Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study
Peter Kiiza,
Sarah I. Mullin,
Koren Teo,
Len Goodman,
Adic Perez,
Ruxandra Pinto,
Kelly Thompson,
Dominique Piquette,
Trevor Hall,
Elhadj I. Bah,
Michael Christian,
Jan J. Hajek,
Raymond Kao,
François Lamontagne,
John C. Marshall,
Sharmistha Mishra,
Srinivas Murthy,
Abel Vanderschuren,
Robert A. Fowler,
Neill K. J. Adhikari
Affiliations
Peter Kiiza
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
Sarah I. Mullin
Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON M1C 1A4, Canada
Koren Teo
Canadian Forces Health Services Group (CFHS), Toronto, ON M3K 0A1, Canada
Len Goodman
Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada
Adic Perez
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
Ruxandra Pinto
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
Kelly Thompson
The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
Dominique Piquette
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M4N 3M5, Canada
Trevor Hall
Healthcare Insurance Reciprocal of Canada and Interactive Media Lab., University of Toronto, Toronto, ON M2N 6K8, Canada
Elhadj I. Bah
Infectious Diseases Department, Donka National Hospital, Conakry, Guinea
Michael Christian
Island Health Authority, Comox, BC V9M 1P2, Canada
Jan J. Hajek
Division of Infectious Diseases, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
Raymond Kao
Division of Critical Care Medicine, Western University, London, ON N6A 5W9, Canada
François Lamontagne
Department of Medicine, Université de Sherbrooke, and Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
John C. Marshall
Departments of Surgery and Critical Care, St. Michael’s Hospital, Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5B 1W8, Canada
Sharmistha Mishra
Li Ka Shing Knowledge Institute, Department of Medicine, Division of Infectious Diseases, St. Michael’s Hospital and University of Toronto, Institute of Health Policy, Management and Evaluation and Institute of Medical Science, University of Toronto, Toronto, ON M5B 1W8, Canada
Srinivas Murthy
Department of Paediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
Abel Vanderschuren
Division of Intensive Care, Université Laval-CHU de Québec, Québec, QC G1J 1Z4, Canada
Robert A. Fowler
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M4N 3M5, Canada
Neill K. J. Adhikari
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M4N 3M5, Canada
Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35 °C, 60% relative humidity) or thermo-neutral (20 °C, 20% relative humidity) conditions. In this pilot phase to determine the feasibility of study procedures, HCWs in PPE were non-randomly allocated to hot or thermo-neutral conditions to perform peripheral intravenous (PIV) and midline catheter (MLC) insertion and endotracheal intubation (ETI) on mannequins. Eighteen HCWs (13 physicians, 4 nurses, 1 nurse practitioner; 2 with prior ETU experience; 10 in hot conditions) spent 69 (10) (mean (SD)) minutes in the simulated ETU. Mean (SD) task completion times were 16 (6) min for PIV insertion; 33 (5) min for MLC insertion; and 16 (8) min for ETI. Satisfactory task completion was numerically higher for physicians vs. nurses. Participants’ blood pressure was similar, but heart rate was higher (p = 0.0005) post-simulation vs. baseline. Participants had a median (range) of 2.0 (0.0–10.0) minor PPE breaches, 2.0 (0.0–6.0) near-miss incidents, and 2.0 (0.0–6.0) health symptoms and concerns. There were eight health-assessment triggers in five participants, of whom four were in hot conditions. We terminated the simulation of two participants in hot conditions due to thermal discomfort. In summary, study tasks were suitable for physician participants, but they require redesign to match nurses’ expertise for the subsequent randomized phase of the study. One-quarter of participants had a health-assessment trigger. This research model may be useful in future training and research regarding clinical care for patients with highly infectious pathogens in austere settings.
