Fig 1.
HF/ethnography team members observed clean PPE (gowns, gloves, and supplies) stored haphazardly on chairs, carts, and tray tables throughout the hallways of the unit during our first walkthrough.
Note food tray awaiting delivery placed on waste bin.
Fig 2.
Clean and contaminated items were stored in close proximity to one another.
There was no clear indication if the plastic bag was dedicated for clean or contaminated stethoscopes. The pink basin located on the floor was intended for dirty equipment, which was placed too close to clean PPE and was not positioned with the black waste bin across the doorway.
Fig 3.
Working alongside unit staff, the team’s recommendations were implemented within 48 hours.
Clean PPE was consolidated onto a single cart, with designated areas for gowns, gloves, and clean stethoscopes. Contaminated equipment was confined to a single area outside patients’ rooms, with the pink basin (for dirty goggles and stethoscopes) moved from the floor onto the designated dirty tray table. Doffing bins for gowns and linens were made available inside each room on the same side as the dirty tray tables outside the room.
Fig 4.
HF/ethnography team members observed clean supplies (pictured here: Sterile wipes and ultrasound gel) being placed on contaminated tray tables outside patients’ rooms.
Fig 5.
Standardizing the placement of pink basins, hand sanitizer pumps, and Cavi-wipes™ on the ‘designated dirty’ tray tables discouraged their use as a temporary clean supply storage surface.
However, clinical staff occasionally ended up placing clean meal trays and other clean equipment on the waste bins beneath the tray tables, as our team discovered during subsequent walkthroughs.
Fig 6.
Unit leadership responded quickly to the reports of staff contamination related to dirty linens by installing a dedicated doffing station inside the laundry chute room.
Fig 7.
While IPC had assumed that the outsides of linen bags were ‘clean’, during our walkthrough and co-design session we observed that almost every bag had contaminated PPE or linens draped over the sides.