INFECTION CONTROL
Separation of traffic between clean and contaminated regions We separated the regions with coronavirus infected/potentially infected patients from clean regions. For this purpose, we utilised a fire door and built a new corridor door to isolate the infection wards from the rest of the hospital. As a result, patient traffic was effectively separated and the general patients were protected.
Modified ventilation to mitigate aerosol transmission The existing heating, ventilation, and air conditioning (HVAC) systems were converted to 100 per cent outside air to eliminate the risk of recirculated air. Ventilation conditions were monitored continuously in each room and the nurse station of the isolated wards, using CO2 concentration sensors.
Utilisation of outdoor space of hospital In order to maximise the screening capacity for COVID-19, we utilised the existing hospital premises regardless of their size, where an emergency pneumatic-supported tent was set up to administer COVID-19 nasal swab tests. A negative pressure generator ensured negative pressurisation of the tent. Another tent was used as a quarantine space, where we could separate symptomatic individuals from asymptomatic ones. In the emergency outpatient department, floor screens equipped with HEPA filters were arranged in the waiting room, and negative pressure canopied beds were arranged in the emergency examination room.
Achievement of infection control practice Healthcare workers are essential resources to mitigate infection during a pandemic. Besides standard precautions, we introduced an observation system with a camera monitor for patients in isolation rooms to reduce the frequency of visits by nurses. This also facilitated observation of COVID-19 patients by nurses. As isolation room operating conditions may shift easily and become insufficiently ventilated, we advised staff to always use PPE regardless of the CO2
sensor results. Results
Admission capacity for COVID-19 patients and incident of hospital clusters In 2020, 152 patients were hospitalised and 1,342 patients were treated in the outpatient department, while only one patient was hospitalised and 50 patients were treated in 2019. No member of our medical staff became infected with severe acute respiratory syndrome due to a hospital cluster of COVID-19 during the pandemic.
IFHE DIGEST 2023
We introduced an observation system with a camera monitor for patients in isolation rooms to reduce the frequency of visits by nurses.
Hospital activity for ordinary patients during COVID-19 surge Annual bed occupancy rate decreased from 86.6 per cent to 77.7 per cent while the number of emergency outpatients conveyed by ambulance decreased from 2,914 in 2019 to 2,221 in 2020. The number of operations decreased from 3,733 to 2,791. Although clinical activities declined by approximately 25 per cent, hospital activities never stopped entirely during the pandemic.
Cost of hospital integration (see Table 1) The integration of hospital functions included transformation of two general awards with eight negative pressure private rooms and 40 beds, installation of portal floor-standing units equipped with HEPA filters, seven floor screens equipped with HEPA filters, three negative-pressure canopied beds in the emergency outpatient, the establishment of two pneumatic-supported tents, construction of two corridor doors, and 250 CO2 sensors. The cost was 757,460 USD.
Discussion It has been considered that the care environment is less frequently a source of microorganisms causing health care- associated infection (HAI) compared with other sources, such as the patient’s endogenous microflora. However, SARS- CoV-2 transmission has revealed that the constructed environment is an essential component of infection prevention and control. Scientists in a broad range of specialties have recommended the prevention of aerosol transmission.3
We
realised that we could achieve the minimum requirements for infection control, based on remodelling of the hospital building. ASHRAE updated its Position
Document on Infectious Aerosols,4 which
stated that mitigation of infectious aerosol dissemination should be a consideration in infection control. ASHE has also recently published guidance on the use of HVAC engineering controls to prevent transmission.5
We believe that even ward
transformation should be based on both the specifications of the existing hospital and the requirements of infection wards. In our transforming of private rooms, a negative-pressure system was arranged as a headwall ventilation system, as suggested in the ASHE guidelines. We also adhered to the following principles: to provide a full volume of clean outdoor air with minimal recirculation, to supplement general ventilation with airborne infection controls, and to avoid overcrowding. In Wuhan, a temporary shelter hospital and became a
was constructed6,7
precondition for determining the locations of cabin hospitals.8
However, this strategy
does not appear to have been widely adopted, regardless of the location or country. In urban hospitals, there are various limitations such as small hospital space or small budget. For these reasons, we implemented a compromised option to integrate our hospital, instead of constructing a new building. Various renovations of hospital buildings to reinforce the COVID-19 response capability have been reported.5,6,9 We aimed to achieve mitigation and prevention of the aerosol dissemination risk. Improvement of EOC is the core framework to adhere to the guidelines of infection control and FGI guidelines. Infection risk was also carefully assessed using the checklist of infection control risk assessment (ICRA) during the renovation. Some articles emphasise dedication of whole units such as the OR to care for a
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