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Jennifer R. DuBose et al


Table 1. General Design Features Relevant to Doffing Personal Protective Equipment (PPE) in the Biocontainment Units (BCUs) in 4 State-Designated US Ebola Treatment Centers


Facility Variable


Space size and layout Patient room


(A) Dedicated BCU 22.6m2 (243 ft2)


Location of PPE donning and doffing activities Donning in Doffing in


Corridor Treatment room


Location of healthcare workers In the doffing area


Outside the doffing area


Floor demarcation of doffing area


Supplies and equipment


Hand hygiene products used during doffing PPE


Motion-activated hand sanitizer dispenser (height: 113cm or 44.5”)


Stabilization aid during doffing


Waste disposal Disinfection of doffing area


Hand grip (height: 119– 142cm or 47–56”)


Open, round bin (diameter: 70cm or 14”)


Step into the disinfectant pan in the doffing area


Simple visual aids for doffing Poster of doffing protocol checklist


Communication and visibility


- Headsets, microphone - HCW and TO are together in doffing area


Note. HCW, healthcare worker; TO, trained observer. aDoffing area is divided by plastic curtain.


the simulations. Regardless of the method used to optimize com- munication, technological solutions (eg, headsets) should have a simple backup method (eg, white boards) in case of technology failure.


Signify Steps in the PPE Doffing Process


To minimize the information a HCW needs to remember or consider during doffing, the built environment should intuitively guide the appropriate process and workflow. The complex process can be embedded in the physical space rather than solely relying on the memory of the TO and HCW using the following approaches:


Designate separate areas for donning and doffing and establish unidirectional flow Distinct areas for donning and doffing prevents cross con- tamination and can be used to establish unidirectional flow. Current Centers for Disease Control and Prevention (CDC) guidance also recommends separation of the doffing area from the treatment room, but this may be difficult to accomplish given space constraints especially in adapted spaces.23 Of 4 study sites, 3 had doffing areas inside the patient room near the door to facilitate communication with the TO and to enable the doffed HCW to step directly to the clean zone after doffing. Design can provide visual cues, such as dividing a space into zones using color to indicate 3 levels of potential contamination and different


- Aerosol foam dispenser (height: 145cm or 57”)


- Wipe dispensers (height: 160cm or 63”)


Chair (height: 81cm or 32”) L-shaped step stool (height: 86cm or 34”)Height: 34”


Open, round bin (diameter: 110cm or 22”)


Chemical pad at the entrance to clean/green zone


None


HCW and TO are together in doffing area


Open, rectangular bin (51 × 28 cm or 20 × 11”)


Chemical pad in the doffing area


- Clock - Mirror


- Windows - Open door of the treatment room


Hand sanitizer pump (height: 125cm or 49”)


- Aerosol foam dispenser (height: 132cm or 52”)


- Hand hygiene dispenser with multidirectional tip and splash guard (height: 147cm or 58”)


None


Step-on, rectangular bin (48 × 38 × 79cm or 19 × 15 × 31”)


Create a disinfecting mat with wipes in the doffing area


- Clock and timer - Mirror


- Windows


(B) Convertible Space: Nondedicated BCU


13.8m2 (149 ft2) Adjacent room


Dedicated decontamination space


Doffing HCW Trained observer


Monitor nurse (in the monitoring room)


Blue rectangle (91 × 122cm or 36 × 48”)


Doffing HCW PPE buddya Trained observera


Site manager (in the corridor)


None (C) Dedicated BCU 14.9m2 (160 ft2) Anteroom Treatment room


(D) Convertible Space: Nondedicated BCU


18.6m2 (200 ft2)


Dedicated space Treatment room


Doffing HCW Trained observer


Red rectangle (91 × 160cm or 36 × 63”)


Doffing HCW


Trained observer Monitor nurse (in the corridor)


None


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