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Barriers to physical distancing among healthcare workers on an academic hospital unit during the coronavirus disease 2019 (COVID-19) pandemic

Published online by Cambridge University Press:  07 April 2021

Sara C. Keller*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sara Pau
Affiliation:
Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Alejandra B. Salinas
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Opeyemi Oladapo-Shittu
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sara E. Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Robin Lewis-Cherry
Affiliation:
Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
Briana Vecchio-Pagan
Affiliation:
Johns Hopkins Applied Physics Laboratory, Laurel, Maryland
Patience Osei
Affiliation:
Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Ayse P. Gurses
Affiliation:
Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Clare Rock
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Anna C. Sick-Samuels
Affiliation:
Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Corresponding author: Email Skeller9@jhmi.edu

Abstract

Background:

Physical distancing among healthcare workers (HCWs) is an essential strategy in preventing HCW-to-HCWs transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2).

Objective:

To understand barriers to physical distancing among HCWs on an inpatient unit and identify strategies for improvement.

Design:

Qualitative study including observations and semistructured interviews conducted over 3 months.

Setting:

A non–COVID-19 adult general medical unit in an academic tertiary-care hospital.

Participants:

HCWs based on the unit.

Methods:

We performed a qualitative study in which we (1) observed HCW activities and proximity to each other on the unit during weekday shifts July–October 2020 and (2) conducted semi-structured interviews of HCWs to understand their experiences with and perspectives of physical distancing in the hospital. Qualitative data were coded based on a human-factors engineering model.

Results:

We completed 25 hours of observations and 20 HCW interviews. High-risk interactions often occurred during handoffs of care at shift changes and patient rounds, when HCWs gathered regularly in close proximity for at least 15 minutes. Identified barriers included spacing and availability of computers, the need to communicate confidential patient information, and the desire to maintain relationships at work.

Conclusions:

Physical distancing can be improved in hospitals by restructuring computer workstations, work rooms, and break rooms; applying visible cognitive aids; adapting shift times; and supporting rounds and meetings with virtual conferencing. Additional strategies to promote staff adherence to physical distancing include rewarding positive behaviors, having peer leaders model physical distancing, and encouraging additional safe avenues for social connection at a safe distance.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

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