Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

Abstract

During the 2014–2015 Ebola Virus Disease (EVD) outbreak, hospitals in the United States selected personal protective equipment (PPE) and trained healthcare personnel (HCP) in anticipation of receiving EVD patients. To improve future preparations for high-consequence infectious diseases, it was important to understand factors that affected PPE selection and training in the context of the EVD outbreak. Semistructured interviews were conducted with HCP involved with decision-making during EVD preparations at acute care hospitals in the Chicago, IL area to gather information about the PPE selection and training process. HCP who received training were surveyed about elements of training and their perceived impact and overall experience by email invitation. A total of 28 HCP from 15 hospitals were interviewed, and 55 HCP completed the survey. Factors affecting PPE selection included: changing guidance, vendor supply, performance evaluations, and perceived risk and comfort for HCP. Cost did not affect selection. PPE acquisition challenges were mitigated by: sharing within hospital networks, reusing PPE during training, and improvising with existing PPE stock. Selected PPE ensembles were similar across sites. Training included hands-on activities with trained observers, instructional videos, and simulations/drills, which were felt to increase HCP confidence. Many felt refresher training would be helpful. Hands-on training was perceived to be effective, but there is a need to establish the appropriate frequency of refresher training frequency to maintain competence. Lacking confidence in the CDC guidance, interviewed trainers described turning to other sources of information and developing independent PPE evaluation and selection. Response to emerging and/or high consequence infectious diseases would be enhanced by transparent, risk-based guidance for PPE selection and training that addresses protection level, ease of use, ensembles, and availability.

Keywords:

• Ebola virus disease
• healthcare personnel training
• high-consequence infections
• occupational health
• personal protective equipment
• qualitative research
• standard precautions

Acknowledgments

We would like to acknowledge Isabel Farrar with the UIC Survey Research Laboratory for assistance and advice with the interview and survey instruments, Agnes Kalat for programming our survey, and Yu-Kai Huang for analyzing the survey responses. The data generated by the interviews in this study are not publicly available because it is not possible to effectively de-identify these data, which were sampled from a small geographic region. Extended and additional quotes are available in the Supplementary Materials, and survey data will be available within 12 mo of publication at UIC INDIGO, indigo.uic.edu.

Conflicts of Interest

The authors have no conflict of interest to disclose related to this manuscript.

Additional information

Funding

This work was supported by the Centers for Disease Control and Prevention Epicenters Program, Cooperative Agreement 1U54CK000445-01.