Following the SARS outbreak, hospitals across Canada started actively preparing for a major epidemic. But no one was prepared for the scale of pandemic that we are currently experiencing with COVID-19. The impact on hospitals across the country and in particular, the impacts on long-term care facilities, has been unprecedented.
Older healthcare facilities often do not have the most up-to-date features that create the optimal environments for preventing the spread of illness during a pandemic. They tend to have multiple occupancy patient bedrooms, not enough hand hygiene sinks, fewer negative pressure isolation rooms (AIR) and aging mechanical systems. This has created a struggle to implement appropriate barriers between patients, protect staff from the infection and isolate the contagious.
Part of the issue has been the contradictory information provided by different authorities and how that confusion has impacted patient care, sometimes leaving healthcare providers with questions and unclear answers.
Some of these questions include: Should they hold patients with suspected cases of COVID-19 in ambulatory clinics until test results are confirmed? Or should they assume everyone is positive and isolate until confirmed? Should all elective surgery be cancelled to keep critical care beds and equipment available for COVID-19 patients needing specialized nursing? Or will this create too many available beds with no patients in them?
People will always require hospital care. Accidents happen, and patients need surgery and admission to a bed. Children have fevers, people have strokes and heart attacks, dialysis patients need treatment and patients continue to undergo chemotherapy.
The pandemic is having an impact on members of the public who haven’t been diagnosed with the virus. One such example: pregnancies and deliveries, which present unique challenges. Babies are born when they decide the time is right for them; they and their mothers require care. The challenge for staff is to accommodate parents’ birth plans, assist them to celebrate their new arrival and keep them safe in a time when no one is immune to the dangers of this pandemic.
In terms of hospital construction to create safer environments, the problem is complicated to solve. Adding anterooms to existing patient rooms is a complex process, as is splitting large, multiple-bed rooms into single rooms. Washrooms and lighting need to be added along with upgraded air supply, which means new air handlers and finding the appropriate space. Hospital construction is time consuming, detail oriented and requires specialized documentation to implement.
Unfortunately, COVID-19 is a stubborn virus, difficult to remove once it is within a facility. It can live for many hours on surfaces and requires extreme diligence to sanitize. It can also be easily transferred from patient care areas to other parts of the hospital. One study found COVID-19 on the floors of the hospital pharmacy, an area where no patients travel, meaning the virus was tracked there on the soles of staff shoes.
Despite the challenges that many hospitals and healthcare workers face, there are steps that can be taken to improve safeguards. The following are some sources of information for how to assess the physical situation of the facility, its preparedness for the pandemic, and information on how far COVID-19 can travel within a facility: