Michelle Schwedhelm

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

Planning and response to Ebola virus disease: An integrated approach

The care of patients with Ebola virus disease (EVD) requires the application of critical care medicine principles under conditions of stringent infection control precautions. The care of patients with EVD requires a number of elements in terms of physical layout, personal protective apparel, and other equipment. Provision of care is demanding in terms of depth of staff and training. The key to safely providing such care is a system that brings many valuable skills to the table, and allows communication between these individuals. We present our approach to leadership structure and function--a variation of incident command--in providing care to 3 patients with EVD.

Frequently Identified Gaps in Antimicrobial Stewardship Programs in Critical Access Hospitals

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project. ICAP team works in collaboration with NE Department of Health and Human Services (NEDHHS) to assess and improve infection prevention and control programs (IPCP) in various health care settings including resource limited settings like critical access hospitals (CAH). Little is known about the existing gaps in antimicrobial stewardship programs (ASP) of CAH. Hence, we decided to study the current level of ASP activities and factors associated with these activities in CAH. Methods NE ICAP conducted on-site surveys in 36 CAH from October 2015 to February 2017. ASP activities related to the 7 CDC recommended core elements (CE) including leadership support (LS), accountability, drug expertise (DE), action, tracking, reporting, and education were assessed using a CDC Infection Control Assessment Tool for acute care hospitals. Descriptive analyses evaluated CAH characteristics and frequency of CE implementation. Fisher’s exact, Mann–Whitney, and Kruskal–Wallis tests were used for statistical analyses examining the association of various factors with level of ASP activities. Results The 36 surveyed CAH had a median of 20 (range 10–25) beds and employed a median of 0.4 (range 0.1–1.6) infection preventionist (IP) full-time equivalent (FTE)/25-bed. Frequency of CE implementation varied among CAH with action and LS as the most (69%) and least (28%) frequently implemented elements, respectively. Close to half (47%) of surveyed CAH had implemented ≥4 CE but only 14% of facilities had all 7 CE. Median bed size and IP FTE/25-bed were similar among CAH with 0–2, 3-5, or ≥6 CE in place. CAH with LS or accountability for ASP implemented higher median numbers of the remaining CE compared with CAH without LS or accountability (5 vs. 2, P < 0.01 and 4 vs. 2, P < 0.01, respectively). Facilities with The presence of LS, accountability and drug expertise were more likely to have all 4 remaining CE implemented than others (56% vs. 8%, P < 0.01). Conclusion LS, accountability, and DE are important factors for the implementation of the remaining 4 CE in CAH. Although LS was the least frequently implemented CE, when present was associated with implementation of most of the other CE. Acquiring LS will facilitate implementation of additional ASP efforts in CAH. Disclosures All authors: No reported disclosures.

Frequently Identified Gaps in Antimicrobial Stewardship Programs in Long-Term Care Facilities

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project. ICAP team works in collaboration with NE Department of Health and Human Services (NEDHHS) to assess and improve infection prevention and control programs (IPCP) in acute care, outpatient and long-term care facilities (LTCF). New Centers for Medicare and Medicaid Services (CMS) regulation requires LTCF to develop antimicrobial stewardship programs (ASP) by November 2017. Hence, we decided to study the current level of ASP activities and associated factors in LTCF. Methods NE ICAP conducted on-site surveys in 30 LTCF from 11/2015 to 3/2017. ASP activities related to 7 CDC recommended core elements (CE) including leadership support (LS), accountability, drug expertise, action, tracking, reporting, and education were assessed using the CDC Infection Control Assessment Tool for LTCF. Gap frequencies were calculated for CE. Fisher’s exact, Mann–Whitney and Kruskal–Wallis tests were used for statistical analyses examining the associations of LS, accountability, bed size (BS), hospital affiliation (HA), presence of trained infection preventionist (IP), and IP weekly hours (WH)/100-bed for IPCP with level of ASP activites. Results Of the 30 LTCF surveyed, 23% had HA and 60% had trained IP. Median BS, IP WH/100-bed for IPCP, and number of CE implemented were 60.5, 6.5, and 3, respectively. Only 1 (3%) LTCF had all 7 CE in place. LTCF with LS had a higher median number of the 6 remaining CE implemented compared with LTCF without LS (3 vs. 2; P = 0.03). Similarly, LTCF with accountability for ASP had a median of 3 remaining CE in place as opposed to 2 in LTCF without accountability (P < 0.05). LTCF with LS, accountability, and ≥20 IP WH/100-bed for IPCP were more likely to implement ≥2 of the last 4 CE, i.e., action, tracking, reporting and education (100% vs. 30%, P < 0.05). LTCF with ≥20 IP WH/100-bed dedicated towards IPCP were more likely to have ≥5 CE in place than the LTCF with lower dedicated IP time (60% vs. 8%, P < 0.05). Conclusion Implementation of all 7 ASP CE in LTCF is uncommon. The presence of LS, accountability for ASP, and ≥20 IP WH/100-bed for IPCP are significant factors driving implementation of more ASP CE. Further guidance is needed for LTCF to assist them in dedicating appropriate IP time towards IPCP for promoting ASP as IP time varies greatly among LTCF. Disclosures All authors: No reported disclosures.

Critical Care for the Patient with Ebola Virus Disease (EBV): The Nebraska Perspective

Care for patients with Ebola Virus Disease (EVD) and other highly infectious diseases is demanding and requires an unwavering commitment to teamwork and stringent infection control measures. Patients with EVD are severely ill and require specialized critical care interventions. The care of these patients is resource intensive from a clinical, technical, emotional, and financial perspective. Successful treatment of these patients requires facilities to be fully prepared for the intense resource demand associated with their admission and continued cares.

Use of transatlantic telebroncoscopy to confirm proper endotracheal tube placement during a simulated chemical, biological, radiological or nuclear or explosive (CBRNE) event

Airway management is a cornerstone of medical support in the event of a chemical, biological, radiological, nuclear, or explosive event (CBRNE). Challenges are presented due to: the potential of having a large number of patients needing immediate treatment, lack of medical providers skilled in complex airway management tasks such as intubation, tactile and movement challenges caused by providers wearing protective gear and copious airway secretions in the event of a nerve agent exposure. These difficulties may increase the chance of emergency providers placing the endotracheal tube in an improper location during intubation. This study utilized telebronchoscopy to confirm proper endotracheal tube placement by anesthesia providers located at a transcontinental site. The results of this paper show that tele-video laryngoscopy and telebronchoscopy may be useful tools for emergency personnel providing airway management in the event of a CBRNE situation.