P. Martin-Tuite1, L. Chehab2, B. Alpers3, J. Liao4, A. Sammann2 1University Of California – Berkeley / University Of California – San Francisco,Joint Medical Program,Berkeley, CA, USA 2University Of California – San Francisco,San Francisco, CA, USA 3Stanford University,Palo Alto, CA, USA 4George Washington University School Of Medicine And Health Sciences,Washington, DC, USA
Introduction: Personal protective equipment (PPE) utilization rates are at a decade low across the healthcare industry. The International Safety Center (ISC) has issued a call to action to increase the rates of PPE utilization among healthcare workers at increased risk of occupational exposure, as recent data from the Exposure Prevention Information Network (EPINet) illuminated especially poor compliance among this cohort. While this applies across all health care settings, it is essential in high-risk environments such as level 1 trauma resuscitations, where the possibility of an occupational exposure is extremely high. The aim of this study is to understand the factors influencing poor compliance with PPE at an urban, safety-net teaching hospital and level 1 trauma center.
Methods: Human-centered design (HCD) is a well-established research methodology in the design community that uses ethnographic, in-context observations and in-depth interviews to understand the challenges and unmet needs facing stakeholders in a system. We used this approach to conduct 50 hours of live observation of trauma care providers. Workflows and workarounds were identified from video recordings of 15 level 1 trauma resuscitations. We also conducted 35 in-depth interviews with stakeholders including nurses, doctors, technicians and students and identified common themes. Usability testing was performed in context to observe a range of users, from novice to experienced providers, don PPE.
Results: Upon review of 15 video recorded trauma resuscitations, we found that adequate PPE compliance (gown, gloves and face shield) at our institution is low at 29.0%. In interviews, stakeholders identified an inability to either locate or retrieve multiple items stored in inaccessible locations and separate packaging. Furthermore, PPE is a barrier to accessing the trauma patient, and providers express concern leaving the room to retrieve PPE. During usability testing, providers took 90 seconds to don PPE and an additional 30 seconds to don high shoe covers. Through live observations and video recordings, we also observed providers exiting and re-entering the room to retrieve PPE, struggle to remove PPE from packaging, or unfold and hand PPE over patients.
Conclusion: Providers report an understanding of the importance of PPE and cite a desire to wear it, but identify accessibility as the greatest challenge. While common approaches to increasing compliance in healthcare and workforce development tend to focus on incentives, education and training, HCD revealed that there is an important need to redesign PPE, as well as its storage and packaging, for the trauma setting. To help trauma providers increase compliance to wearing PPE, we must design it in such a way that allows them to don rapidly in a time-limited environment, and package and store it in a way that does not interfere with provider workflows.