High-consequence microorganisms can put healthcare workers (HCWs) at risk for infection during treatment. The recent 2014-2105 Ebola outbreak raised awareness about the importance of personal protective equipment (PPE) in preventing HCWs from contracting this deadly disease. Organizations across the country have formed unprecedented collaborations to share experiences and lessons learned, with the hope of improving procedures and designs for existing and new treatment facilities. Consensus and standardization have not been achieved, however, which raises the question of what are the best practices to keep care providers and patients safe.
HCWs contaminate themselves and their PPE during routine patient care and in the doffing process. A better understanding of how errors occur is needed. Integral to this understanding are considerations of how modifications to the “built environment” can reduce errors in this process by creating better physical spaces to accommodate accurate PPE processes. Understanding these processes in the context of Ebola virus disease can not only inform future prevention strategies for Ebola, but for more common pathogens including MRSA, VRE, CRE and C. difficile.
Specifically, PEACH is currently undertaking 3 related but independent projects that:
- Identify steps in the doffing protocol that are error prone;
- Evaluate design elements in the physical space where doffing occurs; and
- Provide pragmatic hand hygiene solutions to these problems that could be immediately implemented to improve the safety of HCWs.
Although isolation guidelines for the use of PPE in healthcare settings for common pathogens exist, there is a need to protect HCWs from Ebola virus (EBOV) and other high-risk pathogens. High-risk pathogens require the use of complex high-level isolation PPE. The objectives of this project are to: use harmless viruses and fluorescent tracers to determine if there is transfer of viruses and fluorescent tracer to hands and clothing during simulated doffing of PPE by HCWs trained in use of high-level isolation PPE, and conduct human factors analysis to determine:
- How deviations from correct doffing protocol occur
- Where deviations are likely to occur
- The relationship between virus transfer and protocol deviations.
The design of healthcare spaces can make it easier to follow the appropriate steps and prevent contamination during the process. Building on the network of Georgia Ebola treatment centers we will study how trained HCW put on and remove PPE to understand how the built environment supports or hinders safe donning and doffing. We then will create designs for improved settings for removing PPE and test these designs in the SimTigrate lab, a unique full-scale mockup facility at Georgia Tech. The objectives of this project are: to document variability in the current donning and doffing process, the systemic contributors to this variability, and the predicted impacts on errors and transmission of pathogens and using a simulation lab and a human factors approach, re-design and improve the donning and doffing process and the built environment to reduce variability and improve outcomes.
Many healthcare-associated infections in acute care hospitals are transmitted by contact and the hands of HCWs can play an important role in this transmission. Because of this, performance of hand hygiene (HH) is considered by the Centers for Disease Control and Prevention and the World Health Organization to be one of the most important interventions in healthcare settings. Electronic systems to monitor, prompt, and cue HCWs have been implemented to improve rates of HH compliance, but further research is needed to optimize the use of this technology. The objectives of this project are to: identify the optimal combination of provider feedback and device audio reminders to improve HH compliance using a prospective observational cohort design, and assess HCW attitudes and beliefs regarding the monitoring of, and providing feedback on, individual HH compliance and the use of audio reminders to promote HH compliance using qualitative research methods.