June 14, 2017
Laura Bix is a professor at the School of Packaging in the College of Agriculture and Natural Resources. She was appointed, and currently serves as the United States delegate to ISO TC122 WG 9, a group which is developing international standards related to the accessibility of packages. In 2008 she was named one of the 100 most notable people in the medical device industry by Medical Devices and Diagnostics Industry.
I believe that the best solutions to problems occur at the intersection of art and science. This belief, coupled with the spirit of innovation and entrepreneurship in the field of packaging, and my father’s work in the field, were central to my choice to be a packaging major.
Packaging is an interdisciplinary field integrating science, engineering, technology, management and art to protect and identify products for distribution, storage, sale, use and disposal. Although packaging may not be an obvious response to emerging global problems (e.g., obesity, food scarcity and waste, and illness caused from microorganisms or toxic substances), it has the potential to favorably improve each (and many others). In short, it is a really interesting way to make a difference.
Family experiences further shaped my passions and trajectory. I watched as my grandmother, besieged with arthritis, struggled to open and manage a multitude of medication required by her son, who had Down’s syndrome. Years later, this same woman required an antibiotic PICC line to treat a MRSA infection that she caught at the hospital when her hip was replaced.
An investigation of the literature affirmed that there were complex problems in healthcare for which I could provide insights to make a difference. Medication errors, patient non-adherence/non-compliance, healthcare acquired infections and unintentional poisoning of children due to unsupervised ingestion of medications, were among those that I believed packaging could positively impact.
This was the impetus for starting the Packaging HUB (Healthcare, Universal Design and Biomechanics). The mission of HUB is to employ a user-centered approach to package design, informed by science, with the goal of improving health outcomes.
Healthcare Acquired Infections, or infections caught while receiving treatment, impact one out of every 25 patients in the United States and are one focus area of the work we do. Most of the work conducted in HAI prevention has focused on preventing direct contact transmissions, where the microbe is directly transferred from one person to the patient. Work focused on indirect routes of contamination, where the microbe is transferred through an intermediate object or a second person, are not as well studied, and those which focus on how package design and opening technique affect the issues are even less prevalent.
The outside of packages containing medical devices are not sterile, while the inside, and contents within, are. As a result, operating room technicians must transfer the package contents without having the medical device touch the outside of the package or their hands. This can be done with a “pick” where the scrubbed (sterile) healthcare provider removes the contents while the circulator (nonsterile personnel) opens the package. The second way is a “dump,” where package contents are tossed onto the field. As you can imagine, preventing any portion of the device from contatcting non-sterile surfaces during transfer can be tricky.
Our work indicates that devices do come in contact with non-sterile surfaces during some transfers and that opening technique and multiple aspects of package design impact the probability of contact. We are working to objectively characterize these relationships to create a safer system by generating designs that facilitate successful transfers.
Recently, we have expanded our focus to characterize how context impacts opening technique. Specifically, we are investigating how extreme conditions (e.g. an ambulance or zones of infectious outbreaks which require protective gear) challenge providers interacting with packaging. Preliminary work indicates that emergency personnel encounter difficulties opening packaging, and the coping mechanisms that they report have the potential to negatively impact patient care; for example, the use of teeth and trauma shears (which are not sterilized between patients) to assist with opening.
Clearly, packaging, as a field, needs to do a better job. Items should be designed to enable sterile transfer of package contents without the need for tool (or tooth). We intend to change this.