The Isolation System for Treatment and Agile Response for High-Risk Infections (ISTARI) Unit, a Carecubes Design: Moving PPE Around the Patient, An Assessment of Provider Safety and Infection Control with Emergency Medicine Residents During Simulation

Abstract

Introduction:

The ISTARI unit is designed to be assembled in buildings or field hospitals to provide negative-pressure rooms in low-resource areas and decrease PPE use in the setting of highly-infectious diseases. Each unit is designed to perform ~20 air exchanges/hour with HEPA filters with multiple access points for providers to perform patient care without entering the unit while decreasing overall PPE usage. The goals of the design include patient safety, ease of use for, decreased infectious spread, and unit affordability.

Method:

A survey was obtained following a medical simulation within the ISTARI unit with Emergency Medicine resident physicians. The case involved an Ebola patient with Ventricular Tachycardia which progressed to cardiac arrest. Teams were given written and video instructions for the ISTARI unit and Ebola-level PPE. They were limited to one set of high-level PPE for the case. The survey scoring was a 0-5 scale, five being the highest.

Results:

Medical history-taking provider safety (PS)- 2.87, infection control (IC)-3.09, physical examination PS-3.52, IC-3.78, ultrasound usage PS-3.35, IC-3.43, intubation PS-2.35, IC-2.57, CPR PS-3.43, IC-3.65, cardioversion PS-3.35, IC-3.78, and overall average PS-3.145, IC-3.383.

Limitations were noted compared with traditional care, but 100% of teams met critical actions for patient management, including intubation, cardioversion, and CPR. GloGerm showed no contamination to those providing care outside the unit, but a small amount of contamination after doffing for those who entered the unit.

Conclusion:

The ISTARI unit is a cost-effective isolation unit maximizing provider safety in management of patients with highly-infectious diseases, particularly in low-resource settings. It allows for easy mobilization of units and decreased medical supplies waste. The preliminary study shows satisfactory data about provider safety and infection control when using ISTARI for a highly-infectious patient, especially in providers unfamiliar with typical high-level PPE. Providers were able to provide all necessary critical actions for highly-infectious, critically-ill patients.