Ebola: Education Challenge for Patient and Staff Safety

Purpose:
To develop a more comprehensive plan for infection prevention preparedness for Ebola Virus Disease (EVD)through an interdisciplinary process improvement approach.

Relevance/Significance:
The 2014 Ebola epidemic is the largest in history, with mortality rates as high as 70%. Health care organizations were required to develop policies and procedures for suspected cases of EVD based on The Centers for Disease Control and Prevention (CDC) recommendations. Infection Prevention and Control and Nursing Administration met with key stakeholders to determine the course of action to prevent transmission of and contamination with the Ebola Virus and ensure the safety of staff and patients.

Strategy and Implementation:
Our organization identified workflow and process gaps when a suspected case of Ebola presented in the Emergency Department (ED). One of the major gaps identified was donning and doffing of Personal Protective Equipment (PPE) by healthcare workers. An interdisciplinary team was formed and analyzed the current process of donning and doffing PPE, the transfer of a patient from the ED or ambulatory area to the Critical Care Unit (CCU), solid and human waste management, adequate equipment and supplies, room and equipment disinfection and contamination mitigation. Simulation in the work settings (ED and CCU) was the primary method to determine effectiveness of the processes and workflows. PPE education and competencies were developed and education was completed by 185 staff members. Improvements were made throughout the education process based on identified process gaps and feedback from the bedside nurses and providers during simulation sessions.

Evaluation:
When the first suspected case of EVD presented to the ED, the department had one EVD workflow and one modified droplet isolation cart that contained PPE and basic CDC handouts. Our organization has since developed 23 specific workflows, 14 PPE competencies, 11 Enterprise-wide Ebola policies and trained 185 staff members to be competent in use of Ebola PPE.

Implications for Practice:
Interdisciplinary planning, simulation and training were critical in determining the best practice and workflows for caring for patients with EVD. The workflows and education plans developed for EVD preparedness can be applied to other infection prevention threats in the future.