Prevention Epicenter of Emory and Atlanta Consortium Hospitals

Keywords: Infection Control, Built Environment, PPE Doffing Safety
Methods: Simulations
 

The study objective is to identify ways that the built environment may support or disrupt safe doffing of personal protective equipment (PPE) in biocontainment units (BCU). We observed interactions between healthcare workers (HCWs) and the built environment during 41 simulated PPE donning and doffing exercises, conducted across the BCUs of four Ebola treatment facilities and one high-fidelity BCU mockup. In total, 64 participants took part in this study, including 41 doffing HCWs and 15 trained observers (TOs).

In each facility, we observed how the physical environment influences risky behaviors by the HCW. The environmental design impeded communication between 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 the lack of clear demarcation of zones resulted in HCWs inadvertently leaving the doffing area and stepping back into the contaminated areas. Lack of a 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. In conclusion, 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.
 

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Design Strategies for Biocontainment Units: Creating Safer Environments
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Visibility and Accessibility of Hand Hygiene Stations and Fatigue among Nurses Working in Long-term Care (LTC) during the COVID-19 Pandemic

Keywords: Long-term care (LTC), COVID-19, Nurses
Methods: National Survey
 

This cross-sectional study examined how visibility and accessibility of hand hygiene stations (HHS) in long-term care (LTC) settings related to nurse fatigue during the COVID-19 pandemic. Using an online survey of LTC nurses between June 2020 and January 2021, the researchers found that a large majority of nurses (over 78 %) reported moderate to very severe fatigue. After controlling for factors like demographics, guilt about leaving family or patients, workplace support, and confidence in the future of LTC, nurses who perceived fewer or less accessible hand hygiene stations in their work environment were significantly more likely to report higher fatigue levels compared with those who felt HHS were adequate. The authors suggest that improving the visibility and accessibility of infection-control infrastructure, like hand hygiene stations, could help mitigate nurse fatigue in LTC environments during public health crises.

Keywords: Hand Hygiene, Infection Control, Nursing Unit Typology, Space Syntax, Visibility
Methods: Comparative Study, Statistical Analysis
 

This study compared two hospital nursing units to examine how the visibility and accessibility of hand sanitizer dispensers affects healthcare workers’ hand hygiene behavior. The unit where dispensers were more visible and easier to reach had significantly more hand hygiene activity, even though it had fewer dispensers per bed. This shows that nursing unit layout and design directly influence healthcare workers’ behavior and patient safety. Designing spaces where hand sanitizer is clearly visible and integrated into daily workflows can help improve hand hygiene and reduce the risk of infections.

Improving Hand Hygiene Compliance through Collaborative Computational Design

Keywords: -
Methods: Computational Scenario Planning, Fuzzy Cognitive Mapping, Machine Learning
 

Hand sanitization by healthcare staff remains one of the most effective ways for controlling infection in healthcare settings. However, predicting faithful adherence to Hand Hygiene Compliance (HHC) is difficult in complex environments such as inpatient hospital settings. The main challenge is understanding how different components of human and built systems interact to achieve specific goals, such as HHC at the critical moments of care delivery. The aim of this explorative study was to evaluate how Human Factors-derived visual salience cues and proximity-compatibility principles might be used in the design of healthcare spaces to support nurse moments of HHC through increased perceived behavioral control and intention. 

The investigative team used a Collaborative Computational Scenario Planning (CCSP) Model approach to determine the integrative effects of reinforcing and detracting operational and environmental factors on discrete moments of HHC behavior. Supervised Machine Learning analysis was conducted on data collected by a large academic medical center that included HHC observance in clinical staff spanning from 2017 to 2021 in two inpatient hospital units. The probabilistic outcomes of unit-based HHC observance likelihood were used to compute Fuzzy Cognitive Model Edge Probabilities between Hand Hygiene (HH) cues and detected HHC at key moments. Hospital infection control experts were then engaged to identify the weight of various reinforcing and detracting operational and environmental factors contributing to HHC observance. Combining the quantitative and qualitative methods, allowed the team to then develop integrative CCSP models, which facilitated predictive insight into the development of targeted environmental improvements that might contribute to HHC control and intention to support safer patient care.

Image credit: Photographed by Hui Cai, Designed by Cannon Design