Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study.

Peter Kiiza,Sharmistha Mishra,Abel Vanderschuren,François Lamontagne,Kelly Thompson,Trevor Hall,Neill K J Adhikari,Koren Teo,Raymond Kao,John C Marshall,Srinivas Murthy,Ruxandra Pinto,Len Goodman,Dominique Piquette,Michael D Christian ,Elhadj Ibrahima Bah ,Jan Hájek ,Robert Fowler ,Sarah Mullin ,Adic Pérez

doi:10.3390/v13112205

Abstract

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 (p = 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.

Highlights

Ebola Virus Disease (EVD) is a contagious zoonotic infection with case-fatality rates of up to 90% in humans [1,2]
We designed a simulated Ebola Treatment Unit (ETU) in accordance with established guidance [17] and standardized and calibrated study procedures and data collection methods
More physicians than nurses achieved satisfactory completion of each task (PPE donning and doffing, peripheral intravenous (PIV) catheter and midline catheter (MLC) insertions, endotracheal intubation (ETI)), likely related to differences in scope of professional practice and experience in austere environments, and possibly related to a smaller group of nurses participating in the study

Summary

Introduction

Ebola Virus Disease (EVD) is a contagious zoonotic infection with case-fatality rates of up to 90% in humans [1,2]. A recent completed EVD outbreak in the DRC had a case-fatality rate of 42%. Over the past five decades, the prevention and control of EVD outbreaks have relied upon disease surveillance, infection prevention and control in health facilities and communities, risk communication, social mobilization, case management [2], and more recently, vaccination of high-risk groups [5] and EVD-specific investigational therapies [6,7]. Despite these strategies, EVD case-fatality rates remain at 40–60% in Africa [2], compared to 19%

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