A n d r e w B a g a t e l l a

B r a d W o r o s c h u k

H a i l e y W h i t t

c l e a n h a n d sf o r h e a l t h

p r o c e s s

b o o k

D e s n 3 1 0

J o n a t h a n A i t k e n

“Fun is the element of life that is

enjoyable and frees us from the

normal stresses of the everyday, and

also the means by which we re-retain

our brain to learn knew patterns

of behaviour”

A Theory of Fun for Game Design, Ralph Koster

P r o j e c t B r i e f / c o n t e x t

P r o j e c t c r i t e r i a

r e s e a r c h r e v i e w

v i s u a l r e s e a r c h

e x P l o r a t i o n c o - c r e a t i o n

c o n c e P t d e v e l o P m e n t

d e v l e o P m e n t / r e f i n e m e n t

f i n a l o u t c o m e s

s e l f a s s e s s m e n t / r e f l e c t i o n

B i B l i o g r a P h y

1

2

3

7

9

13

20

26

32

34

c o n t e n t s

1

Using primary and secondary research, co-

creation, brainstorming sessions, and concept

development through prototyping and refine-

ment we were we were asked by the Vancouver

Coastal Health Authority to address the issue of

hand hygiene, find it’s root cause, and suggest

a design solution for the hospitals that would

encourage the staff and visitors to perform

proper hand hygiene by using the hand sanitiz-

er dispensers at the entrances and exits of (and

around) the hospitals.

p r o J e c t b r I e F & c o n t e X t

2

p r o J e c t c r I t e r I aOur design criteria was to include the following:

a human centered design approach•

primary and secondary research •

co-creation workshops •

user testing •

prototyping•

strong conceptual development •

documentation of our process •

and our final design and presentation•

3

At the beginning stages of the project, we each visited a differ-

ent hospital; Richmond General Hospital, Lionsgate Hospital, and

Vancouver General Hospital. We were shown around the hospital’s

different wards and other areas to give us more insight into the

problems associated with the compliance of hand sanitization. We

compared our notes to narrow down what information was common

to focus our problem to make it more general. We also compared

what we learnt on these visits to the secondary research both pro-

vided to us and the additional research we found in order to start

understanding and exploring the problem at hand more thoroughly.

r e s e a r c h r e V I e W

4

policies and procedures requires a good understanding of what is re-

quired and why (individual factors); a workplace that promotes a safety

climate, clearly outlines expectations for performance, and provides ed-

ucational programmes to facilitate compliance (organisational factors);

and an environment that provides accessible resources, the equipment

and supplies required to support compliance (environmental factors).”

(Clean Hands for Life: results of a large, multicentre, multifaceted,

social marketing hand-hygiene campaign, L.A. Forrester*, E.A. Bryce,

A.K. Mediaa. Division of Infection Control, Vancouver Coastal Health,

Vancouver, British Columbia, Canada. 24 October 2009) This informa-

tion further enforced the fact that the number, location, and availability

of the sanitizer was not the problem. The locations of the dispensers

themselves was taken into account so that each unit has multiple dis-

pensers which are located in various places. There are dispensers inside

and outside of the patients rooms, alongside the sinks which are inside

of the room. They must be located where they are ‘expected to be lo-

cated’ (Four Steps to a User-Friendly Hand Hygiene Environment CPSI

Hand Hygiene Toolkit, March 10, 2009), for example at every entrance

and exit, which are mostly for visitors use, in order to prevent infection

from coming in and going out of the hospital. We were told that each

dispenser is checked on a daily basis to ensure that the product has not

run out.

It is a general feeling around the hospital that the current poster

campaigns were largely ineffective due to a number of factors which

are, there is too much clutter in and around the posters so they don’t

t e c h n I c a l I n F o r M a t I o n / r e s t r a I n t s

Technical information about the hand sanitizer dispensers include many

human factors such as visibility, as they must stand out in their environ-

ment and therefore the hand sanitizer cases could not be modified due to a

specific ‘color coding’ system currently in place (blue handles indicate alco-

hol/foam disinfectant rub, whereas white handles indicate soap), as well as

the company providing the hand sanitizer (Microsan) want their brand to

be identified through their visual identity (logo and design of the casing).

However, some of the dispensers have a stainless steal box around them

in order to prevent theft, as people often steal them to consume them for

the alcohol. This metal casing has saved the hospital over (approximately)

$3000.00 in product. Another technical restraint we were posed with was

the fact that any signage displayed must be easy to understand for those

who cannot read (the visual language must be strong), as well as any writ-

ten words must be ‘multilingual’ in order for everyone to understand them.

c U r r e n t c a M p a I G n s

We discussed the problems with current campaigns and initiatives taken

towards raising compliance rates for hand sanitization. There were many

different campaigns that were initiated throughout the hospitals in order

to raise compliance rates of both staff and visitors, rigorous planning and

initiative was taken in order to address the many issues around hand hy-

giene compliance. In our research we found that the following ‘PRECEDE

model of health promotion’ guidelines have been set in place in order to

approach the issue from an individual, environmental, and organizational

standing: “This model postulates that successful application of desired

5

feeling uncomfortable. Initially, we were curious to explore how we

could perhaps include a degree of humor to this methodology to ease

patient/doctor tension on the topic.

On our tours we were shown the hospitals online orientation for

staff which included a cartoon, information, and an interactive activ-

ity (basically a game) that tested the staff members knowledge on hand

hygiene, in particular the four moments for hand hygiene which are; 1.

before initial patient/patient environment contact in order to protect

the patient from harmful germs that may be on their hands.

2. Before aseptic procedure to ensure that harmful germs don’t enter

the patient’s bodies.

3. After body fluid exposure risk to protect oneself and the environ-

ment from harmful germs.

4. After patient/patient environment contact for the same reasons and

the previous stated moment.

(from Vancouver Coastal Health poster “Your 4 moments for Hand Hy-

giene”.)

Although every new staff member is required to do this activity, we were

told that the information it provides is often ignored due to both for-

getfulness and confusion as to when it is important to do so. From the

information we gathered from both primary and secondary research we

noticed that there seems to be a lot of information being shared to staff

members and visitors on hand hygiene, but is largely ignored due to a

number of factors such as doubting the importance of the issue at hand.

stand out, there are too many campaigns going on at once therefore add-

ing to the visual clutter, and the use of posters is too static so people have

become ‘visually numb’ to them and over time they have become ignored.

In terms of the ‘visual clutter’ we were given some suggestions as to where

we could place our campaigns in order to have them stand out, this in-

cluded the elevators and the windows. These campaign posters were also

run on the computers throughout the hospital as screen savers, however

the staff felt as though they were also becoming visually numbed towards

the messages because they were too constant. Another insight that was

touched upon during our discussions around the practices, was that when

the SARS and swine flue outbreaks occurred, compliance of both staff

and visitors skyrocketed due to a fear of these serious infections spread-

ing within and outside of the hospital and also effective campaign strate-

gies aimed at a general sense fear of the diseases. However, this approach

(under normal circumstances) would be less desired due to the fact that

hospitals are already high stress environments, and making people fearful

within the hospital would only contribute negatively on an emotional level.

Another initiative that was taken were the ‘ask me pins’ which were worn

by nurses, doctors, and staff in order to promote patients and visitors to

ask their health care providers if they had washed their hands before com-

ing into contact with them. These pins were not well received by the staff,

as they felt as though their authority was being questioned, and also were

not well received by the patients as they felt uncomfortable asking. How-

ever, there was some insight taken from this initiative that the patients

family members or loved ones were more likely to ask the doctors without

6

a U d I t I n G p r o c e s s

The hand hygiene of hospital staff is audited, but there are some problems

surrounding this issue. For the most part, this problem revolves around

power struggles, as the auditors do not feel as though they are in a position

to tell the staff what they should be doing or what they are doing wrong.

Therefore, there is a lack of communication between the auditors and the

staff during the process; the auditors go to the staff ’s superiors to report on

poor hygiene practices rather than directly confronting the person. They

also try to ‘hint’ towards washing their hands if they see that a nurse or

doctor hasn’t done so by doing things such as washing their hands and

commenting on how clean they feel. Although it seems as though direct

‘peer to peer’ confrontation would probably better enforce hygienic practic-

es, apparently those hospitals which do so have the same compliance rates

and results.

d o c t o r / n U r s e h a n d h Y G I e n e

From this we discussed the issues around doctor and nurse hand hygiene

and their general habits around the hospital. We learnt that the doctors

do not typically work inside the hospitals full time, so their hand hygiene

within the space would be less habitual than those of the nurses. One

of the main issues is getting the doctors and nurses to sanitize between

patients in the same room, and to highlight this as being important be-

cause for the most part the doctors and nurses don’t feel the need to sani-

tize more than once within the same location. Another big problem is the

improper use of gloves. Apparently a lot of nurses and doctors wear their

gloves when they aren’t required to, also they often don’t wash their hands

before putting on the gloves (which act as an ‘incubator’ for germs, there-

fore enhancing the chances of spreading infection when the gloves are

removed, and not only then because approximately 3-5% of the gloves have

perforations on them therefore there is a chance that germs and infections

could be spread even with the gloves on. An interesting insight we were of-

fered was that the hospital staff was much more compliant to proper hand

hygiene when they aren’t wearing their gloves.

a d d I t I o n a l r e s e a r c h

In addition to the primary and secondary research revolving around hand

sanitization, we did a lot of research into behaviour change, and chang-

ing behaviour through design and found that many of the articles we read,

and inspiration we came across motioned towards interactivity and fun

as being strong driving forces in changing people’s habits and behaviour.

“We learn by experience, by interacting with the world using our senses”

(Changing Behaviours: Start Here, The Design Council) We also deter-

mined through our research that positive re-enforcements (a consequence

of ones action that is somehow measured or apparent) will serve to shape

behaviour in the absence of negative re-enforcement, especially when the

experience one has is memorable, as memory serves to re-enforce patterns

of action (The ABC of Behaviour, Johnny Holland). It’s important to under-

stand whether or not a person is in favor doing a certain behaviour, how

much pressure they feel to do it, and whether the person feels personally in

control of the action.

7

V I s U a l r e s e a r c h

o U r G r o U p V I s I t

We visited St. Paul’s Hospital as a group in

order to get a better feel for the environment

and the placement of the hand sanitizing sta-

tions, and the flow of people coming in and out.

We noticed that there were a lot of sanitizing

stations all over the hospital, which clarified

that the problem was most definitely not about

a need for more. We started to define our prob-

lem as being either a communication issue or

perhaps more environmental problem (maybe

the placement was inconvenient, or the stands

themselves were going unnoticed).

8

We looked into arduino systems,

which initially inspired us to create an

interactive hand sanitizer.

We were inspired by Ben Bogart’s

interactive pieces titled “Step & Repeat

#2, 2009” (http://www.ekran.org/ben/

wp/2009/step-repeat-2-2009/)

We also took inspiration from the Max

Kerning website to develop our charac-

ter we would later come to use in our

interactive animations.

Our primary and secondary research led us into the exploration of

a number of strategies revolved around interactive design, which

would offer the ‘user’ a sense of control and the addition of fun

elements and experiences that would incorporate some sort of

‘positive reward’ or positive re-enforcement.

One of our sources of inspiration/visual research that helped us

solidify our direction was The Fun Theory by Volkswagen (www.

TheFunTheory.com).

9

e X p l o r a t I o n c o - c r e a t I o n

c o - c r e a t I o n W o r k s h o p

In addition to the hospital visits, we participated in a co-creation

workshop with the staff from the various hospitals involved in the

clean hands for health initiative. We were to create a toolkit that

would allow for brainstorming, ideation, and discussion between

our group and the staff. We did a lot of research into successful co-

creation workshops and design firms that use co-creation as part of

their design process, such as maketools, IDEO, and Copenhagen Co

Creation. We based our co-creation activities on the following steps

we found on the Copenhagen Co Creation website:

“you need to let people observe their current behavior, reflect on it

and talk about it remember, relive, and share their past memories

and feelings, then use the experiences from the previous steps to move

into the imagination and expression of ideas about the future”

(Elizabeth Sanders, http://copenhagencocreation.com/2009/11/13/

the-right-tools-for-the-job/)

10

From our co-creation workshop we wanted to find out the following:

what else has been tried?•

personal experience•

patterns of behaviour•

routines and habits •

emotions involved •

sensory and tactile issues•

awareness •

attitudes •

After brainstorming ideas revolved around our findings from our re-

search we created a toolkit that included:

a survey that would collect information on the staffs attitudes to-•

wards hand sanitization and prompt the staff to use the foam hand

sanitizer provided.

a printed layout of one of the hospitals to open discussion about •

daily routines of hospital staff and placement of the sanitizer dis-

pensers.

a printed outline of a sanitizer dispenser stand that was to be writ-•

ten and drawn on in order to open discussion about the problems

associated to the physical properties of the dispensers.

a mind mapping activity which included sticky notes with words •

that would provoke some discussion around sanitization, pictures

relating to hand sanitization such as the stands and existing post-

ers around the hospital, and markers which were given to our co-

creators to share ideas and thoughts, and promote creativity.

11

Each of us had different roles in order to run through the process and

document it easily. We had a ‘group leader’ who’s role was to explain the

various activities we had planned, as well as prompt and engage our co-

creators in discussion. The other two roles were to document the activities

by taking notes and photographing our co-creation sessions.

W h a t W o r k e d :

The survey proved to be a great jumping off point to a discussion around

the current problems and our co-creators general feelings toward hand

hygiene. The mind map turned out to be a very successful activity, as our

co-creators were very willing to engage in a discussion and come up with

some very creative ideas and insights into the problems and solutions re-

lating to proper hand hygiene.

W h a t d I d n ’ t W o r k :

Unfortunately, the layouts of the hospitals weren’t used very much due

to the fact that the locations of the dispensers was not a significant part

of the issue. And although the mind map was effective, after reflecting

on our activities we came to the conclusion that it would have been even

more effective if it was laid out on a table rather than being posted up on

a wall so that it would be more welcoming for participants to share their

opinions and ideas. We also felt that having more participants in each

group would have served to be more affective, as our co-creators seemed

more open to discussion and creative suggestions when there was a larger

number of them per group, and would have liked more time per group as

the time we did have limited our discussions.

12

from our co creation sessions we gathered a lot of

information which included the following:

Doctors are competitive.

• Especially when it comes to competition with the nurses.

The hand sanitizer locations were pretty much set in place.

• The nurses were allowed to have one wherever they wished

(marked on the wall with a posted note and later installed).

Pretty much everywhere the images for hand sanitizer (including

the screen savers) have become visually null.

The hand sanitizer formula (the foaming one) is currently the best

solution available

A humorist approach or competitive approach is much more

suited to reinforce the use of hand sanitizer than that of scare

tactics or negative reinforcement.

Hand sanitizer is a higher concern for doctors.

• Patients and visitors are typically more compliant and the risk

of disease transfer is not as great. Not to say no focus is required

to the patients.

The campaign needs to be a sustainable process.

this led us in the following direction:

A cycling of images (between that of hand sanitizing and other-

wise) such as with the Chicago airport (as mentioned by a par-

ticipant) would help to attract attention and as well enforce the

campaign.

The campaign needs to be a sustainable process.

Use of humor as an effective reinforcement process.

Play on the competitive nature of the doctors will possibly help

them to strive more in their compliance with using the hand

sanitizer.

Mention of a Kidney failure story in which could be used as a

spokesperson of some sort to connote the effective nature and

patient/visitor liking to see full hand washing and sanitizing

compliance.

Possible rewards campaign on top of the trophy for the monthly

compliance winning ward.

13

c o n c e p t d e V e l o p M e n t

We started to develop our concept through many brain-

storming sessions. We focused mainly on ways of using

humor and interactivity as ways to get people to use the

hand sanitizer. During our brainstorming sessions we

came across the idea of engaging the user with a character

(based on Max Kerning, www.maxkerning.com) in a way

that would tie the existing ‘Give germs a rub’ campaign in

a fun and interactive setting.

14

s k e t c h e s o F I n I t I a l p l a n n I n G

We started to develop the idea of re-designing

the kiosk stand by taking away the stop sign and

including a screen instead, from this the develop-

ment of an interactive kiosk was initiated, which

included our character and the existing campaign

poster graphics in an interactive scenario.

looked at the dimensions of

LCD screens. Wanted a size that

would represent a human figure

in scale.

looked at a base that could be in

the form of a human body. at the

very least wanted something to

scale with the human body.

need to design the base of our

kiosk so it can cleanly cover the

wires and sensor equipment.

Have to figure out a way to incorporate

the hand sanitizer. as well as, finding a

way to emphasize the hand sanitizer.

15

s t o r Y b o a r d I n G a n I M a t I o n s s k e t c h e s

When the user put his or her hand up to the screen,

the ‘dirty’ germs (graphics from ‘Give Hands a Rub’

would be left behind), and when the user used the

hand sanitizer, the germs would disappear.

Wanting to incorporate the germ

hand used by the hospital.

The character Will be triggered

with a motion sensor. He will

motion you in, then wave. This

will trigger the person to wave

back.

The person’s wave will cause a

germ hand to come on screen.

This will then make the character

clean the germs off the screen.

Germs will increase until person

uses the hand sanitizer.

Germ hand used in Hospital

campaign.

character is drowning in liquid

germs. The only way to save him

is to use the hand sanitizer.

16

c h a r a c t e r d e V e l o p M e n t r e s e a r c h

We wanted to base our character on a super nerdy

uptight stereotype.

Max kerning:

http://www.maxkerning.com/

Buster Bluth:

http://1.bp.blogspot.com/_sVueLdSWRdo/SXl0VTiQjMI/

AAAAAAAAAUs/PfQs3RftLAM/s400/Buster_Bluth_arrested.jpg

Dwight Schrute:

http://blog.submityourquote.com/wp-content/up-

loads/2009/10/rainn-wilson-as-dwight-schrute.jpg

We want our character to have

glasses and an intense stare.

He has to have a tie, and some of

the quirkiness of Dwight Shrute

from the office.

like the idea of a character who

is obsessed with neatness. and

our character would ideally be

British.

17

F I r s t F I l M I n G I n G r e e n s c r e e n r o o M

After story-boarding our ideas we went into

production by filming in the green screen studio

here at Emily Carr University.

18

c r e a t I n G o U r F I r s t p r o t o t Y p e o F t h e k I o s k

After filming and beginning editing our interactive video and

screen savers, we began prototyping our kiosk. We included

a hand print behind the hand sanitizer that would act as a

‘pulsating light’ to grab the attention of people passing by and

indicate them using the sanitizer.

Opaque hand with pulsating light.

The hand sanitizer will be mounted on

the pulsating hand. also, trying to gage

the the hand sanitizer height,

Trying to gage what an appropriate

height would be.

19

We brought our prototyped kiosk, our beginning stages of our anima-

tions, and ideas for the screensaver to our critique on March 7, 2011.

We discussed our concept with our clients and were given the follow-

ing feedback:

for the kiosk:

make sure to take into account mobility, could it include wheels? or be •

made of a lighter material?

Also to think of stability, could it be tapered in the back or include •

some sort of non-permanent bolting methods?

They also wanted to see approximate costs and methods for manufac-•

turing the kiosk

for the animations:

they liked the idea and thought it was very clever•

however, they would like some more resources and information on •

how this would actually work as far as programming and sensors

perhaps we should include examples of other interaction design in our •

presentations

also, they would like some sort of demonstration of this working to •

give them a better idea of what were talking about

another concern was that there was a disconnect between the actions •

of the character and the hand sanitizer, so they wanted us to look into

ways of making it more obvious for people to know they have to use

the sanitizer in order to ‘erase the hand prints’

they also wanted to see the character being tied into the screen saver •

somehow, to make it a more concrete element

From this information we were then able to refine our concept and begin

developing our final design.

20

d e V e l o p M e n t & r e F I n e M e n t

21

After the client critique we continued to work on

our animations and screen shots in co-ordinance

with the creation of our kiosk: We decided to add

our character to the screen savers. We filmed him

so that it looked as though he was cleaning the

actual screen of the computer, while keeping the

hand prints.

We took our first prototype we had made, and

created a smaller version of our kiosk with the

suggestions provided from the client critique. The

smaller version was 1/3 the size of our initial kiosk

made of white poster paper. This helped us have a

basis of how we were going to enhance the stability

while keeping to our modern streamlined look. We

took into account the average weight of an LCD

flat-screen TV, which is approximately 20 pounds,

in order to ensure the angles of the kiosk would

ensure it would not topple over.

Dimensions to scale Dimensions to 1/4 scale

22

The second attempt (added taper etc. to deal with stability) After

taking a look at the smaller prototype we went into some ideation

and sketching to refine the forms measurements and angles. We

used coroplast sheets to create another life-size prototype of our

kiosk with the measurements we decided on from the last. Unfor-

tunately we encountered an issue with the aesthetics of the kiosk:

the proposed back instinctively looked more like the front than our

proposed front. We also had to re-consider the ergonomics, as the

screen height was too high for a general range of people to use.

after building our model to scale

we decided to get rid of tapered

front.

We also had to change the height

of or screen after building a full

scale model. Had to find the aver-

age mean of canadians, as well as

considering height of children and

people in wheel chairs.

23

After carefully considering these problems we did some

research into how we could fix them and re-construct our

prototype. We looked at more existing kiosks, which ended

up inspiring our final form, while looking into the ergonom-

ics: by keeping a tapered back, and making the front flat we

could enhance the aesthetics by allowing for our initial idea

of having a straight up and down front while keeping the

stability by using sand bags.

We looked also into ergonomics into eye height in order

to figure out the height for both the hand sanitizer and the

screen within the kiosk. From our research we determined

that the height for the hand sanitizer should be no more than

112 cm and the height for the screen should be 155 cm in

order to include the broadest range of people. .html )

24

t h e r e s U l t o F t h I s r e F I n e M e n t :

Materials for Kiosk: We went to Associated Plastics in order to figure

out what materials we would need for the actual kiosk, including the

outer material and the material for the ‘hand light’. http://www.associ-

atedplastics.com/aps_contact.asp for body: Alucabond for light: Trans-

lucent Acrylic (Matte Blue Color) Hours 8:30 - 4:30 mon - fri

Associated Plastics & Supply Corp 1104 Franklin Street Vancouver, bc

Tel: 604.251.9441 Fax: 604.251.9478 e-mail: info@associatedplastics.

com Cost of manufacturing: $1239.84 Screen specifications: The pro-

posed size of the screen we wish to include is 29 inches, as this size

proved to be big enough to display our character at a visible and engag-

ing size, while not being too big as to compromise a feasible size for the

kiosk itself. Cost of LCD flat screens: approx $250.00 to $300.

Work OrderDate

17/03/2011

Quote no.

83

Invoice To

Hailey Whitt604 369-7993haileyjswhitt@hotmail.com

Associated Plastics & Supply Corp.1104 Franklin StreetVancouver, BC V6A 1J6

P.O. No.

Quote only

Terms

COD

Salesperson

ES

Tel. 604-251-9441

Total

Description Qty Price Total

APS Custom fabricated display made from 6mm thick aluminium skinned pvcsheetQuote includes: cnc set up and cut panels (as per drawing) labour to assemble unit fasteners and inside frame work

1 1,107.00 1,107.00

Delivery 10-14 days50% deposit required on all custom ordersHST 12.00% 132.84

$1,239.84

25

F I l M I n G t h e F I n a l d e s I G n

After all of the animations were finished we went back to the

green screen room to film a demonstration of our final product

to demonstrate how it would work in reality.

26

F I n a l o U t c o M e s

27

28

29

30

31

32

s e l F a s s e s s M e n t & r e F l e c t I o n

33

it is said designer’s are never satisfied with their work and

the designer always wants to work towards a further iteration.

The same is true with our assessment and reflection towards

our project. That being said, we are satisfied with our project,

and as well the final piece that has come to fruition. Our video

iterations project the concept and ideas of our I.K. (Interactive

Kiosk). However, we do wish that we could have had some more

time and training to edit the video content to finnish off details

that may hinder the clean, real look that we were attempting to

convey.

To that end, we did encounter other barriers, of which we

did break, in working with a green screen and editing the video

content, as well as working out the details for what is needed in

creating a full, programmed, working piece. Much of this en-

tailed research as well as contacting working professionals to

access information that is directly related to the industry.

Overall, the learning curve with this project was a steep,

but we agree we were able to climb it together to achieve positive

results. The research, from the literary to the workshops, provid-

ed a plethora of data to work with and through which kept our

34

b I b l I o G r a p h Y

35

Research (what was given to us): 6th Design & Emotion Conference 2008 —

Poster Brief. Game Design for Personal Health Management: An Emo-

tional and Educational Perspective. Peter Kwok Chan, Ph.D. Depart-

ment of Industrial, Interior, and Visual Communication Design, The

Ohio State University, Columbus, Ohio, USA. 2008.

Clean Hands for Life: results of a large, multicentre, multifaceted, social mar-

keting hand-hygiene campaign, L.A. Forrester*, E.A. Bryce, A.K.

Mediaa. Division of Infection Control, Vancouver Coastal Health,

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