Preventing Occupational Infections in Healthcare Professionals Using Risk Models

Details

• Personal Author:
  Casanova L
• Description:
  Occupational safety and health issues that were addressed: To prevent occupational infections spread by droplets, aerosols, and bodily fluids in healthcare professionals (HCP), practices and guidelines for personal protective equipment (PPE) need to be continually developed and improved. Research and adoption of best practices for PPE is a NIOSH priority, but there are few studies that demonstrate which practices reduce potential transmission of these occupational infections. Worker group(s) or setting(s) studied: Our unique study population of HCP trained in Ebola PPE and patient care (some had cared for Ebola patients) used complex PPE in intensive care-type settings. Approaches used: We developed a novel approach for designing exposure models, identifying unknown parameters, and integrating realistic simulations of patient care using volunteers, surrogate viruses, and human factors analysis (HFE) to produce models of exposure and risk. HCPs participated in simulations using virus-contaminated PPE, where processes, actions, and tasks were analyzed with HFE methods. Significant and Key Findings: A key finding was that we could refine transmission models with simulation. Using simulations of Ebola PPE use across four hospitals, we determined parameters and values for risk models of transmission while using Ebola PPE. Using iterative simulations, we were able to estimate transfer of virus from PPE to HCP's hands, face, and clothing, and viral die-off rates on hands. Our models can be used to predict infection risks to HCPs using Ebola PPE, particularly the HFE modeling approaches of failure modes and effects analysis and fault tree analysis. Once modeling identified risk points and failure modes, we designed new simulations to mitigate risk. We can measure changes in risk when changes in wearing and removing PPE and design changes in the patient care environment were implemented. These methods can inform exposure assessments by following and quantifying viruses moving through different transmission routes. We worked in facilities with different environments, training, and protocols for Ebola PPE. We determined there are weaknesses in PPE practices that result in observable transfer of virus to hands and clothing during PPE doffing. We were able to identify the failure modes and high-risk tasks and actions that contributed to risk. Translation to improvements for worker safety and health We developed and refined models to identify key processes, actions, and failure modes creating transmission risks. We altered actions and processes to test mitigation measures. Interactive presentations to our facilities provided suggestions for improvement tailored to their environment and protocols. We provided suggestions to redesign the patient care environment to reduce risk, for constructing new environments and making simple changes to current environments. Our methods can be used in healthcare facilities where researchers and clinicians collaborate to improve PPE use. Our findings have resulted in changes to PPE doffing practices after patient care and redesign of the patient care environment in the high-risk pathogen patient care program where we conducted research. These methods can and have been adopted by healthcare facilities and researchers to evaluate PPE practices to protect HCP from infection. We are putting our methods into practice to respond to the SARS-CoV-2 pandemic to optimize PPE to protect HCP from this deadly disease during patient care. [Description provided by NIOSH]
• Subjects:
  Aerosols Body Fluids Communicable Diseases Health Personnel Occupational Health Personal Protective Equipment Safety
• Keywords:
  Body Fluids Coronavirus COVID-19 Ebola Virus Disease Health Care Personnel Indoor Environments Infection Prevention Personal Protective Equipment PPE SARS-CoV-2 Simulation Methods

  More +
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  Georgia ; OSHA Region 4
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-42
• NIOSHTIC Number:
  nn:20064437
• NTIS Accession Number:
  PB2022-100421
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, K01-OH-010757, 2020 Nov; :1-42
• Contact Point Address:
  Lisa Casanova MS, PhD, P.O. Box 3995 Atlanta, GA 30302
• Email:
  lcasanova@gsu.edu
• Federal Fiscal Year:
  2021
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  Georgia State University
• Peer Reviewed:
  False
• Start Date:
  20150901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20180831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:027f012000cdb33850ad1ea23109d1d0c82f942e68b658f6893114f5fe35e1e88bfda88b9670cff9e7af0884c698d77a32a7ac02c030535a57565b5eaa867e62
• Download URL:
  https://stacks.cdc.gov/view/cdc/219095/cdc_219095_DS1.pdf
• File Type:
  [PDF - 1.62 MB ]