Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study
Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35...
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MDPI AG
2021
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oai:doaj.org-article:aff97822af56471b94b91779386564d82021-11-25T19:13:19ZEstablishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study10.3390/v131122051999-4915https://doaj.org/article/aff97822af56471b94b91779386564d82021-11-01T00:00:00Zhttps://www.mdpi.com/1999-4915/13/11/2205https://doaj.org/toc/1999-4915Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35 °C, 60% relative humidity) or thermo-neutral (20 °C, 20% relative humidity) conditions. In this pilot phase to determine the feasibility of study procedures, HCWs in PPE were non-randomly allocated to hot or thermo-neutral conditions to perform peripheral intravenous (PIV) and midline catheter (MLC) insertion and endotracheal intubation (ETI) on mannequins. Eighteen HCWs (13 physicians, 4 nurses, 1 nurse practitioner; 2 with prior ETU experience; 10 in hot conditions) spent 69 (10) (mean (SD)) minutes in the simulated ETU. Mean (SD) task completion times were 16 (6) min for PIV insertion; 33 (5) min for MLC insertion; and 16 (8) min for ETI. Satisfactory task completion was numerically higher for physicians vs. nurses. Participants’ blood pressure was similar, but heart rate was higher (<i>p</i> = 0.0005) post-simulation vs. baseline. Participants had a median (range) of 2.0 (0.0–10.0) minor PPE breaches, 2.0 (0.0–6.0) near-miss incidents, and 2.0 (0.0–6.0) health symptoms and concerns. There were eight health-assessment triggers in five participants, of whom four were in hot conditions. We terminated the simulation of two participants in hot conditions due to thermal discomfort. In summary, study tasks were suitable for physician participants, but they require redesign to match nurses’ expertise for the subsequent randomized phase of the study. One-quarter of participants had a health-assessment trigger. This research model may be useful in future training and research regarding clinical care for patients with highly infectious pathogens in austere settings.Peter KiizaSarah I. MullinKoren TeoLen GoodmanAdic PerezRuxandra PintoKelly ThompsonDominique PiquetteTrevor HallElhadj I. BahMichael ChristianJan J. HajekRaymond KaoFrançois LamontagneJohn C. MarshallSharmistha MishraSrinivas MurthyAbel VanderschurenRobert A. FowlerNeill K. J. AdhikariMDPI AGarticleEbola Virus DiseaseEbola Treatment Unitsimulationpersonal protective equipmentcritical carecritical illnessMicrobiologyQR1-502ENViruses, Vol 13, Iss 2205, p 2205 (2021) |
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Ebola Virus Disease Ebola Treatment Unit simulation personal protective equipment critical care critical illness Microbiology QR1-502 |
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Ebola Virus Disease Ebola Treatment Unit simulation personal protective equipment critical care critical illness Microbiology QR1-502 Peter Kiiza Sarah I. Mullin Koren Teo Len Goodman Adic Perez Ruxandra Pinto Kelly Thompson Dominique Piquette Trevor Hall Elhadj I. Bah Michael Christian Jan J. Hajek Raymond Kao François Lamontagne John C. Marshall Sharmistha Mishra Srinivas Murthy Abel Vanderschuren Robert A. Fowler Neill K. J. Adhikari Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study |
| description |
Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35 °C, 60% relative humidity) or thermo-neutral (20 °C, 20% relative humidity) conditions. In this pilot phase to determine the feasibility of study procedures, HCWs in PPE were non-randomly allocated to hot or thermo-neutral conditions to perform peripheral intravenous (PIV) and midline catheter (MLC) insertion and endotracheal intubation (ETI) on mannequins. Eighteen HCWs (13 physicians, 4 nurses, 1 nurse practitioner; 2 with prior ETU experience; 10 in hot conditions) spent 69 (10) (mean (SD)) minutes in the simulated ETU. Mean (SD) task completion times were 16 (6) min for PIV insertion; 33 (5) min for MLC insertion; and 16 (8) min for ETI. Satisfactory task completion was numerically higher for physicians vs. nurses. Participants’ blood pressure was similar, but heart rate was higher (<i>p</i> = 0.0005) post-simulation vs. baseline. Participants had a median (range) of 2.0 (0.0–10.0) minor PPE breaches, 2.0 (0.0–6.0) near-miss incidents, and 2.0 (0.0–6.0) health symptoms and concerns. There were eight health-assessment triggers in five participants, of whom four were in hot conditions. We terminated the simulation of two participants in hot conditions due to thermal discomfort. In summary, study tasks were suitable for physician participants, but they require redesign to match nurses’ expertise for the subsequent randomized phase of the study. One-quarter of participants had a health-assessment trigger. This research model may be useful in future training and research regarding clinical care for patients with highly infectious pathogens in austere settings. |
| format |
article |
| author |
Peter Kiiza Sarah I. Mullin Koren Teo Len Goodman Adic Perez Ruxandra Pinto Kelly Thompson Dominique Piquette Trevor Hall Elhadj I. Bah Michael Christian Jan J. Hajek Raymond Kao François Lamontagne John C. Marshall Sharmistha Mishra Srinivas Murthy Abel Vanderschuren Robert A. Fowler Neill K. J. Adhikari |
| author_facet |
Peter Kiiza Sarah I. Mullin Koren Teo Len Goodman Adic Perez Ruxandra Pinto Kelly Thompson Dominique Piquette Trevor Hall Elhadj I. Bah Michael Christian Jan J. Hajek Raymond Kao François Lamontagne John C. Marshall Sharmistha Mishra Srinivas Murthy Abel Vanderschuren Robert A. Fowler Neill K. J. Adhikari |
| author_sort |
Peter Kiiza |
| title |
Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study |
| title_short |
Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study |
| title_full |
Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study |
| title_fullStr |
Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study |
| title_full_unstemmed |
Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study |
| title_sort |
establishing healthcare worker performance and safety in providing critical care for patients in a simulated ebola treatment unit: non-randomized pilot study |
| publisher |
MDPI AG |
| publishDate |
2021 |
| url |
https://doaj.org/article/aff97822af56471b94b91779386564d8 |
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