Improving physical distancing among healthcare workers in a pediatric intensive care unit

Abstract

Background: Healthcare workers (HCWs) not adhering to physical distancing recommendations is a risk factor for acquisition of severe acute respiratory coronavirus virus 2 (SARS-CoV-2). The study objective was to assess the impact of interventions to improve HCW physical distancing on actual distance between HCWs in a real-life setting.

Methods: HCWs voluntarily wore proximity beacons to measure the number and intensity of physical distancing interactions between each other in a pediatric intensive care unit. We compared interactions before and after implementing a bundle of interventions including changes to the layout of workstations, cognitive aids, and individual feedback from wearable proximity beacons.

Results: Overall, we recorded 10,788 interactions within 6 feet (∼2 m) and lasting >5 seconds. The number of HCWs wearing beacons fluctuated daily and increased over the study period. On average, 13 beacons were worn daily (32% of possible staff; range, 2-32 per day). We recorded 3,218 interactions before the interventions and 7,570 interactions after the interventions began. Using regression analysis accounting for the maximum number of potential interactions if all staff had worn beacons on a given day, there was a 1% decline in the number of interactions per possible interactions in the postintervention period (incident rate ratio, 0.99; 95% confidence interval, 0.98-1.00; P = .02) with fewer interactions occurring at nursing stations, in workrooms and during morning rounds.

Conclusions: Using quantitative data from wearable proximity beacons, we found an overall small decline in interactions within 6 feet between HCWs in a busy intensive care unit after a multifaceted bundle of interventions was implemented to improve physical distancing.

Fig. 1.

Detailed timeline of study activities.

Fig. 2.

Run chart of unadjusted measures of interactions between healthcare workers within 6 feet by day over the study period. Note: From left to right top to bottom, the graphs depict the number of daily interactions within 6 feet, the number of beacon devices worn by day, the number of interactions per potential beacon interaction by day, the daily median duration of interaction in minutes, the daily median distance of interaction in feet, and the daily median effective exposure risk of the interactions. The vertical line depicts introduction of interventions to improve physical distancing between healthcare workers.

Fig. 3.

Number of interactions in pre- or postintervention periods by number of possible interactions based on the total number of beacons worn on the same day.