Personal Protective Equipment (PPE): Design for Comfort

The impacts of Covid-19 pandemic on the Australian health system have been significant, but the past eighteen months have also demonstrated our healthcare practitioners’ immense resilience and ability to deliver services in the face of severe and persistent disruptions. Despite this, many opportunities for improvement, innovation and redesign have been uncovered over this period. One such area of emerging global concern has been the impact of personal protective equipment (PPE) on healthcare workers from prolonged use. Specifically, there are growing reports of discomfort and irritation experienced by frontline healthcare workers after the implementation of stringent PPE protocols in clinical settings. In response to similar reports arising in Queensland, the government committed to undertake research in collaboration with the frontline workforce to improve personal protective equipment design to mitigate these risks where possible. This priority was taken up by the Healthcare Excellence Accelerator (HEAL) Bridge Lab which is a collaboration program between Queensland Health and the QUT Design Lab. The Bridge Labs, initiated by Clinical Excellence Queensland’s (CEQ) Healthcare Improvement Unit (HIU) were established to amplify our health system’s ability to innovate rapidly around emerging improvement priorities. A collaborative front-line focused quality improvement project was developed and led by team from the QUT Design Lab comprising of Associate Professor Marianella Chamorro-Koc (Program Co-Lead Design for Health, QUT Design Lab), Associate Professor Rafael Gomez (School of Design, QUT) and Ms Erina Wannenburg (Research Associate and Project Manager, QUT Design Lab). The project was supported internally by Dr Satyan Chari (Program Director – CEQ Bridge Labs), Ms Linda McCormack (Clinical Director, HIU) and Ms Anna Wesselman (Project officer – HIU). The project utilised a mixed-methods iterative approach comprising of an initial rapid review of the published and grey literature & informal interviews with several healthcare decision makers to establish scope and to compile key issues. This informed the creation of a formal semi-structured survey which was then deployed widely across the health system. A parallel survey was deployed with important external stakeholders (such as healthcare workers in primary care and in private hospitals). We received responses from 589 healthcare staff, representing all clinical streams and almost every Queensland Health Service. An additional 60 responses were received from HCW’s from the primary care and private hospital sectors. Results from the survey were then synthesised and injected into a series of design-oriented focus groups with clinical users to develop and refine key themes. The following report presents the data compiled and a set of preliminary design guidelines to seed future innovation efforts and to inform procurement. Whilst the design of PPE was a major contributor to HCW comfort, other factors such as work design (shift lengths, the organisation of tasks and workflows), fit testing methods, and supply factors in clinical areas (availability of appropriate sizing) all contributed (positively and negatively) to the experience of worker comfort. Healthcare workers also highlighted unanticipated ways in which clinical performance was shaped by long periods of PPE use such as difficulties in communication when wearing PPE, impairment of visibility when examining patients or challenges when undertaking emergency care. It was established that these issues may be (at least partially) alleviated through design improvement. Where possible these factors are reflected in the preliminary design guidelines proposed at the end of this report. We commend these guideline for optimising procurement strategies and for guiding future user centred innovation in Queensland