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Analysis

Coronavirus: 5 Lessons Learned from Temporary Hospitals in China

By Christopher Cheney  
   March 31, 2020

Doctors in Wuhan, China, share steps to establish temporary hospitals for coronavirus patients.

At the epicenter of the coronavirus disease 2019 (COVID-19) pandemic—Wuhan, China—health officials followed a five-step process to establish more than a dozen temporary hospitals in preexisting nonmedical buildings, a recent journal article says.

Over the past two weeks, China has had a relatively stable number of reported COVID-19 cases at more than 81,000, according to worldometer. in the United States as of March 31, there had been more than 164,000 confirmed cases, with more than 3,100 deaths, worldometer reported.

The recent journal article on temporary COVID-19 hospitals in Wuhan was published as part of a special article series in the journal Anesthesiology. The temporary hospitals played a key role in addressing the COVID-19 outbreak in Wuhan, the journal article says. "The establishment and operation of temporary COVID-19 specialty hospitals proved to be useful in the control of an infectious crisis within Wuhan, China, and will hopefully provide a blueprint for the management of future epidemiologic disasters."

The primary purpose of the temporary hospitals is to help control the COVID-19 outbreak in Wuhan by admitting all COVID-19 patients who are asymptomatic or exhibiting mild symptoms, the journal article says. "These temporary specialty hospitals can dramatically and immediately expand the admission capacities of the whole city, reduce the burdens/patient loads of designated comprehensive hospitals, manage COVID-19 patients centrally, eliminate virus transmission routes, and protect susceptible populations from COVID-19."

Patients who develop severe illness are transferred from the temporary hospitals to comprehensive care hospitals.

The temporary hospitals are 10 times less expensive than building a new comprehensive COVID-19 care hospital, and they reduce fear and anxiety in the community, the journal article says. "These facilities serve to quickly contain all potential sources of infection from the public, and because all patients have the same confirmed COVID-19 virus, patient-to-patient cross infection is not present."

Wuchang Ark Hospital in Wuhan, China, was established in a sports arena. Photo credit: Anesthesiology

5-step process

The Wuhan temporary COVID-19 hospitals utilized five strategies to build and operate the facilities.

1. Infrastructure renovation and infection control: In early February, the journal article's co-authors established a temporary hospital (Wuchang Ark Hospital) in a Wuhan sports arena. The first step was ensuring that the arena could be renovated to comply with international infection control and treatment standards.

"Through close communication with our architects and engineers, we provided constructive advice on patient care area distribution, hallway design, electricity arrangement, and information network connections," the journal article says.

2. Hospital configuration and staffing management: At Wuchang Ark Hospital, the clinical care area including an ICU is in the arena, and supply, screening, and testing facilities are located in tents and ambulances outside the arena. The clinical care staff is drawn from a national emergency team and local medical professionals.

Recent staffing at the temporary hospital featured 125 physicians, 500 nurses, and 90 administrative workers. There are several personnel departments at the hospital, including administration, clinical care, infection control, and supply chain.

3. Procedure and policy standardization: With the temporary hospital's staff drawn from several sources, standard procedures and policies were necessary, including patient identification verification policy, admission and discharge procedures, medical waste disposal procedures, and standards for nursing, infection control, and supply chain.  

There also are priorities for patient care, the journal article says. "We especially focus on the elderly and patients with comorbidities secondary to the high mortality rate in this population. Fear, anxiety, and depression are common, and we provide mental health care and intervene on emotionally unstable patients."

4. Staff education and infection control measures: When the temporary hospital opened, infectious disease experts provided infection control and prevention training as well as guidance on how to use personal protective equipment. The infectious disease experts also provided training for three levels of infection control procedures.

Level 1 infection control features scrubbing, disposable hats, disposable gowns, and disposable surgical masks. Level 2 infection control features scrubbing, disposable hats, medical masks—N95 or above, anti-fog eye and face shields, disposable gloves, and disposable shoe covers. Level 3 infection control features all Level 2 requirements, except eye and face shields are replaced with positive pressure respirator hoods.

Training efforts were extensive, the journal article says. "Our Division of Infectious Disease provided 13 sessions to educate more than 500 physicians, nurses, policemen, security, and environmental services. For our team of more than 450 nurses, we provided training with lectures, simulations, and live demonstrations on proper throat swab procedures in COVID-19 patients for testing."

5. Supply preparation and logistics management: "Frontline leadership and the National Health Commission coordinated with local government public health departments to ensure adequate personal protective equipment for healthcare providers as well as daily necessities. Special attention is paid to fulfill the personal needs of patients if possible to help relieve their anxiety," the journal article says.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

In China, temporary hospitals are 10 times less expensive than building a new comprehensive COVID-19 care hospital.

In Wuhan, China, a primary goal of temporary hospitals for COVID-19 patients has been to help stop the spread of the novel coronavirus.

For Chinese healthcare providers, the first step in establishing a temporary hospital is infrastructure renovation and infection control.


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