● ● Collaborate in regional plans to be able to make at least
200 percent of licensed-bed capacity in the region available
for COVID-19 patients ontwo2 weeks’ notice.
● ● Limit the nosocomial spread of the virus by the following
practices:
¢ Limit the accidental contamination of the hospital
environment by implementing respiratory etiquette and by
using simple surgical masks for everyone entering the facility
(staff, patients, and visitors) during a pandemic. Assuming
re-supply may be difficult during a pandemic, stockpile
enough masks for three weeks.
¢ Prevent staff from getting infected by training
healthcare workers on the use of personal protective
equipment (PPE) and infection control procedures and
by stockpiling a supply of PPE. Powered air-purifying
respirators (PAPRs) should be available for use in high-risk
aerosol-generating procedures.
¢ Limit the number of staff who are exposed
to COVID-19 patients by cohorting (dedicated staff in
dedicated units). Utilize overtime and long shifts for staff
in the COVID-19 units to limit the number of staff needed.
When possible, use staff who are immune (recovered) in
the COVID-19 units.
¢ Prevent infected staff from working (except with
COVID-19 patients) by tracking staff who are sick and testing
for COVID-19, if possible, and keeping a log of staff who
have had confirmed COVID-19.
● ● Maintaining, augmenting, and stretching the hospital
workforce:
¢ Vaccinate all staff for influenza to reduce the burden
of that disease.
¢ Allay fear through open, honest, and transparent
planning and careful training.
¢ Shift clinical staff to highest-need areas from areas
that may be closed or quiet; employ “just in time” education
and “buddy teaming.”
¢ Prioritize which services and types of procedures
can be deferred, for how long, and with what consequences
and create an alternative plan for patients who will be
deferred. Create a process for refining and updating this
plan as circumstances change. Create a process to track
deferred patients.
¢ Plan for the graceful transition to contingency and
crisis standards of care. In a severe pandemic, not all patients
in need of intensive care will be able to be accommodated
in the ICU. Normal staffing ratios and standard operating
procedures will not be able to be maintained.
¢ Plan for alternative sites to provide ICU-like care
within the hospital (e.g., catheterization lab, catheterization
recovery, OR, PACU, endoscopy units, etc).
¢ Implement contingency and crisis standards, which
will be justified when conventional standards cannot be
maintained despite the use of all available resources, including
mutual aid arrangements. The legal and ethical framework
for these decisions should be considered well in advance of a
crisis. Alterations in hospital policy and procedures should be
implemented by an active decision of the hospital leadership
in consultation with the medical staff and civil authorities.
¢ Create criteria/clinical guidelines for use (or denial)
of resource-intensive services (e.g., admission, mechanical
18
ventilation, invasive monitoring) based on national guidelines.
¢ Establish a process for triage of patients competing
for limited resources, including admission, early discharge,
and life support. These decisions should not be made solely
by 1 person. The criteria used to make these decisions
should be created in advance and formally sanctioned by
the medical staff and hospital administration.
Essential Components of a Hospital Preparedness
Plan for COVID-19
The Society of Critical Care Medicine estimates that
approximately 95,000 critical care beds, including surgical
and specialty unit beds, are available in U.S. hospitals today.
COVID-19 has tested the preparedness of healthcare systems
and challenged their readiness to care for a large influx of
patients with this disease.
Chopra, et al. (2020) acknowledge that, “Best-case
estimates suggest that COVID-19 will stress bed capacity,
equipment, and healthcare personnel in U.S. hospitals in
ways not previously experienced.”
It is imperative that hospitals develop a strategy for
patient volume and complexity. Chopra, et al. (2020)
assert that healthcare systems may need twice the number
of available beds to meet the demands triggered by the
COVID-19 pandemic, should it become sustained. They add,
“Because some patients will be critically
ill and need scarce resources, such as
extracorporeal membrane oxygenation Best-case estimates
and ventilators, hospitals must prepare
suggest that
now for how they will triage patients,
allocate resources, and staff wards.”
COVID-19 will
Chopra, et al. (2020) emphasize
stress bed capacity,
the importance of geographically
cohorting patients with COVID-19 equipment, and
to limit the number of healthcare
healthcare personnel
personnel exposed and to conserve
in U.S. hospitals in
supplies: “This type of geographic
capacity generation is extremely difficult
ways not previously
because many U.S. hospitals run at full
experienced.”
capacity. Geographic cohorting options
may also be challenged by locations
of airborne isolation rooms, with negative pressure being
scattered throughout the hospital. It may be necessary
to use innovative approaches, such as converting single
rooms to double occupancy; expediting discharges; slowing
admission rates; and converting spaces like catheterization
laboratories, lobbies, postoperative care units, or waiting
rooms into patient-care venues.”
For example, the researchers point out, at Michigan
Medicine, “designated beds in critical care units and
non–critical care settings for persons under investigation
and patients who test positive for COVID-19 have been
identified,” Chopra, et al. (2020) explain. “A dedicated
team of hospitalists and critical care providers has been
established, with clinical schedules and roles for leadership,
communication, and activation criteria. Contingency plans
have been developed, including activation criteria for opening
a respiratory intensive care floor where cohorting of both
critically ill and noncritically ill patients can occur. Similarly,
ensuring the ongoing care of vulnerable patients, such
as those in the posttransplant and immunocompromised
april 2020 • www.healthcarehygienemagazine.com