Are We Ready for Ebola?

Monday, 9 November 2015

Leah B. Abecassis, MSN, BS, RN, CCRN
Medicine Intensive Care Unit, Boston Children’s Hospital, Boston, MA, USA
Paula Conrad, BSN, RN, CCRN, CPN
Medicine Intensive Care Unit, Boston Children's Hospital, Boston, MA, USA
Joanne Kinlay, MMedSci, BSN, RN, CIC
Infection Prevention and Control, Boston Children’s Hospital, Boston, MA, USA

Ebola virus disease (EVD) is one of many viral hemorrhagic fevers. It is a horrible, often deadly disease in humans. Bodily fluids from a patient with EVD are highly infectious, and therefore use of special contact and droplet precautions while caring for patients with potential Ebola Virus Disease (EVD) is vital to preventing spread of the virus (CDC, 2014). Our hospital started preparations for these distinct precautions with use of specialized protective personal equipment (PPE) that follows the Centers for Disease Control guidelines. In preparation for a suspected or real case of EVD, there have been PPE trainings done with the Intensive Care Unit staff in the location in the hospital where these patients would be cared for.  This training included a one hour practice session with a trainer on donning and doffing, staff being sent home with kits to practice on their own, and then a sign off, done by a trainer, of competence in the skills to don and doff the PPE. The training process was done during work hours and there were rooms dedicated just for use in training purposes for four weeks.

The objective of this quality improvement project was to determine whether health care providers (HCPs) felt adequately prepared in PPE use, should a suspected or confirmed case of EVD present to our hospital for care.

An online survey of 49 HCPs (41 nurses and 7 physicians) working in the medical intensive care unit was conducted. The years of experience as a nurse or physician ranged, with 16 (49%) HCPs having 5-10 years of experience. The 10 question survey, using the Likert scale, assessed comfort level with PPE training and care of the EVD patient.

There were 29 (68%) nurses and 4 (57%) physicians who responded to the survey. That is a 67% response rate to the survey (n=33). Prior to receiving PPE training, 4 (12%) of HCPs indicated they were comfortable with caring for an EVD patient, while 17 (52%) stated they were uncomfortable. Following training, 9 (27%) HCPs were comfortable with caring for an EVD patient, while 8 (24%) were uncomfortable. 21 (65%) HCPs practiced donning and doffing PPE between 3-5 times. 6 (18%) had practiced 6 or more times. 18 (55%) staff members felt that they had adequate practice using the PPE.

Understanding the factors that contribute to the willingness of health care providers to provide care during an Ebola outbreak is critical to emergency preparedness. Some studies have shown that keeping staff informed of the emergency plans, stocking PPE, and having the PPE available to HCPs, improves their willingness to work during a pandemic (Devnani, 2012). Another important factor is comfort with the contents of their PPE and how to use it. In order for people to be more comfortable and prepared, there need to be frequent training sessions (Loke, Fung, and Liu, 2013). Feistritzer, Hill, Vanairsdale, and Gentry (2014), stated that the HCP team at Emory in their biocontainment unit has rapid cycle education with competency verification, including the donning and doffing of PPE, to ensure the safety of their staff.

In the next iteration of our survey, we should include more questions that lead us to understand the background behind the discomfort that staff have, and how to improve their comfort level. The information from this survey leads our group to conclude that a smaller volunteer team with more hours of practice may be in the best solution to who should care for these patients.