February 28, 2020By Lance Baily

HHS Whistleblower Complaint Demonstrates Immediate Need for Medical Simulation Coronavirus Training

Numerous news agencies like the Huffington Post, the Washington Post, the New York Times and the Wall Street Journal have reported this week that a whistleblower within the U.S. Department of Health and Human Services alleged that “federal health employees who interacted with Americans quarantined for potential exposure to Coronavirus [at Travis Air Force Base] were not wearing protective gear or given proper medical training”. Huffington Post shared that “The whistleblower’s complaint comes a day after the Centers for Disease Control and Prevention confirmed the first known instance of someone testing positive for coronavirus without exposure to anyone known to be infected or without recently traveling to a country where it is confirmed to be spreading. The patient lives in Solano County, California ― where Travis Air Force Base is located.” Regardless of the outcomes of this particular complaint, the need for Coronavirus Simulation training through medical simulation should be clear to all healthcare educators.

Editor’s Note: See our dedicated Coronavirus Medical Simulation Page for the most up to date Medical Simulation resource list and our Coronavirus simulation training resources which includes a scenario, online training guides, and procedures list. For more details of the items on this list, please be sure to also read / share this and our previous Coronavirus Simulation articles:

More From the Huffington Post About the HHS Whistleblower Complaint: “A government whistleblower has alleged that federal health employees who interacted with Americans quarantined for potential exposure to coronavirus were not wearing protective gear or given proper medical training, according to several media reports on Thursday. Officials from the Department of Health and Human Services sent more than a dozen ill-equipped workers to California earlier this month to receive the Americans evacuated from Wuhan, China, according to the whistleblower’s 24-page complaint filed Wednesday and obtained first by The Washington Post and later by The New York Times and The Wall Street Journal.

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According to the reports, the complaint alleges that HHS employees were “improperly deployed” and “not properly trained or equipped to operate in a public health emergency situation.” The whistleblower also said that some workers were potentially exposed to coronavirus because they were not trained in wearing protective equipment — despite having face-to-face contact with passengers returning from Wuhan, where the outbreak originated.

In her complaint, the whistleblower wrote that she received “panicked calls” from “deployed staff members expressing concerns with the lack of HHS communication and coordination.” They also told her about “being sent into quarantined areas without personal protective equipment, training or experience in managing public health emergencies” and worried that they would pose a “potential danger to both themselves and members of the public they come into contact with,” according to the Times.”

Dr. Jeffrey H. Barsuk, M.D., M.S., from the Northwestern University Feinberg School of Medicine shared while working with the AHRQ (linked below) that “We have learned that preparing detailed guidance is not enough. We must conduct realistic simulation in healthcare drills and offer clinicians and administrators both practice and honest feedback on their performance.” In that sense, it is crucial now that every hospital, EMS organization, medical center, school and educational program immediately begin implementation of coronavirus infection control simulated training procedures. The more time spent in simulated training now, the better the outcomes will be, as shown by research supporting our field.

Medical Simulation provides healthcare learners with the opportunity to practice “just in time training” of the clinical skills necessary for specific procedures relevant to their current practice. A research study “Cost Savings From Reduced Catheter-Related Bloodstream Infection After Simulation-Based Education for Residents in a Medical Intensive Care Unit” by Dr. Barsuk et al. showed an 88% reduction in lethal infection rates thanks to a medical simulation training program, which also brought along with it a 7:1 cost savings!

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CDC Recommendation for Clinical Simulation Training for Coronavirus

The CDC 2019-nCoV website suggests that “Infection control procedures including administrative rules and engineering controls, environmental hygiene, correct work practices, and appropriate use of personal protective equipment (PPE) are all necessary to prevent infections from spreading during healthcare delivery. Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility.

All healthcare facilities must ensure that their personnel are correctly trained and capable of implementing infection control procedures; individual healthcare personnel should ensure they understand and can adhere to infection control requirements. This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration. This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States. This guidance is applicable to all U.S. healthcare settings.”

Research Articles Supporting Medical Simulation for Infection Control

Scenario-based simulation training for the World Health Organization (WHO) hand hygiene self-assessment framework (Ermira Tartari et al.): The objective of this paper is to provide case scenario-based simulation for IPC specialists to simulate and fully assimilate the correct completion of the WHO Hand Hygiene Self-Assessment Framework (HHSAF) framework in a standardized format. The three case scenarios have been tested and are proposed for the reader to assess the HHSAF of different HCFs in a variety of contexts, even in low-resource settings. They were designed for simulation training purposes to achieve standardization and interactive learning. These scenarios are meant to be used by professionals in charge of implementing a hand hygiene improvement strategy within their HCF, as well as for simulation and standardized training purposes prior to completing and submitting data for the 2019 WHO Global Survey.

AHRQ’s Health Care Simulation to Advance Safety: By providing practice, simulation can serve a useful role in helping to detect breaches in safety protocols as they evolve and in establishing high levels of individual and team performance. Simulation’s value was recently demonstrated by a team at Northwestern University Feinberg School of Medicine that was featured in AHRQ’s WebM&M. The Northwestern team was able to identify serious gaps in Ebola safety protocols by using simulation to detect breaches in sterile technique when providers were fully donned in personal protective equipment, transporting suspected Ebola patients, drawing blood from a peripheral intravenous catheter, and in placing a central venous access line.

The healthcare simulation took place in a hospital that considered itself “ready” for Ebola patients as a result of earlier developed guidelines and training in donning and doffing personal protective equipment. “At Northwestern Memorial Hospital, we have learned that preparing detailed guidance is not enough,” noted Jeffrey H. Barsuk, M.D., M.S., associate professor of medicine at Northwestern University Feinberg School of Medicine. “We must conduct realistic drills and offer clinicians and administrators both practice and honest feedback on their performance.” The learning that occurred as a result of the simulation reveals opportunities for organizations to address gaps and improve aspects of their preparedness efforts to respond successfully to real patients.

Scenario-based simulation health care education for performance of hand hygiene (Nakamura et al.): Simulation health care education is widely used in medical education and has great potential. However, scenario-based simulation health care education for preventing health care-associated infections has not been described. This training course had a positive effect on hand hygiene. This study is the first effective scenario-based simulation health care education on hand hygiene and control of health care-associated infection.

Simulation Shows Hospitals That Cooperate On Infection Control Obtain Better Results Than Hospitals Acting Alone (Lee et al.): This simulation found that the implementation of surveillance and isolation at one hospital decreased MRSA prevalence not only in that hospital, but also in many other hospitals in the county that had not implemented the intervention. The magnitude of the effect depended on which hospital implemented the intervention. This study showed that concerted infection control campaigns among a regional group of hospitals can yield substantial indirect benefits for hospitals involved and for hospitals not involved in the campaign. What’s more, the synergistic effects of persuading other hospitals in the same county to implement control mechanisms can help individual hospitals achieve better MRSA control than they can on their own. The more hospitals that work together, the more benefits accrue; doubling the number of hospitals that adopt the intervention can more than double the improvement in infection control.

Use of personal protective equipment among health care personnel: Results of clinical observations and simulations (Kang et al.): Very little is known about how health care personnel (HCP) actually use personal protective equipment (PPE). Although HCP knew they were being videotaped, contamination occurred in 79.2% of the PPE simulations. Devising better standardized PPE protocols and implementing innovative PPE education are necessary to ensure HCP safety.

Simulation-based training in Ebola Personal Protective Equipment for healthcare workers: Experience from King Abdulaziz University Hospital in Saudi Arabia (Abualenain et al.): Millions of Muslims from across the world gather annually to perform pilgrimage. This can import unusual communicable diseases such as Ebola. Communicable diseases with a high risk of mortality necessitate special training to master the required competency to avert transmission of infections. The efficacy of simulation-based training (SBT) has been shown in such circumstances. This research team sought to “develop an SBT program in Ebola Personal Protective Equipment (PPE) for all healthcare workers (HCWs)” and found that “Using SBT could be an effective method of developing competent HCWs in Ebola PPE.”

Visit Our Coronavirus Simulation Training Article for More Resources!

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