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Table 2 Identified design requirements

From: User-centred participatory design of visual cues for isolation precautions

Functional requirements (what the system should do)
Information dissemination• Draw the attention of anyone entering the room that special precautions must be taken.
• Inform any person entering the patient room what isolation status that patient has.
• Inform any person entering the patient room about the isolation precautions they must employ according to the patient’s isolation status.
  ▪ Inform healthcare personnel about required personal protective equipment.
  ▪ Inform cleaning staff about required protective equipment, adapted disinfectants, and prioritised cleaning measures.
  ▪ Inform visitors about required personal protective equipment, or instruct them to see a staff member.
• Inform any person entering the room about the order in which precautions (e.g. donning and doffing personal protective equipment, hand hygiene) should be performed.
• Inform anyone transporting the patient about the transmission-based precautions that should be respected.
• In addition to the three main categories of transmission-based precautions (contact, droplet, and airborne), signage should also be designed to communicate combined or “light” isolation precautions specific to the USZ.
USZ guidelines• Be consistent with USZ guidelines for isolation precautions. The three main isolation categories include:
  ▪ Contact isolation: don gown
  ▪ Droplet isolation: don surgical mask
  ▪ Airborne isolation: don FFP2 mask
• Communicate combined isolation precautions:
  ▪ Contact + Droplet isolation: don gown and surgical mask
  ▪ Contact + Airborne isolation: don gown and FFP2 mask
Non-functional requirements (constraints on the system and its development)
Maintenance restraints• Must be easy to hang and remove on an as-need basis.
• If printed on paper, must either be laminate so that it may be cleaned and reused, or single use.
Accessibility and confidentiality requirements• Should include graphics and symbols to accommodate non-native German speaking personnel.
• Signage should avoid potential patient stigmatisation and should not disclose any confidential patient information.
• Signage must be accessible to individuals with colour vision deficiency, for example by avoiding problematic colour combinations and employing both colours and symbols to convey messages over multiple channels.
Physical environment requirements• Signage must be noticeable relative to other signs in the healthcare setting (appropriate single-to-noise ratio).
• Some indication of the patient’s isolation status should travel with the patient at all times so that the appropriate transmission-based precautions can be communicated at all times (e.g. when the patient is outside of the room where the sign is posted) – this could be attached to the patient herself or to the patient’s bed.
• Signage for housekeeping personnel should be of a portable size (A4 or smaller) so that it can fit on the cleaning trolleys.
Organisational environment requirements• The signage should be able to quickly communicate the required actions, so that healthcare providers do not need to slow down (‘break the rhythm’) to interpret them.
• If sign will be paper-based, it should be easily accessible to staff on the ward when an isolated patient arrives (e.g. printed copies from intranet) or purchasable.
• Any posted signs must be consistent with the Corporate Design Guidelines.
• Information communicated through signage must be consistent with evidence based-guidelines, such as the CDC 2007 guidance, as well as institutional infection control guidelines.
Technical environment requirements• Colour printer must be available if units are to print their own copies of paper-based signage.
• Intranet connection must be available if units are to download the signs.
• Staff must be able to post the signage either by using an adhesive material, or the signs may be printed directly onto an adhesive sheet.
• Handling of signage material should be cost-effective and practical in every-day use.
• It should be possible to update the signage system easily in case new hospital rules/guidelines are introduced.
  1. Legend: Design requirements identified during interviews and observations served as a guide to ensure that subsequent designs met user needs while satisfying functional and non-functional requirements. USZ, University Hospital Zurich; CDC, Centers for Disease Control.