COVID-19
confirmed COVID-19, trauma and other non-urgent medical cases. Healthcare facilities had to be innovative to overcome these challenges while maintaining crucial IPC standards to prevent transmission to others.
Novel interventions Speed, resilience and innovation were key words during the initial stages of the COVID-19 pandemic and hospital management teams, IPC practitioners and infrastructure departments worked hand-in-hand to develop and implement practical, cost effective solutions to ensure the safety of patients and healthcare workers. Plans were made to accommodate
increased numbers of patients requiring screening, triage, oxygen supplementation, isolation as well as additional storage of personal protective equipment (PPE). Ventilation was improved and increased airflow were implemented to ensure safe working conditions and prevent transmission of the SARS-CoV-2 virus. IPC proved to be an essential aspect of the response to the pandemic and all interventions had to adhere to sound IPC principles. Interventions had to take the hierarchy
of IPC controls into consideration, which refers to the following: l Elimination - the physical removal of the hazard through adequate screening and triage at the point of entry.
l Substitution - the replacement of the hazard through the implementation of the COVID-bundle: masking, social distancing, hand hygiene, clean environment, ventilation, screening and stay home when ill.
l Engineering controls refer to the separation and isolation of people from the hazard through isolation and improved ventilation.
l Administrative controls are a change in the way we work by following guidelines, leadership and feedback to all stakeholders.
l PPE to protect workers from the hazard.4,5
Screening areas Screening can be done anywhere and only requires a worksurface such as a table, chairs, adequate space between people and protection against the elements. It further requires adequate ventilation and IPC supplies such as PPE, alcohol-based handrub and surface disinfectant. Hospitals utilised tents, gazebos and retrofitted storage containers outside healthcare facilities to screen patients. Parking garages were ideal due to the
good ventilation, space and protection from elements as illustrated in Figures 1 and 2. Lines and stickers on floors and
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Figure 3. Aluminium frame with industrial plastic walls creating an isolation area.
Figure 1. Parking garage used as a screening area.
Figure 2. Parking garage.
chairs were used to ensure compliance to social distancing requirements. Bigger units used industrial plastic
to create separate ‘’infectious’’ and ‘’non-infectious’’ areas (see Fig 3) for screening and triage.
Isolation rooms Cost-effective solutions were found to create additional isolation areas in ECs without infrastructure changes that impacted adversely on operations. Building materials were not freely available during the initial stages of the pandemic due to the international lockdown restrictions. Aluminium was used to build a frame covered with industrial plastic to create walls while a zipper was inserted to close the opening that served as a door (see Figs 3&4). The plastic and aluminium surfaces were easy to clean and disinfect and adhered to IPC standards.6 Dedicated PPE storage areas were
created. One of the solutions was to erect shelves with hooks for the individual storage of respirators and visors (see Fig 5). The isolation area had to be supplied with additional fresh air, as well as additional extraction to ensure the safety of healthcare workers during aerosol generating procedures (AGP). This was achieved by installing extractor fans that provided 12 air changes per hour (ACH) with an airflow of about 135 litres per second per bed (see Fig 6).5,6 If an extractor fan was used, the
windows had to remain closed and the zipped door in the temporary barrier remained open for up to 200 mm from the floor to ensure adequate supply of air from the adjacent area.6
Figure 4. Isolation area.
Figure 5. PPE storage area.
Oxygen Oxygen is a critical component of emergency respiratory resuscitation and it is not only used for pneumonia and other lung diseases, but also essential for treating various non-respiratory conditions that result in hypoxaemia.7
Pneumonia is a
predominant clinical feature of COVID-19, and supplemental oxygen is an essential first step for the treatment of patients with hypoxaemia and is the primary focus to ensure patient survival, especially in EC.7 The need for oxygen increased
exponentially due to the pandemic and in some places more than ten times of what was normally used.8
The increased
demand in oxygen use could result in a sudden pressure drop of piped oxygen or facilities could run out of oxygen, leading to the unnecessary death of patients.9 Medical oxygen is a regulated
commodity that must be at least 82 per cent pure.10
for oxygen supply include oxygen cylinders, oxygen concentrators and centralised, piped oxygen systems. The preferred modality depends on local
IFHE DIGEST 2022 The most common modalities
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