Transcription

OpenWHO: Severe Acute Respiratory Infection (SARI)

Treatment Facility Design

WHO- Severe Acute Respiratory Infection (SARI) Treatment Facility Design

Module: 2

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[Slide #1] Welcome to module two, Designing SARI Screening Area and Treatment Center.

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[Slide #2] By the end of this lecture, you will be able to: identify the basic principles and layout of a COVID-19
screening point for healthcare facilities. Describe how to set up a SARI treatment center. And also be able to
describe how to set up a SARI treatment center using tents.

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[Slide #3] The lecture is organized in three different sections for easy understanding. Section 2A looks at basic
principles and lay out of a COVID-19 screening point for healthcare facilities. 2B, setting up a SARI treatment
center. And 2C is about SARI treatment center in tents.

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[Slide #4] Module 2A, basic principles and lay out of a COVID-19 screening point for healthcare facilities.

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[Slide #5] Screening and clinical triage includes a system for assessing all patients at admission, allowing for
early recognition of possible COVID-19, and immediate isolation of patients with suspected disease in an area
separate from other patients. To facilitate the early identification of cases, establish a proper screening
system at all different levels of a public health system, to enable early detection of potential suspected cases.
It should include temporary isolation capacity, referral ambulance, trained staff, protocols and all needed
supplies. Screening area can be set up in existing facilities, built as new construction, or using semi-permanent
structures, such as tents of different sizes.

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[Slide #6] The proposed layout is based on the standard screening setting endorsed with proper infection
prevention and control measures regarding ventilation. It describes the basic structure principles and
essential services.

One, patient entry. This is where the patient access the healthcare facility. It is essential that all patients
should pass through the triage. At this point, anybody arriving should receive a mask, perform hand hygiene
and be directed to the waiting room.

The waiting room should be composed of different individual booth, with separate entrances and exits, and
be completely open in order to allow good natural ventilation. Three, toilets for patients, both male and
female, should be nearby.

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OpenWHO: Severe Acute Respiratory Infection (SARI)
Right from Facility
Treatment the waiting room, patients should access the screening area, which is divided into two zones, one
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for the patient and another for staff. This special separation allows staff to screen a patient without wearing
any personal protective equipment.

After the screening, patients can either be moved direct to the healthcare facility if the case definition is not
met, or be kept in a temporary isolation room while you are waiting for a referral towards a SARI treatment
center.

This is the representation of a flow as just describe with the patient here represented as the blue circle
moving from the entrance to the waiting room, accessing this screening area and being addressed either to
the healthcare facility or to the temporary isolation room, waiting for the referral.

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[Slide #7] This is an example of a waiting room and screening area within a tent with a surface area of a
hundred square meters. Services are integrated in a single structure, but always following the same patient
flow. It is worth mentioning that the special distance in the screening station can, as well, be replaced with a
transparent surface such as glass or plexiglass in order to protect healthcare workers and to rationalize the
use of PPE.

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[Slide #8] And here's an example of a screening area within it and with a surface area of about 45 square
meters. It lays on the same principle, only that due to the difference in size, waiting room and screening area
are in different structures.

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[Slide #9] Here's how a standard 45 square meter tent, commonly used in emergency settings, is divided
into 10 individual booth for patients waiting to access the screening area.

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[Slide #10] Small tents allow more flexibility in terms of capacity. Thus, if required by the epidemiological
situation, installing more of these smaller tents to increase the waiting room capacity and installing a second
screening tent can easily be done.

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[Slide #11] Tents to be used for screening and waiting rooms should it be correctly installed, in order to allow
a clear and practical patient flow.

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[Slide #12] Module 2B, setting up a SARI treatment center.

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OpenWHO: Severe Acute Respiratory Infection (SARI)
Treatment Facility Design
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[Slide #13] A SARI treatment center should be set up as close as possible to the center of the outbreak. This is
very important to reduce time for the sick to reach the facility the soonest for medical care.

The treatment center could be set up next to an existing healthcare facility, or choose to set it up in new place
according to specific strategic reasons. However, you need to consider some of the construction
requirements, such as; enough space in case of future extensions, and water source accessibility, the soil
condition, and take into account the prevailing winds for the smoke and odors.

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[Slide #14] Basically, some of the rationale behind principle lay out of a SARI treatment center are; provision
of medical care as soon as possible, even prior to laboratory confirmation, in order to avoid medical
conditions worsening.

Consider the different levels of risk represented by a patient with specific medical conditions, such as severe
cases needing aerosol generating procedures, such as aspiration, intubation, bronchoscopy, et cetera. Ensure
a clear demarcation and separation from patient and staff areas, to reduce the risk of healthcare workers and
allow optimal use of the personal protective equipment.

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[Slide #15] Here the diagram with an overview lay out based on clinical definition associated with COVID-19.
The clinical syndromes will help determine whether a patient suspected of COVID-19 case is considered mild,
or moderate, or severe. That includes some critical patients too.

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[Slide #16] In this diagram, the different colors represents different zones of the SARI treatment center with
specific functions in each zone.

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[Slide #17] The next series of slides highlights key elements of a SARI treatment center. This first part starts
with where patients would enter from to the waiting room. Triage and room for taking samples are located in
this area.

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[Slide #18] Here you have the mild or moderate zone for observation, and all just for a short stay.

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[Slide #19] A ward for severe cases,

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[Slide #20] critical cases would be treated in this ward.

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[Slide #21] Staff working in the facility would enter from this area, with the facility to change to working
suits. But also on the middle, you will notice the laboratory which is accessed from here too.

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[Slide #22] Any SARI facility should have a zone for managing waste as well as a mortuary too.

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[Slide #23] Patients categorized by medical severity are thus mild, or moderate, severe, or critical, and are
physically separated from each other.

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[Slide #24] This categorization by severity means that each ward has its specific case management, as
uncomplicated in as, that would require a short stay, and later could as well be managed at a local or
community facility. Severe pneumonia cases requiring oxygen, and also critical case ward, with ventilation
installation from which to manage patients,

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[Slide #25] as well as different IPC measures as: droplet and contact precautions in moderate case ward,
airborne and contact precautions in the severe and critical case wards.

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[Slide #26] From a structure point of view, wards have different types of ventilation. Natural ventilation is
for the short stay, special separation ward. Ventilation of 160 liters per second per patient for severe cases, in
ward or individual self-contained room. And ventilation of at least 160 liters per second per patient for critical
cases in the individual self-contained room.

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[Slide #27] Now Let's see the patient's flow. One, the patient entry. At this point, all patients should receive a
mask, wash their hands, and they are directed to a dedicated individual booth in the waiting room.

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OpenWHO: Severe Acute Respiratory Infection (SARI)
Treatment
[Slide Second,
#28]Facility waiting room. A waiting room has several individual booths, with separated entrances
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and exits. There are no doors fitted, and allows good natural ventilation. The waiting room has dedicated
toilets.

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[Slide #29] Third, triage patients are investigated in individual triage booths, with a one meter distance fence
of about 1.2 meters high, that separates patients from staff. This facility is open without doors, so it allows a
proper natural ventilation and is equipped with dedicated toilets.

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[Slide #30] Fourth, sampling. A sampling room has four individual booths with natural or hybrid ventilation.
However, patients can only be tested if a doctor decides so.

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[Slide #31] The patient's accessing details should look like this image with different services. You see, number
one is patient entry.

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[Slide #32] Number two, the reception. This is where the patients perform hand hygiene and receive clear
indication to move a specific waiting booth.

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[Slide #33] Number three, waiting room. This should be with individual waiting rooms.

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[Slide #34] Four, patients' toilets.

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[Slide #35] Number five, this is the triage section.

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[Slide #36] Number six, these are the four individual sampling booths.

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[Slide #37] Number seven, this is where ambulances can enter the facility from.

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Treatment Facility Design
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[Slide #38] Eight, donning and doffing. Here is to put on and put off the PPE.

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[Slide #39] Number nine is a barrier. It should be 1.2 meters high, and this is to identify the patients' arrival
area.

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[Slide #40] Patients are moved to the short stay ward, where distances and natural ventilation assure
infection prevention and control standards. Patients can wait for a few hours for the laboratory results, while
receiving health promotion sessions and treatment.

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[Slide #41] For discharge, if patients are tested negative, they can be referred to another healthcare facility.
However, if they've tested positive, the mild and moderate cases can be referred to the community facility for
isolation and follow-up.

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[Slide #42] A moderate case is only moved to the observation room in such a case where the medical
department wants to keep him or her under observation for a few more hours,

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[Slide #43] while severe cases are moved directly to the severe case ward. Medical care will be provided, as
well as a sample taken from the patient. There are individual self-contained rooms with hybrid ventilation in
this ward.

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[Slide #44] If tested negative, the patient will then be discharged through a dedicated discharge room.

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[Slide #45] Critical cases are moved directly to the critical case ward, where medical care will be provided and
a sample taken. The ward has individual self-content rooms with hybrid ventilation.

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OpenWHO: Severe Acute Respiratory Infection (SARI)
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[Slide However,
#46]Facility if a critical case is tested negative, then the patient will be discharged through a
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dedicated discharge room.

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[Slide #47] Patient's flow follows a certain logic. It is not unidirectional; as according to medical conditions,
patients can be moved from one ward to another. For instance, if a moderate patient's condition deteriorates,
the patient will be moved to the severe ward,

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[Slide #48] or to the critical ward.

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[Slide #49] Likewise, a critical patient whose condition has improved can be moved from the severe ward,

[Slide #50] and to the short stay ward,

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[Slide #51] and to be finally discharged according to the discharge criteria.

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[Slide #52] Here we'll look in detail in the mild and moderate wards.

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[Slide #53] Patients have at least two meters in between them. One meter as infection prevention and
control measure, and one meter to facilitate healthcare worker movement.

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[Slide #54] And if you see at number two, this is a single barrier of about 1.2 meters high. Although not
mandatory, a double fence with one meter distance can be used to help visitors respect the spatial distance
while visiting patients.

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[Slide #55] Number three is a working area. This is only for staff.

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[Slide #56] Number four is the place to remove working gear, or the personal protective equipment.
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Treatment Facility Design
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[Slide #57] Number five are shelves where you can keep the personal protective equipment.

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[Slide #58] Number six is the entrance for patients.

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[Slide #59] And on number seven, only staff would enter from here.

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[Slide #60] Number eight is a discharge room, pending patients release.

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[Slide #61] Nine, are windows for ventilation,

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[Slide #62] and 10 is the observation.

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[Slide #63] Here we are going to look in detail in the flow of patients in the severe and critical wards.

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[Slide #64] Number one is individual doffing room.

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[Slide #65] Number two is an individual self-contained room with a terrace.

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[Slide #66] Three are toilets and showers per individual self-contained room.

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OpenWHO: Severe Acute Respiratory Infection (SARI)
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[Slide Number
#67]Facility four, you have the PPE shelves.
Design

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[Slide #68] Five is the staff working area.

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[Slide #69] Six, patients entrance.

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[Slide #70] Number seven is the entrance for staff only.

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[Slide #71] And finally on number eight, the space for cleaning and disinfecting equipment.

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[Slide #72] On this diagram we are going to look at the staff flow. First, staff entry. Staff at this point will
receive a mask. They wash their hands, have their temperature checked, and record their presence.

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[Slide #73] Number two are changing rooms. There are changing room for male and female to remove
personal clothes and wear scrubs and boots or closed shoes. Staff toilets are situated nearby.

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[Slide #74] Third, triage. Staff will check on patients in the individual triage booths. A one meter distance
fence of 1.2 meters high separates patients from staff. The facility is completely open, so no doors, to allow a
proper natural ventilation.

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[Slide #75] Number four is a triage donning and doffing place. Staff can wear specific personal protective
equipment before going to meet patients at the triage.

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[Slide #76] Five is the staff area in the wards. Each ward has a functional working space for staff, where
patients are not allowed. You will get more information in the next chapter.

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[Slide #77] On this image, it shows a facility with transparent surfaces. On the left is an outside view of the
facility, and on your right is a facility from inside.

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[Slide #78] A treatment center with transparent surfaces have improved case management, but also the
relationship between patient and the medical personnel in the sense that there is the visual contact with the
patient without need of personal protective equipment. The biomedical devices can be placed on the staff
side, such as the monitor, oxygen, or the IV. Flexible and uniform technical plateau for all rooms, as medical
devices can be moved. It is humanized care, as there is interaction between patient and clinicians, or the
medical personnel. There is a huge reduction of entries in the patient's area. Thereby, there is a considerable
reduction of personal protective equipment use.

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[Slide #79] Welcome to module two C, SARI treatment center in tents.

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[Slide #80] Small tents of about 45 square meters can be used to set up wards for mild and moderate cases,
by installing individual booth with beds in it. You can set up a toilet close, but outside the tent.

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[Slide #81] For severe and critical patients, private rooms, together with private toilets are recommended.

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[Slide #82] This layout is an example of a staffs entrance, with small tents of about 45 square meters, and
the different zones for the temperature screening, toilet, changing room, reception, the office, but also the
logistics warehouse.

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[Slide #83] And on this last slide you have an overview layout of a SARI treatment center in tents. It follows
some logic, so you need to have all the zones. Like one, the staff area. Two, triage area. Three, the short stay.
Four, the moderate ward. And five, this for the severe cases.

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