{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:37:09Z","timestamp":1788302229696,"version":"build-2803163510"},"reference-count":33,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T00:00:00Z","timestamp":1644796800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X21005262_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Understand how the built environment can affect safety and efficiency outcomes during doffing of personal protective equipment (PPE) in the context of coronavirus disease 2019 (COVID-19) patient care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X21005262_as2\">\n                    <jats:title>Study design:<\/jats:title>\n                    <jats:p>We conducted (1) field observations and surveys administered to healthcare workers (HCWs) performing PPE doffing, (2) focus groups with HCWs and infection prevention experts, and (3) a with healthcare design experts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X21005262_as3\">\n                    <jats:title>Settings:<\/jats:title>\n                    <jats:p>This study was conducted in 4 inpatient units treating patients with COVID-19, in 3 hospitals of a single healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X21005262_as4\">\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>The study included 24 nurses, 2 physicians, 1 respiratory therapist, and 2 infection preventionists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X21005262_as5\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The doffing task sequence and the layout of doffing spaces varied considerably across sites, with field observations showing most doffing tasks occurring around the patient room door and PPE support stations. Behaviors perceived as most risky included touching contaminated items and inadequate hand hygiene. Doffing space layout and types of PPE storage and work surfaces were often associated with inadequate cleaning and improper storage of PPE. Focus groups and the design charrette provided insights on how design affording standardization, accessibility, and flexibility can support PPE doffing safety and efficiency in this context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X21005262_as6\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>There is a need to define, organize and standardize PPE doffing spaces in healthcare settings and to understand the environmental implications of COVID-19\u2013specific issues related to supply shortage and staff workload. Low-effort and low-cost design adaptations of the layout and design of PPE doffing spaces may improve HCW safety and efficiency in existing healthcare facilities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2021.526","type":"journal-article","created":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T05:47:48Z","timestamp":1644817668000},"page":"1796-1805","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":13,"title":["Healthcare design to improve safe doffing of personal protective equipment for care of patients with COVID-19"],"prefix":"10.1017","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5165-4317","authenticated-orcid":false,"given":"Herminia","family":"Machry","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6223-3841","authenticated-orcid":false,"given":"Zorana","family":"Mati\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeinn","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8690-1023","authenticated-orcid":false,"given":"Jennifer R.","family":"DuBose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-9406","authenticated-orcid":false,"given":"Jill S.","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8532-0772","authenticated-orcid":false,"given":"Kari L.","family":"Love","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9811-6260","authenticated-orcid":false,"given":"Jesse T.","family":"Jacob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3991-3603","authenticated-orcid":false,"given":"Craig M.","family":"Zimring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,2,14]]},"reference":[{"key":"S0899823X21005262_ref3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1117"},{"key":"S0899823X21005262_ref23","unstructured":"23. Connors, B. Six common mistakes when donning and doffing PPE that could lead to COVID-19 infections. Environmental Health & Engineering website. https:\/\/eheinc.com\/blog\/six-common-mistakes-when-donning-and-doffing-ppe-that-could-lead-to-covid-19-infections\/2020. Published June 2020. Accessed February 14, 2022."},{"key":"S0899823X21005262_ref16","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004940"},{"key":"S0899823X21005262_ref6","doi-asserted-by":"publisher","DOI":"10.13075\/ijomeh.1896.01741"},{"key":"S0899823X21005262_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2018.11.003"},{"key":"S0899823X21005262_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz614"},{"key":"S0899823X21005262_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(21)00068-0"},{"key":"S0899823X21005262_ref33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230573"},{"key":"S0899823X21005262_ref19","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2018.125"},{"key":"S0899823X21005262_ref32","unstructured":"32. Mati\u0107, Z , Humphreys, B , DuBose, J. Design strategies for next-generation biocontainment units. Georgia Tech Library website. https:\/\/smartech.gatech.edu\/handle\/1853\/62548. Published February 2020. Accessed February 14, 2022."},{"key":"S0899823X21005262_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2020.11.027"},{"key":"S0899823X21005262_ref30","doi-asserted-by":"publisher","DOI":"10.1016\/S0166-4115(08)62386-9"},{"key":"S0899823X21005262_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2020.103653"},{"key":"S0899823X21005262_ref4","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13951"},{"key":"S0899823X21005262_ref20","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2018.206"},{"key":"S0899823X21005262_ref22","doi-asserted-by":"publisher","DOI":"10.1515\/med-2020-0172"},{"key":"S0899823X21005262_ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s10668-020-01033-0"},{"key":"S0899823X21005262_ref18","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz617"},{"key":"S0899823X21005262_ref28","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-020-00864-w"},{"key":"S0899823X21005262_ref29","unstructured":"29. Facemask Do\u2019s and Don\u2019ts, 2020. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/downloads\/hcp\/fs-facemask-dos-donts.pdf. Published 2020. Accesssed February 14, 2022."},{"key":"S0899823X21005262_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2021.113847"},{"key":"S0899823X21005262_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2016.08.011"},{"key":"S0899823X21005262_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2021.05.022"},{"key":"S0899823X21005262_ref2","unstructured":"2. COVID-19: Occupational health and safety for health workers. World Health Organization website. https:\/\/www.who.int\/publications-detail-redirect\/WHO-2019-nCoV-HCW_advice-2021-1. Published 2021. Accessed February 14, 2022."},{"key":"S0899823X21005262_ref26","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-020-01648-x"},{"key":"S0899823X21005262_ref24","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000023310"},{"key":"S0899823X21005262_ref21","first-page":"S241","article-title":"Design strategies for biocontainment units: creating safer environments","volume":"3","author":"Mati\u0107","year":"2019","journal-title":"Clin Infect Dis"},{"key":"S0899823X21005262_ref31","volume-title":"Case Study Research: Design and Methods","author":"Yin","year":"2014"},{"key":"S0899823X21005262_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2020.12.016"},{"key":"S0899823X21005262_ref27","unstructured":"27. Pyrek, KM. PPE Donning and doffing reveals gaps in knowledge and Practice. Infect Control Today 2018."},{"key":"S0899823X21005262_ref8","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.169"},{"key":"S0899823X21005262_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix957"},{"key":"S0899823X21005262_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix956"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X21005262","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T05:25:14Z","timestamp":1670995514000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X21005262\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,14]]},"references-count":33,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["S0899823X21005262"],"URL":"https:\/\/doi.org\/10.1017\/ice.2021.526","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,14]]},"assertion":[{"value":"\u00a9 The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}