Using Design to Keep the Frontline Healthcare Workers Safe during a Pandemic: A Research-Based Approach

Abstract

As the current outbreak of Coronavirus Disease continues to affect the countries worldwide, addressing the needs of frontline healthcare workers (HCW) has become a high priority. During the 2014 Ebola outbreak, the doffing of personal protective equipment (PPE) and activities in the doffing area were identified as one of the biggest challenges for HCW's safety. In response, the importance of environmental design has become more evident. In response to the 2014 Ebola outbreak, the CDC updated their guidance on PPE donning and doffing, in which they emphasized the importance of BCU design. Recent studies have found that the doffing area's design can support a safer process by reducing self- and cross-contamination risk. However, as many patient-care sites are often adapted for biocontainment use to address the patient surge, there is significant variability in the doffing area's design. The efficiency of such various design layouts remains unclear. In this presentation, we will provide examples of doffing area design and illustrate ways to evaluate the various design layouts from the users' perspective and implications to their safety. We will define the different roles of healthcare workers in the doffing area, namely the doffing healthcare workers (DHCW) and the Trained Observer (TO), and discuss their specific spatial requirements. We will then explain how different configurations may impact DHCWs' doffing performance. For instance, the DHCW needs to have access to critical items within arm's reach, but at the same time enough maneuvering clearance around their designated doffing spot to minimize the risk of unexpected cross-contamination to the environment. On the other hand, the trained observer needs to have visibility of the DHCW at all times and a designated working area. Our findings reveal performance scores of several doffing area configurations and demonstrate the method that can be used for design, evaluation, and comparison of layouts when choosing between options. Finally, we will discuss the design strategies that designers can employ to improve communication between HCWs, reduce the cognitive and physical load, and, ultimately, enhance the HCWs' safety during the doffing process. These strategies should be considered for implementation in both current and future doffing spaces and non-traditional patient-care sites where PPE doffing occurs.