Hazard Assessment and Remediation Tool for Simulation-Based Healthcare Facility Design Testing.

OBJECTIVES: To develop an objective, structured observational tool to enable identification and measurement of hazards in the built environment when applied to audiovisual recordings of simulations by trained raters. BACKGROUND: Simulation-based facility design testing is increasingly used to optimize safety of healthcare environments, often relying on participant debriefing or direct observation by human factors experts. METHODS: Hazard categories were defined through participant debriefing and detailed review of pediatric intensive care unit in situ simulation videos. Categories were refined and operational definitions developed through iterative coding and review. Hazard detection was optimized through the use of structured coding protocols and optimized camera angles. RESULTS: Six hazard categories were defined: (1) slip/trip/fall/injury risk, impaired access to (2) patient or (3) equipment, (4) obstructed path, (5) poor visibility, and (6) infection risk. Analysis of paired and individual coding demonstrated strong overall reliability (0.89 and 0.85, Gwet's AC1). Reliability coefficients for each hazard category were >0.8 for all except obstructed path (0.76) for paired raters. Among individual raters, reliability coefficients were >0.8, except for slip/trip/fall/injury risk (0.68) and impaired access to equipment (0.77). CONCLUSIONS: Hazard Assessment and Remediation Tool (HART) provides a framework to identify and quantify hazards in the built environment. The tool is highly reliable when applied to direct video review of simulations by either paired raters or trained single clinical raters. Subsequent work will (1) assess the tool's ability to discriminate between rooms with different physical attributes, (2) develop strategies to apply HART to improve facility design, and (3) assess transferability to non-ICU acute care environments.

Airborne fungal spores in a cross-sectional study of office buildings.

Airborne fungal spores were measured in 44 office buildings in the summer and winter throughout the continental United States, as part of the Building Assessment, Survey and Evaluation (BASE) program. Six indoor air and two outdoor air samples were collected on a single day from each building. The cross-sectional and repeated measure design afforded evaluation of between-building and within-building variability of fungal spore levels in buildings. Total fungal spore concentrations in indoor air ranged from < 24 to 1000 spores/m3, except for one building with natural ventilation where indoor levels were approximately 9000 spores/m3. Indoor air concentrations of total spores did not vary significantly between winter and summer or morning and afternoon monitoring periods or among climate zones or locations within a test area. Indoor-outdoor ratios of total spore concentrations typically ranged between 0.01 and 0.1 and were approximately seven times greater in winter than summer because of relatively low outdoor levels in the winter. The indoor-outdoor ratio of total spore concentrations for a building was consistent (reliability coefficient = 0.91) among repeated measures. Distributions of rank correlation coefficients for spore types in pairs of individual indoor-outdoor and indoor-indoor samples were weakly correlated (Spearman correlation = 0.2 on average). When spore type data were aggregated among samples from the same building, the central tendency of the rank correlation coefficients increased to 0.45. Rank correlation coefficients were also proportional to the number of spore types present in the samples that were compared. The BASE study provides normative data on concentrations of fungal spores that can aid in identification of problematic levels of mold in buildings.

Indicators of moisture and ventilation system contamination in U.S. office buildings as risk factors for respiratory and mucous membrane symptoms: analyses of the EPA BASE data.

We assessed associations between indicators for moisture in office buildings and weekly, building-related lower respiratory and mucous membrane symptoms in office workers, using the U.S. EPA BASE data, collected in a representative sample of 100 U.S. office buildings. We estimated the strength of associations between the symptom outcomes and moisture indicators in multivariate logistic regression models as odds ratios (ORs) and 95% confidence intervals (CI), controlling for potential confounding factors and adjusting for correlation among workers in buildings. This analysis identified associations between building-related symptoms and several indicators of moisture or contamination in office buildings. One set of models showed almost a tripling of weekly building-related lower respiratory symptoms in association with lack of cleaning of the drip pans under air-conditioning cooling coils (OR [CI] = 2.8 (1.2-6.5)). Other models found that lack of cleaning of either drip pans or cooling coils was associated with increased mucous membrane symptoms (OR [CI] = 1.4 (1.1-1.9)). Slightly increased symptoms were also associated with other moisture indicators, especially mucous membrane symptoms and past water damage to building mechanical rooms (OR [CI] = 1.3 (1.0-1.7)). Overall, these findings suggest that the presence of moisture or contamination in ventilation systems or occupied spaces in office buildings may have adverse respiratory or irritant effects on workers. The analysis, however, failed to confirm several risks identified in a previous study, such as condition of drain pans or outdoor air intakes, and other hypothesized moisture risks. Studies with more rigorous measurement of environmental risks and health outcomes will be necessary to define moisture-related risks in buildings.