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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.
BMC Med Educ ; 18(1): 321, 2018 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-30591050

RESUMEN

BACKGROUND: Point-of-care-ultrasound (POCUS) training is expanding in undergraduate and graduate medical education, but lack of trained faculty is a major barrier. Two strategies that may help mitigate this obstacle are interprofessional education (IPE) and near-peer teaching. The objective of this study was to evaluate a POCUS course in which diagnostic medical sonography (DMS) students served as near-peer teachers for internal medicine residents (IMR) learning to perform abdominal sonography. METHODS: Prior to the IPE workshop, DMS students participated in a train-the-trainer session to practice teaching and communication skills via case-based simulation. DMS students then coached first-year IMR to perform POCUS examinations of the kidney, bladder, and gallbladder on live models. A mixed-methods evaluation of the interprofessional workshop included an objective structured clinical exam (OSCE), course evaluation, and qualitative analysis of focus group interviews. RESULTS: Twenty-four of 24 (100%) IMR completed the OSCE, averaging 97.7/107 points (91.3%) (SD 5.2). Course evaluations from IMR and DMS students were globally positive. Twenty three of 24 residents (96%) and 6/6 DMS students (100%) participated in focus group interviews. Qualitative analysis identified themes related to the learning environment, scanning technique, and suggestions for improvement. IMR felt the interprofessional training fostered a positive learning environment and that the experience complimented traditional faculty-led workshops. Both groups noted the importance of establishing mutual understanding of expectations and suggested future workshops have more dedicated time for DMS student demonstration of scanning technique. CONCLUSION: An interprofessional, near-peer workshop was an effective strategy for teaching POCUS to IMR. This approach may allow broader adoption of POCUS in medical education, especially when faculty expertise is limited.


Asunto(s)
Medicina Interna/educación , Sistemas de Atención de Punto , Enseñanza , Ultrasonografía , Abdomen/diagnóstico por imagen , Educación Médica/métodos , Humanos , Grupo Paritario , Estudiantes de Medicina
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
12.
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
13.
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
15.
Am J Infect Control ; 43(5): 441-6, 2015 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-25952046

RESUMEN

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.


Asunto(s)
Prestación Integrada de Atención de Salud , Transmisión de Enfermedad Infecciosa/prevención & control , Servicios Médicos de Urgencia/métodos , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/prevención & control , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Humanos
16.
Am J Nurs ; 115(4): 44-9, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25811520

RESUMEN

OVERVIEW: In 2014, the authors published the results of a study investigating nurses' use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note that making use of reflective practice for complicated care situations such as infection control may help nurses improve decision making in isolation care.


Asunto(s)
Infección Hospitalaria/prevención & control , Educación en Enfermería/organización & administración , Hospitales de Aislamiento/métodos , Control de Infecciones/métodos , Control de Infecciones/normas , Personal de Enfermería en Hospital/educación , Equipos de Seguridad , Curriculum , Adhesión a Directriz , Humanos , Guías de Práctica Clínica como Asunto , Estados Unidos
19.
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
20.
Infect Control Hosp Epidemiol ; 35(5): 564-9, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24709726

RESUMEN

OBJECTIVE: To assess the effect of adenosine triphosphate (ATP) device measurement of hospital room cleaning and feedback of pooled results to environmental service workers (EVS) to improve cleaning efficacy. DESIGN: Nonrandomized controlled trial conducted over 20 months. SETTING: Three hospitals of varying size. PARTICIPANTS: EVS workers, randomly selected on the basis of convenience sample of rooms. INTERVENTIONS: Environmental cleanliness composite scores were combined with layered educational interventions and used to provide feedback to EVS workers on specific hospital units. Trends in cleaning efficacy were observed after the interventions. RESULTS: Cleaning efficacy improved significantly with each intervention (P < .01) and decreased during the washout period. CONCLUSIONS: The ATP detection device combined with educational feedback for EVS workers resulted in significant improvement in cleaning efficacy of the hospital room environment.


Asunto(s)
Adenosina Trifosfato/análisis , Servicio de Limpieza en Hospital/métodos , Habitaciones de Pacientes/normas , Centros Médicos Académicos/métodos , Centros Médicos Académicos/normas , Infección Hospitalaria/prevención & control , Retroalimentación , Servicio de Limpieza en Hospital/normas , Humanos
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