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Design strategies to improve healthcare worker safety in biocontainment units: learning from ebola preparedness

Published online by Cambridge University Press:  18 June 2018

Jennifer R. DuBose
Affiliation:
SimTigrate Design Lab, School of Architecture, Georgia Institute of Technology, Atlanta, Georgia
Zorana Matić
Affiliation:
SimTigrate Design Lab, School of Architecture, Georgia Institute of Technology, Atlanta, Georgia
Maria Fernanda Wong Sala
Affiliation:
SimTigrate Design Lab, School of Architecture, Georgia Institute of Technology, Atlanta, Georgia School of Industrial Design, Georgia Institute of Technology, Atlanta, Georgia
Joel M. Mumma
Affiliation:
School of Psychology, Georgia Institute of Technology, Atlanta, Georgia
Colleen S. Kraft
Affiliation:
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Lisa M. Casanova
Affiliation:
Division of Environmental Health, School of Public Health, Georgia State University, Atlanta, Georgia
Kimberly Erukunuakpor
Affiliation:
Division of Environmental Health, School of Public Health, Georgia State University, Atlanta, Georgia
Francis T. Durso
Affiliation:
School of Psychology, Georgia Institute of Technology, Atlanta, Georgia
Victoria L. Walsh
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Puja Shah
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Craig M. Zimring
Affiliation:
SimTigrate Design Lab, School of Architecture, Georgia Institute of Technology, Atlanta, Georgia
Jesse T. Jacob
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Corresponding

Abstract

Objective

To identify ways that the built environment may support or disrupt safe doffing of personal protective equipment (PPE) in biocontainment units (BCU).

Design

We observed interactions between healthcare workers (HCWs) and the built environment during 41 simulated PPE donning and doffing exercises.

Setting

The BCUs of 4 Ebola treatment facilities and 1 high-fidelity BCU mockup.

Participants

A total of 64 HCWs (41 doffing HCWs and 15 trained observers) participated in this study.

Results

In each facility, we observed how the physical environment influences risky behaviors by the HCW. The environmental design impeded communication between trained observers (TOs) and HCWs because of limited window size or visual obstructions with louvers, which allowed unobserved errors. The size and configuration of the doffing area impacted HCW adherence to protocol, and lack of clear demarcation of zones resulted in HCWs inadvertently leaving the doffing area and stepping back into the contaminated areas. Lack of standard location for items resulted in equipment and supplies frequently shifting positions. Finally, different solutions for maintaining balance while removing shoe covers (ie, chair, hand grips, and step stool) had variable success. We identified the 5 key requirements that doffing areas must achieve to support safe doffing of PPE, and we developed a matrix of proposed design strategies that can be implemented to meet those requirements.

Conclusions

Simple, low-cost environmental design interventions can provide structure to support and improve HCW safety in BCUs. These interventions should be implemented in both current and future BCUs.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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