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Article ; Online: Personnel Management and Biosecurity of U.S. High-Level Isolation Units.

Herstein, Jocelyn J / Biddinger, Paul D / Gibbs, Shawn G / Le, Aurora B / Jelden, Katelyn C / Hewlett, Angela L / Lowe, John J

The Journal of nursing administration

2020 Volume 48, Issue 11, Page(s) 553–560

Abstract: Objective: To describe strategies used by US high-level isolation units (HLIUs) to recruit, train, and sustain a full team of multidisciplinary staff and identify how units are secured.: Background: Fifty-six US hospitals have been designated HLIUs, ... ...

Abstract	Objective: To describe strategies used by US high-level isolation units (HLIUs) to recruit, train, and sustain a full team of multidisciplinary staff and identify how units are secured. Background: Fifty-six US hospitals have been designated HLIUs, capable of providing safe care to patients with highly infectious disease. Methods: An electronic survey was administered to the 56 HLIUs in spring of 2016. Responses were collected via a fillable PDF and analyzed using descriptive statistics. Results: Thirty-six HLIUs (64%) responded; 33 completed surveys, and 3 reported no longer being a designated HLIU. HLIUs reported large numbers of multidisciplinary staff, primarily consisting of RNs and critical care clinicians. Nearly all HLIUs (94%) required orientation training, although hours varied. Conclusions: Over a short period, HLIUs recruited and trained significant numbers of staff with little guidance. Costs of ongoing trainings are considerable, and it remains unclear how HLIUs will continue funding these activities.
Language	English
Publishing date	2020-11-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	193141-6
ISSN	1539-0721 ; 1539-073X ; 0002-0443
ISSN (online)	1539-0721 ; 1539-073X
ISSN	0002-0443
DOI	10.1097/NNA.0000000000000679
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Article ; Online: U.S. High-Level Isolation Unit Clinical Laboratory Capabilities Update.

Herstein, Jocelyn J / Iwen, Peter C / Jelden, Katelyn C / Biddinger, Paul D / Gibbs, Shawn G / Le, Aurora B / Hewlett, Angela L / Lowe, John J

Journal of clinical microbiology

2018 Volume 56, Issue 2

Abstract: In late 2014, 56 hospitals in the United States were designated by state and federal public health authorities as specially designed high-level isolation units (HLIUs) equipped with advanced infrastructure, laboratory capabilities, and trained staff to ... ...

Abstract	In late 2014, 56 hospitals in the United States were designated by state and federal public health authorities as specially designed high-level isolation units (HLIUs) equipped with advanced infrastructure, laboratory capabilities, and trained staff to care for patients with highly hazardous communicable diseases (HHCDs), such as Ebola virus disease. This survey describes the clinical laboratory support capabilities of U.S. HLIUs, including the specific test menus that HLIUs have identified to safely manage HHCD patients and the locations where such testing would be performed. In spring 2016, a survey was electronically distributed, as a fillable pdf file, to the 56 U.S. HLIUs. Site representatives completed the surveys, and data were coded and analyzed in an electronic spreadsheet, using descriptive statistics. Thirty-six HLIUs (64%) responded, and 33 completed the laboratory capabilities section. Thirty-one HLIUs (94%) had performed risk analyses for all laboratory procedures and equipment. Twenty-nine (88%) had decontamination procedures specified for all laboratory equipment used for patients with suspected or confirmed HHCDs. On-site laboratories in 27 HLIUs (81%) had the capacity to inventory and to securely store HHCD patient specimens. Ten HLIUs (31%) had at least one test they would conduct within the patient isolation room. The high-risk nature of HHCDs and the occupational exposures that may occur in clinical laboratories demand advanced preparation and risk assessment of work practices, laboratory equipment, and instrumentation by HLIU laboratories. Although risk analyses of clinical laboratory testing and equipment that HLIUs have conducted have likely focused on those for Ebola virus, HLIUs must be prepared to revise their current procedures for other HHCDs.
MeSH term(s)	Clinical Laboratory Techniques/instrumentation ; Communicable Diseases/epidemiology ; Decontamination ; Humans ; Infection Control/statistics & numerical data ; Laboratories, Hospital/statistics & numerical data ; Occupational Exposure/prevention & control ; Patient Isolation ; Risk Assessment/statistics & numerical data ; Surveys and Questionnaires ; United States/epidemiology
Keywords	covid19
Language	English
Publishing date	2018-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	390499-4
ISSN	1098-660X ; 0095-1137
ISSN (online)	1098-660X
ISSN	0095-1137
DOI	10.1128/JCM.01608-17
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Article ; Online: A Gap Analysis Survey of US Aircraft Rescue and Fire Fighting (ARFF) Members to Determine Highly Infectious Disease Training and Education Needs.

Le, Aurora B / Herron, Rene / Herstein, Jocelyn J / Jelden, Katelyn C / Beam, Elizabeth L / Gibbs, Shawn G / Lowe, John J / Smith, Todd D

Disaster medicine and public health preparedness

2018 Volume 12, Issue 6, Page(s) 675–679

Abstract: Objective: Despite lessons learned from the recent Ebola epidemic, attempts to survey and determine non-health care worker, industry-specific needs to address highly infectious diseases have been minimal. The aircraft rescue and fire fighting (ARFF) ... ...

Abstract	Objective: Despite lessons learned from the recent Ebola epidemic, attempts to survey and determine non-health care worker, industry-specific needs to address highly infectious diseases have been minimal. The aircraft rescue and fire fighting (ARFF) industry is often overlooked in highly infectious disease training and education, even though it is critical to their field due to elevated occupational exposure risk during their operations. Methods: A 44-question gap analysis survey was distributed to the ARFF Working Group to determine where highly infectious education and training can be improved. In total, N=245 responses were initiated and collected. Descriptive statistics were generated utilizing Qualtrics Software Version 2016.17©. Results: Supervisors perceived Frontline respondents to be more willing and comfortable to encounter potential highly infectious disease scenarios than the Frontline indicated. More than one-third of respondents incorrectly marked transmission routes of viral hemorrhagic fevers. There were discrepancies in self-reports on the existence of highly infectious disease orientation and skills demonstration, employee resources, and personal protective equipment policies, with a range of 7.5%-24.0% more Supervisors than Frontline respondents marking activities as conducted. Conclusions: There are deficits in highly infectious disease knowledge, skills, and abilities among ARFF members that must be addressed to enhance member safety, health, and well-being. (Disaster Med Public Health Preparedness. 2018;12:675-679).
MeSH term(s)	Aerospace Medicine/education ; Aerospace Medicine/methods ; Aircraft ; Firefighters/education ; Firefighters/statistics & numerical data ; Hemorrhagic Fever, Ebola/diagnosis ; Hemorrhagic Fever, Ebola/transmission ; Humans ; Needs Assessment/trends ; Rescue Work/methods ; Rescue Work/trends ; Surveys and Questionnaires ; Teaching/standards ; Teaching/trends
Language	English
Publishing date	2018-01-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2017.142
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Article ; Online: A pilot study of core body temperatures in healthcare workers wearing personal protective equipment in a high-level isolation unit.

Herstein, Jocelyn J / Abdoulaye, Abdoulaziz A / Jelden, Katelyn C / Le, Aurora B / Beam, Elizabeth L / Gibbs, Shawn G / Hewlett, Angela L / Vasa, Angela / Boulter, Kathleen C / Stentz, Terry L / Kopocis-Herstein, Kelli R / ElRayes, Wael / Wichman, Chris / Lowe, John J

Journal of occupational and environmental hygiene

2021 Volume 18, Issue 9, Page(s) 430–435

Abstract: Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of ...

Abstract	Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8
Language	English
Publishing date	2021-08-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2131820-7
ISSN	1545-9632 ; 1545-9624
ISSN (online)	1545-9632
ISSN	1545-9624
DOI	10.1080/15459624.2021.1949459
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Article ; Online: Sustainability of High-Level Isolation Capabilities among US Ebola Treatment Centers.

Herstein, Jocelyn J / Biddinger, Paul D / Gibbs, Shawn G / Le, Aurora B / Jelden, Katelyn C / Hewlett, Angela L / Lowe, John J

Emerging infectious diseases

2017 Volume 23, Issue 6, Page(s) 965–967

Abstract: To identify barriers to maintaining and applying capabilities of US high-level isolation units (HLIUs) used during the Ebola virus disease outbreak, during 2016 we surveyed HLIUs. HLIUs identified sustainability challenges and reported the highly ... ...

Abstract	To identify barriers to maintaining and applying capabilities of US high-level isolation units (HLIUs) used during the Ebola virus disease outbreak, during 2016 we surveyed HLIUs. HLIUs identified sustainability challenges and reported the highly infectious diseases they would treat. HLIUs expended substantial resources in development but must strategize models of sustainability to maintain readiness.
Keywords	covid19
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2306.170062
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Zs.A 4778: Show issues

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Article ; Online: US State Public Health Departments Special Pathogen Planning.

Herstein, Jocelyn J / Biddinger, Paul D / Gibbs, Shawn G / Le, Aurora B / Jelden, Katelyn C / Hewlett, Angela L / Lowe, John J

Journal of public health management and practice : JPHMP

2017 Volume 24, Issue 5, Page(s) E28–E33

Abstract: Context: US state public health departments played key roles in planning for and responding to confirmed and suspected cases of Ebola virus disease (EVD) during the 2014-2016 outbreak, including designating select hospitals as high-level isolation units ...

Abstract	Context: US state public health departments played key roles in planning for and responding to confirmed and suspected cases of Ebola virus disease (EVD) during the 2014-2016 outbreak, including designating select hospitals as high-level isolation units (HLIUs) for EVD treatment in conjunction with the Centers for Disease Control and Prevention. Objective: To identify existing guidelines and perspectives of state health departments pertaining to the management and transport of patients with EVD and other highly hazardous communicable diseases (HHCDs). Design: An electronic 8-question survey with subquestions was administered as a fillable PDF. Setting: The survey was distributed to publicly accessible e-mails of state health department employees. Participants: State epidemiologists, emergency preparedness directors, or chief medical officers from each of the 50 states and the District of Columbia were contacted; a representative from 36 states and the District of Columbia responded (73%). Main outcome measures: Descriptive statistics were used to identify the proportion of state health departments with various existing protocols. Results: A majority of states reported that they would prefer patients confirmed with viral hemorrhagic fevers (eg, EVD, Marburg fever) and smallpox be transported to an HLIU for treatment rather than remain at the initial hospital of diagnosis. While most (89%) states had written guidelines for the safe transportation of patients with HHCDs, only 6 (16%) had written protocols for the management of accidents or other travel disruptions that may occur during HHCD transport within the state. Twenty-two state health departments (59%) had operationally exercised transport of a patient to an HLIU. Conclusions: Nearly half of states in the United States lack an HLIU, yet most prefer to have patients with HHCDs treated in high-level isolation. Recent budget cuts and uncertainty of future funding threaten the abilities of health departments to devote the necessary resources and staff to prepare for and deliver the desired care to HHCD cases. The lack of HLIUs in some states may complicate transport to a geographically proximate HLIU. Moreover, limited guidance on diseases that warrant high-level isolation may cause disagreement in HHCD patient placement between health departments, diagnosing facilities, and HLIUs.
MeSH term(s)	Communicable Diseases/diagnosis ; Communicable Diseases/epidemiology ; Disaster Planning/methods ; Disaster Planning/statistics & numerical data ; Ebolavirus/pathogenicity ; Hemorrhagic Fever, Ebola/diagnosis ; Hemorrhagic Fever, Ebola/epidemiology ; Humans ; Patient Isolators/standards ; Patient Isolators/trends ; Public Health/methods ; State Government ; Surveys and Questionnaires ; Zika Virus/pathogenicity ; Zika Virus Infection/diagnosis ; Zika Virus Infection/epidemiology
Language	English
Publishing date	2017-12-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2027860-3
ISSN	1550-5022 ; 1078-4659
ISSN (online)	1550-5022
ISSN	1078-4659
DOI	10.1097/PHH.0000000000000714
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Article ; Online: High-Level Isolation Unit Infection Control Procedures.

Herstein, Jocelyn J / Biddinger, Paul D / Gibbs, Shawn G / Le, Aurora B / Jelden, Katelyn C / Hewlett, Angela L / Lowe, John J

Health security

2017 Volume 15, Issue 5, Page(s) 519–526

Abstract: The 2014-2016 Ebola outbreak in West Africa prompted a select group of US hospitals to establish high-level isolation units equipped with advanced engineering controls, trained staff, and stringent protocols to safely treat highly infectious disease ... ...

Abstract	The 2014-2016 Ebola outbreak in West Africa prompted a select group of US hospitals to establish high-level isolation units equipped with advanced engineering controls, trained staff, and stringent protocols to safely treat highly infectious disease patients. This survey details the comprehensive infection control protocols developed by these units, including for decontamination of units, post-mortem management, liquid waste disposal, and personal protective equipment (PPE) use. In spring 2016, a survey was electronically distributed to the 56 original Centers for Disease Control and Prevention (CDC)-designated high-level isolation units. Responses were collected via a fillable PDF and analyzed using descriptive statistics. Thirty-six (64%) high-level isolation units responded; 33 completed the survey, and 3 reported they no longer maintained high-level isolation unit capabilities. Nearly all responding units had written procedures for decontamination, liquid waste disposal, and PPE use; however, infection control protocols varied between units. High-level isolation units implemented multiple strategies in promoting hand hygiene among staff and in monitoring correct PPE use. Maximum time allowed in full PPE was restricted in all but 2 units (average of 3.45 hours per shift). Almost all (94%) had written procedures for the management of human remains, although only 2 units had written protocols for an autopsy of a patient with a highly infectious disease. While the vast majority of high-level isolation units reported having written protocols for infection control practices, staff compliance and procedural application are the true indicators of the state of preparedness. Therefore, rigorous training and staff adherence to infection control practices is critical to minimizing exposure risks.
Language	English
Publishing date	2017-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2823049-8
ISSN	2326-5108 ; 2326-5094
ISSN (online)	2326-5108
ISSN	2326-5094
DOI	10.1089/hs.2017.0026
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Article ; Online: A gap analysis of the United States death care sector to determine training and education needs pertaining to highly infectious disease mitigation and management.

Le, Aurora B / Witter, Lesley / Herstein, Jocelyn J / Jelden, Katelyn C / Beam, Elizabeth L / Gibbs, Shawn G / Lowe, John J

Journal of occupational and environmental hygiene

2017 Volume 14, Issue 9, Page(s) 674–680

Abstract: Purpose: A United States industry-specific gap analysis survey of the death care sector-which comprises organizations and businesses affiliated with the funeral industry and the handling of human remains- was developed, the results analyzed, and ... ...

Abstract	Purpose: A United States industry-specific gap analysis survey of the death care sector-which comprises organizations and businesses affiliated with the funeral industry and the handling of human remains- was developed, the results analyzed, and training and education needs in relation to highly infectious disease mitigation and management were explored in an effort to identify where occupational health and safety can be enhanced in this worker population. Methods: Collaborating national death care organizations distributed the 47-question electronic survey. N = 424 surveys were initiated and results recorded. The survey collected death care sector-specific information pertaining to the comfortability and willingness to handle highly infectious remains; perceptions of readiness, current policies and procedures in place to address highly infectious diseases; current highly infectious disease training levels, available resources, and personal protective equipment. Results: One-third of respondents have been trained on how to manage highly infectious remains. There was a discrepancy between Supervisor/Management and Employee/Worker perceptions on employees' willingness and comfortability to manage potentially highly infectious remains. More than 40% of respondents did not know the correct routes of transmission for viral hemorrhagic fevers. Conclusions: Results suggest death care workers could benefit from increasing up-to-date industry-specific training and education on highly infectious disease risk mitigation and management. Professional death care sector organizations are positioned to disseminate information, training, and best practices.
MeSH term(s)	Communicable Disease Control/methods ; Communicable Diseases/transmission ; Cremation/statistics & numerical data ; Funeral Homes/statistics & numerical data ; Hemorrhagic Fevers, Viral/transmission ; Humans ; Mortuary Practice/education ; Surveys and Questionnaires ; United States
Keywords	covid19
Language	English
Publishing date	2017-05-26
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2131820-7
ISSN	1545-9632 ; 1545-9624
ISSN (online)	1545-9632
ISSN	1545-9624
DOI	10.1080/15459624.2017.1319570
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Article ; Online: Ultraviolet (UV)-reflective paint with ultraviolet germicidal irradiation (UVGI) improves decontamination of nosocomial bacteria on hospital room surfaces.

Jelden, Katelyn C / Gibbs, Shawn G / Smith, Philip W / Hewlett, Angela L / Iwen, Peter C / Schmid, Kendra K / Lowe, John J

Journal of occupational and environmental hygiene

2017 Volume 14, Issue 6, Page(s) 456–460

Abstract: An ultraviolet germicidal irradiation (UVGI) generator (the TORCH, ClorDiSys Solutions, Inc.) was used to compare the disinfection of surface coupons (plastic from a bedrail, stainless steel, and chrome-plated light switch cover) in a hospital room with ... ...

Abstract	An ultraviolet germicidal irradiation (UVGI) generator (the TORCH, ClorDiSys Solutions, Inc.) was used to compare the disinfection of surface coupons (plastic from a bedrail, stainless steel, and chrome-plated light switch cover) in a hospital room with walls coated with ultraviolet (UV)-reflective paint (Lumacept) or standard paint. Each surface coupon was inoculated with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus faecalis (VRE), placed at 6 different sites within a hospital room coated with UV-reflective paint or standard paint, and treated by 10 min UVC exposure (UVC dose of 0-688 mJ/cm
MeSH term(s)	Colony Count, Microbial ; Cross Infection/prevention & control ; Disinfection/instrumentation ; Disinfection/methods ; Equipment Contamination ; Methicillin-Resistant Staphylococcus aureus/radiation effects ; Paint ; Patients' Rooms ; Ultraviolet Rays ; Vancomycin-Resistant Enterococci/radiation effects
Language	English
Publishing date	2017-03-06
Publishing country	England
Document type	Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2131820-7
ISSN	1545-9632 ; 1545-9624
ISSN (online)	1545-9632
ISSN	1545-9624
DOI	10.1080/15459624.2017.1296231
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Article ; Online: Comparison of hospital room surface disinfection using a novel ultraviolet germicidal irradiation (UVGI) generator.

Jelden, Katelyn C / Gibbs, Shawn G / Smith, Philip W / Hewlett, Angela L / Iwen, Peter C / Schmid, Kendra K / Lowe, John J

Journal of occupational and environmental hygiene

2016 Volume 13, Issue 9, Page(s) 690–698

Abstract: The estimated 721,800 hospital acquired infections per year in the United States have necessitated development of novel environmental decontamination technologies such as ultraviolet germicidal irradiation (UVGI). This study evaluated the efficacy of a ... ...

Abstract	The estimated 721,800 hospital acquired infections per year in the United States have necessitated development of novel environmental decontamination technologies such as ultraviolet germicidal irradiation (UVGI). This study evaluated the efficacy of a novel, portable UVGI generator (the TORCH, ChlorDiSys Solutions, Inc., Lebanon, NJ) to disinfect surface coupons composed of plastic from a bedrail, stainless steel, chrome-plated light switch cover, and a porcelain tile that were inoculated with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus faecalis (VRE). Each surface type was placed at 6 different sites within a hospital room and treated by 10-min ultraviolet-C (UVC) exposures using the TORCH with doses ranging from 0-688 mJ/cm(2) between sites. Organism reductions were compared with untreated surface coupons as controls. Overall, UVGI significantly reduced MRSA by an average of 4.6 log10 (GSD: 1.7 log10, 77% inactivation, p < 0.0001) and VRE by an average of 3.9 log10 (GSD: 1.7 log10, 65% inactivation, p < 0.0001). MRSA on bedrail was reduced significantly (p < 0.0001) less than on other surfaces, while VRE was reduced significantly less on chrome (p = 0.0004) and stainless steel (p = 0.0012) than porcelain tile. Organisms out of direct line of sight of the UVC generator were reduced significantly less (p < 0.0001) than those directly in line of sight. UVGI was found an effective method to inactivate nosocomial pathogens on surfaces evaluated within the hospital environment in direct line of sight of UVGI treatment with variation between organism and surface types.
MeSH term(s)	Colony Count, Microbial ; Cross Infection/prevention & control ; Disinfection/instrumentation ; Disinfection/methods ; Hospitals ; Methicillin-Resistant Staphylococcus aureus/radiation effects ; Patients' Rooms ; Ultraviolet Rays ; Vancomycin-Resistant Enterococci/radiation effects
Language	English
Publishing date	2016
Publishing country	England
Document type	Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2131820-7
ISSN	1545-9632 ; 1545-9624
ISSN (online)	1545-9632
ISSN	1545-9624
DOI	10.1080/15459624.2016.1166369
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