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1.
Ann Ig ; 33(5): 513-517, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34224553

RESUMO

Abstract: Starting from the minimum requirements indicated by Lombardy Region, a validation checklist has been developed by experts in design, healthcare layout planning, hygiene and public health, planning and compliance, in order to provide managers of COVID-19 massive vaccination centers with a useful and easy-to-use tool to ensure quality, safety and efficiency of the different activities performed.


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Centros Comunitários de Saúde/organização & administração , Vacinação em Massa/organização & administração , SARS-CoV-2 , Estudos de Validação como Assunto , Vacinas contra COVID-19/provisão & distribuição , Lista de Checagem , Centros Comunitários de Saúde/normas , Eficiência Organizacional , Arquitetura de Instituições de Saúde , Humanos , Higiene , Itália , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde
3.
HERD ; 14(3): 34-48, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34075789

RESUMO

OBJECTIVE: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care. BACKGROUND: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit had a physical visual connection between the control room and the contaminated zone through a window, while the other had only a virtual connection with digital technologies. METHODS: The findings are based on semistructured interviews with Sheba medical staff, telemedicine companies, and the architectural design team and observations at the COVID-19 units during March-August 2020. RESULTS: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users' sense of control, orientation in space, teamwork, safety, quality of care, and well-being. CONCLUSIONS: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.


Assuntos
COVID-19/terapia , Unidades de Terapia Intensiva/organização & administração , Telemedicina/métodos , COVID-19/prevenção & controle , Arquitetura de Instituições de Saúde/métodos , Arquitetura de Instituições de Saúde/normas , Humanos , Controle de Infecções/métodos , Israel , Estudos de Casos Organizacionais , Isolamento de Pacientes/métodos , SARS-CoV-2 , Telemedicina/organização & administração
4.
Ann Ig ; 33(5): 499-512, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34113956

RESUMO

Abstract: After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery be-came the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evalua-tion of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro mass-immunization model was developed building a la-yout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamen-tal to achieve population health during health emergencies.


Assuntos
COVID-19/prevenção & controle , Centros Comunitários de Saúde/organização & administração , Vacinação em Massa/organização & administração , Modelos Teóricos , Pandemias , SARS-CoV-2 , COVID-19/epidemiologia , Vacinas contra COVID-19 , Centros Comunitários de Saúde/estatística & dados numéricos , Eficiência Organizacional , Utilização de Instalações e Serviços , Arquitetura de Instituições de Saúde , Humanos , Itália/epidemiologia , Vacinação em Massa/métodos , Vacinação em Massa/estatística & dados numéricos , Melhoria de Qualidade
9.
Waste Manag ; 128: 122-131, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33989858

RESUMO

Diverting organic waste from landfills provides significant emissions benefits in addition to preserving landfill capacity and creating value-added energy and compost products. Dry anaerobic digestion (AD) is particularly attractive for managing the organic fraction of municipal solid waste because of its high-solids composition and minimal water requirements. This study utilizes empirical data from operational facilities in California in order to explore the key drivers of dry AD facility profitability, impacts of market forces, and the efficacy of policy incentives. The study finds that dry AD facilities can achieve meaningful economies of scale with organic waste intake amounts larger than 75,000 tonnes per year. Materials handling costs, including the disposal of inorganic residuals from contaminated waste streams and post-digester mass (digestate) management, are both the largest and the most uncertain facility costs. Facilities that utilize the biogas for vehicle fueling and earn associated fuel credits collect revenues that are 4-6x greater than those of facilities generating and selling electricity and 10-12x greater than facilities selling natural gas at market prices. The results suggest important facility design elements and enabling policies to support an increased scale of organic waste handling infrastructure.


Assuntos
Eliminação de Resíduos , Anaerobiose , Arquitetura de Instituições de Saúde , Políticas , Resíduos Sólidos/análise
10.
PLoS One ; 16(4): e0249826, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33909647

RESUMO

Billions of birds fatally collide with human-made structures each year. These mortalities have consequences for population viability and conservation of endangered species. This source of human-wildlife conflict also places constraints on various industries. Furthermore, with continued increases in urbanization, the incidence of collisions continues to increase. Efforts to reduce collisions have largely focused on making structures more visible to birds through visual stimuli but have shown limited success. We investigated the efficacy of a multimodal combination of acoustic signals with visual cues to reduce avian collisions with tall structures in open airspace. Previous work has demonstrated that a combination of acoustic and visual cues can decrease collision risk of birds in captive flight trials. Extending to field tests, we predicted that novel acoustic signals would combine with the visual cues of tall communication towers to reduce collision risk for birds. We broadcast two audible frequency ranges (4 to 6 and 6 to 8 kHz) in front of tall communication towers at locations in the Atlantic migratory flyway of Virginia during annual migration and observed birds' flight trajectories around the towers. We recorded an overall 12-16% lower rate of general bird activity surrounding towers during sound treatment conditions, compared with control (no broadcast sound) conditions. Furthermore, in 145 tracked "at-risk" flights, birds reduced flight velocity and deflected flight trajectories to a greater extent when exposed to the acoustic stimuli near the towers. In particular, the 4 to 6 kHz stimulus produced the greater effect sizes, with birds altering flight direction earlier in their trajectories and at larger distances from the towers, perhaps indicating that frequency range is more clearly audible to flying birds. This "acoustic lighthouse" concept reduces the risk of collision for birds in the field and could be applied to reduce collision risk associated with many human-made structures, such as wind turbines and tall buildings.


Assuntos
Estimulação Acústica/métodos , Migração Animal , Aves/fisiologia , Arquitetura de Instituições de Saúde/métodos , Som , Comportamento Espacial , Animais , Percepção Auditiva , Sinais (Psicologia) , Estimulação Luminosa , Percepção Visual
11.
PLoS One ; 16(4): e0247786, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33887759

RESUMO

The quantitative relationship between the spatial variation of building's height and the associated land surface temperature (LST) change in six Chinese megacities is investigated in this paper. The six cities involved are Beijing, Shanghai, Tianjin, Chongqing, Guangzhou, and Shenzhen. Based on both remote sensing and building footprint data, we retrieved the LST using a single-channel (SC) algorithm and evaluate the heating/cooling effect caused by building-height difference via correlation analysis. The results show that the spatial distribution of high-rise buildings is mainly concentrated in the center business districts, riverside zones, and newly built-up areas of the six megacities. In the urban area, the number and the floor-area ratio of high to super high-rise buildings (>24m) account for over 5% and 4.74%, respectively. Being highly urbanized cities, most of urban areas in the six megacities are associated with high LST. Ninety-nine percent of the city areas of Shanghai, Beijing, Chongqing, Guangzhou, Shenzhen, and Tianjin are covered by the LST in the range of 30.2~67.8°C, 34.8~50.4°C, 25.3~48.3°C, 29.9~47.2°C, 27.4~43.4°C, and 33.0~48.0°C, respectively. Building's height and LST have a negative logarithmic correlation with the correlation coefficients ranging from -0.701 to -0.853. In the building's height within range of 0~66m, the LST will decrease significantly with the increase of building's height. This indicates that the increase of building's height will bring a significant cooling effect in this height range. When the building's height exceeds 66m, its effect on LST will be greatly weakened. This is due to the influence of building shadows, local wind disturbances, and the layout of buildings.


Assuntos
Ambiente Controlado , Arquitetura de Instituições de Saúde , China , Cidades , Indústria da Construção , Humanos , Temperatura , Urbanização
12.
Undersea Hyperb Med ; 48(1): 89-96, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33648038

RESUMO

The New York Bridge and Tunnel Commission began planning for a tunnel beneath the lower Hudson river to connect Manhattan to New Jersey in 1919. At 8,300 feet, it would be the longest tunnel for passenger vehicles in the world. A team of engineers and physiologists at the Yale University Bureau of Mines Experiment Station was tasked with calculating the ventilation requirements that would provide safety from exposure to automobile exhaust carbon monoxide (CO) while balancing the cost of providing ventilation. As the level of ambient CO which was comfortably tolerated was not precisely defined, they performed human exposures breathing from 100 to 1,000 ppm CO, first on themselves and subsequently on Yale medical students. Their findings continue to provide a basis for carbon monoxide alarm requirements a century later.


Assuntos
Intoxicação por Monóxido de Carbono/prevenção & controle , Arquitetura de Instituições de Saúde/história , Instalações de Transporte/história , Emissões de Veículos/envenenamento , Monóxido de Carbono/análise , Intoxicação por Monóxido de Carbono/história , Carboxihemoglobina/análise , História do Século XX , Humanos , New Jersey , Cidade de Nova Iorque , Valores de Referência , Rios , Ventilação/economia , Ventilação/métodos
13.
Indoor Air ; 31(5): 1625-1638, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33772881

RESUMO

The use of Ultraviolet Germicidal Irradiation (UVGI) devices in the upper zones of occupied buildings has gained increased attention as one of the most effective mitigation technologies for the transmission of COVID-19. To ensure safe and effective use of upper-room UVGI, it is necessary to devise a simulation technique that enables engineers, designers, and users to explore the impact of different design and operational parameters. We have developed a simulation technique for calculating UV-C fluence rate within the volume of the upper zone and planar irradiance in the lower occupied zone. Our method is based on established ray-tracing light simulation methods adapted to the UV-C wavelength range. We have included a case study of a typical hospital patient room. In it, we explored the impact of several design parameters: ceiling height, device location, room configuration, proportions, and surface materials. We present a spatially mapped parametric study of the UV-C irradiance distribution in three dimensions. We found that the ceiling height and mounting height of the UVGI fixtures combined can cause the largest variation (up to 22%) in upper zone fluence rate. One of the most important findings of this study is that it is crucial to consider interreflections in the room. This is because surface reflectance is the design parameter with the largest impact on the occupant exposure in the lower zone: Applying materials with high reflectance ratio in the upper portion of the room has the highest negative impact (over 700% variation) on increasing hot spots that may receive over 6 mJ/cm2 UV dose in the lower occupied zone.


Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Desinfecção/métodos , Quartos de Pacientes , Análise Espacial , Raios Ultravioleta , COVID-19/prevenção & controle , Arquitetura de Instituições de Saúde , Humanos , SARS-CoV-2
16.
J Med Syst ; 45(4): 42, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608811

RESUMO

In confronting the sudden epidemic of COVID-19, China and other countries have been under great deal of pressure to block virus transmission and reduce death cases. Fangcang shelter hospital, which is converted from large-scale public venue, is proposed and proven to be an effective way for administering medical care and social isolation. This paper presents the practice in information technology support for a Fangcang shelter hospital in Wuhan, China. The experiences include the deployment strategy of IT infrastructure, the redesign of function modules in the hospital information system (HIS), equipment maintenance and medical staff training. The deployment strategy and HIS modules have ensured smoothness and efficiency of clinical work. The team established a quick response mechanism and adhered to the principle of nosocomial infection control. Deployment of network and modification of HIS was finished in the 48 hours before patient admittance. A repair hotline and remote support for equipment and software were available whenever medical workers met with any questions. No engineer ever entered the contaminated areas and no one was infected by the coronavirus during the hospital operation. Up to now, Fangcang shelter hospital is adopted by many regions around the world facing the collapse of their medical systems. This valuable experience in informatization construction and service in Wuhan may help participators involving in Fangcang shelter hospital get better information technology support, and find more practical interventions to fight the epidemic.


Assuntos
COVID-19/terapia , Abrigo de Emergência/organização & administração , Hospitais Especializados/organização & administração , Unidades Móveis de Saúde/organização & administração , Isolamento de Pacientes/estatística & dados numéricos , COVID-19/epidemiologia , China , Emergências , Arquitetura de Instituições de Saúde , Hospitais de Isolamento , Humanos , Tecnologia da Informação , Fatores de Risco
18.
Int Nurs Rev ; 68(2): 172-180, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33506989

RESUMO

BACKGROUND: The rampant spread of the novel coronavirus disease (COVID-19) has assumed pandemic proportions across the world. Attempts to contain its spread have entailed varying early screening and triage strategies implemented in different countries and regions. AIM: To share the experience of scientific and standardized management of fever clinics in China, which provide the first effective checkpoint for the prevention and control of COVID-19. INTRODUCTION: A fever clinic was established at our hospital in Tianjin, China, for initially identifying suspected cases of COVID-19 and controlling the spread of the disease. METHODS: The management system covered the following aspects: spatial layout; partitioning of functional zones; a work management system and associated processes; management of personnel, materials and equipment; and patient education. RESULTS: Within two months of introducing these measures, there was a comprehensive reduction in the number of new COVID-19 cases in Tianjin, and zero infections occurred among medical staff at the fever clinic. DISCUSSION: The fever clinic plays an important role in the early detection, isolation and referral of patients presenting with fevers of unknown origin. Broad screening criteria, an adequate warning mechanism, manpower reserves and staff training at the clinic are essential for the early management of epidemics. CONCLUSION: The spread of COVID-19 has been effectively curbed through the establishment of the fever clinic, which merits widespread promotion and application. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Health managers should be made aware of the important role of fever clinics in the early detection, isolation and referral of patients, and in the treatment of infectious diseases to prevent and control their spread. In the early stage of an epidemic, fever clinics should be established in key areas with concentrated clusters of cases. Simultaneously, the health and safety of health professionals require attention.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , COVID-19/enfermagem , Febre de Causa Desconhecida/enfermagem , Pneumonia Viral/enfermagem , COVID-19/epidemiologia , China/epidemiologia , Arquitetura de Instituições de Saúde , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/virologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2
19.
Br J Anaesth ; 126(3): 633-641, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33160603

RESUMO

BACKGROUND: The safety and efficiency of anaesthesia care depend on the design of the physical workspace. However, little is known about the influence that workspace design has on the ability to perform complex operating theatre (OT) work. The aim of this study was to observe the relationship between task switching and physical layout, and then use the data collected to design and assess different anaesthesia workspace layouts. METHODS: In this observational study, six videos of anaesthesia providers were analysed from a single centre in the United States. A task analysis of workflow during the maintenance phase of anaesthesia was performed by categorising tasks. The data supported evaluations of alternative workspace designs. RESULTS: An anaesthesia provider's time was occupied primarily by three tasks: patient (mean: 30.0% of total maintenance duration), electronic medical record (26.6%), and visual display tasks (18.6%). The mean time between task switches was 6.39 s. With the current workspace layout, the anaesthesia provider was centred toward the patient for approximately half of the maintenance duration. Evaluating the alternative layout designs showed how equipment arrangements could improve task switching and increase the provider's focus towards the patient and visual displays. CONCLUSIONS: Our study showed that current operating theatre layouts do not fit work demands. We report a simple method that facilitates a quick layout design assessment and showed that the anaesthesia workspace can be improved to better suit workflow and patient care. Overall, this arrangement could reduce anaesthesia workload while improving task flow efficiency and potentially the safety of care.


Assuntos
Anestesiologia/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Arquitetura de Instituições de Saúde/métodos , Salas Cirúrgicas/organização & administração , Fluxo de Trabalho , Humanos , Recursos Humanos em Hospital , Carga de Trabalho
20.
Ann Intern Med ; 174(2): 247-251, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32941059

RESUMO

Singapore is one of the most densely populated small island-states in the world. During the coronavirus disease 2019 (COVID-19) pandemic, Singapore implemented large-scale institutional isolation units called Community Care Facilities (CCFs) to combat the outbreak in the community by housing low-risk COVID-19 patients from April to August 2020. The CCFs were created rapidly by converting existing public spaces and used a protocolized system, augmented by telemedicine to enable a low health care worker-patient ratio (98 health care workers for 3200 beds), to operate these unique facilities. In the first month, a total of 3758 patients were admitted to 4 halls, 4929 in-house medical consults occurred, 136 patients were transferred to a hospital, 1 patient died 2 weeks after discharge, and no health care workers became infected. This article shares the authors' experience in operating these massive-scale isolation facilities while prioritizing safety for all and ensuring holistic patient care in the face of a public health crisis and lean health care resources.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Arquitetura de Instituições de Saúde , Quarentena , Humanos , Pandemias , SARS-CoV-2 , Singapura/epidemiologia , Telemedicina
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