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. 2023 Jun;44(6):908-914.
doi: 10.1017/ice.2022.165. Epub 2022 Jun 17.

Creation and impact of containment units with high-risk zones during the coronavirus disease 2019 (COVID-19) pandemic

Natalie A Schnell  1 , Brooke Brewer  1 , Kimberly Young  2 , Turkeisha S Brown  3 , Shannon S Carson  4 , Loc Culp  3 , Cynthia Culbreth  1 , Lauren M DiBiase  1   5 , William A Fischer  4   6 , Katherine M Schultz  1 , Emily E Sickbert-Bennett  1   7   5 , Lisa Stancill  1 , David J Weber  1   7   6   5 , Erica Wolak  3 , Lisa J Teal  1
Affiliations

Creation and impact of containment units with high-risk zones during the coronavirus disease 2019 (COVID-19) pandemic

Natalie A Schnell et al. Infect Control Hosp Epidemiol. 2023 Jun.

Abstract

Background: The rapid spread of coronavirus disease 2019 (COVID-19) required swift preparation to protect healthcare personnel (HCP) and patients, especially considering shortages of personal protective equipment (PPE). Due to the lack of a pre-existing biocontainment unit, we needed to develop a novel approach to placing patients in isolation cohorts while working with the pre-existing physical space.

Objectives: To prevent disease transmission to non-COVID-19 patients and HCP caring for COVID-19 patients, to optimize PPE usage, and to provide a comfortable and safe working environment.

Methods: An interdisciplinary workgroup developed a combination of approaches to convert existing spaces into COVID-19 containment units with high-risk zones (HRZs). We developed standard workflow and visual management in conjunction with updated staff training and workflows. The infection prevention team created PPE standard practices for ease of use, conservation, and staff safety.

Results: The interventions resulted in 1 possible case of patient-to-HCP transmission and zero cases of patient-to-patient transmission. PPE usage decreased with the HRZ model while maintaining a safe environment of care. Staff on the COVID-19 units were extremely satisfied with PPE availability (76.7%) and efforts to protect them from COVID-19 (72.7%). Moreover, 54.8% of HCP working in the COVID-19 unit agreed that PPE monitors played an essential role in staff safety.

Conclusions: The HRZ model of containment unit is an effective method to prevent the spread of COVID-19 with several benefits. It is easily implemented and scaled to accommodate census changes. Our experience suggests that other institutions do not need to modify existing physical structures to create similarly protective spaces.

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Figures

Fig. 1.
Fig. 1.
Layout of acute care unit with high-risk and low-risk zones denoted. (Adapted from image courtesy of Katherine Rowe, MSN, RN, PCCN, UNC Medical Center.)
Fig. 2.
Fig. 2.
Demarcated low-risk footpath within a high-risk zone.
Fig. 3.
Fig. 3.
Containment unit entrance signage.
Fig. 4.
Fig. 4.
Patient placement workflow at UNCMC. Note. ACU, acute care unit; ICU, intensive care unit; ID, infectious disease; OSH, outside hospital. *Contraindications for shared suite placement include concurrent infection requiring additional isolation precautions (eg, C. difficile), COVID-19 exposure; required aerosol-generating procedure, unable to comply with masking, other non–infection-related clinical reasons as indicated by diagnosis and/or behavior or status (eg, forensic patients, psychiatric patients, etc).
Fig. 5.
Fig. 5.
Comparison of estimated minimum number of person protective equipment doffing opportunities for every 6 COVID-19 intensive care unit patients per 12-hour shift.
Fig. 6.
Fig. 6.
Percentage of healthcare providers who agreed or strongly agreed with infection prevention strategies for COVID-19.
See this image and copyright information in PMC

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