Hospitals' Strategies To Combat Coronavirus

Hospitals worldwide have been scrambling to prepare for the COVID-19 outbreak. The World Health Organization (WHO) and local governments have been issuing guidelines and advisories to healthcare facilities to help them prepare for a potential influx of patients. Hospitals are reviewing their supplies, staff, space, and systems to ensure they can accommodate COVID-19 patients and prevent the spread of the virus within their facilities. They are also modifying screening and triage protocols to detect COVID-19 patients early and prevent the further spread of the virus. Healthcare workers' protection is a key concern, with many hospitals ensuring their staff have access to N95 respirators and other personal protective equipment (PPE).

Hospitals are modifying screening and triage protocols to detect COVID-19 patients early

Hospitals are working to modify their screening and triage protocols to detect COVID-19 patients as early as possible. For example, NYU Langone is adopting previous preparedness protocols for the flu with some changes. Patients with flu-like symptoms who test negative for flu and other common respiratory illnesses are immediately placed in isolation as a precaution. Anyone coming into contact with these patients is required to wear a surgical mask and eye protection.

Dr. Mark Jarrett, the chief quality officer for Northwell Health, has stated that they are "working on screening, triage and identification so that any places of entry are included and addressed". This includes all 23 Northwell Health sites.

In addition, hospitals are preparing to receive patients infected with the novel coronavirus and have been given instructions by the Centers for Disease Control and Prevention (CDC) on how to accommodate an influx. Medical centers are expected to ""identify and isolate patients with 2019-nCoV and inform key facility staff and public health authorities", immediately.

NYU Langone has also implemented conservation plans, which include taking N95 respirators from units where utilization is historically low, and instructing doctors on how to safely reuse their respirators. Phillips, an infectious disease doctor at Children's Mercy Kansas City, has stated that they are "building up our stock in case we see a situation where we need to use a whole lot more".

Hospitals are urged to review the four Ss: supplies, staff, space, and the system

Supplies

Hospitals should ensure that they have adequate supplies of personal protective equipment (PPE) and respirators for their staff. This includes masks and eye protection, and other necessary equipment to protect healthcare workers from infection. Additionally, hospitals should have a system in place to manage and store these supplies effectively, ensuring quick access and improving response times.

Staff

Healthcare workers are at the forefront of the response to the coronavirus outbreak. Hospitals should focus on training and educating their staff about the virus, including infection prevention and control measures. This involves providing clear and frequent communication to ensure staff are well-informed and can limit the spread of misinformation. Additionally, hospitals should assess their staffing levels and ensure they have sufficient personnel to handle a potential influx of patients.

Space

The physical space and design of hospitals play a crucial role in managing the outbreak. Hospitals should review their floor plans and make adjustments to accommodate the isolation of infected patients, while also ensuring separate areas for staff and public access to prevent cross-contamination. This includes setting up designated respiratory isolation units or utilizing existing infectious disease units. Additionally, hospitals should optimize their storage spaces to efficiently manage the increased demand for supplies and equipment.

System

Hospitals should work in collaboration with public health departments and follow the guidance provided by organizations like the Department of Health and Human Services (DHHS) to enhance their preparedness. This includes developing emergency response plans, improving surveillance and epidemiology, and enhancing laboratory capacities. Hospitals should also establish clear roles, expectations, and accountability measures for their leadership and staff to ensure a coordinated response to the outbreak.

Healthcare workers' protection is ensured by providing N95 respirators and other PPE

As hospitals prepared for a national coronavirus spike, Paul Biddinger, an ER physician and medical director of emergency preparedness at Massachusetts General Hospital, recommended that hospitals review the "four Ss": supplies, staff, space, and the system that governs them.

To ensure healthcare workers' protection, hospitals are providing N95 respirators and other personal protective equipment (PPE). N95 respirators offer better protection against smaller particles due to their tight-fitting nature, and they are to be used only by healthcare workers in clinical settings. However, the misuse and hoarding of masks by the general public have led to shortages. As a result, hospitals have implemented conservation plans, such as instructing doctors on safely reusing respirators and restricting access to N95 masks.

In addition to respirators, healthcare workers are also being provided with surgical masks and eye protection when in contact with patients who have flu or pneumonia-like symptoms. Hospitals are also modifying screening and triage protocols to detect COVID-19 patients early. To prevent the spread of misinformation, hospitals are focusing on frequent and explicit communication with healthcare workers, providing them with the most current information.

Hospitals are also preparing for worst-case scenarios, such as potential shortages of ventilators and intensive care beds. They are making difficult decisions about rationing lifesaving care and developing policies to determine which patients receive ventilators. These policies consider various factors, including age, pre-existing health conditions, and overall life expectancy.

Hospitals are asked to streamline communication and monitor staff for signs of infection

Hospitals are facing the challenge of preparing for a potential influx of coronavirus patients. They are asked to streamline communication and monitor staff for signs of infection.

Effective communication is critical in such situations. Hospitals are advised to establish pre-approved, systematic protocols to guide decision-making and ensure a streamlined and consistent message. This includes coordination with key stakeholders through email, informational materials, and joint decision-making meetings. Web-based, secure communication systems can facilitate the exchange of information and input. A predetermined, hierarchical chain of command is also essential for an organized response.

Healthcare workers should receive frequent, focused, and current information to limit misinformation. This empowers them to feel informed and confident in their leadership's response. Hospitals should also ensure reliable communication infrastructure to support optimal decision-making.

Monitoring staff for signs of infection is crucial. Hospitals must provide access to negative-pressure airborne infection isolation rooms and ensure fully stocked hygiene products to control the spread of the virus. They should also be prepared for potential staff shortages due to illness or quarantine and have plans in place to manage their workforce effectively.

Hospitals are also preparing for difficult decisions regarding rationing lifesaving care, such as ventilators, in the event of a surge in coronavirus patients. These decisions may consider age, pre-existing health conditions, and overall life expectancy. Hospitals are working with state officials to develop policies and ensure transparency and consistency in patient care.

Hospitals are preparing negative-pressure airborne infection isolation rooms

One company, PortaFab, offers modular cleanroom systems that can be used to quickly create temporary, semi-permanent, and permanent negative-pressure airborne infection isolation rooms within hospitals and medical centers. Their systems feature airtight ceiling barriers and seamless connections between walls, ceilings, and floors to prevent the spread of contaminants. Windows can also be seamlessly integrated into isolation walls, allowing for easy cleaning and maintenance.

To ensure proper ventilation and negative pressure, these rooms can be outfitted with ceiling-mounted fan filter units integrated into existing mechanical systems or portable systems. Negative-pressure isolation wards are crucial in managing a surge in airborne infectious patients, such as those with COVID-19. Hospitals must carefully check and prepare these rooms to ensure an ample supply of medical air and oxygen for the patients' needs.

In addition to preparing negative-pressure rooms, hospitals are also implementing other measures to prevent the spread of COVID-19. This includes modifying screening and triage protocols, adopting previous preparedness protocols for respiratory infections, and improving communication and coordination between healthcare workers, departments, and stakeholders. Hospitals are also reviewing their supplies, staff, space, and governing systems to ensure they are equipped to handle a potential spike in cases.

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