Movements

Consider how patients will be transported from the waiting room through the emergency department to the isolation or precautions room. What route will they take to minimize exposure from the emergency department to the floor or unit dedicated within your hospital?

What route will patients take from the emergency department to the inpatient unit? Use security to facilitate clearing the route, hold the elevator, and ensure that the elevator is cleaned after patient transport.

What route will your used supplies take to be cleaned, and how will your nasal swabs be transported to the lab (eg, we are not using our tube system)?

Diagnostics

Develop plans for terminal cleaning of CT scan rooms and other bedside diagnostic equipment (portable radiology, ultrasound, etc.). For example, will you have a dedicated ultrasound?

We have developed a process to perform portable radiographs through the door window for patients in isolation, reducing risk to staff and the need to clean portable units (see Figure 1). The radiographs have been found to be of acceptable quality for reading using this technique.

Figure 1: Radiology teams from our institution have minimized staff and equipment exposure by performing single-view portable radiographs through the windows on doors to isolation rooms. Left: The patient is positioned standing or sitting in front of the door inside the isolation room with a nurse/staff wearing a lead shield, holding the plate to the patient’s chest. Center: The portable machine camera is brought close to the glass, and adjustments are made to the machine to optimize the film. The film is passed by the gowned nurse outside the room with removal of the plastic sheet while passing to the X-ray staff outside the room, keeping the plate clean. Right: While artifact from the window is sometimes present on the film, our radiologists have been able to read from these for multi-focal pneumonia and tube placement.
Credit: University of Washington

Systems

Staffing

Plan to have a double backup system in place ensuring that if staff members are sick, there is an easy system to call in relief without having to scramble. This system also protects against staff members feeling remorse or hesitance about calling in sick and contributing to dangerous “presenteeism” and coming to work sick.

Consider:

• Canceling communal food in meetings and care areas and moving to tele-education and online meetings.
• Updating staff flu shots.
• Requiring use of scrubs instead of wearing personal clothes to work and encouraging minimization of jewelry and personal items as fomites.
• Using gel-in/gel-out hand hygiene and redoubling efforts to ensure 100 percent compliance for all patients.
• Creating a hospital-wide plan for backup child care so physicians, nurses, and other staff are not staying home to care for their children if schools close.

Figure 2: Physicians practice intubating using the glidescope while in a PAPR with a shroud.
Credit: University of Washington