DESIGNING FOR RESILIENCE Results
A total of 257 hospitals (5%) responded to the questionnaire. These included 193 with 100-399 beds, 52 with 400-799 beds, and 12 with 800 or more beds. The mean number of admissions of COVID-19 patients was 6.0 in hospitals with 100-399 beds, 4.8 in hospitals with 400-799 beds, and 5.6 in hospitals with 800 or more beds. Hospitals with fewer than 400 beds appeared to play a major role in accepting COVID-19 patients regardless of their disease severity in the earliest phase of the pandemic in 2019 (Table 1). In the univariate analysis, all candidate explanatory variables were selected for the next multivariate analysis. As a result, the infrastructural adaptations listed in Table 2 were considered candidate explanatory variables.
Significant explanatory variables for increased accommodation capacity for COVID-19 patients (Fig. 1) In the logistic analysis, three infrastructural adaptations emerged as important explanatory variables for increasing the accommodation capacity for COVID-19 (Table 3). Remodelling a general ward to an infection ward associated with improved air ventilation may have been effective for moderately increased accommodation capacity without infection risk. However, it was not shown to be a statistically significant variable.
Significant explanatory variables for incidence of clusters (Fig. 2) In the univariate analysis for clusters, employment of infection disease specialists was excluded from the possible explanatory variables. According to the multivariate analysis, a large increase in the accommodation capacity for COVID-19 patients was selected as a single explanatory variable (Table 4). Three infrastructural adaptations emerged as important
explanatory variables for increasing the accommodation capacity for COVID-19 patients; mandatory securing of beds for COVID-19 patients (odds ratio [OR] 10.24, 95% confidence interval [CI] 4.79-21.85, P<0.000), additional purchase of ventilators (OR 2.46, 95%CI 1.28-4.73, P=0.007), and installation of negative pressure rooms (OR 3.84, 95%CI 1.68-8.78, P=0.001). As regards infection clusters, a large increase in the accommodation capacity was selected as a single explanatory variable (OR 9.45, 95%CI 3.16-28.24, P=0.00006).
Discussion There have been many reports that hospitals had to accommodate an enormous number of infected patients beyond their capacity during the surge phase of the COVID-19 pandemic. Since most hospitals cannot afford to enlarge their accommodation space immediately, managing the already existing beds should have been key to this emergent situation. Besides clinical preventive practices, there were several options to manage beds for COVID-19 patients, such as remodelling wards by improving the air ventilation in hospital rooms, changing bed use, increasing the number of isolation rooms, increasing the medical equipment, introducing portable negative pressure systems, and employing specialist healthcare staff. However, multivariate analysis showed that none of those measures was effective for receiving emergent infected patients. Our results indicated that mandatorily securing beds for COVID-19 patients was one of the most effective ways to increase the number of patient admissions (Fig. 3). Another important finding is that securing sufficient accommodation capacity for COVID-19 patients was
(Intercept)
Infection disease specialist Infection control nurse Infection control doctor ICU beds
Isolation rooms Negative pressure rooms
Operational change in bed management
Ward remodelling
Mandatory securing COVID beds
Ward closure due to cluster
Purchase of ventilators Purchase of ECMOs
haemodialysis machines
Purchase of negative pressure systems
Odds ratio (95%CI) 10 20 30 Purchase of
(Intercept)
Infection control nurse Infection control doctor
ICU beds Isolation rooms Negative pressure rooms
Operational change in bed management
Ward remodelling
Mandatory securing COVID beds
Purchase of ventilators Purchase of ECMOs
haemodialysis machines
Purchase of negative pressure systems
Increased accommodation capacity for COVID patients
Odds ratio (95%CI)
not necessarily safe for patients or healthcare staff. Multivariate analysis showed that a large increase in hospital accommodation capacity was a single explanatory variable for the incidence of clusters. It has also been reported that COVID-19 patient admissions are associated with a psychological burden on healthcare staff.1
It is thus essential to balance the acute increase in
admissions of COVID-19 patients and the associated infection risk.
Speed of response Speed is another important factor in the responses to the pandemic, particularly during the surge phase. To this aim, facilities should have been robust and adaptable beforehand. Infection control measures need to be incorporated into architectural and structural design, with planning for versatile spaces with convertible walls and
May 2025 Health Estate Journal 27 10 20 30
Top. Figure 1: Significant explanatory variables for increased accommodation capacity for COVID-19 patients.
Above. Figure 2: Significant explanatory variables for incidence of clusters.
Purchase of
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