The main difficulties faced by the health system during a pandemic –the lack of shocks. This resulted in the inability of hospitals to accept a sharply increased flow of patients, lack of staff, equipment and means of protection, the lack of space in the infectious ward. Worldwide experts make up the lists of measures designed to soften the blow COVID-19. Among other things, the recommendations relate to the conversion and redevelopment of hospitals. Roman Sabirov, managing partner, member of the Board of Directors of the company of Philips in Russia and CIS, told about the steps that should be taken during this process.
World experience shows that most healthcare organizations face a shortage of staff: doctors, nurses and other medical staff. One of the ways to increase staff during a pandemic – to attract professionals of other profiles of residents, as well as senior students of medical universities (as was done, for example, in the USA). As nurses, you can also attract volunteers.
The important role played by the organized employees. Retrained specialists will work with experienced therapists in a team with anesthesiologists, with the support of clinical pharmacologists, and physicians. While work schedules should be combined in teams of people of different age, with different knowledge and experiences, their level of empathy. So while working employees can exchange skills with each other.
Representatives of other profiles, you need to learn a new profession, and those who continue to work within its usual direction (e.g., physicians and anesthesiologists-resuscitators), requires constant updating of knowledge about new coronavirus infection. For this there are training materials developed by the Ministry of health, and guidelines of Federal and regional Executive authorities. However, each institution should make its own training program, based on recommendations and international best practices, in accordance with the specificity. The main topics that should affect educational program for employees working with COVID-19:
• Signs and symptoms COVID-19, the dynamic observation of patients to determine their availability;
• The safety of patients, visitors, medical staff;
• The use of new approaches to diagnosis and triaging patients (ultrasound diagnostics of the lungs, etc.);
• Placement of patients in isolation rooms;
• Proper cleansing and disinfection of surfaces and equipment;
• Data protection;
• Recommended actions in case of contact with infected patients (in the absence of PPE);
• Rules of conduct in identifying himself signs of SARS;
• Policy on sick leave of staff.
Maximum attention should be paid to practical training in the use by employees of personal protective equipment (PPE) and proper treatment of the hands.
In addition to providing the new knowledge needed to maximize the use of existing staff skills and apply them in new formats of work. For example, in a Russian hospital established a disinfection team of nurses, who promptly carried out a backlog for disinfection in case of such need. Staff have offered to organize activities, because they have a lot of experience with disinfectants.
Health institutions in the early stages of the fight against COVID-19 faced with a shortage of personal protective equipment for staff. In this situation effective were the measures proposed by the American center for control and prevention (CDC) that have already been tested in hospitals around the world, including in Russia. In conditions of limited amount of PPE it is recommended to divide the staff into groups depending on how they implement the manipulation associated with the probability of infection. For each group it is necessary to provide protective measures adequate to the risk. So, employees who work exclusively in “clean” zone, just use a medical mask. When collecting history from the patient, the doctor may use a mask, cap, gloves, goggles and disposable surgical gown. But the experts conducting the intubation or endoscopy, require the highest level of protection.
Due to the shortage of places for hospitalization of patients with COVID-19 for their reception will shift health, not worked previously with infections. This requires the use of special measures in the preparation of the hospitals needed to reduce the risks of transmission within the institution, to protect employees and patients from other profiles. The main measures are listed below:
1. The location of the redesigned structural units in separate buildings
For example, in a hospital in Cordoba, Argentina, in an infectious case involved the building of the cardiology center. A separate enclosure to reduce the risk of spreading the infection to other parts of the hospital. To protect staff and to reduce the expense of means of individual protection, the working group also systematized and divided the flows of patients, medical and other personnel. This measure is also used in most pereprofilirovaniju hospitals of Moscow.
If, due to the peculiarities of the institution to organize a separate infectious body fails, it is allowed to place it in the same building with other offices, provided that:
• you can divide the flows of patients and workers infectious offices and other profiles – there are separate entrances, isolated areas;
• the building is equipped with an isolated supply and exhaust ventilation system. If not, the ventilation should be improved.
2. The layout of the location of functional areas
Because some of the hospitals become dangerous from the point of view of probability of transmission, it is necessary to divide the territory into “clean” and “dirty” zones. This is followed by:
• Arrange entry into the building and exit only through the “clean” zone;
• To set up a gateway with the sanitary inspection room at the transition between “dirty” and “clean” zones, to exclude the possibility of transition between zones, passing a sanitary inspection;
• To provide gateways at the entrance to the offices.
For the convenience of doctors, many hospitals use visual cues. For example, In nmhts them. N. And. Pirogov all the rooms “dirty” zone is marked by large signs in red.
3. The separation
Patients with community-acquired pneumonia of unknown etiology, people with a confirmed COVID-19 and noninfectious patients should not overlap. Similarly, the staff working with potential infection, and other employees should be separated at all stages. If there is no possibility of the spatial separation that we need to “spread” flows in time with mandatory disinfection of intersections. As well as area hospitals, “clean” and “dirty” flows should be marked with special posters, diagrams or pictures available to every employee. So, at the Filatov hospital (GBUZ “city clinical hospital №15 DZM”), all of the routes employees hung signs designating “clean” and “dirty” areas. In addition, useful are visual materials on the means of protection required to locate in each of the premises.
4. Reorganized reception wards
Redeveloped part of the receiving Department should be provided with the necessary number of insulators and diagnostic premises and separated from areas where hospitalitynet non-infectious patients. You also need to make it so that routes patients with confirmed COVID-19 and with community-acquired pneumonia of unknown etiology do not overlap. Need to equip areas for sorting patients at the entrance to the emergency Department or outside of it. For example, in one regional hospital in Massachusetts, USA, area sorting and sampling of biological material for testing COVID-19 was organized in a temporary pavilion at the Parking area.
You should also minimize movement of patient on the reception Department. You can use the principle of “doctor to patient”: patient is in a special room, and the specialists come to him with the equipment for mobile diagnostics.
5. Optimization pereprofilirovaniju offices
Pereprofilirovanie structural unit shall be equipped with box chambers over the gateway, and private bathrooms. For example, in a number of Moscow hospitals increase the number of boxes due to the construction in the General wards of the partitions of plasterboard washable.
All the rooms of the disused offices belong to the “dirty” area, the entrance to which is installed a sanitary inspection.
6. Equipment for additional intensive care beds
In medical facilities can be much less intensive care beds than required in a pandemic. The experience of the Moscow clinics intensive care bedspace should not be less than 15% of the “linear” beds.
Additional space can be arranged, for example, in the operating room. With this purpose in many hospitals now are transferred for elective surgery. There are other approaches: in Israel, the Sheba Medical center in the NICU converted underground bomb shelter.
Global health organizations such as the world health organization, the Center for control and prevention of diseases (CDC) and European centre for control and prevention of diseases (ECDC) has developed checklists of questions (check sheets) to help healthcare institutions assess and improve their readiness to fight with the COVID-19. Such a recommendation is prepared and medical device manufacturers, including Philips, to the clinic would maximize the use of existing equipment during a pandemic. It can take as a basis for managers when realigning. However, it is important that the plan be drawn up individually tailored to each hospital. In this case, the hospitals will definitely be easier to face the challenges of the pandemic.