Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-18T04:02:59.497Z Has data issue: false hasContentIssue false
  • English
  • Français

Barriers to physical distancing among healthcare workers on an academic hospital unit during the coronavirus disease 2019 (COVID-19) pandemic

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  07 April 2021

Sara C. Keller Open the ORCID record for Sara C. Keller [Opens in a new window] ,
Sara Pau ,
Alejandra B. Salinas ,
Opeyemi Oladapo-Shittu ,
Sara E. Cosgrove ,
Robin Lewis-Cherry ,
Briana Vecchio-Pagan ,
Patience Osei ,
Ayse P. Gurses  and
Clare Rock
...Show all authors
Sara C. Keller*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sara Pau
Affiliation:
Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Alejandra B. Salinas
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Opeyemi Oladapo-Shittu
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sara E. Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Robin Lewis-Cherry
Affiliation:
Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
Briana Vecchio-Pagan
Affiliation:
Johns Hopkins Applied Physics Laboratory, Laurel, Maryland
Patience Osei
Affiliation:
Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Ayse P. Gurses
Affiliation:
Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Clare Rock
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
Anna C. Sick-Samuels
Affiliation:
Department of Healthcare Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Corresponding author: Email Skeller9@jhmi.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Physical distancing among healthcare workers (HCWs) is an essential strategy in preventing HCW-to-HCWs transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2).

Objective:

To understand barriers to physical distancing among HCWs on an inpatient unit and identify strategies for improvement.

Design:

Qualitative study including observations and semistructured interviews conducted over 3 months.

Setting:

A non–COVID-19 adult general medical unit in an academic tertiary-care hospital.

Participants:

HCWs based on the unit.

Methods:

We performed a qualitative study in which we (1) observed HCW activities and proximity to each other on the unit during weekday shifts July–October 2020 and (2) conducted semi-structured interviews of HCWs to understand their experiences with and perspectives of physical distancing in the hospital. Qualitative data were coded based on a human-factors engineering model.

Results:

We completed 25 hours of observations and 20 HCW interviews. High-risk interactions often occurred during handoffs of care at shift changes and patient rounds, when HCWs gathered regularly in close proximity for at least 15 minutes. Identified barriers included spacing and availability of computers, the need to communicate confidential patient information, and the desire to maintain relationships at work.

Conclusions:

Physical distancing can be improved in hospitals by restructuring computer workstations, work rooms, and break rooms; applying visible cognitive aids; adapting shift times; and supporting rounds and meetings with virtual conferencing. Additional strategies to promote staff adherence to physical distancing include rewarding positive behaviors, having peer leaders model physical distancing, and encouraging additional safe avenues for social connection at a safe distance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 4 , April 2022 , pp. 474 - 480
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

References

Social distancing: keep a safe distance to stop the spread. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html. Published 2020. Updated November 17, 2020. Accessed March 19, 2021.Google Scholar
Schneider, S, Piening, B, Nouri-Pasovsky, PA, Kruger, AC, Gastmeier, P, Aghdassi, SJS. SARS-CoV-2 cases in healthcare workers may not regularly originate from patient care: lessons from a university hospital on the underestimated risk of healthcare worker to healthcare worker transmission. Antimicrob Resist Infect Control 2020;9:192.CrossRefGoogle Scholar
Knoll, RL, Klopp, J, Bonewitz, G, et al. Containment of a large SARS-CoV-2 outbreak among healthcare workers in a pediatric intensive care unit. Pediatr Infect Dis J 2020;39(11):e336–e339.CrossRefGoogle Scholar
Arora, VM, Chivu, M, Schram, A, Meltzer, D. Implementing physical distancing in the hospital: a key strategy to prevent nosocomial transmission of COVID-19. J Hosp Med 2020;15:290–291.CrossRefGoogle ScholarPubMed
Wilson, JR, Haines, H, Morris, W. Participatory ergonomics. In: Wilson JR, Corlett EN, eds. Evaluation of Human Work, 3rd edition. Boca Raton, FL: Taylor and Francis; 2005:933–962.CrossRefGoogle Scholar
Carayon, P, Hundt, AS, Karsh, BT, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care 2006;15:150–158.CrossRefGoogle ScholarPubMed
Trends in confirmed cases: Maryland. Johns Hopkins University and Medicine Coronavirus Resource Center website. https://coronavirus.jhu.edu/data/new-cases-50-states/maryland. Published 2021. Accessed January 12, 2021.Google Scholar
Crabtree, BF, Miller, WL. Doing Qualitative Research. Washington, DC: Sage Publications; 1999.Google Scholar
Guest, G, Bunce, A, Johnson, L. How many interviews are enough? An experiment with data saturation and variability. Field Method 2006;18:59–82.CrossRefGoogle Scholar
Kaufmann, CP, Stampfli, D, Hersberger, KE, Lampert, ML. Determination of risk factors for drug-related problems: a multidisciplinary triangulation process. BMJ Open 2015;5(3):e006376.CrossRefGoogle ScholarPubMed
Bradley, EH, Curry, LA, Devers, KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res 2007;42:1758–1772.10.1111/j.1475-6773.2006.00684.xCrossRefGoogle ScholarPubMed
Statement for media regarding COVID-19 cluster. Brigham and Women’s Hospital website. https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=3684. Published 2020. Updated October 16, 2020. Accessed March 23, 2021.Google Scholar
Oxner, R. Costume may have contributed to an outbreak at California hospital, infecting 44. National Public Radio website. https://www.npr.org/sections/coronavirus-live-updates/2021/01/04/953287746/costume-may-have-contributed-to-an-outbreak-at-california-hospital-infecting-44. Published 2021. Updated January 4, 2021. Accessed March 23, 2021.Google Scholar
Narayanan, RP, Nordlund, J, Pace, RK, Ratnadiwakara, D. Demographic, jurisdictional, and spatial effects on social distancing in the United States during the COVID-19 pandemic. PLoS One 2020;15(9):e0239572.CrossRefGoogle ScholarPubMed
Goodwin, R, Hou, WK, Sun, S, Ben-Ezra, M. Psychological and behavioural responses to COVID-19: a China–Britain comparison. J Epidemiol Commun Health 2021;75:189–192.Google ScholarPubMed
Goodwin, R, Hou, WK, Sun, S, Ben-Ezra, M. Quarantine, distress and interpersonal relationships during COVID-19. Gen Psychiatr 2020;33(6):e100385.CrossRefGoogle ScholarPubMed
Pronovost, PJ, Berenholtz, SM, Goeschel, CA, et al. Creating high reliability in healthcare organizations. Health Serv Res 2006;41:1599–1617.CrossRefGoogle Scholar
Parmasad, V, Keating, JA, Carayon, P, Safdar, N. Physical distancing for care delivery in healthcare settings: considerations and consequences. Am J Infect Control 2020. doi: 10.1016/j.ajic.2020.12.014.CrossRefGoogle Scholar
Zavalkoff, S, Korah, N, Quach, C. Presence of a physician safety champion is associated with a reduction in urinary catheter utilization in the pediatric intensive care unit. PLoS One 2015;10(12):e0144222.CrossRefGoogle ScholarPubMed
Supplementary material: File

Keller et al. supplementary material

Keller et al. supplementary material 1

Download Keller et al. supplementary material(File)
File 16.5 KB
Supplementary material: File

Keller et al. supplementary material

Keller et al. supplementary material 2

Download Keller et al. supplementary material(File)
File 89.3 KB