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.ParticipantsA 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.
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.ParticipantsA 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.
Authors: Sean Wei Xiang Ong; Kristen K Coleman; Po Ying Chia; Koh Cheng Thoon; Surinder Pada; Indumathi Venkatachalam; Dale Fisher; Yian Kim Tan; Boon Huan Tan; Oon Tek Ng; Brenda Sze Peng Ang; Yee-Sin Leo; Michelle Su Yen Wong; Kalisvar Marimuthu Journal: Singapore Med J Date: 2020-07-30 Impact factor: 3.331
Authors: Maria F Wong; Zorana Matić; Gabrielle C Campiglia; Craig M Zimring; Joel M Mumma; Colleen S Kraft; Lisa M Casanova; Francis T Durso; Victoria L Walsh; Puja Y Shah; Andi L Shane; Jesse T Jacob; Jennifer R Dubose Journal: Clin Infect Dis Date: 2019-09-13 Impact factor: 9.079
Authors: Joel M Mumma; Francis T Durso; Lisa M Casanova; Kimberly Erukunuakpor; Colleen S Kraft; Susan M Ray; Andi L Shane; Victoria L Walsh; Puja Y Shah; Craig Zimring; Jennifer DuBose; Jesse T Jacob Journal: Clin Infect Dis Date: 2019-09-13 Impact factor: 9.079
Authors: Joel M Mumma; Francis T Durso; Lisa M Casanova; Kimberly Erukunuakpor; Colleen S Kraft; Susan M Ray; Andi L Shane; Victoria L Walsh; Puja Y Shah; Craig Zimring; Jennifer DuBose; Jesse T Jacob Journal: Clin Infect Dis Date: 2019-09-13 Impact factor: 9.079
Authors: Susan Alum; Moses Asiimwe; Gerald Kanyomozi; Jacqueline Nalikka; Peace Okwaro; Isabella Migisha; Brenda Muhindo; Abdullah Wailagala; Stephen Okello; Paul Blair; Peter Waitt; Nahid Bhadelia; Rodgers Ayebare; Antonia Kwiecien; David Saunders; Mohammed Lamorde; Hannah Kibuuka; Danielle Clark Journal: Disaster Med Public Health Prep Date: 2021-11-25 Impact factor: 1.385
Authors: Jesse T Jacob; Craig M Zimring; Herminia Machry; Zorana Matić; Yeinn Oh; Jennifer R DuBose; Jill S Morgan; Kari L Love Journal: Infect Control Hosp Epidemiol Date: 2022-02-14 Impact factor: 3.254
Authors: Jos H Verbeek; Blair Rajamaki; Sharea Ijaz; Riitta Sauni; Elaine Toomey; Bronagh Blackwood; Christina Tikka; Jani H Ruotsalainen; F Selcen Kilinc Balci Journal: Cochrane Database Syst Rev Date: 2020-04-15