31
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore Translated title: Se préparer pour la pandémie de COVID-19: revue des moyens déployés dans un bloc opératoire d’un grand hôpital tertiaire au Singapour

      review-article
      , MBBS, MMed (Anaes), FANZCA , , MBBS, MMed (Anaes), EDIC, , MB ChB, MMed (Anaes), , MBBS, MRCP, MMed (Anaes), , MBBS, MMed (Anaes), , MBBS, MMed (Anaes), EDIC, PGDip (Clinical Ultrasound), FCCP, FCCM, FAMS, , MBBS, MMed (Anaes), FANZCA, CICM
      Canadian Journal of Anaesthesia
      Springer International Publishing

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.

          Résumé

          L’épidémie liée au coronavirus 2019 (COVID-19) a été qualifiée d’urgence de santé publique de portée internationale. La préparation face à une pandémie nécessite de la part d’un hôpital l’élaboration de stratégies pour gérer ses infrastructures, ses processus, son personnel et ses patients; il doit notamment instaurer des mesures de prévention des infections pour réduire la transmission intrahospitalière. Pour un bloc opératoire, ces préparations impliquent la participation de nombreux acteurs et peuvent constituer un véritable défi. Nous décrivons les mesures prises en réponse à l’épidémie par le département d’anesthésie qui sert le plus grand hôpital universitaire de soins aigus (1700 lits) de Singapour ( Singapore General Hospital) et un plus petit hôpital régional ( Sengkang General Hospital). Cela a été obtenu grâce à des expertises d’ingénierie, telles que l’identification et la préparation d’une salle d’opération en isolation, des mesures administratives telles que la modification du déroulement des activités et des processus, l’introduction d’équipements de protection individuels pour le personnel et — enfin — la formulation de lignes directrices cliniques pour la gestion anesthésique. La simulation a été importante pour évaluer la faisabilité de toutes nouvelles modifications des salles d’opération ou d’un nouveau flux de travail. Dans le contexte des différentes phases d’une pandémie, nous discutons de l’application d’une hiérarchie de contrôles comme cadre des modifications à chaque niveau de contrôle et nous passons aussi en revue les données probantes soutenant les mesures prises. Ces mesures de confinement sont nécessaires pour optimiser la qualité des soins procurés aux patients atteints de COVID-19 et pour réduire le risque de transmission du virus à d’autres patients ou employés du domaine de la santé.

          Related collections

          Most cited references38

          • Record: found
          • Abstract: found
          • Article: not found

          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Clinical Characteristics of Coronavirus Disease 2019 in China

            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found

              Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

              In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
                Bookmark

                Author and article information

                Contributors
                jolin.wong@singhealth.com.sg
                Journal
                Can J Anaesth
                Can J Anaesth
                Canadian Journal of Anaesthesia
                Springer International Publishing (Cham )
                0832-610X
                1496-8975
                11 March 2020
                : 1-14
                Affiliations
                GRID grid.163555.1, ISNI 0000 0000 9486 5048, Division of Anaesthesiology, , Singapore General Hospital, ; Outram Road, Singapore, 169608 Singapore
                Author information
                http://orcid.org/0000-0001-8318-5685
                http://orcid.org/0000-0002-3856-8342
                http://orcid.org/0000-0001-8565-1934
                Article
                1620
                10.1007/s12630-020-01620-9
                7090449
                32162212
                6ffe3ac2-d0cc-4e8b-a281-dce6d1ff6ed9
                © Canadian Anesthesiologists' Society 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 2 March 2020
                : 4 March 2020
                : 4 March 2020
                Categories
                Review Article/Brief Review

                Anesthesiology & Pain management
                Anesthesiology & Pain management

                Comments

                Comment on this article