Rapid conversion of an in-patient hospital unit to accommodate COVID-19: An interdisciplinary human factors, ethnography, and infection prevention and control approach

Abstract

Background In response to the Coronavirus disease-19 (COVID-19) pandemic, in-patient units in hospitals around the world have altered their patient care routines and Infection Prevention and Control (IPC) practices. Our interdisciplinary team of applied Human Factors (HF), ethnography, and IPC experts assisted one Unit, normally serving general surgical and orthopedic patients, as it rapidly converted to deliver COVID-19-specific care. This paper describes the conversion experience of the Unit, and outlines broader lessons for other acute care teams faced with similar issues. Methods We deployed walkthroughs, simulations, and ethnography to identify important safety gaps in care delivery processes on the Unit. These interventions were undertaken using interdisciplinary theories of implementation that combined systems-level HF perspectives, ethnographic approaches, and individual-level IPC perspectives. Timely recommendations were developed and delivered to Unit staff for feedback and implementation. Results We describe three interventions on the Unit: 1) the de-cluttering and re-organization of personal protective equipment (PPE); 2) the reconfiguring of designated ‘dirty’ tray tables and supplies; and 3) the redesign of handling pathways for ‘dirty’ linens and laundry. Each of these interventions was implemented to varying degrees, but all contributed to discussions of safety and IPC implementation that extended beyond the Unit and into the operations of the broader hospital. Conclusions Leveraging our team’s interdisciplinary expertise and blended approaches to implementation, the interventions assisted in the Unit’s rapid conversion towards providing COVID-19-specific care. The deployment and implementation of the interventions highlight the potential of collaboration between HF, ethnography, and IPC experts to support frontline healthcare delivery under pandemic conditions in an effort to minimize nosocomial transmission potential in the acute healthcare setting.

Seroprevalence in health care workers during the later phase of the second wave: Results of three hospitals in Serbia, prior to vaccine administration

“…Our primary goal was to compare risk in three types of hospitals since one of the hospitals was completely transformed into a hospital only for the care of COVID-19 patients. The process of converting the whole hospital into a dedicated COVID-19 specialty hospital has been practiced in other countries in response to unprecedented surges in COVID-19 patients [24] , [25] .…”

Prevention and control strategies for the post-pandemic era: finding a balance between COVID-19 and reviving medical service

“…In principle, in addition to the rational partition (clean zone, semi-contaminated zone, buffer zone, and contaminated zone), the ideal hardware facility for isolation may include but is not limited to the following: separated ventilation, separated bathroom, toilet, and dedicated entrances for patients and HCWs. Several hospitals worldwide have documented their experience of repurposing hospital inpatient units, including the redesigning of isolation partition, dedicated pathway, and buffer zone, which resulted in substantial improvements in layout and reduced the risk of transmission [25][26][27]. The current hospital faces a similar challenge.…”

Personal protective equipment implementation in healthcare: A scoping review

“…Study settings were mainly hospitals. 18,20−26,28, 30,31,33,37−39,43,47−52,55,56,59−64,67,68,70,71,73,74,79,80,82−84,86−89 Methods most frequently used to collect and report data were intervention proposals, 22,25,37,39,40,47,48,54,57,59,65,66,[70][71][72]74,76,80,82,85,86,89,90 surveys, 18 −21,24,26,41,45,46,51,58,61,68,69,79,81,83 practices/actions implementation description 31,32,36,[42][43][44]49,63,78,87,88 and interviews, 23,27,28,[33][34][35]38,50,52,55,56,60,62,…”

“…19,23,42,51 In a pandemic context a distinct response plan is especially needed. 64 Besides standard universal masking adoption in the whole HF for respiratory diseases like COVID-19, 91 critical policy elements would include (1)robust regular training and qualifications as a requirement to provide care of patients requiring additional transmission-based precautions 39,71,75,77 ; periodic fit testing and appropriate mask sizing 22,44,49,51,57,72,73,75,77,87,91 ; (2)PPE compliance monitoring by checking expiration date, proper stock management, and ensuring the adherence to PPE manufacturer instructions 51,55 ; (3)PPE provision as per the level of risk in 3 different zones (eg, high, medium or low risk) 23,75 ; use of additional PPE like powered air purifying respirators (PAPRs) 75 in all areas allocated for aerosol-generating procedures; (4)donning and doffing area designations and establishment of standard PPE ensemble and illustrations of step-by-step instructions for safe donning and doffing ensuring separation of clean PPE from contaminated items, preferably in negativepressure rooms with mirrors. 23,35,50,55,64,70,84,91 In case of full body coverage, simple tools for maintaining balance while removing shoe covers are advised, such as chairs, hand grips, and step stool 53 ; (5) organization of the PPE carts and supplies 55,82 ; (6) adoption of reuse and waste disposal policies, designating appropriate storage, contamination areas and disposal arrangements…”