Improving Safety and Comfort of Healthcare Workers Caring for Patients With High-Consequence Infectious Diseases in a High-Level Isolation Unit Using Innovative Approaches
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Updated: Jun 19, 2025

Safety Precautions and Operating Procedures in an ABSL-4 Laboratory: 3. Aerobiology
Published on: October 3, 2016
Luca N Zweers1, Manon Tingen-Wieland1, Edmée Bowles1
1Luca N. Zweers, MSc, is a PhD Candidate and Project Team Member, and Chantal P. Rovers, MD, PhD, is an Infectious Diseases Specialist, Full Professor, and Medical Manager; both in the High-Level Isolation Unit, Department of Internal Medicine, Radboudumc Community for Infectious Diseases. Manon W. M. Tingen-Wieland is an Infection Prevention and Control Expert, Edmée C. Bowles, MD, is a Clinical Microbiologist and Unit Head, and Alma Tostmann, PhD, is an Infectious Diseases Epidemiologist and Deputy Unit Head; all in the Infection Prevention and Control Unit, Department of Medical Microbiology, Radboudumc Community for Infectious Diseases. Jacqueline M. van Tricht and Jos Velers are Learning and Development Advisors, Radboudumc Health Academy. All authors are at the Radboud University Medical Center, Nijmegen, the Netherlands.
Abstract:
Patients with high-consequence infectious diseases (HCIDs) require high-quality care by specially trained staff in a high-level isolation unit (HLIU) that follows strict infection prevention and control (IPC) measures. Caring for patients with (suspected) HCID is challenging, mainly because of the strict personal protective equipment (PPE) and IPC protocols healthcare workers (HCW) must adhere to for protection. The Radboud University Medical Center, located in Nijmegen, the Netherlands, has been a dedicated HLIU facility since 2008. A newly built HLIU opened in May 2022, and encouraged us to review the existing PPE selection, IPC protocols, and HCID training program to improve safety and comfort for HCWs working in the HLIU. Based on a systematic search through (inter)national HCID PPE guidelines and semistructured interviews with end users, we selected an improved, more comfortable set of PPE. Additionally, we developed a more concise and easier-to-use patient care process flow and implemented a new teaching strategy. The new way of working was tested in October 2022 when the first 2 patients with suspected HCID were admitted to our unit. We used surveys to evaluate the experiences of HCWs involved in this care to further improve the workflow of the unit. When optimizing safety and comfort for HCWs, it is important to consider (inter)national guidelines as well as user preferences. By systematically evaluating recent experiences of patient admission to the HLIU and then adjusting protocols and training, we can ensure that the quality of provided healthcare and the safety of HCWs working in the HLIU remains high.
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