum shift times in personal protective equipment. Discussion This research suggests EMS practitioners could benefit from enhanced industry-specific education, training, and planning on HID mitigation and management. Conclusion Strengthening EMS preparedness in response to suspected or confirmed HID cases may not only improve patient outcomes, but also worker and community safety.
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Affiliation(s)
- Aurora B Le
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, IN; Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN.
| | - Sean A Buehler
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, IN; Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN
| | - Paul M Maniscalco
- International Association of Emergency Medical Services Chiefs, Washington, DC
| | - Pamela Lane
- National Association of Emergency Medical Technicians, Clinton, MS
| | - Lloyd E Rupp
- Emergency Medical Services, Omaha Fire & Rescue, Omaha, NE
| | - Eric Ernest
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Debra Von Seggern
- Center for Continuing Education, EMS and Trauma Program, University of Nebraska Center, Omaha, NE
| | - Katherine West
- Infection Control/Emerging Concepts, Inc, Alexandria, VA
| | - Jocelyn J Herstein
- Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Katelyn C Jelden
- College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Elizabeth L Beam
- College of Nursing, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha, NE
| | - Shawn G Gibbs
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, IN
| | - John J Lowe
- Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha, NE
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Le AB, Hoboy S, Germain A, Miller H, Thompson R, Herstein JJ, Jelden KC, Beam EL, Gibbs SG, Lowe JJ. A pilot survey of the U.S. medical waste industry to determine training needs for safely handling highly infectious waste. Am J Infect Control 2018; 46:133-138. [PMID: 28958444 PMCID: PMC7132720 DOI: 10.1016/j.ajic.2017.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/15/2017] [Accepted: 08/15/2017] [Indexed: 11/12/2022]
Abstract
Waste management is overlooked in the containment of highly infectious pathogens. Complexities of category A waste deter facilities' willingness to accept the waste. Enhanced training on properly handling and transporting category A waste is urged.
Background The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus. Category A waste—contaminated with EVD and other highly infectious pathogens—is strictly regulated by governmental agencies, and led to only several facilities willing to accept the waste. Methods A pilot survey was administered to determine if U.S. medical waste facilities are prepared to handle or transport category A waste, and to determine waste workers' current extent of training to handle highly infectious waste. Results Sixty-eight percent of survey respondents indicated they had not determined if their facility would accept category A waste. Of those that had acquired a special permit, 67% had yet to modify their permit since the EVD outbreak. This pilot survey underscores gaps in the medical waste industry to handle and respond to category A waste. Furthermore, this study affirms reports a limited number of processing facilities are capable or willing to accept category A waste. Conclusions Developing the proper management of infectious disease materials is essential to close the gaps identified so that states and governmental entities can act accordingly based on the regulations and guidance developed, and to ensure public safety.
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Le AB, Witter L, Herstein JJ, Jelden KC, Beam EL, Gibbs SG, Lowe JJ. A gap analysis of the United States death care sector to determine training and education needs pertaining to highly infectious disease mitigation and management. J Occup Environ Hyg 2017; 14:674-680. [PMID: 28609169 DOI: 10.1080/15459624.2017.1319570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE A United States industry-specific gap analysis survey of the death care sector-which comprises organizations and businesses affiliated with the funeral industry and the handling of human remains- was developed, the results analyzed, and training and education needs in relation to highly infectious disease mitigation and management were explored in an effort to identify where occupational health and safety can be enhanced in this worker population. METHODS Collaborating national death care organizations distributed the 47-question electronic survey. N = 424 surveys were initiated and results recorded. The survey collected death care sector-specific information pertaining to the comfortability and willingness to handle highly infectious remains; perceptions of readiness, current policies and procedures in place to address highly infectious diseases; current highly infectious disease training levels, available resources, and personal protective equipment. RESULTS One-third of respondents have been trained on how to manage highly infectious remains. There was a discrepancy between Supervisor/Management and Employee/Worker perceptions on employees' willingness and comfortability to manage potentially highly infectious remains. More than 40% of respondents did not know the correct routes of transmission for viral hemorrhagic fevers. CONCLUSIONS Results suggest death care workers could benefit from increasing up-to-date industry-specific training and education on highly infectious disease risk mitigation and management. Professional death care sector organizations are positioned to disseminate information, training, and best practices.
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Affiliation(s)
- Aurora B Le
- a Department of Environmental Health and Occupational Health , Indiana University School of Public Health , Bloomington , Indiana
| | - Lesley Witter
- b Advocacy, National Funeral Directors Association (NFDA) , Brookfield , Wisconsin
| | - Jocelyn J Herstein
- c Department of Environmental, Occupational and Agricultural Health, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska
| | - Katelyn C Jelden
- d College of Medicine , University of Nebraska Medical Center , Omaha , Nebraska
| | - Elizabeth L Beam
- e Nebraska Biocontainment Unit , Omaha , Nebraska
- f College of Nursing , University of Nebraska Medical Center , Omaha , Nebraska
| | - Shawn G Gibbs
- a Department of Environmental Health and Occupational Health , Indiana University School of Public Health , Bloomington , Indiana
| | - John J Lowe
- c Department of Environmental, Occupational and Agricultural Health, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska
- e Nebraska Biocontainment Unit , Omaha , Nebraska
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15
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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] [What about the content of this article? (0)] [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.
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Beam EL. Call for improvement in personal protective equipment guidance and research. Am J Infect Control 2016; 44:1428. [PMID: 27671362 PMCID: PMC7135500 DOI: 10.1016/j.ajic.2016.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 10/28/2022]
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Beam EL, Schwedhelm S, Boulter K, Kratochvil C, Lowe J, Hewlett A, Gibbs SG, Smith PW. Personal protective equipment processes and rationale for the Nebraska Biocontainment Unit during the 2014 activations for Ebola virus disease. Am J Infect Control 2016; 44:340-2. [PMID: 26559735 DOI: 10.1016/j.ajic.2015.09.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/26/2022]
Abstract
In response to the Ebola virus disease outbreak of 2014, specific procedures for personal protective equipment use were developed in the Nebraska Biocontainment Unit for the isolation care of patients with the illness. This brief report describes the 2 different levels used for patient care and presents the rationales for the specialized processes.
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Jelden KC, Smith PW, Schwedhelm MM, Gibbs SG, Lowe JJ, Beam EL, Kratochvil CJ, Boulter KC, Hewlett AL. Learning from Ebola: Interprofessional practice in the Nebraska Biocontainment Unit. ACTA ACUST UNITED AC 2015; 1:97-99. [PMID: 32289082 PMCID: PMC7104021 DOI: 10.1016/j.xjep.2015.07.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/23/2015] [Indexed: 11/18/2022]
Abstract
Caring for patients with Ebola virus disease (EVD) in the Nebraska Biocontainment Unit (NBU) has necessitated and enabled extensive interprofessional relationships and the creation of a collaborative care model. Critical aspects of NBU functionality include a constructive leadership environment, staff inclusion and consideration during protocol development, and a culture of partnership and communication.
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Affiliation(s)
- Katelyn C Jelden
- Department of Environmental, Agricultural & Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE 68198, USA
| | - Philip W Smith
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE 68198, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Michelle M Schwedhelm
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE 68198, USA.,Emergency Preparedness & Infection Prevention, Nebraska Medicine, Omaha, NE 68198, USA
| | - Shawn G Gibbs
- Department of Environmental, Agricultural & Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE 68198, USA.,Department of Environmental Health, Indiana University School of Public Health, Bloomington, IN 47405, USA
| | - John J Lowe
- Department of Environmental, Agricultural & Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE 68198, USA
| | - Elizabeth L Beam
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE 68198, USA.,College of Nursing, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Christopher J Kratochvil
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE 68198, USA.,Office of the Vice Chancellor for Research, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | | | - Angela L Hewlett
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE 68198, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Lowe JJ, Olinger PL, Gibbs SG, Rengarajan K, Beam EL, Boulter KC, Schwedhelm MM, Hayes AK, Kratochvil CJ, Vanairsdale S, Frislie B, Lewis J, Hewlett AL, Smith PW, Gartland B, Ribner BS. Environmental infection control considerations for Ebola. Am J Infect Control 2015; 43:747-9. [PMID: 25934067 DOI: 10.1016/j.ajic.2015.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 11/20/2022]
Affiliation(s)
- John J Lowe
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE.
| | | | - Shawn G Gibbs
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE
| | | | - Elizabeth L Beam
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE; College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | | | - Michelle M Schwedhelm
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE; Trauma and Preparedness Services, Nebraska Medicine, Omaha, NE
| | - A Kim Hayes
- Infection Control and Epidemiology, Nebraska Medicine, Omaha, NE
| | - Christopher J Kratochvil
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE; Office of the Vice Chancellor for Research, University of Nebraska Medical Center, Omaha, NE
| | | | - Brian Frislie
- Environmental Services, Emory University Hospital, Atlanta, GA
| | - Jerry Lewis
- Facilities, Emory University Hospital, Atlanta, GA
| | - Angela L Hewlett
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE; Division of Infectious Disease, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Philip W Smith
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE; Division of Infectious Disease, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Bryce Gartland
- Department of Medicine, Emory University Hospital, Atlanta, GA
| | - Bruce S Ribner
- Division of Infectious Disease, Department of Medicine, Emory University Hospital, Atlanta, GA
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Jelden KC, Gibbs SG, Smith PW, Schwedhelm MM, Iwen PC, Beam EL, Hayes AK, Marion N, Kratochvil CJ, Boulter KC, Hewlett AL, Lowe JJ. Nebraska Biocontainment Unit patient discharge and environmental decontamination after Ebola care. Am J Infect Control 2015; 43:203-5. [PMID: 25637433 DOI: 10.1016/j.ajic.2014.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/04/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
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Schwedhelm S, Beam EL, Morris RD, Sebastian JG. Reflections on interprofessional team-based clinical care in the ebola epidemic: the Nebraska Medicine experience. Nurs Outlook 2014; 63:27-9. [PMID: 25645479 DOI: 10.1016/j.outlook.2014.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | - Elizabeth L Beam
- Nebraska Medicine, Omaha, NE; University of Nebraska Medical Center College of Nursing, Omaha, NE
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Beam EL, Gibbs SG, Hewlett AL, Iwen PC, Nuss SL, Smith PW. Method for investigating nursing behaviors related to isolation care. Am J Infect Control 2014; 42:1152-6. [PMID: 25444261 DOI: 10.1016/j.ajic.2014.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although an emphasis has been placed on protecting patients by improving health care worker compliance with infection control techniques, challenges associated with patient isolation do exist. To address these issues, a more consistent mechanism to evaluate specific clinical behaviors safely is needed. METHODS The research method described in this study used a high fidelity simulation using a live standardized patient recorded by small cameras. Immediately after the simulation experience, nurses were asked to view and comment on their performance. A demographic survey and a video recorded physical evaluation provided participant description. A questionnaire component 1 month after the simulation experience offered insight into the timing of behavior change in clinical practice. RESULTS Errors in behaviors related to donning and doffing equipment for isolation care were noted among the nurses in the study despite knowing they were being video recorded. This simulation-based approach to clinical behavior analysis provided rich data on patient care delivery. CONCLUSION Standard educational techniques have not led to ideal compliance, and this study demonstrated the potential for using video feedback to enhance learning and ultimately reduce behaviors, which routinely increase the likelihood of disease transmission. This educational research method could be applied to many complicated clinical skills.
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Affiliation(s)
- Elizabeth L Beam
- College of Nursing, University of Nebraska Medical Center, Omaha, NE.
| | - Shawn G Gibbs
- Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Angela L Hewlett
- Infectious Diseases, College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Peter C Iwen
- Pathology/Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Suzanne L Nuss
- Care Transitions and Nursing Outcomes, Nebraska Medical Center, Omaha, NE
| | - Philip W Smith
- Infectious Diseases, College of Medicine, University of Nebraska Medical Center, Omaha, NE
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Abstract
Public health nurses in local health departments may receive the first call regarding a potential case of avian influenza, monkeypox, or viral hemorrhagic fever. One public health approach to containing these dangerous infectious disease outbreaks is the use of specialized isolation units. Early access to a biocontainment patient care unit (BPCU) for isolation during a bioterrorism or public health emergency event along with appropriate use of epidemiological and therapeutic interventions in the community may dramatically impact the size and severity of a disease outbreak (Smith et al., 2006). As emerging infectious agents, pandemics, resistant organisms, and terrorism continue to threaten human life; health care and emergency care providers must be empowered to work with nurses and other professionals in public health to plan for the consequences. This article describes the evolution of Nebraska's BPCU strategy for public health preparedness in the face of a biological threat. Design priorities, unit management, challenges, and lessons learned will be shared to guide others in establishing similar infrastructure.
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Affiliation(s)
- Elizabeth L Beam
- Nebraska Biocontainment Unit, University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska 68198-5330, USA.
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