FACILITY UPGRADES
depend on various factors such as the number of beds and the number of healthcare staff of a hospital. Especially, the number of nurses required is determined by the type of ward where they work, under medical law in our country. As a result, this strongly influenced the accommodation capacity for coronavirus patients. Therefore, to evaluate the accommodation capacity, the number of admitted COVID-19 patients was adjusted using the following equation. Accommodation capacity for COVID-19 patients (adjusted number of admitted COVID-19 patients) = (total number of admitted COVID-19 patients/year) / (total number of full-time nurses)
Constraints of infrastructural adaptations on clinical practice We assumed that healthcare services were constrained not only by coronavirus infection but also by the structural/ operational anti-pandemic measures in hospitals. We assessed the relationship between the implementation of each structural/operational anti-pandemic measure and difficulties experienced in clinical practice, using a cross-tabulation table of the numbers of hospitals that experienced difficulties in clinical practice.
Influence of infrastructural adaptations and clinical practice on accommodation capacity of COVID-19 patients To determine the influence of infrastructural adaptations, the adjusted number of admitted COVID-19 patients was compared between hospitals with and without implementation of each structural/operational anti-pandemic measure. The same comparison was also conducted between hospitals with and without difficulties with each type of clinical practice.
Statistical analysis A t-test or Wilcoxon test was used to compare two study groups statistically. Chi-squared test or Fisher’s exact test was used in the table analysis. A P-value less than 0.05 was considered significant.
Results We received answers from 62 hospitals. These consisted of 47 hospitals of 100- 400 beds, 12 of 400-800 beds, and one of 800-1,200 beds.
Constraints of infrastructural adaptations on clinical practice In assessing the relationship between infrastructural adaptation and difficulties experienced in clinical practice, significantly more hospitals experienced difficulty in clinical practice caused by structural/operational anti-pandemic measures, except for remodelling a general ward to an isolation ward, regardless of the type of clinical practice.
IFHE DIGEST 2025
Table 1. Infrastructural adaptations and difficulties experienced in clinical practice. Infrastructural adaptations
Clinical practice
Remodelling general ward to isolation ward Portable negative pressure system Air cleaner with HEPA filter
Mandatory securing of COVID-19 beds Closure of general wards
Operational changes in general wards Nursing staff management in general wards
NS
<0.05 NS
<0.01 <0.01 <0.01 <0.01
procedures NS
<0.01 <0.05 <0.01 <0.05 <0.01 <0.01
Statistically significant P values are presented in the table
Introducing air cleaners with HEPA filters only affected clinical practice without therapeutic procedures. On the other hand, remodelling a general ward to an isolation ward was not related to difficulties in clinical practice because the number of hospitals with constraints did not differ in either type of clinical practice (Table 1).
Influence of infrastructural adaptations on the accommodation capacity for COVID-19 patients In a comparison of the accommodation capacity for COVID-19 patients between the implementation and non- implementation of each structural/ operational anti-pandemic measure, the accommodation capacity was significantly different for remodelling a general ward to an isolation ward and mandatorily securing COVID-19 beds. However, both measures had opposite influences. Mandatorily securing COVID-19 beds was associated with increased
1.0 P<0.01 P<0.01 0.8
n Not implemented n Implemented
accommodation capacity for COVID-19 patients, while remodelling a general ward to an isolation ward was associated with decreased capacity (Fig 1).
Influence of difficulties in clinical practice on accommodation capacity for COVID-19 patients Difficulties in clinical practice could have affected the accommodation capacity for COVID-19 patients. However, the accommodation capacity for COVID-19 patients did not differ significantly between hospitals with and without difficulties in clinical practice, regardless of the type of clinical practice (Fig 2).
Discussion Our results demonstrated that most structural/operational anti-pandemic measures were associated with constraints on clinical activities even though they adhered to isolation precautions. It is suggested that they could have had an adverse effect on
Difficulties experienced in clinical practice Therapeutic
procedures including without therapeutic surgery
0.6
0.4
0.2
0
Remodelling general ward to isolation ward
Portable negative pressure system
Air cleaner with HEPA filter
Mandatory securing of COVID-19 beds
Closure of general ward
Operational changes in general ward
Nursing staff management in general ward
Figure 1. Influence of infrastructural adaptations on accommodation capacity for COVID-19 patients.
19
Adjusted COVID-19 patients by number of nurses
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