HIROSHI YASUHARA, PRESIDENT, HEAJ – DIRECTOR, TOKYO TEISHIN (TELECOMMUNICATIONS) HOSPITAL, JAPAN INFECTION CONTROL
Urbanhospitalhealthcare solutions during COVID
Hiroshi Yasuhara, president of the Healthcare Engineering Association of Japan (HEAJ), discusses low-budget solutions for the integration of existing functions in urban hospitals for the purposes of infection control.
The COVID-19 pandemic has revealed that current standard precautions against airborne transmission, including proper hand hygiene and personal protective equipment (PPE), are only a part of infection-control measures. The hierarchy of controls stratifies approaches to improve infection prevention and healthcare delivery through advances in design. This concept gives priority to control methods that are potentially more effective and protective than reliance on PPE alone.1
The establishment of a clean
environment of care (EOC) is a prerequisite for prevention of infections in hospitals. During the recent COVID-19 surge, hospitals needed to boost admission capacity and to secure testing and immunisation facilities in response to the abrupt increase in infected patients. However, reconstruction of a shelter space and installation of sufficient equipment for COVID-19 patients cannot be achieved in a short period of time.
Healthcare workers are essential resources to mitigate infection during a pandemic
Although rural hospitals may be able
to overcome these issues by erecting pop-up facilities adjacent to hospital buildings, urban hospitals are likely to have difficulties securing an area in the vicinity. Moreover, rural hospitals first need to confront a large influx of infected patients because of their ease of access. Otherwise, many urban hospitals might have lost a major source of income from ordinary clinical activities such as elective procedures, and the virus’ financial impact on urban hospitals may have been even greater. In this situation, the hospital administration may be unwilling to support the construction of new buildings because of the high contingent expenses to meet this temporary demand. To solve this problem, we integrated existing hospital infrastructures to improve the capability to treat COVID-19 patients. We thus present our low-budget solutions to integrate the functions of urban hospitals in the current healthcare crisis. This article outlines the comprehensive methods of integration including transformation of general wards to infectious disease wards with anti- infection practices of medical personnel, considering trade-offs between minimal remodelling cost and maximum quality improvement.
Case presentation Our hospital is a general hospital located in the metropolitan area of Tokyo and is
Hiroshi Yasuhara
Hiroshi Yasuhara is the 11th President of the Healthcare Engineering Association of Japan (HEAJ), which takes a wide
view of the whole healthcare system. Before starting his career as a healthcare professional, he spent over 25 years as a
surgeon and a professor at Teikyo University and the University of Tokyo, Japan. As the OR medical director, he also managed the Department of OR Suite at the University of Tokyo Hospital. After a successful career treating many surgical patients, he has been in his current position as the director of Tokyo Teishin (Telecommunications) Hospital since April 2019.
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owned by a governmental agency, Japan Post Holdings. It has 461 acute care beds including 40 beds for community-based care. In 2019, before the COVID-19 pandemic, the bed-occupancy rate was 87 per cent, the mean length of stay was 13.4 days, and the number of operations a year was 3,733. The hospital received 2,914 emergency outpatients conveyed by ambulance. During the COVID-19 surge, our hospital was not designated as a quarantine hospital or shelter hospital, but to provide basic medical care for coronavirus-positive patients with a mild to moderate condition. When we diagnosed a patient as being in a severe to critical condition due to coronavirus infection, he/she was rapidly transferred to a tertiary emergency medical facility for intensive care, such as ECMO treatment. According to the report from Wuhan in China, where COVID-19 first broke out, conversion of outdoor spaces to temporary areas to accommodate medical functions2
assisted with
overcoming the shortage of beds, treatment rooms, and heavy traffic at the very start of the crisis. However, urban hospitals cannot afford to provide enough space for patient treatment. To overcome the limitation of hospital space for COVID-19 patients and budget deficits, we integrated hospital functions as follows.
Ward transformation Instead of establishing a large, isolated space outside the hospital building, two 40-bed standard wards were transformed into surge wards with half the number of beds for low-acuity patients who did not require a ventilator or ECMO equipment. Ward transformation included increasing the number of negative pressure rooms. Private rooms were partly repurposed to accommodate COVID-19 patients, with a portable floor-standing negative pressure system equipped with a high efficiency particulate air (HEPA) filter.
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