Liuyi Li and colleagues take a closer look at the challenges and countermeasures taken to develop stringent infection prevention and control procedures for the dedicated covid-19 hospitals in repurposed buildings in China

Many countries have needed to open additional hospitals to help cope with a surge of patients and pressures on healthcare resources during the covid-19 pandemic. Stadiums, exhibition centres, and idle industrial plants are among the types of buildings that have been repurposed to provide emergency shelter hospitals. As the epicentre of the outbreak in China, Wuhan city constructed 16 such facilities, known as FangCang shelter hospitals, in February 2020.¹ Shelter hospitals have higher risks of nosocomial infection than general hospitals, so several strategies and approaches were applied in Wuhan FangCang hospitals to prevent and control the infection of patients and health workers.

As there was no precedent for shelter hospitals for the treatment of contagious disease in China, there were no specific guidelines or consensus for infection prevention and control that could be followed.² Specialised protocols and procedures were needed for the reconstruction of buildings and facilities; cleaning, disinfection, and sterilization of medical supplies; health worker and patient management; plus a range of contingency plans. Infection control specialists created these for FangCang shelter hospitals by adapting protocols and procedures for other facilities, and by developing new ones based on previous relevant guidelines, regulations, and laws.^3-7

Four key characteristics of FangCang hospitals were considered as the reasons for them being at greater risk of nosocomial infection: lack of administrative management experience, non-medical use buildings, temporarily enrolled health workers, and a high density of patients.

Due to the highly contagious nature of covid-19, the administration and management of infection control in FangCang hospitals had to be more stringent than for general hospitals. Each FangCang hospital established a coordinating department of infection prevention and control, and involved not only infection control professionals, but also doctors, nurses, and logistics managers to supervise nosocomial infection comprehensively and efficiently.

Non-medical use buildings selected as FangCang hospital sites could not meet the general needs for infection prevention and containment. Specific issues included difficulties of partitioning and zoning into clean, potentially contaminated, and contaminated zones; difficulties in partitioning work areas, ward area, and connecting routes; insufficient ventilation and water supplies; and lack of supply and situation of sterile equipment, laboratory testing, and diagnostic imaging. To address these issues, extra physical barriers were constructed between areas and routes; extra ventilation facilities, and portable washbasins and toilets were installed; simple cleaning and disinfection centres were set up with procedures for sending equipment requiring sterilization to covid-19 designated general hospitals; and mobile vans to provide tests and examinations facilities were situated outside.

Healthcare workers came from hospitals across China to staff FangCang hospitals so had inconsistent knowledge, skills, and practices in nosocomial infection control. All were provided with standardised and strengthened training in areas such as the standard operating procedure (SOP) for putting on and removing personal protective equipment (PPE) before they could begin work. Essential PPE were provided and staff were monitored for covid-19 related symptoms more frequently.

A minimum safe distance was kept between beds and physical barriers installed between care units to reduce cross infection with other respiratory infectious diseases, gastrointestinal infectious diseases, and infection with multi-drug resistant (MDR) organisms. Patients with severe covid-19 or other infectious diseases were moved to intensive isolation wards. 

As social interactions between patients might also increase risks of transmission of other infectious disease, patients were provided with surgical masks, alcohol-based hand rub, and disinfecting wipes. They were taught about effective hand hygiene, cough etiquette, maintaining distance and how to use masks, and monitored for symptoms of other infectious diseases frequently. Standard meals were provided in an attempt to prevent outbreaks of foodborne illness.

The set up and the protocols and procedures put in place for infection control at the Wuhan FangCang shelter hospitals appear to have been successful in infection prevention and containment. In March, none of the 12,000 patients were infected with other infectious diseases, and none of the 15,000 health workers tested positive for covid-19.⁸ However, the cost-effectiveness of the infection control strategies and approaches need to be further investigated.

Wuhan FangCang shelter hospitals successfully treated a large number of mild and moderate covid-19 patients, which helped reserve existing medical facilities for patients in a severe or critical condition, blocked the transmission of covid-19, and protected the health care system from breaking down. This suggests that the approach might be a good solution for tackling covid-19 in countries with high demand for treatment but low medical resources.⁹

Liuyi Li is professor and director of the department of infection control, Peking University First Hospital, Beijing, China. 

Shuobin Zhu is research assistant of the medical affairs office, Peking University First Hospital, Beijing, China.

Ruogu Meng is research assistant professor of the National Institute of Health Data Science, Peking University, Beijing, China.

Anhua Wu is professor and director of the Center for Healthcare-associated Infection Control, Xiangya Hospital, Central South University, Changsha, China.

Fu Qiao is technologist-in-charge and section chief of infection prevention and control department, West China Hospital, Sichuan University, Chengdu, China.

Siyan Zhan is professor and chair of Department of Epidemiology and Biostatistics, School of Public Health, Peking University, and director of Center for Clinical Epidemiology, Peking University Third Hospital, Beijing, China.

Competing interests: none declared. 

Funding: this work was supported by a grant from the National Natural Science Foundation of China (81973146) and the Beijing Advanced Discipline Construction Project (BMU2019GJJXK001).

 

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