Healthcare Personnel Attire in Non-Operating-Room Settings

Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition. The role of attire in cross-transmission remains poorly established and until more definitive information exists, priority should be placed on evidence-based measures to prevent hospital acquired infections (HAI). This paper aims to provide a general guidance to the medical community regarding HCP attire outside the operating room. In addition to the initial guidance statement, the manuscript has three major components: 1. A review and interpretation of the medical literature regarding a) perceptions of HCP attire (from both HCP and patients) and b) evidence for contamination of attire and its potential contribution to cross-transmission; 2. A review of hospital policies related to HCP attire, as submitted by members of the SHEA Guidelines Committee; 3. A survey of SHEA and SHEA Research Network members, which assessed both institutional HCP attire policies and perceptions of HCP attire in the cross-transmission of pathogens. Recommendations for HCP attire should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross-transmission of pathogens. Although the optimal choice of HCP attire for inpatient care remains undefined, we provide recommendations on the use of white coats, neck ties, footwear, the bare-below-the-elbows strategy, and laundering. Institutions considering these optional measures should introduce them with a well-organized communication and education effort directed at both HCP and patients. Appropriately designed studies are needed to better define the relationship between HCP attire and HAIs

HYBRID CARDIAC REHABILITATION: EARLY EXPERIENCE FROM RECRUITMENT TO GRADUATION

Disclosures: EMS serves as a consultant to Corrie Health. Under a license agreement between Corrie Health and the Johns Hopkins University, the University owns equity in Corrie Health and the University, FAM, and SSM are entitled to royalty distributions related to technology described in the study discussed in this publication. Additionally, FAM and SSM are founders of and hold equity in Corrie Health. ML and JS have equity ownership in Corrie Health. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. Therapeutic Area: Cardiac Rehabilitation; Secondary Prevention of CVD; Digital Health Background: Low participation in cardiac rehabilitation (CR) is a missed opportunity to improve outcomes in secondary prevention of cardiovascular disease. To increase participation in CR, a multidisciplinary team launched a 12-week hybrid CR program utilizing in-center and virtual CR sessions via an evidence-based digital health platform. Our early experience with >40 participants provides valuable lessons learned for creating a scalable hybrid CR program. Methods: We established a 5-phase approach from recruitment to graduation. Phase 1 - Pre-Bedside: We used the electronic medical record system, Epic, to identify low to moderate risk CR-eligible inpatients. Phase 2 - Bedside: Patient navigators approached inpatients to inform them about hybrid CR, conduct further screening, and for enrollment. Patients were coached how to use the digital health platform including a smartphone application, smartwatch, and blood pressure monitor. Phase 3 - Pre-CR: During hospitalization and after discharge, patients tracked medication use and vital signs, engaged with educational videos, and entered lab values (ex. LDL). Coaches conducted weekly check-in sessions to review progress, safety, and address any technical issues. Phase 4 - CR: Patients completed 2 in-center safety assessments prior to starting home-exercise. Phase 5 - Graduation: Patients received a graduation coaching session at week 12 to celebrate and plan for sustainable healthy lifestyle habits. Results: We identified multiple areas for improvement and enhanced our program. Phase 1: We streamlined patient identification using Epic reports and auto-referral ordersets for eligible patients. Phase 2: We developed flexible onboarding methods with instructional videos tailored for different levels of digital literacy. We also found that assembling a diverse CR team was key for recruiting patients traditionally underrepresented in CR. Phase 3: We created a structured weekly coaching curriculum to promote engagement. Phase 4: We refined low to moderate risk criteria to adjust for lack of exercise data during hospitalization and implemented 2 in-person safety assessments. Phase 5: Some patients expressed interest in advocacy after graduating, possibly through social media support groups. Conclusion: Drawing on lessons learned, we developed a hybrid CR program that adapted to patients’ experiences and provided a scalable solution for patients who cannot attend CR on a regular basis

Rationale and Design of the mTECH‐Rehab Randomized Controlled Trial: Impact of a Mobile Technology Enabled Corrie Cardiac Rehabilitation Program on Functional Status and Cardiovascular Health

Background Cardiac rehabilitation (CR) is an evidence‐based, guideline‐recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in‐center, which limits access and engagement, most notably among underrepresented racial and ethnic groups due to barriers including cost, scheduling, and transportation access. This study is designed to evaluate the Corrie Hybrid CR, a technology‐based, multicomponent health equity‐focused intervention as an alternative to traditional in‐center CR among patients recovering from a cardiac event, surgery, or procedure compared with usual care alone. Methods The mTECH‐Rehab (Impact of a Mobile Technology Enabled Corrie CR Program) trial will randomize 200 patients who either have a diagnosis of type 1 myocardial infarction or who undergo coronary artery bypass grafting surgery, percutaneous coronary intervention, heart valve repair, or replacement presenting to 4 hospitals in a large academic health system in Maryland, United States, to the Corrie Hybrid CR program combined with usual care CR (intervention group) or usual care CR alone (control group) in a parallel arm, randomized controlled trial. The Corrie Hybrid CR program leverages 5 components: (1) a patient‐facing mobile application that encourages behavior change, patient empowerment, and engagement with guideline‐directed therapy; (2) Food and Drug Administration‐approved smart devices that collect health metrics; (3) 2 upfront in‐center CR sessions to facilitate personalization, self‐efficacy, and evaluation for the safety of home exercise, followed by a combination of in‐center and home‐based sessions per participant preference; (4) a clinician dashboard to track health data; and (5) weekly virtual coaching sessions delivered over 12 weeks for education, encouragement, and risk factor modification. The primary outcome is the mean difference between the intervention versus control groups in distance walked on the 6‐minute walk test (ie, functional capacity) at 12 weeks post randomization. Key secondary and exploratory outcomes include improvement in a composite cardiovascular health metric, CR engagement, quality of life, health factors (including low‐density lipoprotein‐cholesterol, hemoglobin A1c, weight, diet, smoking cessation, blood pressure), and psychosocial factors. Approval for the study was granted by the local institutional review board. Results of the trial will be published once data collection and analysis have been completed. Conclusions The Corrie Hybrid CR program has the potential to improve functional status, cardiovascular health, and CR engagement and advance equity in access to cardiac rehabilitation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05238103