Safer Ambu-Bag Manual Ventilation through Addition of a Second High Efficiency Particulate Air (HEPA) Filter

Experts from the Thomas Jefferson University Health Design Lab met with Emergency Medicine and Anesthesia physicians and local engineers A design was envisioned in which 3-D printed connectors could be created to add an additional HEPA Filter as shown in Figure 1 STL Files for the adapters were created based on standard HEPA filter diameters and 3-D printed The second HEPA filter was easily assembled by novice users using the adapters Ventilation adequacy using the double HEPA filter ambu-bag was similar to single HEPA filtered ambu-bag ventilation based on observed inflation of a test lun

Design thinking for community-provider collaboration: Designing a culture- and user-friendly refugee wellness center

Background: Designing South Philadelphia’s first permanent healthcare facility dedicated to refugee health presents a unique opportunity to integrate cultural sensitivity with principles of community health. Design thinking (human-centered design) is a promising strategy to address health and social justice concerns through the development of innovative products and services that prioritize population needs. This project utilized design thinking to inform suggestions to the design of Hansjörg Wyss Wellness Center that promote a culturally sensitive and welcoming environment in order to improve healthcare outcomes for the refugee population in Philadelphia. Methods: Standard qualitative data gathering methods were used to gather insight into the needs of the South Philadelphia refugee population. Seven focus groups were conducted with patient populations (7 ethnic groups) and community partners. Data were coded independently by four members of the research team, organized into themes, and presented to stakeholders. Stakeholders (physicians, architects, designers, and community representatives) participated in a “Design Sprint” which utilized design thinking exercises to ideate and rapidly prototype solutions to common barriers refugees face to health and wellness. Results: Common barriers to access to healthcare reported in the focus groups include: lack of adequate language interpretation (navigating appointments and understanding medical terminology), long wait times, and transportation. Incorporation of health education resources, space for community events, mental health care, and space/activities for children were commonly suggested priorities for services in the wellness center. Design sessions produced prototypes acceptable to community and staff and informed the architects who have iterated and finalized the blueprint for the wellness center. Conclusions: Engaging end-users and stakeholders through design thinking is an effective strategy to gather community insight, achieve cultural sensitivity, and to promote health equity for underserved patient populations. The current project was limited by lack of measurable outcomes of patient satisfaction, as the center is still under development

Applying design thinking for community-provider collaboration: Designing a culture- and user-friendly refugee wellness center

Background: Designing South Philadelphia’s first permanent healthcare facility dedicated to immigrant and refugee health presents a unique opportunity to integrate cultural sensitivity with principles of community health. Philadelphia is a city saturated with many medical institutions and hospitals, yet there are large health disparities within miles of each other. Bringing together healthcare providers with a common goal of improving community health needs from a cultural standpoint can be tasking, even when all are on the same page. Design thinking is an underexplored perspective that has the potential to address these concerns in an efficient way that improves both provider and patient satisfaction. Objective: Using Design thinking to transform the Hansjorg- Wyss wellness center into a culturally diverse and welcoming environment for patients will ultimately improve healthcare outcomes for the immigrant population in Philadelphia. Methods: Seven focus groups were conducted to gather insight and feedback from patient populations, community partners, architects, and healthcare providers. We conducted a healthcare “design sprint,” with the various stakeholders involved to implement design thinking to ideate solutions for the new wellness center Results: Common barriers to access to healthcare reported in the focus groups include: lack of adequate language interpretation, long wait times, and transportation issues. Common findings among the different focus groups were a desire for services such as health education, spaces for community events, mental health services, and activities for children. Design sessions produced prototypes acceptable to community and staff and suitable for use by architects. Conclusions: Design thinking is a useful tool to merge community interests with healthcare delivery when building a culturally sensitive wellness center

Sound Dampening Headband for Infants

Background: Noise in the Intensive Care Nursery (ICN) has been linked to sleep disruption, vital sign destabilization, abnormal development, and stress response induction in infants. Specifically, a sound level ≥60 decibels (dB) was linked to sleep disruption in infants, and the American Academy of Pediatrics (AAP) set a maximum recommended sound level of 45dB in ICNs. The present work was conducted to confirm that the Jefferson ICN exceeds the 60dB and 45dB levels, like most hospitals do, and to conduct preliminary testing on materials for a wearable intervention to reduce infants’ exposure to noise. Methods: A group of 30 neonatologists, nurses, audiologists, music therapists, sound experts, and administrative staff were interviewed about noise in the ICN and the viability of potential solutions. A 24-hour sound recording was recorded in the Jefferson ICN using a REED-SD-4023 meter. The same meter was used to the sound dampening ability of several materials at 990Hz. Results: The 24-hour sound recording showed that the ICN spent 100% of the time above the AAP recommended level of 45dB, and 44% of the time above 60 dB, the level that disrupts sleep. The maximum sound level was 93dB, and the minimum was 49dB. In our preliminary testing of materials, both Sorbothane and mass-loaded vinyl were far superior to the seven other tested materials. Conclusions: Excessive noise in the Jefferson ICN is clearly a problem. Experts showed immense interest in our work to reduce their patients exposure to noise. Additionally, the team was able to identify a sound dampening material to focus on in creating a wearable noise-reducing apparatus for infants. The project was limited by lack of formal user surveys. Future studies can focus on a higher fidelity way of measuring the ability of the wearable apparatus to dampen noise at the level of the ear

Creating A Noise-Reducing, Wearable Intervention For Newborns In The NICU

Background: Excessive auditory stimulation can have negative effects on the growth and development of newborn babies. The American Academy of Pediatrics states that newborns should not be exposed to sounds in excess of 45dB while they are in the hospital, however noise levels in NICUs across the country are often between 50-100dB. A design project was conducted to develop an intervention that could reduce infant exposure to excessive noise. Methods: Neonatologists, nurses, audiologists, music therapists, sound designers, soft materials experts, and medical device designers were interviewed and consulted throughout the design process. A 24-hour sound recording using a REED-SD-4023 meter was performed in multiple areas within the Jefferson NICU where newborns are located. Market, patent, and materials research was also completed, in addition to preliminary sound testing on materials that were considered for use in the intervention. Feedback from primary stakeholders, including neonatologists and nurses, guided improvements to the prototypes. Results: The 24-hour sound recording showed that noise levels in the Jefferson NICU were above 45dB for 100% of the time, and above 60dB for 44% of the time. The maximum noise level reached 93dB. The preliminary sound testing on selected materials showed that a quarter-inch layer of Sorbothane (the primary sound-dampening layer of the earmuff component of the wearable intervention) reduced noise levels by approximately 15dB at 990Hz. Conclusions: Newborns in the Jefferson NICU are consistently exposed to noise levels above the recommended 45dB limit. The wearable intervention developed in this design project could be a solution. The amount of noise-reduction that the intervention provides will need to be tested with high fidelity. Next steps could also include a design validation test or a pilot study within the NICU. The project was limited by a lack of formal user survey data and an inability to obtain primary end-user (i.e., newborn) feedback

A Strategy for Deploying Large-Scale Volunteer Continuous Bag Valve Tube (BVT) Ventilation

Part 1: Hospital Guide The hospital guide outlines steps and considerations for the healthcare system to successfully implement a manual ventilation strategy Part 2: Online BVT Training Module We created an online articulate evidence based training module for safe and effective Bag-Valve-Tube (BVT) ventilation for medical and nonmedical providers

Repairing a Damaged Powered Air-Purifying Respirator (PAPR) Battery Component Component with 3-D Printing

A team from the Thomas Jefferson University Health Design Lab worked with local engineers at FKB to create a 3-D replacement model for the faulty component A new component was designed to function with existing battery components The new component was created using a desktop fused deposition modeling (FDM) 3-D printer with polylactic acid (PLA) filamen

Maintaining Powered Air-Purifying Respirator (PAPR) Supply through Repair of Damaged Hose Units by 3D Printing

What’s the Problem? Powered air-purifying respirators (PAPRs) are a type of Personal Protective Equipment (PPE) that serves an essential line of defense against the spread of COVID-19 and other airborne pathogens. Demand for PAPRs are at a premium during a time where supply chains have been disrupted. The hose component of the 3M™ Air-Mate™ PAPR has a fragile interface with the hood, leading to damage and rendering the PAPR unit unsafe for continued use. PAPR units are on backorder, as are their components. Given the acute need for functional PAPRs other approaches for repair were explored

Effect of the Sphere Standards on the incidence of communicable and infectious diseases in a returnee camp in South Sudan

Background: The Sphere Standards are primarily focused on factors that acutely affect survival instead of guiding long-term development in displaced populations and have gained consensus in more than 200 aid organisations. However, research was not available to back up every Standard and in those cases the Standards were based on expert or consensus opinion. Therefore, research to validate or refine the Standards will be of benefit to the humanitarian community and the people they serve. Methods: A retrospective study was done at a UN High Commissioner for Refugees camp for returnees from Sudan to South Sudan before and after an intervention to introduce the Sphere Standards for water, sanitation, and hygiene (WASH). Data were collected from May 17, 2012, to July 31, 2012. The daily proportion of the camp diagnosed with a communicable or infectious disease was calculated by comparing the daily camp population to the daily counts from the camp's medical clinic. A χ2 analysis was done to compare the weekly disease proportions before and after the camp met the Sphere Standards for WASH. Findings: The camp clinic recorded 12 655 consultations. The weekly prevalences of the camp population diagnosed with diarrhoea, an upper respiratory tract infection, or a lower respiratory tract infection in the week before the camp met the Sphere Standards were 0·67%, 0·59%, and 0·34%, respectively. 2 weeks afterwards, they were 0·99%, 1·68%, and 0·57%, respectively. In the fourth week the prevalences for all three decreased (0·82%, 1·48%, and 0·39%, respectively). This pattern was statistically significant for all age groups and also for subgroup analysis on returnees younger than 5 years. Percentages for the diseases tracked ranged from 0·14% to 1·68% with p<0·05. Interpretation: Factors such as the massive influx of returnees to the camp and the introduction of local pathogens into the returnee camp population probably muted the initial effects of improved WASH on the camp. These results suggest that achievement and maintainence of the Sphere Standards will have a significant, although possibly delayed, effect on the incidence of communicable and infectious diseases during a complex humanitarian emergency. Funding: None