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CL IN ICAL ENGIN E E R ING


What have we learnt from the pandemic?


The NHS has had to adapt its practices to meet the challenges of the pandemic – with the rapid change of use of clinical areas, new ways of working using video conferencing, ramping up of medical device supplies and the setting up of Nightingale hospitals. Dr Scott Brown discusses what we have learnt during this time and what needs to be considered for the future.


The worldwide pandemic of the coronavirus (COVID-19) causes the acute respiratory symptoms from the SARS-CoV-2 virus. The UK’s first two patients who tested positive for COVID-19 were Chinese nationals from the same family staying at a hotel in York who fell ill on 29 January. (Embury-Denis, 2020) In preparation for the first wave, hospitals turned off almost all of the elective activity freeing up valuable bed spaces that could be switched to critical care beds quickly if needed and also to minimise unnecessary exposure. Providing this surge capacity so quickly meant equipping areas of the hospital rapidly to the level of infrastructure and medical equipment in a critical care unit.


Now that the first wave of COVD-19 has abated, there is an opportunity to take stock and learn for the future. We have learned a lot during the first phase and purchased additional medical equipment which will put us all in a better place, should we need to deal with subsequent phases in the future.


Future building layout Hospitals have moved clinical services and reconfigured their sites over a number of years. We have seen a trend towards grouping services together, such as trauma wards near the operating theatres and intensive care. Another model is separating hot and cold service provision. This is being done to improve operational efficiencies


to meet the growing demands on NHS services and the NHS Efficiency map (2017). That said, some of that thinking and configuration around patient flow has had to change rapidly to address the challenges of COVID-19. We have seen measures introduced by the Government on social distancing (the two-metre rule) and this has been a challenge for many hospital sites. We do not know whether COVID-19 is a one- off event, or whether it will come back in subsequent waves in future years, so the question arises: do we need to plan for new hospitals to be designed to meet social distancing requirements? This could mean wider corridors on our main hospital streets to allow people to pass while socially distancing or one-way systems. There is a need to plan for flexibility to facilitate wider spacing between bed bays that can be implemented quickly. What we need to consider now is how this can tbe integrated into the new business as usual (BAU) model for hospitals in the NHS and the private sector.


Medical gas supplies


One of the key areas of concern centred around hospitals needing to ensure an adequate supply of oxygen (O2


). For acute


hospitals oxygen is usually stored in liquid form in a Vacuum Insulated Evaporator (VIE) and modern piped systems can produce in the order of 3000 litres per minute, although older systems may have a much lower flow rate capacity. Critical care units were planning to meet surge capacity with large numbers of patients requiring ventilation. In addition, the use of high flow oxygen therapy (HFOT) may well mean that the design flow of the medical gas pipeline system is exceeded and the VIE would be depleted


SEPTEMBER 2020 WWW.CLINICALSERVICESJOURNAL.COM l 27





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