Emergency management in fever clinic during the outbreak of COVID-19: an experience from Zhuhai

Coronavirus disease 2019 (COVID-19) is a global health threat. A hospital in Zhuhai adopted several measures in Fever Clinic Management (FCM) to respond to the outbreak of COVID-19. FCM has been proved to be effective in preventing nosocomial cross infection. Faced with the emergency, the hospital undertook creative operational steps in relation to the control and spread of COVID-19, with special focuses on physical and administrative layout of buildings, staff training and preventative procedures. The first operational step was to set up triaging stations at all entrances and then complete a standard and qualified fever clinic, which was isolated from the other buildings within our hospital complex. Secondly, the hospital established its human resource reservation for emergency response and the allocation of human resources to ensure strict and standardised training methods through the hospital for all medical staff and ancillary employees. Thirdly, the hospital divided the fever clinic into partitioned areas and adapted a three-level triaging system. The experiences shared in this paper would be of practical help for the facilities that are encountering or will encounter the challenges of COVID-19, i.e. to prevent nosocomial cross infection among patients and physicians.

Chemical Pollution in Healing Spaces: The Decalogue of the Best Practices for Adequate Indoor Air Quality in Inpatient Rooms

Indoor air quality (IAQ) is one of the main topics in which governments are focusing. In healthcare facilities, several studies have reported data analysis and case studies to improve users' health. Nowadays, although many studies have been conducted related to the biological and physical risks, the chemical risks have been less investigated and only in some specific functional areas of the hospitals. Starting from some systematic reviews and research works, this paper aims to list the best healthy practices for an adequate IAQ in inpatient wards. In particular, the decalogue lists the strategies related to chemical pollution, starting from design and management, with a focus on (a) localization of hospitals and inpatient rooms, (b) hospital room, (c) microclimatic parameters, (d) ventilation systems, (e) materials and finishing, (f) furniture and equipment, (g) cleaning products and activities, (h) maintenance and (i) management activities, and (l) users and workers. The multidisciplinary approach emphasizes the need for interdisciplinary knowledge and skills aimed to find solutions able to protect users' health status. The design and management decision-making, ranging from the adequate choices of construction site and hospital exposure, finishing materials, cleaning and maintenance activities, etc., which can affect the IAQ must be carried out based on scientific research and data analysis.

Designing Penfield: Inside the Montreal Neurological Institute

Neurosurgeon Wilder Penfield (1891-1976) envisioned hospital architecture as a powerful medical tool. Focusing on two key interiors in the 1934 Montreal Neurological Institute (MNI)-the operating room and the foyer-this article engages newly accessible textual and material evidence to show Penfield's intense involvement in the design of the building. A unique, tri-level surgical room, with a sophisticated setup for photography, made the MNI's surgery interactive. The OR is discussed with regard to the relationship of doctors and architects and Penfield's penchant for architectural travel. Subsequently, we visit the foyer as a spatial counterpoint to the operating room. Its design enabled a particular, Penfield-inspired view of the brain and recounted neurological history in the language of Art Deco design. An emphasis on axial movement pushed visitors to "consume" a work of sculpture, meticulously copied from another in Paris. The architecture of the MNI thus monumentalized Penfield's accomplishments, by his own design.

Hospital Bathrooms and Showers: A Continuing Saga of Inadequacy

Previous surveys of UK hospitals have highlighted many deficiencies in the standards of hospital inpatient washing and bathing facilities--especially inadequate access for wheelchair users, insufficient bathing equipment, and unsatisfactory cleanliness and privacy. We conducted a qualitative survey in three hospitals in the North of England to see whether these facilities have improved. There have been some improvements, particularly in the provision of bath hoists, adapted taps, alarm call systems, shower seats and wheelchair access to bathrooms. But many basic problems remain-absent locks and signs, inadequate heating, poor standards of privacy, insufficient bath aids, wet floors, and the inappropriate use of bathrooms as store rooms. The overall condition of hospital bathrooms and showers remains unsatisfactory. Too many hospital bathrooms are austere, cold, smelly and poorly maintained.

Challenges set by the ErP Directive addressed

In January this year, new Eco-design requirements for ventilation products came into force in the form of the Ecodesign Directive 2009/125/EC for energy-related products (ErP). The tighter requirements signal the growing need for products that are even more energy-efficient, which will help EU countries reach their carbon reduction commitments. Here David White, UK service sales manager at supplier of air technology solutions, Fläkt Woods, considers what the new standards will mean for HVAC systems in hospitals and healthcare facilities.

Making the meaning of guidance clearer

Inconsistencies in language usage in guidance documents that impose compliance obligations can lead to confusion and misinterpretation, argue John Prendergast and Sue Holding, directors of Technical Publishing Resources, both of Whom have extensive experience in compiling and editing healthcare estates technical information. In this article they look at language use in Health Building Notes (HBNs) and Health Technical Memoranda (HTMs), highlight some of the problems with existing wording and phraseology, and suggest a way forward.

Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital

Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient.

Serious impact of poor planning shown

This article analyses the design, project management, and construction work entailed in of the renovation of the emergency department and surgical suite of an old, highly complex healthcare facility in Caracas which has a School of Medicine, and encounters high patient throughput due to its location in the centre of the metropolitan area of Caracas. The project, involving an area of 3,000 m, had to overcome obstacles including security, the site's location, and its immediate environs. The article describes the remodeling project, and some of the lessons learned, in some detail.

Protecting a CT simulator room to accommodate a cyberknife facility

In 2012, a plan to develop Stereotactic treatments using a Cyberknife was unveiled at the Hermitage Medical Clinic, Dublin. Due to planning restrictions the new facility had to be contained in the existing hospital's blue print with the only available location being an unused CT simulation room. The room design would be different from conventional radiotherapy bunkers due to the fact the Cyberknife can fire an unfiltered beam in any direction bar the roof (restriction of 22° above the horizontal). Therefore all walls must be primary barriers with the roof designed to protect against the large leakage radiation resulting from the high MU's used during the treatments. Space consideration indicated that concrete alone could not be used to restrict the radiation beam to acceptable limits. To this end a combination of steel, lead, normal and heavy concrete were used to meet the dose constraints established by the Irish licensing authorities.

Changes in patient satisfaction related to hospital renovation: experience with a new clinical building

IMPORTANCE

There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction.

OBJECTIVE

To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility.

DESIGN

Natural experiment utilizing a pre-post design with concurrent controls.

SETTING

Academic tertiary care hospital.

PARTICIPANTS

We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls.

EXPOSURE

Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities.

MAIN OUTCOMES AND MEASURES

The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores.

RESULTS

The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical providers, ancillary staff, and only 1 of 4 measures of overall satisfaction improved. The most prominent increase was with pleasantness of décor (33.6% vs 64.8%) and visitor accommodation and comfort (50.0% vs 70.3%).

CONCLUSION AND RELEVANCE

Patients responded positively to pleasing surroundings and comfort, but were able to discriminate their experiences with the hospital environment from those with physicians and nurses. The move to a new building had significant impact on only 1 of the 4 measures of overall patient satisfaction, as clinical care is likely to be the most important determinant of this outcome. Hospital administrators should not use outdated facilities as an excuse for suboptimal provider satisfaction scores.

[A survey about client orientation and wayfinding in Chilean hospitals]

BACKGROUND

Sense of orientation in hospitals can be tricky considering the large extension of buildings and the inadequate signage.

AIM

To report some of the findings of a larger research project on wayfinding and patient navigation in Chilean hospitals.

MATERIAL AND METHODS

Five hundred nine hospital users waiting for attention in three hospitals were contacted and asked to answer a survey that lasted 10 minutes, about wayfinding and sense of orientation within the hospital.

RESULTS

Users declared to have a good opinion of existing signage in the three hospitals analyzed as well as their architectural organization in terms of their capacity to orient people. However, the vast majority of users asked for directions to navigate within the hospital to staff and medical personnel.

CONCLUSIONS

Patient navigation problems are imposing a great "hidden" cost to hospitals management due to missed appointments.

Navigating through 'a labyrinth' of guidance

Devising a strategy to deliver safe water to thousands of outlets spread across numerous buildings is always going to be a challenge, so how do you navigate your way through a bewildering labyrinth of sometimes contradictory guidance documents? Is there, in fact, simply too much guidance? Posing this question at a recent one-day conference on waterborne infections in healthcare facilities, Paul Nolan, authorised water engineer (AE), and operations manager for PFI provider, Lend Lease, took delegates through a review of the latest guidance and regulations, as Susan Pearson reports.

Ensuring quality builds in South Africa

In an article first published in the IFHE Digest 2014, Llewellyn van Wyk, principal researcher, Built Environment Unit (Building Science & Technology) at South Africa's Council for Scientific and Industrial Research (CSIR), describes the regulatory environment controlling the erection of buildings in the country--including so-called 'temporary' structures; the role of Agr6ment South Africa in certifying non-standard building technologies; the performance matrix developed by the Council for Scientific and Industrial Research (CSIR) to evaluate innovative building technologies, the selection methodology, and the findings.

CHP project brings substantial savings

With the NHS having committed to reduce its carbon footprint by 10% by 2015, Alan Newman, a partner at building services engineers, Troup Bywaters + Anders (TB+A), describes how, with the company's expertise and help, customer, the East and North Hertfordshire NHS Trust, 'surpassed the targets two years in advance'. As he explains, the key element of an ambitious carbon reduction scheme that won the 2013 IHEEM Healthcare Estates Sustainability Award (HEJ - November 2013) was a new combined heat and power-based energy centre at the Trust's Lister Hospital in Stevenage.

Collective efforts, better engagement

In this article, Dr Mike Simmons, Public Health Microbiologist at Public Health Wales, and the clinical lead for Public Health Wales Microbiology Services to the Hywel Dda Health Board, examines and explains healthcare-associated infections, or HCAls. He also highlights some of the key implications for healthcare engineers and estates managers in their day-to-day roles, and stresses the importance of interaction and collaboration between estates professionals and their clinical, infection control, nursing, and other hospital counterparts, in both reducing the number of such infections, and creating environments unconducive to their spread.

Dementia-friendly design resource

Although estimates suggest that, on average, some 30 per cent of all patients in general acute medical wards may have some form of dementia, Stirling University's Dementia Services Development Centre (DSDC), one of the leading international knowledge centres working to improve the lives of dementia sufferers, says progress in designing healthcare facilities that address such patients' needs has been 'patchy at best'. With the number of individuals living with dementia expected to double in the next 25 years, the DSDC has recently worked with Edinburgh-based architects, Burnett Pollock Associates, to develop an online resource that clearly illustrates, via 15 simulated 'dementia-friendly' healthcare 'spaces', some of the key principles to consider when designing effectively for this fast-growing group. HEJ editor, Jonathan Baillie, attended the launch of the so-called 'Virtual Hospital'.

Reducing costs via standardisation

Speaking in a presentation at October's Healthcare Estates 2013, senior representatives from a number of Principal Supply Chain Partners (PSCPs) within the ProCure21 + National Framework explained their ongoing work to develop designs for standardised and repeatable rooms, along with a range of associated standard components--from flooring to air-handling units--all intended to reduce NHS capital building costs in line with the Government Construction Strategy. HEJ editor, Jonathan Baillie, reports.

Residential hospice environments: evidence-based architectural and landscape design considerations

The residential hospice care movement is increasingly accepted and supported globally, and yet, unfortunately, the amount of literature on best practices in the planning and design of residential hospice facilities and adjacent outdoor spaces remains relatively small. This paper reports on a compendium of architectural and landscape design considerations that reflect the fundamental dimensions of the residential hospice experience: site and context, arrival spaces, communal and private spaces of the residential milieu, transitional spaces, and nature connectivity. Additionally, key staffing and administrative ramifications of this built-environment compendium are addressed, as are prognostications and challenges for the future.