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1.
Air Med J ; 38(5): 359-365, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31578975

RESUMEN

INTRODUCTION: Aeromedical evacuation (AE) is a challenging process, further complicated when a patient has a highly hazardous communicable disease (HHCD). We conducted a review of the literature to evaluate the processes and procedures utilized for safe AE high-level containment transport (AE-HLCT) of patients with HHCDs. METHODS: A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019). Authors screened abstracts for inclusion criteria and full articles were reviewed if the abstract was deemed to contain information related to the aim. RESULTS: Our search criteria yielded 14 publications and were separated based upon publication dates, with the natural break point being the beginning of the 2013-2016 Ebola virus disease epidemic. Best practices and recommendations from identified articles are subdivided into pre-flight preparations, inflight operations, and post-flight procedures. CONCLUSIONS: Limited peer-reviewed literature exists on AE-HLCT, including important aspects related to healthcare worker fatigue, alertness, shift scheduling, and clinical care performance. This hinders the sharing of best practices to inform evacuations and equip teams for future outbreaks. Despite the successful use of different aircraft and technologies, the unique nature of the mission opens the opportunity for greater coordination and development of consensus standards for AE-HLCT operations.

2.
Nurs Clin North Am ; 54(2): 169-180, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31027659

RESUMEN

The 2014 to 2016 Ebola outbreak response resulted in many lessons learned about biocontainment patient care, leading to enhanced domestic capabilities for highly infectious and hazardous communicable diseases. However, additional opportunities for improvement remain. The article identifies and describes key considerations and challenges for laboratory analysis, clinical management, transportation, and personnel management during the care of patients infected with Ebola or other special pathogens. Dedication to maintaining preparedness enables biocontainment patient care teams to perform at the highest levels of safety and confidence.


Asunto(s)
Contención de Riesgos Biológicos/normas , Brotes de Enfermedades/prevención & control , Guías como Asunto , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/terapia , Medidas de Seguridad/normas , África Occidental , Humanos , Estados Unidos
4.
Am J Infect Control ; 46(3): 246-252, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29499788

RESUMEN

BACKGROUND: The Ebola virus disease outbreak highlighted the lack of consistent guidelines and training for workers outside of hospital settings. Specifically, emergency medical services (EMS) workers, who are frequently the first professionals to evaluate patients, often do not have advanced notice of patient diagnosis, and have limited time in their national curricula devoted to highly infectious disease (HID) identification and containment. All of these can place them at increased risk. To explore the depth of US EMS practitioners' HID training and education, a pilot gap analysis survey was distributed to determine where the aforementioned can be bolstered to increase occupational safety. METHODS: Electronic surveys were distributed to EMS organization members. The survey collected respondent willingness to encounter HID scenarios; current policies and procedures; and levels of knowledge, training, and available resources to address HIDs. RESULTS: A total of 2,165 surveys were initiated and collected. Eighty percent of frontline personnel were aware that their agency had an HID standard operating guideline. Almost 85% of respondents correctly marked routes of exposure for select HIDs. More than half of respondents indicated no maximum shift times in personal protective equipment. DISCUSSION: This research suggests EMS practitioners could benefit from enhanced industry-specific education, training, and planning on HID mitigation and management. CONCLUSION: Strengthening EMS preparedness in response to suspected or confirmed HID cases may not only improve patient outcomes, but also worker and community safety.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/normas , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/normas , Personal de Salud/educación , Enfermedades Transmisibles/transmisión , Recolección de Datos , Servicio de Urgencia en Hospital , Tratamiento de Urgencia , Guías como Asunto , Humanos , Estados Unidos
5.
Am J Infect Control ; 46(5): 579-580, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29329915

RESUMEN

Video review and scoring was used to evaluate the behaviors of nurses wearing N95 filtering face piece respirators while providing isolation care in a simulated patient care environment. This study yielded a detailed description of behaviors related to N95 respirator use in a health care setting. Developing a more robust and systematic behavior analysis tool for use in demonstration, simulation, and clinical care would allow for improved respiratory protection of health care workers.


Asunto(s)
Adhesión a Directriz , Máscaras , Enfermeras y Enfermeros , Atención de Enfermería/métodos , Aislamiento de Pacientes/métodos , Equipo de Protección Personal , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Grabación en Video , Adulto Joven
6.
Disaster Med Public Health Prep ; 12(6): 675-679, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29352835

RESUMEN

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).


Asunto(s)
Medicina Aeroespacial/métodos , Bomberos/educación , Evaluación de Necesidades/tendencias , Trabajo de Rescate/métodos , Enseñanza/normas , Medicina Aeroespacial/educación , Aeronaves , Bomberos/estadística & datos numéricos , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/transmisión , Humanos , Trabajo de Rescate/tendencias , Encuestas y Cuestionarios , Enseñanza/tendencias
7.
Am J Infect Control ; 46(2): 133-138, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28958444

RESUMEN

BACKGROUND: The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus. Category A waste-contaminated with EVD and other highly infectious pathogens-is strictly regulated by governmental agencies, and led to only several facilities willing to accept the waste. METHODS: A pilot survey was administered to determine if U.S. medical waste facilities are prepared to handle or transport category A waste, and to determine waste workers' current extent of training to handle highly infectious waste. RESULTS: Sixty-eight percent of survey respondents indicated they had not determined if their facility would accept category A waste. Of those that had acquired a special permit, 67% had yet to modify their permit since the EVD outbreak. This pilot survey underscores gaps in the medical waste industry to handle and respond to category A waste. Furthermore, this study affirms reports a limited number of processing facilities are capable or willing to accept category A waste. CONCLUSIONS: Developing the proper management of infectious disease materials is essential to close the gaps identified so that states and governmental entities can act accordingly based on the regulations and guidance developed, and to ensure public safety.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Enfermedades Transmisibles/transmisión , Eliminación de Residuos Sanitarios/métodos , Eliminación de Residuos Sanitarios/normas , Residuos Sanitarios/clasificación , Recolección de Datos , Brotes de Enfermedades/prevención & control , Servicio de Limpieza en Hospital , Humanos , Proyectos Piloto , Estados Unidos
8.
Health Secur ; 15(4): 432-439, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28805464

RESUMEN

The Ebola outbreak of 2014-2016 highlighted the need for the development of a more robust healthcare infrastructure in the United States to provide isolation care for patients infected with a highly hazardous contagious disease. Routine exercises and skills practice are required to effectively and safely prepare care teams to confidently treat this special population of patients. The Nebraska Biocontainment Unit (NBU) at Nebraska Medicine in Omaha has been conducting exercises since 2005 when the unit was opened. Previous activities and exercises conducted by the Nebraska Biocontainment Unit have focused on transporting and caring for up to 3 patients with Ebola virus disease or other special pathogens. Changes in regional and national mandates, as well as the increased potential for receiving multiple patients at once, at a single location, have resulted in a greater demand to exercise protocols for the treatment of multiple patients. This article discusses in detail the planning, execution, and outcomes of a full-scale exercise involving 10 simulated patients with a highly infectious pathogen transmitted by the airborne route.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Planificación en Desastres , Brotes de Enfermedades/prevención & control , Simulación de Paciente , Enfermedades Transmisibles , Infecciones por Coronavirus/epidemiología , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Coronavirus del Síndrome Respiratorio de Oriente Medio , Nebraska , Estados Unidos
9.
J Occup Environ Hyg ; 14(9): 674-680, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28609169

RESUMEN

PURPOSE: A United States industry-specific gap analysis survey of the death care sector-which comprises organizations and businesses affiliated with the funeral industry and the handling of human remains- was developed, the results analyzed, and training and education needs in relation to highly infectious disease mitigation and management were explored in an effort to identify where occupational health and safety can be enhanced in this worker population. METHODS: Collaborating national death care organizations distributed the 47-question electronic survey. N = 424 surveys were initiated and results recorded. The survey collected death care sector-specific information pertaining to the comfortability and willingness to handle highly infectious remains; perceptions of readiness, current policies and procedures in place to address highly infectious diseases; current highly infectious disease training levels, available resources, and personal protective equipment. RESULTS: One-third of respondents have been trained on how to manage highly infectious remains. There was a discrepancy between Supervisor/Management and Employee/Worker perceptions on employees' willingness and comfortability to manage potentially highly infectious remains. More than 40% of respondents did not know the correct routes of transmission for viral hemorrhagic fevers. CONCLUSIONS: Results suggest death care workers could benefit from increasing up-to-date industry-specific training and education on highly infectious disease risk mitigation and management. Professional death care sector organizations are positioned to disseminate information, training, and best practices.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Cremación/estadística & datos numéricos , Funerarias/estadística & datos numéricos , Prácticas Mortuorias/educación , Enfermedades Transmisibles/transmisión , Fiebres Hemorrágicas Virales/transmisión , Humanos , Encuestas y Cuestionarios , Estados Unidos
11.
Comput Inform Nurs ; 34(9): 387-92, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27232856

RESUMEN

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.


Asunto(s)
Competencia Clínica , Computadores/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa/prevención & control , Conductas Relacionadas con la Salud , Enfermeras y Enfermeros , Aislamiento de Pacientes/métodos , Adulto , Actitud del Personal de Salud , Femenino , Adhesión a Directriz/normas , Humanos , Masculino , Persona de Mediana Edad , Simulación de Paciente , Grabación en Video
12.
Am J Infect Control ; 44(3): 340-2, 2016 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-26559735

RESUMEN

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.


Asunto(s)
Transmisión de Enfermedad Infecciosa/prevención & control , Personal de Salud , Fiebre Hemorrágica Ebola/terapia , Control de Infecciones/métodos , Equipo de Protección Personal , Humanos , Nebraska
16.
Am J Infect Control ; 42(11): 1152-6, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25444261

RESUMEN

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.


Asunto(s)
Actitud del Personal de Salud , Transmisión de Enfermedad Infecciosa/prevención & control , Adhesión a Directriz/normas , Enfermeras y Enfermeros , Aislamiento de Pacientes/métodos , Adulto , Terapia Conductista/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
17.
Am J Infect Control ; 39(5): 415-420, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21255874

RESUMEN

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.


Asunto(s)
Benchmarking , Adhesión a Directriz , Personal de Salud , Equipos de Seguridad/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/métodos , Desinfección de las Manos , Humanos , Eliminación de Residuos Sanitarios , Proyectos Piloto
18.
Public Health Nurs ; 27(2): 140-7, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20433668

RESUMEN

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 Nebraska's 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.


Asunto(s)
Bioterrorismo/prevención & control , Descontaminación , Brotes de Enfermedades/prevención & control , Unidades Hospitalarias/organización & administración , Aislamiento de Pacientes/organización & administración , Enfermería en Salud Pública/organización & administración , Aire Acondicionado , Enfermedades Transmisibles Emergentes/prevención & control , Descontaminación/métodos , Planificación en Desastres/organización & administración , Urgencias Médicas , Humanos , Diseño Interior y Mobiliario , Nebraska , Rol de la Enfermera , Grupo de Atención al Paciente , Transferencia de Pacientes , Desarrollo de Programa , Cuarentena/organización & administración , Transporte de Pacientes
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