Experiences of Hospitals in the Chicago Area with PPE Acquisition and Use During the 2014 Ebola Virus Disease Outbreak

Abstract Background During the 2014–2015 Ebola Virus Disease (EVD) outbreak, US hospitals prepared to receive patients by acquiring personal protective equipment (PPE). Methods Twenty-seven individuals who participated in EVD preparations from 14 acute care hospitals in the Chicago area were interviewed using a semi-structured interview guide. A codebook was developed iteratively. Two members of the research team coded each interview, and a third team member reconciled the codes. The research team used the focused conversation method to identify evidence responsive to a priori research objectives about the selection, use and acquisition of PPE. Results Factors motivating PPE selection included: vendor supply, stock existing in different areas of hospitals (e.g., orthopedic surgery, emergency response), recommendations from the Centers of Disease Control (CDC) and designated biocontainment units, hospital networks, perceived risk/safety, comfort, and anticipated care delivery for EVD patients. Some organization were proactive in their decision-making, while others were reactive. Proactive organizations chose relatively high levels of PPE protection, used external experts and multi-disciplinary teams, and experimented with PPE. Reactive organizations had few people participating in decision-making, and relied on CDC guidance. Costs did not effect PPE acquisition. All participants reported PPE acquisition challenges. This was mitigated by: sharing among hospital networks, ordering from multiple suppliers, reusing PPE during training, and improvising with existing PPE stock. Conclusion Future responses to high consequence and emerging infections would be enhanced by PPE guidance that considers infection risk, clinical scenarios, and describes how PPE prevents exposure. Improved PPE design or selection could reduce the number of PPE pieces in ensembles, and reduce infection risks during doffing. Participation of employees in PPE selection could lead to PPE ensembles with improved comfort and usability. Alternative PPE options should be available in official recommendations because of supply chain issues in outbreak scenarios. Disclosures All authors: No reported disclosures.