Over the last few months, we have seen many sectors respond to the cross-infection risk of COVID-19. What can we learn from them? How can our new focus on emerging technologies such as vocal interfaces, facial recognition, and mobile-based applications support improved healthcare in a pandemic era?
Infection prevention and control is a vital aspect of healthcare. The use of good handwashing and appropriate personal protective equipment has always been paramount. But the focus was previously on preventing cross infection between patients or between carer and patient. We have never before had the same intense focus on transfer between carers.
In other sectors, the importance of the hierarchy of hazard controls is widely recognized – elimination, substitution, engineering, administrative controls, PPE. This was developed in the chemicals industry where it was a one-way flow, protecting the worker from a hazardous substance. In healthcare, it is more complex. The hazardous substance, for instance a virus, still exists but we need to protect individuals from the virus that is carried by people as well as physical objects.
In shops, we regularly see physical barriers; in restaurants, there are often screens between tables; in hospitals, there are often screens between patients – but I rarely see them between staff at workstations. Every time a person makes contact with a surface, there is the potential to deposit or pick up an infectious agent. A key concept in retail has been “contactless” – to me one of the biggest lifestyle changes is no longer carrying cash. A single patient will come in to contact with many staff and many objects touched by staff, can this be reduced? Devices can warn you of your proximity to others and can analyze the locations to assist redesign of one-way flow systems, used in manufacturing plants but not in hospitals.
Touchless delivery of supplies from storerooms to the patient could reduce human contact; autonomous trollies could carry drugs from pharmacy, linen for the laundry, food from the kitchens, directly to the patient’s room. Ordering these supplies can mirror online ordering with which we are so familiar, with minimal human contact.
Can we deliver touchless care? Since the time of Osler, medical assessment has depended on taking a history, examining, and then undertaking tests. Taking the history can be contactless (videoconsults and phone consults are now commonplace). But can the examination be replaced? Contactless vital sign observations are now possible, Bluetooth stethoscopes that can be held by the patient already exist, but can we replace palpation? Many tests could be remote or robotic. Robots are already used for remote surgery but how long before we have bedside robots that can put up a drip, change your catheter, give you a wash?
Staff who have been with a patient then contact equipment that will be used by other staff. Can we copy the example of banking with contactless payment systems? For example, instead of a dirty keyboard each individual uses a personal device, or drug cupboard keys are replaced with smartphone proximity access.
Even the process of washing your hands can be made safer. Far more hotels and airports have contactless taps, toilets, hand dryers than I have seen in hospitals. I suspect short-term cost takes precedent over safety.
But there is one big problem. Healthcare is more personal than shopping. You feel better if you have human company; you recover better with personal conversations about your care; you want to have conversations and physical contact with your family. A simple hand on the shoulder or holding a hand is a powerful clinical treatment. Could we not be smarter than just refusing people access to their relatives?
We know that the public support a move to touchless technologies. How do we best use technology to reduce cross infection without isolating the individual physically and mentally? This is one of big challenges of healthcare design in the era of the pandemic.
I would love to hear from you if you are thinking about how you can shift to contact lite healthcare and think we might be able to help you develop your ideas.
Matthew Cooke is Chief Clinical Officer at Capgemini. He spent most of his career working in the NHS as an emergency physician and was the National Clinical Director for Urgent and Emergency Care.