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Published on: April 6, 2019
They Will Come, You Must Build It: A Modified Delphi Process Applied to Preparing Acute Care Facilities
Justin Chan1, Eileen F Searle1, Dmitry Khodyakov1
1Justin Chan, MD, MPH, is Director, Infection Prevention and Control, NYC Health + Hospitals/Bellevue, and an Associate Professor, Department of Medicine, NYU Grossman School of Medicine; both in New York, NY. Eileen F. Searle, PhD, RN, CCRN, is Director of Funded Projects, and Logan Denson, MPA, is Biothreats Project Manager; both at the Center for Disaster Medicine, Massachusetts General Hospital, Boston, MA. Dmitry Khodyakov, PhD, MA, is a Senior Behavioral/Social Scientist, RAND; Director, ExpertLens; Co-Director, Center for Qualitative and Mixed Methods; and Professor of Policy Analysis, Pardee RAND Graduate School; all in Santa Monica, CA. Andrea Echeverri is Associate Director, Infection Control, NYC Health + Hospitals/Bellevue, New York, NY. Edward M. Browne, MS, CHPA, CHFM, FASHE, LFACHE, is a Consultant; Yvonne Chiarelli is an Associate Editor; and Douglas S. Erickson is CEO Emeritus; all at the Facility Guidelines Institute, St. Louis, MO. Linda L. Dickey, BSN, MPH, is Past President 2022, Association for Professionals in Infection Control and Epidemiology, Washington, DC. Jonathan Flannery, MHSA, FACHE, FASHE, CHFM, is Senior Associate Director, ASHE Regulatory Affairs, American Society for Health Care Engineering of the American Hospital Association, Chicago, IL. Lewis J. Kaplan, MD, FACS, FCCP, FCCM, is a Professor of Surgery, Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Sarah Markovitz, AIA, is Principal, NBBJ, Boston, MA. Saskia V. Popescu, PhD, MPH, MA, is an Assistant Professor, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. Erica S. Shenoy, MD, PhD, is Chief of Infection Control, Mass General Brigham; a Physician, Division of Infectious Diseases, Massachusetts General Hospital; and an Associate Professor, Harvard Medical School, Boston, MA.
Abstract:
Patients with suspected or confirmed high-consequence infectious diseases (HCIDs) may present for care at any acute care facility. However, there are limited data to inform recommendations for the design, maintenance, and operation of isolation spaces for patients with suspected or confirmed HCIDs. To address this gap, we developed consensus statements by convening a group of 29 subject matter experts to participate in a modified Delphi process facilitated by a validated tool (the RAND-developed ExpertLens system). The subject matter experts participated in 3 consensus rounds, providing feedback and rating the appropriateness of 36 draft consensus statements. These draft statements were then revised based on their feedback. As a result, we developed 36 consensus statements addressing 5 domains: (1) patient room physical space, (2) doors and windows, (3) air handling, (4) electrical and plumbing, and (5) soiled utility rooms and waste management. These statements could inform the approaches of frontline acute care facilities when building new spaces or modifying existing spaces to enable appropriate HCID patient isolation and care.
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