More than a year out from the emergence of Ebola, many infection preventionists report they received no additional resources to deal with the crisis, still lack adequate supplies of personal protective equipment (PPE), and remain uncertain about how frequently healthcare workers need to be trained to ensure they are donning and doffing PPE correctly.
The troubling trends appear in a national survey of 981 hospital-based IPs conducted by the Association for Professionals in Infection Control and Epidemiology (APIC). Ebola revealed that the nation’s infection control programs are not adequately funded and have little surge capacity. Unfortunately, that still seems to be the case in many hospitals. Despite the most highly publicized and publicly feared infectious disease since the emergence of HIV in 1981, 55% of APIC survey respondents said they never received any additional resources from their hospitals to deal with the many issues raised by Ebola.
Ebola also exposed longstanding problems with PPE use that have probably been contributing to infection transmission between hospital patients for some time. New studies continue to show workers lack training and frequently contaminate themselves removing the equipment.1,2 The issue is the subject of ongoing confusion, as evidenced by 33% of the respondents in the APIC survey answering “we have not made that determination yet” when asked what frequency of retraining is needed to maintain PPE competency.
It is tempting to conclude that some hospitals simply gambled that they would not have to deal with a case of Ebola and avoided additional expenditures to prepare for an unlikely event. Those that did so may have dodged a deadly bug, but one could certainly argue they are less prepared for the next emerging infection. With global travel and continuing encroachment on animal habitats, we are in age of pandemics where zoonotic viruses can find a fast track into human populations.
In the recent APIC survey, 92% of respondents said their facility is more prepared for Ebola than it was a year ago. A positive response to be sure, but with the notable exception of highly-trained containment teams like those at Emory University Hospital and the University of Nebraska, it is questionable how many hospitals were really prepared in 2014 to deal with an emerging virus that had never been transmitted in the U.S. The CDC originally took the position that any hospital could handle an Ebola case, but dropped that assumption in favor of dispatching response teams after two nurses were infected by a dying patient in a Dallas hospital.
REFERENCES
- John A, Tomas M, Cadum J, et al. Are Healthcare Personnel Trained in correct Use of Personal Protective Equipment? IDWeek. Session 53: HAI: Occupational Health. San Diego, CA.Oct.7-11, 2015.
- Tomas ME, Kundrapu S, Thota P, et al. Contamination of Health Care Personnel During Removal of Personal Protective Equipment. JAMA Intern Med. Published online Oct.12, 2015.doi:10.1001/jamainternmed.2015.4535.
