Quantifying Simulated Contamination Deposition on Healthcare Providers Using Image Analysis : Simulation in Healthcare

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Quantifying Simulated Contamination Deposition on Healthcare Providers Using Image Analysis

Lin, Yiqun MD, MHSc, PhD; Cheng, Adam MD; Pirie, Jonathan MD, MEd; Davidson, Jennifer RN; Levy, Arielle MD, Med; Matava, Clyde MBChB, MMed, MHSC; Aubin, Carl-Eric PhD; Robert, Etienne PhD; Buyck, Michael MD; Hecker, Kent PhD; Gravel, Genevieve MD; Chang, Todd P. MD, MAcM;  for the INSPIRE Aerosol Generating Medical Procedures (AGMP) Investigators


Madadi, Mohsen; Neveu, Guylaine; Singer-Harel, Dana; Collia, Natasha; Fayyaz, Jabeen; Wan, Brandi; Williams, RJ; Lo, Carl Y.

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Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 18(3):p 207-213, June 2023. | DOI: 10.1097/SIH.0000000000000664



Simulation-based research has played an important role in improving care for communicable diseases. Unfortunately, few studies have attempted to quantify the level of contamination in these simulation activities. We aim to assess the feasibility and provide validity evidence for using integrated density values and area of contamination (AOC) to differentiate various levels of simulated contamination.


An increasing number of simulated contamination spots using fluorescent marker were applied on a manikin chest to simulate a contaminated healthcare provider. An ultraviolet light was used to illuminate the manikin to highlight the simulated contamination. Images of increasing contamination levels were captured using a camera with different exposure settings. Image processing software was used to measure 2 outcomes: (1) natural logarithm of integrated density; and (2) AOC. Mixed-effects linear regression models were used to assess the effect of contamination levels and exposure settings on both outcome measures. A standardized “proof-of-concept” exercise was set up to calibrate and formalize the process for human subjects.


A total of 140 images were included in the analyses. Dose-response relationships were observed between contamination levels and both outcome measures. For each increment in the number of contaminated simulation spots (ie, simulated contaminated area increased by 38.5 mm2), on average, log-integrated density increased by 0.009 (95% confidence interval, 0.006–0.012; P < 0.001) and measured AOC increased by 37.8 mm2 (95% confidence interval, 36.7–38.8 mm2; P < 0.001), which is very close to actual value (38.5 mm2). The “proof-of-concept” demonstration further verified results.


Integrated density and AOC measured by image processing can differentiate various levels of simulated, fluorescent contamination. The AOC measured highly agrees with the actual value. This method should be optimized and used in the future research to detect simulated contamination deposited on healthcare providers.

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