FACILITY UPGRADES
accommodating as many infected patients as possible. Nevertheless, the present study also showed that mandatorily securing COVID-19 beds had the beneficial effect of increasing admitted patients. This is consistent with our previous results showing that the efficiency of hospital activities was improved even though healthcare staff experienced difficulties in healthcare services during the pandemic. Our results also suggested that remodelling a whole ward would be the exception that did not bring about difficulties in clinical activities. However, this anti-pandemic measure subsequently led to decreased accommodation capacity for infected patients. According to the guidelines for
preventing airborne transmission, we should adhere to the strict regulation of ventilation such as total air changes, room pressure, and the necessity of an anteroom. However, recent studies demonstrated that aerosol transmission differs from airborne transmission. Preventive measures against aerosol infection could be a relevant alternative against coronavirus infection. Most measures were implemented throughout the pandemic, assuming that precautions against airborne transmission were the only measure. Aerosol infection should be differentiated from airborne infection when structural/operational anti-pandemic measures are adopted. Particularly, during the surge phase of the pandemic, we needed to establish a strategy quickly, focusing more on enforcing the hospital’s capacity and accommodating as many infected patients as possible. Our study demonstrated the structural remodelling of a general ward decreased the number of admitted infected patients regardless of the effectiveness of preventing airborne transmission and alleviating the practical burden on healthcare staff.
Mandatory securing of COVID-19 beds
Constraints Increased admitted patients Difficulties in clinical practice
Therapeutic procedures including surgery Clinical practice without therapeutic procedures
Potential inhibitory effects Decrease in admitted patients
Remodelling general ward to isolation ward
1.4 1.2 1.0 0.8 0.6 0.4 0.2 0
n Difficulties (–) n Difficulties (+)
NS NS
1.4 1.2 1.0 0.8 0.6 0.4 0.2 0
Therapeutic
procedures including surgery
Clinical practice without therapeutic procedures
n Difficulties (–) n Difficulties (+)
Mandatory securing of COVID-19 beds NS
NS
Therapeutic
procedures including surgery
Clinical practice without therapeutic procedures
Figure 2. Influence of difficulties in clinical practice on accommodation capacity for COVID-19 patients.
Previous findings on the pandemic
indicated there might be at least three phases of the coronavirus pandemic. Throughout the progression of the pandemic, timely measures should be adopted according to the phase. In this study, it was demonstrated that remodelling of the whole ward was important, not only because the measure adhered to the guidelines of airborne prevention, but also because the workload was the lowest for healthcare staff. However, in the surge stage of the pandemic, it is likely that we could not afford to remodel a general ward because of the abrupt increase in demand for patient admissions. Alternatively, there are several other important strategies to prevent aerosol transmission, as opposed to airborne transmission. These include a portable negative pressure system or an air cleaner equipped with a HEPA filter, which can improve the ventilation
Infrastructural adaptations
Remodelling general ward to isolation ward
conditions, reducing the practical load on healthcare professionals. In this context, structural remodelling of the whole ward to improve the ventilation conditions against airborne transmission could be reserved for the later phase of the pandemic. The present study indicated that the
mandatory securing of COVID-19 beds could enforce the accommodation capacity for COVID-19 patients directly. However, this measure was associated with constraints on implementing clinical practices although it was not statistically proven that the number of admitted patients subsequently decreased. Nevertheless, we need to understand this potential effect on the workload of medical services because there is a possibility that this would lead to hospital staff resignations and affect hospital activity indirectly (Fig 3). In conclusion, it was suggested that
prompt improvement of ventilation of the whole ward against airborne infection could enable healthcare staff to deal with the coronavirus pandemic, associated with an increased burden on healthcare staff caused by the expanded hospital capacity. On the contrary, in the surge phase of the coronavirus pandemic, other measures such as introducing portable negative pressure systems and air cleaners equipped with HEPA filters were feasible and associated with quick effects. It was suggested that remodelling a whole general ward might be justified only during the later phase of the pandemic.
Accommodation capacity for COVID-19 patients (Adjusted number of admitted COVID-19 patients)
Figure 3. Model of COVID-19 patient admission. 20
Acknowledgement This work was supported by MHLW Research on Emerging and Re-emerging Infectious Diseases and Immunization (Program Grant Number JPMH23HA2011).
IFHE DIGEST 2025
IFHE
Adjusted COVID-19 patients by number of nurses
Adjusted COVID-19 patients by number of nurses
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