Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-25T08:14:29.258Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Zorana Matić ,
Maria Fernanda Wong Sala ,
Joel M. Mumma ,
Colleen S. Kraft ,
Lisa M. Casanova ,
Kimberly Erukunuakpor ,
Francis T. Durso ,
Victoria L. Walsh  and
Puja Shah
...Show all authors
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
for the CDC Prevention Epicenters Program
Affiliation:
SimTigrate Design Lab, School of Architecture, Georgia Institute of Technology, Atlanta, Georgia School of Industrial Design, Georgia Institute of Technology, Atlanta, Georgia School of Psychology, Georgia Institute of Technology, Atlanta, Georgia 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 Division of Environmental Health, School of Public Health, Georgia State University, Atlanta, Georgia
*
Author for correspondence: Jennifer R. DuBose, SimTigrate Design Lab, 828 West Peachtree St. NW, Suite #334, Atlanta, GA 30332-0477. E-mail: Jennifer.dubose@design.gatech.edu
Get access Rights & Permissions [Opens in a new window]

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
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 961 - 967
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Casanova, LM, Teal, LJ, Sickbert-Bennett, EE, et al. Assessment of self-contamination during removal of personal protective equipment for Ebola patient care. Infect Control Hosp Epidemiol 2016;37:1156–1161.Google Scholar
2. Fischer, WA 2nd, Weber, DJ, Wohl, DA. Personal protective equipment: protecting health care providers in an Ebola outbreak. Clin Therapeut 2015;37:2402–2410.Google Scholar
3. Tomas, ME, Kundrapu, S, Thota, P, et al. Contamination of health care personnel during removal of personal protective equipment. JAMA Intern Med 2015;175:1904–1910.Google Scholar
4. Dubost, C, Pasquier, P, Kearns, K, et al. Preparation of an intensive care unit in France for the reception of a confirmed case of Ebola virus infection. Anaesth Crit Care Pain Med 2015;34:349–355.Google Scholar
5. Doll, M, Feldman, M, Hartigan, S, et al. Acceptability and necessity of training for optimal personal protective equipment use. Infect Control Hosp Epidemiol 2017;38:226–229.Google Scholar
6. Casanova, L, Alfano-Sobsey, E, Rutala, WA, Weber, DJ, Sobsey, M. Virus transfer from personal protective equipment to healthcare employees’ skin and clothing. Emerg Infect Dis 2008;14:1291.Google Scholar
7. Beam, EL, Gibbs, SG, Boulter, KC, Beckerdite, ME, Smith, PW. A method for evaluating health care workers’ personal protective equipment technique. Am J Infect Control 2011;39:415–420.Google Scholar
8. Tomas, ME, Cadnum, JL, Mana, TS, Jencson, AL, Donskey, CJ. Seamless suits: reducing personnel contamination through improved personal protective equipment design. Infect Control Hosp Epidemiol 2016;37:742–744.Google Scholar
9. Zellmer, C, Van Hoof, S, Safdar, N. Variation in health care worker removal of personal protective equipment. Am J Infect Control 2015;43:750–751.Google Scholar
10. Mitchell, R, Roth, V, Gravel, D, et al. Are health care workers protected? An observational study of selection and removal of personal protective equipment in Canadian acute care hospitals. Am J Infect Control 2013;41:240–244.Google Scholar
11. Kang, J, O’Donnell, JM, Colaianne, B, Bircher, N, Ren, D, Smith, KJ. Use of personal protective equipment among health care personnel: results of clinical observations and simulations. Am J Infect Control 2017;45:17–23.Google Scholar
12. Hallihan, GM, Baers, JH, Wiley, K, et al. Human Factors Evaluation of Simulated Ebola Virus Disease Patient Scenarios: System Factors Associated with Donning and Doffing During Triage, Treatment and Transport. Alberta Health Services, University of Calgary. W21C; 2015.Google Scholar
13. Herlihey, TA, Gelmi, S, Flewwelling, CJ, et al. Personal protective equipment for infectious disease preparedness: a human factors evaluation. Infect Control Hosp Epidemiol 2016;37:1022–1028.Google Scholar
14. Garibaldi, BT, Kelen, GD, Brower, RG, et al. The creation of a biocontainment unit at a tertiary care hospital. The Johns Hopkins medicine experience. Ann Am Thorac Soc 2016;13:600–608.Google Scholar
15. Stephens, DS, Ribner, BS, Gartland, BD, et al. Ebola virus disease: experience and decision making for the first patients outside of Africa. PLoS Med 2015;12(7):e1001857.Google Scholar
16. Lenaghan, PA, Schwedhelm, M. Nebraska biocontainment unit design and operations. J Nurs Adm 2015;45:298–301.Google Scholar
17. Herlihey, TA, Gelmi, S, Cafazzo, JA, Hall, TNT. The impact of environmental design on doffing personal protective equipment in a healthcare environment: a formative human factors trial. Infect Control Hosp Epidemiol 2017;38:712–717.Google Scholar
18. Casanova, LM, Erukunuakpor, K, Kraft, CS, et al. Assessing viral transfer during doffing of Ebola-level personal protective equipment in a biocontainment unit. Clin Infect Dis 2018;66:945–949.Google Scholar
19. Mumma, JM, Durso, FT, Ferguson, AN, et al. human factors risk analyses of a doffing protocol for Ebola-level personal protective equipment: mapping errors to contamination. Clin Infect Dis 2018;66:950–958.Google Scholar
20. Alhmidi, H, Koganti, S, Tomas, ME, Cadnum, JL, Jencson, A, Donskey, CJ. A pilot study to assess use of fluorescent lotion in patient care simulations to illustrate pathogen dissemination and train personnel in correct use of personal protective equipment. Antimicrob Resist Infect Control 2016;5:40.Google Scholar
21. Cummings, KJ, Choi, MJ, Esswein, EJ, et al. Addressing infection prevention and control in the first U.S. community hospital to care for patients with Ebola virus disease: context for national recommendations and future strategies. Ann Intern Med 2016;165:41–49.Google Scholar
22. Haverkort, JJ, Minderhoud, AL, Wind, JD, Leenen, LP, Hoepelman, AI, Ellerbroek, PM. Hospital preparations for viral hemorrhagic fever patients and experience gained from admission of an Ebola patient. Emerg Infect Dis 2016;22:184–191.Google Scholar
23. Centers for Disease Control and Prevention. Guidance on personal protective equipment to be used by healthcare workers during management of patients with Ebola Virus Disease in US hospitals, including procedures for putting on (donning) and removing (doffing). Ohio Nurs Rev 2014;89:11–17.Google Scholar
24. Casalino, E, Astocondor, E, Sanchez, JC, Díaz-Santana, DE, Del Aguila, C, Carrillo, JP. Personal protective equipment for the Ebola virus disease: a comparison of 2 training programs. Am J Infect Control 2015;43:1281–1287.Google Scholar
25. Thaler, RH, Sunstein, CR. Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University Press; 2008.Google Scholar
26. Tilley, AR. The Measure of Man and Woman: Human Factors in Design. vol 1 New York: John Wiley & Sons; 2002.Google Scholar