Update on Ebola Virus Precautions: Training Hospitals’ Top Concern

The latest news on hospitals Ebola virus preparedness shows that they are most concerned about issues surrounding the proper training of staff and Hazmat shipment, according to a recent study by Environmental Health & Engineering (EH&E). In late October 2014, EH&E, a prominent environmental and engineering consulting service, surveyed hospital environmental health and safety managers (EHS), risk managers and facilities managers in U.S. hospitals to gain an update on Ebola virus precautions and procedures. The results reveal how hospitals have responded to the threat of Ebola and areas of particular concern to those professionals responsible for ensuring hospital safety. Potential vulnerabilities in hospital preparedness may lie in the lack of available time patient care staff members have to participate in training, and uncertainties about the proper certification of staff to ship infectious substances. Almost half (48 percent) of hospitals participating in the survey identified ‘available time for patient care staff’ to participate in training as their top challenge to hospital safety. Another 20 percent indicated money or a lack of qualified staff and internal resources to support training as their main limitation. Such limitations prompted widespread strikes amongst nurses across the nation this month. Hospitals believe it is essential to provide direct, hands-on, Ebola-specific training to clinical staff, particularly to those who may treat such patients directly. EH&E indicates that it is particularly important for hospitals to train staff in the correct way to put on and remove Ebola personal protective equipment (PPE). While it may not seem significant to the lay observer, it is crucial for staff to don and doff protective equipment, such as Ebola suits, boots and double sets of disposable nitrile gloves, in the correct order, and to follow proper safety procedure. Experts have identified failure to follow PPE removal protocol as a potential source of Ebola infection among medical staff. In response to hospitals’ concerns, EH&E recommends that a select number of staff, ranging from physicians and nurses to respiratory therapists and environmental safety staff, receive a high level of Ebola virus training. Since there may not be time to train all staff in effective precautions, members of the select Ebola-trained staff will be available to be called upon to deal with any such patients who may arrive. Bryan Connors, MS, CIH, Senior Scientist and Healthcare Division Practice Leader with EH&E, has added that it is also critical that hospitals train staff to play the role of safety monitor. The safety monitor will observe other staff to ensure that they follow proper Ebola protocol when treating patients at close range. “It works like a buddy system, assuring front line critical staff don and doff PPE appropriately and any safety issues are addressed in real time,” Connors said. Hospitals are also concerned about providing adequate Hazmat shipment training. More than half (55 percent) of hospitals indicated that they do not have or do not know whether they have staff trained to ship Category A infectious substances. Specimens from patients who have or may have Ebola are considered Category A infectious substances, and so must be shipped in accordance with a rigorous safety protocol to prevent any potential infection. Such training can take upwards of eight hours to complete and requires attendant documentation. Hospitals simply cannot rely on ad hoc training. On the plus side, a majority (64 percent) of hospitals indicate that they have been actively conducting Ebola training, including courses specifically on the proper use of PPE. Only 5 percent reported having conducted no Ebola training to date. Meanwhile, 21 percent reported having some preparedness, either through training for other infectious diseases, or on Ebola specifically, but without PPE training. Awareness of safety precautions has likely increased across all categories since the survey was taken, but adequate staff training, Hazmat shipment, and PPE preparedness remain areas of concern at hospitals nationwide.