Dr Mary Wyer1,2,3, Dr Patricia E. Ferguson1,2,3,4, Dr Su-Yin Hor5, Dr Ruth Barratt6, Dr Arwen Morath1,7,8, Catherine Priestley1,2, Alice Polak1,2,8, Professor Lyn Gilbert3,7
1Sydney Institute For Infectious Diseases, Sydney, Australia
2New South Wales Biocontainment Centre, Westmead, Australia
3Infectious diseases, Westmead Hospital, Westmead, Australia
4Westmead Clinical School, Westmead, Australia
5University of Technology, Sydney, Australia
6Health Quality and Safety Commission, Wellington, New Zealand
7Faculty of Medicine and Health, University of Sydney, Sydney, Australia
8The Children’s Hospital at Westmead, Westmead, Australia
Methods: Drawing on the Nebraska ‘Provider Down Protocol’, we designed a paper version, then simulated and video-recorded it, iteratively, in the NBC. The clinicians involved analysed the recordings, collaboratively, in researcher-facilitated reflexive discussions. The aim was to identify how optimal infection prevention and biocontainment could be maintained whilst providing urgent care for the HCW. Suggestions for procedure modification were elicited, and subsequently tested in further video-recorded simulations until consensus on optimal practice was achieved.
Results: Five adaptations and simulations were discussed in video-reflexive sessions before consensus was reached. The final version differed considerably from the original draft. Viewing footage of simulations in situ enabled participants to identify infection and occupational risks not anticipated on paper or recognised in the midst of simulations, and to test alternative viewpoints on what constitutes safe procedure.
Conclusions: Video-reflexivity enables context-sensitive and consensus-building co-design of policies and procedures, critical to protocol-development in a new biocontainment unit. It contributes to a culture of teamwork, preparedness, and confidence before – rather than in the heat of – a crisis.
Background: The NSW Biocontainment Centre (NBC) is the first of its kind in Australia. This is a state-wide referral facility for the care of patients with high consequence infectious diseases (HCID). The NBC team collaborates with researchers to examine and adapt local and international HCID procedures for the NBC, e.g. donning/doffing of HCID PPE. However, little advice is available about to respond safely to a healthcare worker (HCW) who collapses within a contaminated zone, while in full PPE.
Biography: Dr Mary Wyer is an APPRISE Research Fellow based at the Centre for Infectious Diseases and Microbiology at the Westmead Institute for Medical Research. She is also a nurse educator at the NSW Biocontainment Centre; a state-wide facility for the care of patients with high consequence infectious diseases (HCID).
Mary researches collaboratively with healthcare workers, patients and families, using video-reflexive ethnography, to understand and improve local infection prevention and control and biocontainment practices. Her specific focus is on roles patients play in preventing infection transmission.