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1.
Infect Dis Clin North Am ; 35(3): 697-716, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34362539

RESUMO

The built environment has been integral to response to the global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, engineering controls to mitigate risk of exposure to SARS-CoV-2 and other newly emergent respiratory pathogens in the future will be important. Anticipating emergence from this pandemic, or at least adaptation given increasing administration of effective vaccines, and the safety of patients, personnel, and others in health care facilities remain the core goals. This article summarizes known risks and highlights prevention strategies for daily care as well as response to emergent infectious diseases and this parapandemic phase.


Assuntos
COVID-19 , Defesa Civil , Instalações de Saúde/tendências , Controle de Infecções , Gestão da Segurança/organização & administração , COVID-19/epidemiologia , COVID-19/prevenção & controle , Defesa Civil/métodos , Defesa Civil/organização & administração , Ambiente Controlado , Arquitetura Hospitalar/métodos , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , SARS-CoV-2
2.
Artigo em Inglês | MEDLINE | ID: mdl-34444140

RESUMO

The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using telemedicine technologies. The design of the COVID-19 units divided the space into contaminated and clean zones and integrated a control room with audio-visual technologies to remotely supervise, communicate, and support the care being provided in the contaminated zone. The research is based on semi-structured interviews and observations of care processes that implemented a new model of inpatient telemedicine at Sheba Medical Center in Israel in different COVID-19 units, including an intensive care unit (ICU) and internal medicine unit (IMU). The study examines the impact of the diverse design layouts of the different units associated with the implementation of digital technologies for remote care on patient and staff safety. The results demonstrate the challenges and opportunities of integrating inpatient telemedicine for critical and intermediate care to enhance patient and staff safety. We contribute insights into the design of hospital units to support new models of remote care and suggest implications for Evidence-based Design (EBD), which will guide much needed future research.


Assuntos
COVID-19 , Arquitetura Hospitalar , Controle de Infecções , Telemedicina , Humanos , Pacientes Internados , Unidades de Terapia Intensiva , Pandemias , SARS-CoV-2
3.
Emerg Med J ; 38(10): 789-793, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34429371

RESUMO

BACKGROUND: The aim was to describe the organisational changes in French EDs in response to the COVID-19 pandemic with regard to architectural constraints and compare with the recommendations of the various bodies concerning the structural adjustments to be made in this context. METHODS: As part of this cross-sectional study, all heads of emergency services or their deputies were contacted to complete an electronic survey. This was a standardised online questionnaire consisting of four parts: characteristics of the responding centre, creation of the COVID-19 zone and activation of the hospital's emergency operations plan, flow and circulation of patients and, finally, staff management. Each centre was classified according to its workload related to COVID-19 and its size (university hospital centre, high-capacity hospital centre and low-capacity hospital centre). The main endpoint was the frequency of implementation of international guidelines for ED organisation. RESULTS: Between 11 May and 20 June 2020, 57 French EDs completed the online questionnaire and were included in the analysis. Twenty-eight EDs were able to separate patient flows into two zones: high and low viral density (n=28/57, 49.1%). Of the centres included, 52.6% set up a specific triage area for patients with suspected COVID-19 (n=30/57). Whereas, in 15 of the EDs (26.3%), the architecture made it impossible to increase the surface area of the ED. CONCLUSION: All EDs have adapted, but many of the changes recommended for the organisation of ED could not be implemented. ED architecture constrains adaptive capacities in the context of COVID-19.


Assuntos
COVID-19 , Serviço Hospitalar de Emergência/organização & administração , Necessidades e Demandas de Serviços de Saúde , Pandemias , SARS-CoV-2 , Estudos Transversais , França , Pesquisas sobre Serviços de Saúde , Arquitetura Hospitalar , Humanos
4.
BMJ Open Qual ; 10(3)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34301729

RESUMO

INTRODUCTION: Junior doctors are working in an increasingly overstretched National Health Service. In 2018, Kettering General Hospital (KGH) was awarded £60 800 of government funds to create high-quality rest facilities and improve junior doctor well-being. METHODS: An audit and survey in KGH identified the structural and functional improvements needed. From November 2019 to June 2020, £47 841.24 was spent on creating new rest facilities. On completion, a postaction review assessed how the changes impacted morale, well-being and quality of patient care. RESULTS: The majority of doctors were happy with the new rest areas (60%), a majority felt that they would use the on-call room area (63%) and the renovation improved morale and well-being. There was an increased ability to take breaks. However, the majority of doctors are not exception-reporting missing breaks: 79% (2019), 74% (2020). CONCLUSIONS AND IMPLICATIONS: This report recommends the maintenance of increased staffing levels and rest facilities during the recovery phase of COVID-19. The remaining £12 958.76 should be directed at sustaining the quality of KGH rest facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities ensures workforce well-being and translates into patient safety.


Assuntos
Fadiga/prevenção & controle , Arquitetura Hospitalar/métodos , Corpo Clínico Hospitalar/psicologia , Jornada de Trabalho em Turnos , Sono , Humanos , Moral , Segurança do Paciente , Melhoria de Qualidade , Medicina Estatal , Inquéritos e Questionários , Reino Unido
7.
Chest ; 160(2): 671-677, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33811910

RESUMO

Survivors of COVID-19 are a vulnerable population, with complex needs because of lingering symptoms and complications across multiple organ systems. Those who required hospitalization or intensive care are also at risk for post-hospital syndrome and post-ICU syndromes, with attendant cognitive, psychological, and physical impairments, and high levels of health care utilization. Effective ambulatory care for COVID-19 survivors requires coordination across multiple subspecialties, which can be burdensome if not well coordinated. With growing recognition of these needs, post-COVID-19 clinics are being created across the country. We describe the design and implementation of multidisciplinary post-COVID-19 clinics at two academic health systems, Johns Hopkins and the University of California-San Francisco. We highlight components of the model which should be replicated across sites, while acknowledging opportunities to tailor offerings to the local institutional context. Our goal is to provide a replicable framework for others to create these much-needed care delivery models for survivors of COVID-19.


Assuntos
Assistência ao Convalescente/organização & administração , COVID-19 , Ambulatório Hospitalar/organização & administração , Sobreviventes , COVID-19/terapia , Arquitetura Hospitalar , Humanos , Fatores de Tempo
8.
Epidemiol Infect ; 149: e111, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33902767

RESUMO

The explosive outbreak of COVID-19 led to a shortage of medical resources, including isolation rooms in hospitals, healthcare workers (HCWs) and personal protective equipment. Here, we constructed a new model, non-contact community treatment centres to monitor and quarantine asymptomatic and mildly symptomatic COVID-19 patients who recorded their own vital signs using a smartphone application. This new model in Korea is useful to overcome shortages of medical resources and to minimise the risk of infection transmission to HCWs.


Assuntos
COVID-19/terapia , Arquitetura Hospitalar/métodos , Hospitais Comunitários/métodos , Adulto , Feminino , Hospitais Comunitários/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Quarentena/métodos , República da Coreia , Unidades de Autocuidado
9.
Nurs Adm Q ; 45(2): 102-108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33570876

RESUMO

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team.


Assuntos
COVID-19/epidemiologia , Fortalecimento Institucional/organização & administração , Arquitetura Hospitalar/métodos , Unidades Móveis de Saúde/organização & administração , Boston , Feminino , Humanos , Liderança , Masculino , Unidades Móveis de Saúde/estatística & dados numéricos , Pandemias , SARS-CoV-2 , Incerteza
10.
Work ; 68(2): 365-378, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33492263

RESUMO

BACKGROUND: Participatory simulation (PS) is a method that can be used to integrate ergonomics and safety into workplace design projects. Previous studies have mainly focused on tools and methods for the simulation activities. The subsequent process of transferring and integrating the simulation outcomes into the design of workplaces is poorly understood. OBJECTIVE: This study sets out to study the role of actors and objects in the transfer of ergonomics knowledge generated in PS events and in the integration of this knowledge into a design project. The study identifies factors that influence what part of the simulation outcomes are integrated. METHODS: The empirical context of the study was six PS events that were part of a hospital design project. The events were investigated based on knowledge transfer theory, observations, interviews and document studies. RESULTS: Actors and objects with abilities of transferring ergonomics knowledge from the PS events to the hospital design project were identified. The study indicated that persons producing the objects functioned as a filter, meaning that not all ergonomics knowledge was transferred from the PS events. The main influencing factors on the integration were: predetermined building dimensions and room interdependency. CONCLUSIONS: Four recommendations were proposed for ergonomists and safety professionals when planning PS events.


Assuntos
Arquitetura Hospitalar , Simulação por Computador , Ergonomia , Humanos , Conhecimento , Local de Trabalho
11.
Am J Infect Control ; 49(1): 77-81, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32697947

RESUMO

BACKGROUND: On March 27, 2020, the city of Philadelphia was given permission by Temple University to convert the Liacouras Center gymnasium to an alternate care site (ACS) to treat low-acuity COVID-19 patients. ACSs, especially those created to specifically care for infectious patients, require a robust infection prevention and control (IPC) program. METHODS: The IPC program was led by a physician and nurse partnership, both of whom had substantial experience developing IPC programs in US and low-resource settings. The IPC program was framed on a previously described conceptual model commonly referred to as the "4S's": Space, Staff, Stuff, and Systems. RESULTS: The gymnasium was transformed into red, yellow, and green infection hazard zones. The IPC team trained 425 staff in critical IPC practices and personal protective equipment standards. Systems to detect staff illness were created and over 3,550 staff health screening surveys completed. DISCUSSION: Use of existing guidance and comprehensive facility and patient management assessments guided the development of the IPC program. Program priorities were to keep staff and patients safe and implement procedures to judiciously use limited resources that affect infection transmission. CONCLUSION: Planning, executing, and evaluating IPC standards and requirements of an ACS during a pandemic requires creative and nimble strategies to adapt, substitute, conserve, reuse, and reallocate IPC space, staff, stuff, and systems.


Assuntos
COVID-19/terapia , Equipamentos e Provisões Hospitalares , Pessoal de Saúde/educação , Arquitetura Hospitalar , Controle de Infecções/organização & administração , Capacitação em Serviço , Unidades Móveis de Saúde , Equipamento de Proteção Individual , COVID-19/prevenção & controle , Humanos , Ciência da Implementação , Profissionais Controladores de Infecções , Philadelphia , SARS-CoV-2 , Capacidade de Resposta ante Emergências
12.
Infect Control Hosp Epidemiol ; 42(2): 208-211, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32883382

RESUMO

In response to the Ebola outbreak of 2014-2016, the US Office of the Assistant Secretary for Preparedness and Response (ASPR) established 10 regional treatment centers, called biocontainment units (BCUs), to prepare and provide care for patients infected with high-consequence pathogens. Many of these BCUs were among the first units to activate for coronavirus disease 2019 (COVID-19) patient care. The activities of the Johns Hopkins BCU helped prepare the Johns Hopkins Health System for COVID-19 in the 3 domains of containment care: (1) preparedness planning, education and training, (2) patient care and unit operations, and (3) research and innovation. Here, we describe the role of the JH BCU in the Hopkins COVID-19 response to illustrate the value of BCUs in the current pandemic and their potential role in preparing healthcare facilities and health systems for future infectious disease threats.


Assuntos
COVID-19/transmissão , Arquitetura Hospitalar/métodos , Controle de Infecções/métodos , Corpo Clínico Hospitalar/educação , Isolamento de Pacientes/organização & administração , COVID-19/terapia , Contenção de Riscos Biológicos/métodos , Surtos de Doenças/prevenção & controle , Humanos , Maryland , Centros de Atenção Terciária
15.
Can Assoc Radiol J ; 72(2): 215-221, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32281391

RESUMO

OBJECTIVES: To improve the infection control and prevention practices against coronavirus disease 2019 (COVID-19) in radiology department through loophole identification and providing rectifying measurements. METHODS: Retrospective analysis of 2 cases of health-care-associated COVID-19 transmission in 2 radiology departments and comparing the infection control and prevention practices against COVID-19 with the practices of our department, where no COVID-19 transmission has occurred. RESULTS: Several loopholes have been identified in the infection control and prevention practices against COVID-19 of the 2 radiology departments. Loopholes were in large part due to our limited understanding of the highly contagious coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is characterized by features not observed in other SARS viruses. We recommend to set up an isolation zone for handling patients who do not meet the diagnostic criteria of COVID-19 but are not completely cleared of the possibility of infection. CONCLUSIONS: Loopholes in the infection control and prevention practices against COVID-19 of the 2 radiology departments are due to poor understanding of the emerging disease which can be fixed by establishing an isolation zone for patients not completely cleared of SARS-CoV-2 infection.


Assuntos
COVID-19/prevenção & controle , Arquitetura Hospitalar/métodos , Controle de Infecções/métodos , Melhoria de Qualidade , Serviço Hospitalar de Radiologia , SARS-CoV-2 , Humanos , Estudos Retrospectivos
16.
Ann Ig ; 33(4): 381-392, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33270076

RESUMO

Abstract: Many of the devastating pandemics and outbreaks of last centuries have been caused by enveloped viruses. The recent pandemic of Coronavirus disease 2019 (COVID-19) has seriously endangered the global health system. In particular, hospitals have had to deal with a frequency in the emergency room and a request for beds for infectious diseases never faced in the last decades. It is well-known that hospitals are environments with a high infectious risk. Environmental control of indoor air and surfaces becomes an important means of limiting the spread of SARS-CoV-2. In particular, to preserve an adequate indoor microbiological quality, an important non-pharmacological strategy is represented by Heating, Ventilation and Air Conditioning (HVAC) systems and finishing materials. Starting from the SARS-CoV-2 transmission routes, the paper investigates the hospital risk analysis and management, the indoor air quality and determination of microbial load, surface management and strategies in cleaning activities, HVAC systems' management and filters' efficiency. In conclusion, the paper suggests some strategies of interventions and best practices to be taken into considerations for the next steps in design and management.


Assuntos
Microbiologia do Ar , Poluição do Ar em Ambientes Fechados , COVID-19/prevenção & controle , Instalações de Saúde , Pandemias , SARS-CoV-2/isolamento & purificação , Ar Condicionado , COVID-19/transmissão , Materiais de Construção , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Contaminação de Equipamentos , Desenho de Equipamento , Filtração/instrumentação , Filtração/métodos , Calefação , Arquitetura Hospitalar , Humanos , Material Particulado , Medição de Risco , Ventilação/instrumentação
17.
Eur Spine J ; 30(2): 468-474, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33095369

RESUMO

PURPOSE: We present an organized hospital plan for the management of Coronavirus disease (COVID-19) patients requiring emergency surgical interventions. To introduce a multidisciplinary approach for the management of COVID-19-infected patients and to report the first operated patient in the Corona unit. METHODS: A detailed presentation of the hospital plan for a separate Corona unit with its intensive care unit and operating rooms. Description of the management of the first spine surgery case treated in this unit. RESULTS: The Corona unit showed a practical approach for the management of an emergency cervical spine fracture-dislocation with acute paralysis. The patient is 92-year-old female. The mechanism of injury was a simple fall during the stay in the internal medicine department where the patient was treated in the referring hospital. The patient had no other injuries and was awake and oriented. The patient did not have the clinical symptom of COVID-19, and the test result of COVID-19 done in the referring hospital was not available on admission in our emergency room. Education of the medical staff and organization of the operating theatre facilitated the management of the patient without an increased risk of spreading the infection. CONCLUSIONS: The current COVID-19 pandemic requires an extra-ordinary organization of the medical and surgical care of the patients. It is possible to manage an infected or a potentially infected patient surgically, but a multidisciplinary plan is necessary to protect other patients and the medical staff.


Assuntos
COVID-19/prevenção & controle , Vértebras Cervicais/lesões , Fixação Interna de Fraturas/métodos , Unidades de Terapia Intensiva/organização & administração , Luxações Articulares/cirurgia , Salas Cirúrgicas/organização & administração , Fraturas da Coluna Vertebral/cirurgia , Articulação Zigapofisária/lesões , Acidentes por Quedas , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Coronavirus , Infecções por Coronavirus , Serviço Hospitalar de Emergência , Planejamento Ambiental , Feminino , Fraturas Ósseas , Alemanha , Arquitetura Hospitalar , Humanos , Luxações Articulares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pandemias , Paraplegia/etiologia , Equipamento de Proteção Individual , SARS-CoV-2 , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
18.
Emerg Nurse ; 29(3): 34-40, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33377357

RESUMO

Dementia symptoms can manifest in a variety of ways, such as anxiety, agitation and an inability to communicate unmet needs. In emergency departments (EDs), these symptoms, as well as various environmental factors, can lead to behaviour that challenges in people with dementia. Therefore, ED staff must be skilled in screening, assessing and managing this patient group effectively. This article details a literature review that was conducted to explore the evidence on managing behaviour that challenges in people with dementia in the ED and what de-escalation strategies may be useful. A literature search of eight databases was undertaken, resulting in 11 articles that were included in this literature review. Four main themes were identified: violence and aggression towards staff; manual and chemical restraint in the ED; identifying delirium and dementia; and environment and person-centred care. Strategies identified to de-escalate and reduce the risk of behaviour that challenges include: making environmental modifications to the ED; providing person-centred care; excluding or evaluating pain and unmet needs; using various tools and strategies to improve communication; and using distraction techniques.


Assuntos
Demência/diagnóstico , Demência/enfermagem , Serviço Hospitalar de Emergência , Avaliação em Enfermagem , Agressão , Comunicação , Delírio/diagnóstico , Arquitetura Hospitalar , Humanos , Hipnóticos e Sedativos/uso terapêutico , Medição da Dor , Assistência Centrada no Paciente , Restrição Física , Violência
19.
Hosp Top ; 99(2): 92-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33351723

RESUMO

The novel corona virus has reached the pandemic levels since March 2020. This has exerted tremendous pressure on existing infrastructure. Amenities related to quarantine and isolation are new norms in healthcare set-ups all over the world. The present study helps to understand the guidelines needed to change the current available infrastructural resources of essential departments in addition to forecasting and organizing the infrastructure required to cater the special needs of the COVID-19 patients without compromising the smooth functioning of the healthcare facility and not risking the safety of the health care professionals delivering it.


Assuntos
COVID-19/epidemiologia , Arquitetura Hospitalar , Planejamento Hospitalar , Controle de Infecções/normas , Pneumonia Viral/epidemiologia , Humanos , Índia/epidemiologia , Pandemias , Pneumonia Viral/virologia , Quarentena , SARS-CoV-2
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