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Making the invisible visible: Why does design matter for safe doffing of personal protection equipment?

  • Craig M. Zimring (a1), Zorana Matić (a1), Maria Fernanda Wong Sala (a2), Joel M. Mumma (a3), Colleen S. Kraft (a4) (a5), Lisa M. Casanova (a6), Kimberly Erukunuakpor (a6), Francis T. Durso (a3), Victoria L. Walsh (a5), Puja Shah (a5), Jesse T. Jacob (a5), Jennifer R. DuBose (a1) and for the CDC Prevention Epicenters Program (a1) (a2) (a3) (a4) (a6) (a5)...


Corresponding author

Author for correspondence: Craig Zimring, PhD, School of Architecture, SimTigrate Design Lab, Georgia Institute of Technology, Atlanta, GA 30332-0155. E-mail:


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1. DuBose, JR, Matic, Z, Wong Sala, MF, et al. Design strategies to improve healthcare worker safety in biocontainment units: learning from Ebola preparedness. Infect Control Hosp Epidemiol 2018;39:961967.
2. Zimring, C, Denham, ME, Jacob, JT, et al. Evidence-based design of healthcare facilities: opportunities for research and practice in infection prevention. Infect Control Hosp Epidemiol 2013;34:514516.
3. Institute of Medicine. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st century. Washington, DC: National Academies Press; 2001.
4. Zimring, C, Jacob, JT, Denham, ME, et al. The role of facility design in preventing the transmission of healthcare-associated infections: background and conceptual framework. Health Environ Res Design J 2013;7:1830.
5. Mumma, JM, Durso, FT, Ferguson, AN, et al. Human factors risk analyses of a doffing protocol for Ebola-level personal protective equipment: mapping errors to contamination. Clin Infect Dis 2018;66:950958.
6. Casanova, LM, Erukunuakpor, K, Kraft, CS, et al. Assessing viral transfer during doffing of Ebola-level personal protective equipment in a biocontainment unit. Clin Infect Dis 2018;66:945949.
7. Casanova, LM, Erukunuakpor, K, Walsh, VL, et al. Multicenter evaluation of viral self-contamination during doffing of Ebola-level personal protective equipment. Am J Infect Control 2017;45:S17.
8. Leape, LL. Errors in medicine. Clinica Chimica Acta 2009;404:25.
9. Verbeek, JH, Ijaz, S, Mischke, C, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Lib 2016. doi: 10.1002/14651858.CD011621.pub2.
10. Clack, L, Schmutz, J, Manser, T, Sax, H. Infectious risk moments: a novel, human factors–informed approach to infection prevention. Infect Control Hosp Epidemiol 2014;35:10511055.
11. Thaler, RH, Sunstein, CR, Balz, JP. Choice architecture. University of Pennsylvania website. Published 2014. Accessed August 10, 2018.
12. Nevo, I, Fitzpatrick, M, Thomas, R-E, et al. The efficacy of visual cues to improve hand hygiene compliance. Simul Healthcare 2010;5:325331.
13. Herlihey, TA, Gelmi, S, Cafazzo, JA, Hall, TNT. The impact of environmental design on doffing personal protective equipment in a healthcare environment: a formative human factors trial. Infect Control Hosp Epidemiol 2017:16.
14. Endsley, MR. Designing for Situation Awareness: An Approach to User-Centered Design. Boca Raton, FL: CRC Press; 2016.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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