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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Infection Prevention Training Through the Center for Domestic Preparedness: An Infection Preventionist's Experience

DEC 05, 2018 | SASKIA V. POPESCU
For many of us, it has been a while since we’ve donned Ebola personal protective equipment (PPE). In 2014, there was a mad dash to obtain the PPE the US Centers for Disease Control and Prevention (CDC) were recommending for working with patients with Ebola virus disease. We rapidly learned the art that was donning and doffing this enhanced PPE while working to ensure we did not cross contaminate each other, let alone the observer/aid that was helping us. This was a relatively novel moment for many of us in infection prevention and health care. Who would have thought we would be preparing for Ebola in the United States?
   
Last week, I attended the Barrier Precautions and Controls for Highly Infectious Diseases (“HID”) training hosted by the Center for Domestic Preparedness (CDP). CDP is a training center used for military purposes (think chemical and biological incidents, etc). In 2007, the Noble Training Facility was integrated into the CDP and the former Noble Army Hospital was used as a new site to strengthen public health, health care, and medical personnel during disasters and incidents. The CDP is part of the Federal Emergency Management Agency (FEMA) after it was transferred from the Department of Homeland Security in 2007. The whole purpose of CDP is to strengthen critical infrastructure through training and education to state, local, tribal, and territory emergency responders. 
    
I have taken several classes at CDP and each time, my cohort has been a pretty diverse array of members of the public health, health care (both clinical and nonclinical), tribal, and local government communities, and more, from policemen to epidemiologists. This HID course—which focuses on training people on the PPE that would be used for patients with Ebola or other highly infectious diseases—was definitely my favorite (and that’s saying something as I was previously at their COBRA center which is used to train for chemical/biological attacks).
    
Over 3 days, we learned about the intricacies of these practices, managing waste, patient transport, etc. Although the first day was lecture and did not really provide new information for the infection preventionists who had worked during the 2014-2016 outbreak (ie, those memories and trainings have been burned into our brains), it was good to see public health professionals and those working in health care supply learning about how one would dispose of waste from a patient with Ebola, or the importance of an infection control plan. From the management of human remains to frank discussions surrounding isolation precautions, the first day was a solid overview of the importance of infection control measures. 
     
The last 2 days were spent learning about the PPE; wearing it, working in it, removing it safely, and discussing how patient transport would work. We spent a significant amount of time donning and doffing PPE (both versions of the CDC guidelines, which focus on N95 or PAPRs) to feel comfortable with the flow as well as being an observer/aid for those going into the treatment rooms. This was a beneficial component to the training as many of us may not need to fully don PPE, but may be required to observe health care workers to ensure it is properly worn and that no cross contamination occurs.

One of the best aspects of this training, in my opinion, was the focus on performing tasks—starting an IV, cleaning a patient (patients with Ebola frequently have profuse diarrhea and fluid loss)—while wearing the PPE. This may seem unnecessary for nonclinical people in the course, but it was hugely beneficial in revealing the complexities of caring for patients while wearing all the PPE. This knowledge changes the way algorithms are designed, patient care is done, and helps everyone manage the situation better.

The last day of training was spent running exercises and managing communication in teams. If you thought putting on the PPE was tough, try moving a patient (real actors!) from the ambulance bay, up to a room when they are vomiting and you are trying to avoid contamination. The instructors were great in asking why we were going about things in certain ways, posing new challenges, and providing expert knowledge. 
      
Will I be caring for a patient if they come into the hospital with Ebola? No. But, a helpful reminder of what it’s like to perform tasks in the PPE and how complex the coordination is to manage patients with highly infectious diseases, is critical. It has been 4 years since many of us had to consider these processes and this was a welcome reminder of how we can improve.

I would highly suggest the HID course at CDP as it refreshed my PPE skills and reminded me that highly infectious diseases pose unique issues in health care and infection control. Without continued education and training, we are doing ourselves and the public a disservice. A friendly reminder—this course and the travel is paid for by CDP, and so it behooves us all to take advantage of the opportunity. 
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