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

Abstract

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.

Variability in the Duration and Thoroughness of Hand Hygiene

“…Regarding the former, consensus guidelines exist for both adequate duration and coverage of surfaces, although the exact values of these parameters have been debated [1, 7]. Regarding the latter, mechanisms that minimize individual differences between HCWs during hand hygiene are essential and might include standardizing how HCWs are trained to perform hand hygiene (including knowledge, skills, and attitudes toward hand hygiene) [1], increasing the TO’s role in enforcing the duration and thoroughness of hand hygiene (eg, by incorporating written instructions for both duration and thoroughness into a facility’s protocol), and using features of the built environment for regulating adequate duration and thoroughness (eg, a timer or visual cues such as posters) [1, 8].…”

Making the invisible visible: Why does design matter for safe doffing of personal protection equipment?

“…These nudges can be suggestive in the sense that they help channel behavior among a range of available choices, such as providing a green, yellow, or red color-coded floor covering that suggests where to stand during clean, transitional, or potentially contaminated phases of doffing 13 . They can also be more directive, such as a biocontainment unit that only has a single directional flow of movement from a clean or “cold” zone to a transitional or “warm” zone to a contaminated or “hot” zone 1 …”

“…13 They can also be more directive, such as a biocontainment unit that only has a single directional flow of movement from a clean or "cold" zone to a transitional or "warm" zone to a contaminated or "hot" zone. 1…”

“…The 2014 Ebola outbreak revealed gaps and opportunities for PPE doffing protocols, including the role of the built environment (ie, the layout and design of spaces for care and doffing) in either supporting or detracting from safe doffing. Because most Ebola treatment centers were repurposed intensive care units or emergency department rooms and were not intentionally designed to treat serious communicable diseases, the built environment has been underappreciated until recently 1 . As of this writing, a new Ebola outbreak is occurring in the Democratic Republic of Congo, and these lessons apply both to the treatment of EVD and other highly communicable diseases and to the doffing of routine PPE.…”

“…Inner gloves, hands, face, and scrubs were tested for the presence of the bacteriophages after a clinical task and subsequent doffing were performed 5 7 Opportunities to improve the built environment were also noted 1 . These observations are being followed-up by some 45 student volunteers and 10 HCWs making observations in redesign settings.…”