EMERGENCY CARE FACILITIES
Figure 7. Medical director explaining quick-change needs
l Complement the comprehensive monitoring of patients – a closed circuit of cameras was implemented to have a second control from the nursing centre at all times; the nurse call system was activated for the use of loudspeakers so that all internal personnel can communicate easily.
Figure 5b. Standard rooms after the change.
third, block C, like the one related to non- COVID patients. For the new intensive care units, the individual rooms must be changed; in design, the provision was made to carry out an investment in materials and facilities for intermediate therapy patients, which did not require significant changes to treat COVID cases (Figs 5&6). The budget was minimal because the
initial investment had been made when conceiving the rooms, in materials, technology and security backups. Therefore, it was based only on carpentry changes, implementation of cameras, signal connectors to visualise the vital signs and signs of closure and orientation of the areas. The investment in infrastructure was low compared to the one done for the equipment, related to buying respirators, vital signs monitors, monitors, infusion pumps, feeding pumps, and gas meters for the area (Fig 7).
Priorities In order to carry out the changes, it was first necessary to consider the following points in the infrastructure: l Prioritise quality care and safety for patients – environments should not only have the necessary dimensions that guarantee the space of stationary equipment, but also cover the need for manoeuvres with the patient and at the same time had all the primary backup medical facilities in good number, be
IFHE DIGEST 2022
these the differentiated emergency power circuits, backed medical gas systems, nurse call system, information network management systems and medical imaging.
l Promote practices that protect and relieve care personnel of stress – each room became an identical care cubicle. These standardisation allowed to recognise preparation and hygiene activities, in a mnemonic way, before and after treating the patient, automatically reducing the risk of errors. They could focus their activities on really analysing the patient’s evolution.
l Reducing fatigue levels helped to reduce high work stress.
l Effective communication with the staff – visual contact was required, which promoted easy and effective communication, even using all isolation measures at a critical moment. For this purpose, the change of blind doors for glass doors was carried out, allowing easy internal visualisation during daily care, accompanying internal tasks and supporting equipment or instruments to the staff.
l Standardise the spaces to order PPE processes related to the entry and exit of personnel at each moment of attention – standardisation was achieved by using the original storage spaces for linen as the entire PPE dispensing entrance space to the room. On the other hand, the individual clinical hand basin was the PPE outlet hygiene space. This simple action automated the steps and freed the burden on the staff’s mind that made these tasks routine.
l A back-up system was extended to the two existing oxygen generation plants to maintain the high consumption of medicinal oxygen for all COVID patients (emergency, hospitalisation, CPAP and invasive therapy). A peak consumption of 3.1 times the capacity of both oxygen generators was reached and almost always it was close to the double.
l Restriction of the areas – closures were made to connections controlled by the building’s central access control and credential system, thus restricting unauthorised flows.
Figure 8. Preparation of areas and explanation to staff.
l The Infection Control Committee participated in order to determine the strategies to be used and reviewed the
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