People
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Barrier: Some newer members of team unfamiliar with certain
aspects of task.
Facilitator: Supportive working environment, friendly and
respectful team
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Environment
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Physical environment:
Barrier: Difficult for staff in participant’s room to negotiate
bed and table; find comfortable positions to undertake task; see wall
clock and perform the checks.
Barrier: Difficult for member of staff in anteroom to see and
hear what was happening during inoculation.
Barrier: Anteroom too small to support donning and doffing PPE
without risk of contamination.
Facilitator: Large, well-lit spaces which could be adapted
Socio-organisational environment:
Barrier: Regular meeting in the laboratory underway at time of
inoculation
Barrier: Miscommunication between clinical team and laboratory
upstairs led to delay in virus arrival.
Barrier: Communication unclear with staff not involved in
inoculation (e.g. cleaning staff were difficult to find and inform at
the time of inoculation which led to delay).
Facilitator: Structured team briefings already in use – could be
adapted
External environment:
Barrier: Conflicting and rapidly changing advice during course of
pandemic from national bodies on levels of personal protective equipment
(PPE).
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Task
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Barrier: Task required several steps to be taken in order –
process not supported by checklist.
Barrier: Team members reported being unclear on precise time
virus was in OxCRF.
Barrier: Use of PPE not standardised across team members with
lack of clarity over exactly what to wear in different areas e.g.
corridors. Observed different ways of donning and doffing PPE.
Facilitator: Adaptability of team members
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Tools / Technology
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Barrier: Lengthy study protocol used as a form of checking tool
in participant’s room. Protocol cumbersome and time-consuming with more
than 50 steps. Paper based records used - difficult to sort through and
keep clean.
Facilitator: Study team already designing simplified checklist
Barrier: “Do not enter” sign placed on door to anteroom too
early, therefore, ignored before the virus arrived.
Barrier: No other visible indication that virus was in OxCRF.
Barrier: No technology for 2-way communication between
participant’s room and areas outside.
Facilitator: Easy, non-intrusive solution found in collaboration
with OxCRF and the COV-CHIM study team to provide better in-room
audio-visual facilities during study
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