EMERGENCY CARE FACILITIES
Figure 9. Beginning of the closure of the area to be reconditioned – preparation.
processes or objects that could constitute a risk. In this specific case, in order to guarantee the correct periodic cleaning, some of the furniture and/or finishes were removed or replaced. It was also established how the hygiene routine would be when entering and leaving patient care.
Impact on staff Regarding the implementation of the overhaul of Angel Foianini Clinic, nurse Mariela Cuellar said: “The clinic did very well to expand the therapy; with this, it contributed to society to counteract its health problem, which hit very hard. Although the clinic could not cover all patients, maximum efforts were made to avoid rejecting patients. “It is safer, less risk of exposure, and
the rooms with transparent glass doors are also safe for the patients, because one can see them and assist them immediately if there is an emergency. It is also safer for us because we only enter when it’s really necessary to perform a specific action and not be exposed all the working day.” The doctors valued the decision because it prioritised their safety and promoted less stress in care. “The adaptation to ICU 2 (second-floor expansion) was not complex, since there was already a therapy area that had all the conditions required for the doctor, patient, and nursing in each room (bed, bathroom, and sink),” said one. “A point in favour was the patient who was awake could see the light of day (recommended behaviour worldwide).” (Figs 8-11) In the case of the Angel Foianini clinic,
the system of adopted individual cubicles, combined with the standardisation of places for putting on and taking off PPE and hygiene, promoted a mnemonic culture of PPE hygiene and care routine. Proof of this, is that of all the healthcare personnel, only 19.71 per cent had fallen ill (see Table 1).
Conclusion There are five primary conclusions from the overhaul of Angel Foianini clinic in Bolivia. These are as follows: l The extension of the clinic was an
78
Figure 10 Floor configuration.
outstanding contribution to the COVID response. It increased its critical care capacity from 6 spaces to 27 spaces, respecting the criteria of patient care and staff safety.
l The use of individual rooms was a wise decision since it promoted the care of personnel and had fewer cases of illness compared to centres that considered solutions in shared rooms, a classic arrangement in Bolivia of hospitals. Under these conditions, according to a source published by the digital newspaper Escambray of 30 June 2020, ‘20 of the 34 hospitals nationwide closed services at some point due to high infections from the staff’,3
while the clinic, as mentioned
before, only had less than 19 per cent of its personal infected.
l The staff recognises how valuable it has been to facilitate the changes. They are more comfortable, with reduced moments of body fatigue for each patient care; they feel valued.
l This implementation was carried out as
Figure 11. Conditioned environment for COVID care.
a temporary reaction to the pandemic. Thanks to a contingency committee and the analysis of the possibilities of epidemiological progress, it was possible to define a responsible expansion-contraction strategy. Considering that the number of critical patients will eventually be reduced, the investment cost does not affect negatively since the changes in function can be easily reversed, restored or reactivated if a state of a health emergency is required in the future.
l The practice is sustainable and profitable in the future since it represents a low-cost expansion facility for related atypical events, not affecting the free operation of the clinic or its growth opportunities. IFHE
References 1 Tolosa G. Research Briefing Global. Oxford Economics 2020; 1: 4.
2 El Deber, 22 March 2020. 3
Escambray.cu, 30 June 2020.
Table 1. How COVID affected Ángel Foianini Clinic staff (March–August 2020). ICU staff
Does not report symptoms Nursing assistant
Nursing coordinator Nursing
Nursery chief Chief physician Physician
Negative
Nursing assistant Nursing Resident
Positive Nursing Recovered
Nursing assistant Nursing Resident
Total
Number 42 11
1
21 1 1
7
15 1
13 1
1 1
13 4
7 2
71
Percentage 59.15 15.49
1.41
29.58 1.41 1.41
9.86 21.13 1.41
18.31 1.41
1.41 1.41
18.31 5.63
9.86 2.82
100.00 IFHE DIGEST 2022
Source: HHRR, Ángel Foianini Clinic, 2020.
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