Strengthening bio-preparedness for managing patients with suspected high consequence infectious disease (HCID) using simulation and video-reflexive methods
Dr Mary Wyer1,2,3, Dr Su-Yin Hor4, Ms Ruth Barratt1, Dr Patricia Ferguson2,6, Professor Ramon Shaban2,3,5,6, Dr Kavita Varshney2,7, Professor Lyn Gilbert3,7
1Westmead Institute For Medical Research, Westmead, Australia
2New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Westmead, Australia
3Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
4University of Technology, Sydney, Australia
5Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, Australia
6Division of Infectious Diseases and Sexual Health, Westmead Hospital and Western Sydney Local Health District, Westmead, Australia
7University of Sydney, Sydney, Australia
The NSW Biocontainment Centre (NBC) at Westmead will soon become the state-wide facility for the care of patients with high consequence infectious diseases (HCID). Researchers have collaborated with NBC staff and other stakeholders to adapt current local health district HCID procedures, for the care of patients with viral haemorrhagic disease, for the new NBC.
Several HCID exercises were designed on paper, by NBC clinicians, drawing on local policy as well as international biocontainment centre procedures. Exercises focused on procedures within quarantine rooms including: mobile x-rays; preparation of blood samples for transfer to a PC4 laboratory; removal of a deceased person; and healthcare worker collapse. Simulations of these exercises were video-recorded between February and June 2021. After each exercise, the clinicians involved, and colleagues, collaboratively reviewed and analysed the recordings, in researcher-facilitated reflexive discussions. The aim was to identify how optimal infection prevention and biocontainment could be maintained while performing complex procedures. Suggestions for practice optimisation were then tested in subsequent video-recorded simulations and repeated until consensus on optimal practice was achieved.
Preliminary analysis of reflexive discussions shows that the combination of simulation and video-reflexivity enabled participants to identify infection and occupational risks through collaborative analysis of exercise footage. Video-reflexive methods also enabled participants to recognise, discuss and test alternative viewpoints on what constitutes safe and effective practices, leading to adjustments where appropriate, and consensus on adapted guidelines.
Video-reflexivity enables context-sensitive and consensus-building co-design of policies and procedures, critical to the preparation for a new biocontainment unit.
Mary Wyer is a Registered Nurse Educator for Biopreparedness at the NSW Biocontainment Centre, Westmead, and a Postdoctoral Researcher at the Westmead Institute for Medical Research, Sydney. Her research is funded through the National Health and Medical Research Council Centre of Research Excellence (NHMRC CRE), the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE). She researches collaboratively with healthcare-workers, patients and families, using video-reflexive ethnography, to understand and improve infection prevention and control practices.