Modeling of nursing care-associated airborne transmission of SARS-CoV-2 in a real-world hospital setting

Respiratory transmission of SARS-CoV-2 from one older patient to another by airborne mechanisms in hospital and nursing home settings represents an important health challenge during the COVID-19 pandemic. However, the factors that influence the concentration of respiratory droplets and aerosols that potentially contribute to hospital- and nursing care-associated transmission of SARS-CoV-2 are not well understood. To assess the effect of health care professional (HCP) and patient activity on size and concentration of airborne particles, an optical particle counter was placed (for 24 h) in the head position of an empty bed in the hospital room of a patient admitted from the nursing home with confirmed COVID-19. The type and duration of the activity, as well as the number of HCPs providing patient care, were recorded. Concentration changes associated with specific activities were determined, and airway deposition modeling was performed using these data. Thirty-one activities were recorded, and six representative ones were selected for deposition modeling, including patient’s activities (coughing, movements, etc.), diagnostic and therapeutic interventions (e.g., diagnostic tests and drug administration), as well as nursing patient care (e.g., bedding and hygiene). The increase in particle concentration of all sizes was sensitive to the type of activity. Increases in supermicron particle concentration were associated with the number of HCPs (r = 0.66; p < 0.05) and the duration of activity (r = 0.82; p < 0.05), while submicron particles increased with all activities, mainly during the daytime. Based on simulations, the number of particles deposited in unit time was the highest in the acinar region, while deposition density rate (number/cm2/min) was the highest in the upper airways. In conclusion, even short periods of HCP-patient interaction and minimal patient activity in a hospital room or nursing home bedroom may significantly increase the concentration of submicron particles mainly depositing in the acinar regions, while mainly nursing activities increase the concentration of supermicron particles depositing in larger airways of the adjacent bed patient. Our data emphasize the need for effective interventions to limit hospital- and nursing care-associated transmission of SARS-CoV-2 and other respiratory pathogens (including viral pathogens, such as rhinoviruses, respiratory syncytial virus, influenza virus, parainfluenza virus and adenoviruses, and bacterial and fungal pathogens).

Cognitive Distractions During Sonographic Procedures: Reducing Noise-Based and Light-Based Interruptions in Hospital Rooms

Sonographers experience a high cognitive load in hospital-based care. High ambient noise and frequent noise-based interruptions include knocking on the room door, questions from others in the room or through communication technology, alarms, alerts from personal devices, and carts and people passing in the hallway. In addition, other providers turning on the overhead light is distracting for exams that need to be conducted in reduced lighting conditions. This article suggests strategies to improve working conditions for sonographers conducting exams on a patient in the hospital room. Our strategies emerge from human factors methods and principles, which derive from communication principles and theory. These strategies are organized by reducing noise-based and light-based interruptions in the hospital room and hallway, primarily through changes to the built environment and communication technology settings and reducing the use of speech during cognitively challenging time periods through training. Most of the strategies are low-cost and can be implemented within the current built environment and communication technology infrastructure. We anticipate that these strategies could enhance patient outcomes, increase patient satisfaction, improve sonographers’ job satisfaction, protect provider health, and increase procedural efficiency.

Moving Toward Person-Centered Care: Valuing Emotions in Hospital Design and Architecture

The intangible value of emotions is often neglected in healthcare evaluations; however, it forms an important part of the hospital experience that needs to be taken into consideration to move toward person-centered care. This article conceptualizes how space and architecture may influence patient, family, and healthcare provider emotions. Building upon Gaston Bachelard’s Poetics of Space, theories on emotional design and architecture, as well as research in environmental design, we suggest several ways to value emotions in hospital design and architecture. The first theme explores several hospital spaces (the waiting room, the hospital room, the treatment room) using Bachelard’s phenomenology in order to show how to facilitate emotional security by catering to the individual needs of the user. The second discusses the overall hospital room environment, notably the influence of light, color, and sound on the patient’s emotional experience. The third explores architectural theorist Giuliana Bruno’s theory of e(motion) to explore the hospital space as vissuto, a space of lived experiences, that invites us to rethink the design and architecture of hospital spaces to allow for patient participation. The article also gives suggestions of qualitative, person-centered methodologies that can be used to move forward this debate.

435. Outcomes for E484K Mutation Negative COVID-19 Patients Cohorted with E484K Mutation Positive COVID-19 Patients: A Retrospective Cohort Study

Background The emergence of the E484K mutation of SARS-CoV-2 poses a risk of immune evasion but the risk of re-infection during acute infection is not well defined. Our aim was to assess the risk of re-infection among patients with existing acute E484K mutation negative COVID-19 infection who were exposed to an E484K mutation positive SARS-CoV-2 infected patient. Methods We performed a retrospective cohort study of patients admitted with acute E484K negative COVID-19 infection and shared a hospital room with a patient who was E484K mutation positive during their period of communicability. The primary outcome was laboratory confirmed and/or clinical evidence of re-infection within the E484K negative population within 30 days of exposure and the secondary outcome was the 30-day risk of death or re-admission to hospital due to COVID-19. Results We identified 41 patients who were E484K mutation negative who shared a hospital room with some of the identified 34 E484K positive patients. Six (14%) underwent repeat COVID-19 testing and remained E484K negative and none developed signs or symptoms of COVID-19 re-infection during the 30 days following exposure. The mortality rate was 7% (3/41) and re-admission rate was zero at 30 days from exposure. Conclusion Despite the small sample size, we did not observe any evidence of re-infection among patients with COVID-19 who shared a hospital room with E484K positive patients during their acute infection. If necessary due to high hospital occupancy, patients with discordant E484K results can be safely cohorted in a shared room. Disclosures All Authors: No reported disclosures

Revisiting Healing Environments: Islamic Interior Elements in Hospital Rooms in North Africa

Background: A predominant notion among researchers is that hospital room design and decor are subject to the designer’s expression of self, which is contrary to evidence-based studies showing that design and decor can impact patient health. The aim of this study was to examine whether improvement in quality of healthcare provided in hospitals could be achieved through the convergence of expertise of healthcare professionals and hospital room designers. Methods: This was a prospective study to identify the impact of hospital interior design features with a focus on single occupancy rooms. Volunteers were recruited through advertisements and the study was conducted at the Tripoli Medical Center. Responses were analyzed using a three-dimensional computer-aided design software to help respondents accurately map their preferences and visualize outcomes. Results: Participants preferred an aesthetically pleasing hospital room environment that included art and bright colors, window views, and the need for personalization, technology, mobility, and flexibility, all of which improved satisfaction and happiness. Of these, participants’ preference for technology as a cause for satisfaction and happiness was a novel finding. Conclusion: Designers of hospital room interiors should plan and create an appealing single occupancy room for increasing user satisfaction and patient wellness.