Elizabeth L. Beam

A method for evaluating health care workers' personal protective equipment technique

Background Given the potential for the transfer of infectious diseases among patients in isolation, health care workers (HCWs), and other patients in the hospital environment, the proper use of personal protective equipment (PPE) is paramount. The literature is limited regarding studies of HCWs’ use of PPE in patient care tasks. Methods A pilot study was conducted to examine the feasibility of using a simulated health care environment to assess HCWs’ technique when implementing standard airborne and contact isolation precautions. The participants (n = 10) were assigned patient care tasks based on their specific professional roles. The encounters were digitally recorded during donning and doffing of PPE, as well as during interactions with the simulated patient. Powdered fluorescent marker was used as a measure of contamination. Results The pilot data show various inconsistencies in the HCWs’ PPE technique. Each of the 10 participants committed at least one breach of standard airborne and contact isolation precautions. Conclusion An expanded research study of HCW behaviors is needed to properly examine these contamination and exposure pathways. Training programs should be developed that emphasize the common errors in HCWs’ PPE technique.

Nebraska biocontainment unit patient discharge and environmental decontamination after Ebola care

Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE d Trauma and Preparedness Services, Nebraska Medicine, Omaha, NE Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE College of Nursing, University of Nebraska Medical Center, Omaha, NE Division of Infection Control and Epidemiology, Nebraska Medicine, Omaha, NE Office of the Vice Chancellor for Research, University of Nebraska Medical Center, Omaha, NE

Environmental infection control considerations for Ebola

Environmental infection control considerations for Ebola John J. Lowe PhD *, Patricia L. Olinger BS, RBP , Shawn G. Gibbs PhD, CIH , Kalpana Rengarajan PhD, RBP , Elizabeth L. Beam RN, Kathleen C. Boulter BAN , Michelle M. Schwedhelm MSN, A. Kim Hayes RN , Christopher J. Kratochvil MD , Sharon Vanairsdale MS, APRN, Brian Frislie CEH , Jerry Lewis , Angela L. Hewlett MD, Philip W. Smith MD, Bryce Gartland MD , Bruce S. Ribner MD

Impact of adenosine triphosphate detection and feedback on hospital room cleaning.

OBJECTIVE To assess the effect of adenosine triphosphate (ATP) device measurement of hospital room cleaning and feedback of pooled results to environmental service workers (EVS) to improve cleaning efficacy. DESIGN Nonrandomized controlled trial conducted over 20 months. SETTING Three hospitals of varying size. PARTICIPANTS EVS workers, randomly selected on the basis of convenience sample of rooms. INTERVENTIONS Environmental cleanliness composite scores were combined with layered educational interventions and used to provide feedback to EVS workers on specific hospital units. Trends in cleaning efficacy were observed after the interventions. RESULTS Cleaning efficacy improved significantly with each intervention (P < .01) and decreased during the washout period. CONCLUSIONS The ATP detection device combined with educational feedback for EVS workers resulted in significant improvement in cleaning efficacy of the hospital room environment.

Method for investigating nursing behaviors related to isolation care

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.

Personal protective equipment processes and rationale for the Nebraska Biocontainment Unit during the 2014 activations for Ebola virus disease

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.

Reflections on interprofessional team-based clinical care in the ebola epidemic: The Nebraska Medicine experience

Team-based interprofessional care has become the gold standard for comprehensive and efficient health care. Multiple national standard-setting bodies recommend interprofessional team-based care during educational preparation (e.g., Accreditation Council for Pharmacy Education, 2006; American Association of Colleges of Nursing, 2006, 2008, 2011; Interprofessional Education Collaborative Expert Panel, 2011; Liaison Committee for Medical Education, 2014). Interprofessional team-based care has been recommended as part of routine clinical care (Salas & Rosen, 2013). Team-based care has been found to enhance a culture of patient safety (Jones, Skinner, High, & Reiter-Palmon, 2013). Not only is team-based care considered foundational to quality in routine care, but it also has been shown to be effective in high-reliability situations in which the risks are high and many unknowns exist but outcomes remain good (McKeon, Oswaks, & Cunningham, 2006). The Nebraska Medicine experience in launching and operationalizing a biocontainment unit and more recently in treating people diagnosed with Ebola has demonstrated the effectiveness of a high-functioning team within a high-risk and high-pressure situation. The purpose of this article is to share reflections about the team component of this work, emphasizing five key characteristics of teamwork: training persistence, a wide range of clinical expertise, joint problem solving and creativity, a commitment to learning, and

The Nebraska Experience in Biocontainment Patient Care

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 Nebraskas 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.

Evaluating Isolation Behaviors by Nurses Using Mobile Computer Workstations at the Bedside

This secondary analysis from a larger mixed methods study with a sequential explanatory design investigates the clinical challenges for nurses providing patient care, in an airborne and contact isolation room, while using a computer on wheels for medication administration in a simulated setting. Registered nurses, who regularly work in clinical care at the patient bedside, were recruited as study participants in the simulation and debriefing experience. A live volunteer acted as the standardized patient who needed assessment and intravenous pain medication. The simulation was video recorded in a typical hospital room to observe participating nurses conducting patient care in an airborne and contact isolation situation. Participants then reviewed their performance with study personnel in a formal, audio-recorded debriefing. Isolation behaviors were scored by an expert panel, and the debriefing sessions were analyzed. Considerable variation was found in behaviors related to using a computer on wheels while caring for a patient in isolation. Currently, no nursing care guidelines exist on the use of computers on wheels in an airborne and contact isolation room. Specific education is needed on nursing care processes for the proper disinfection of computers on wheels and the reduction of the potential for disease transmission from environmental contamination.

A Gap Analysis Survey of US Aircraft Rescue and Fire Fighting (ARFF) Members to Determine Highly Infectious Disease Training and Education Needs

OBJECTIVE Despite lessons learned from the recent Ebola epidemic, attempts to survey and determine non-health care worker, industry-specific needs to address highly infectious diseases have been minimal. The aircraft rescue and fire fighting (ARFF) industry is often overlooked in highly infectious disease training and education, even though it is critical to their field due to elevated occupational exposure risk during their operations. METHODS A 44-question gap analysis survey was distributed to the ARFF Working Group to determine where highly infectious education and training can be improved. In total, N=245 responses were initiated and collected. Descriptive statistics were generated utilizing Qualtrics Software Version 2016.17©. RESULTS Supervisors perceived Frontline respondents to be more willing and comfortable to encounter potential highly infectious disease scenarios than the Frontline indicated. More than one-third of respondents incorrectly marked transmission routes of viral hemorrhagic fevers. There were discrepancies in self-reports on the existence of highly infectious disease orientation and skills demonstration, employee resources, and personal protective equipment policies, with a range of 7.5%-24.0% more Supervisors than Frontline respondents marking activities as conducted. CONCLUSIONS There are deficits in highly infectious disease knowledge, skills, and abilities among ARFF members that must be addressed to enhance member safety, health, and well-being. (Disaster Med Public Health Preparedness. 2018;12:675-679).