The COVID-19 outbreak has led to a focus by public health practitioners and scholars on ways to limit spread while facing unprecedented challenges and resource constraints. Recent COVID-19-specific enhanced Traffic Control Bundling (eTCB) recommendations provide a cogent framework for managing patient care pathways and reducing health care worker (HCW) and patient exposure to SARS-CoV-2. eTCB has been applied broadly and has proven to be effective in limiting fomite and droplet transmissions in hospitals and between hospitals and the surrounding community. At the same time, resource constrained conditions involving limited personal protective equipment (PPE), low testing availability, and variability in physical space can require modifications in the way hospitals implement eTCB. While eTCB has come to be viewed as a standard of practice, COVID-19 related resource constraints often require hospital implementation teams to customize eTCB solutions. We provide and describe a cross-functional, collaborative on-the-ground adaptive application of eTCB initially piloted at two hospitals and subsequently reproduced at 16 additional hospitals and health systems in the US to date. By effectively facilitating eTCB deployment, hospital leaders and practitioners can establish clearer ‘zones of risk’ and related protective practices that prevent transmission to HCWs and patients. We outline key insights and recommendations gained from recent implementation under the aforementioned constraints and a cross-functional team process that can be utilized by hospitals to most effectively adapt eTCB under resource constraints.

COVID-19疫情导致公共卫生从业人员和学者集中精力研究限制传播的方法，同时面临前所未有的挑战和资源限制。最新的特定于COVID-19的增强型交通控制捆绑（eTCB）建议为管理患者护理途径并减少医护人员（HCW）和患者暴露于SARS-CoV-2的情况提供了强有力的框架。eTCB已被广泛应用，并被证明可以有效地限制医院内以及医院与周围社区之间的烟雾和飞沫传播。同时，资源受限的情况涉及有限的个人防护设备（PPE），测试能力低以及物理空间可变性，可能需要对医院实施eTCB的方式进行修改。尽管eTCB已被视为一种惯例，与COVID-19相关的资源限制通常要求医院实施团队定制eTCB解决方案。我们提供并描述了eTCB的跨功能，协作式地面自适应应用程序，该应用程序最初在两家医院进行了试验，随后在美国的16家其他医院和卫生系统中进行了复制。通过有效地促进eTCB的部署，医院的领导者和从业者可以建立更清晰的“危险区域”和相关的保护措施，以防止传播给HCW和患者。我们概述了在上述限制条件下从最近的实施中获得的重要见解和建议，以及跨职能的团队流程，医院可以利用该团队流程在资源限制下最有效地调整eTCB。