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The transmission of coronavirus disease 2019 (COVID-19) has presented challenges for the control of the indoor environment of isolation wards. Scientific air distribution design and operation management are crucial to ensure the environmental safety of medical staff. This paper proposes the application of adaptive wall-based attachment ventilation and evaluates this air supply mode based on contaminants dispersion, removal efficiency, thermal comfort, and operating expense. Adaptive wall-based attachment ventilation provides a direct supply of fresh air to the occupied zone. In comparison with a ceiling air supply or upper sidewall air supply, adaptive wall-based attachment ventilation results in a 15%–47% lower average concentration of contaminants, for a continual release of contaminants at the same air changes per hour (ACH; 10 h–1). The contaminant removal efficiency of complete mixing ventilation cannot exceed 1.0. For adaptive wall-based attachment ventilation, the contaminant removal efficiency is an exponential function of the ACH. Compared with the ceiling air supply mode or upper sidewall air supply mode, adaptive wall-based attachment ventilation achieves a similar thermal comfort level (predicted mean vote (PMV) of –0.1–0.4; draught rate of 2.5%–6.7%) and a similar performance in removing contaminants, but has a lower ACH and uses less energy.

Early diagnosis is critical for the prevention and control of the coronavirus disease 2019 (COVID-19). We attempted to apply a protocol using teleultrasound, which is supported by the 5G network, to explore the feasibility of solving the problem of early imaging assessment of COVID-19. Four male patients with confirmed or suspected COVID-19 were hospitalized in isolation wards in two different cities. Ultrasound specialists, located in two other different cities, carried out the robot-assisted teleultrasound and remote consultation in order to settle the problem of early cardiopulmonary evaluation. Lung ultrasound, brief echocardiography, and blood volume assessment were performed. Whenever difficulties of remote manipulation and diagnosis occurred, the alternative examination was repeated by a specialist from another city, and in sequence, remote consultation was conducted immediately to meet the consensus. The ultrasound specialists successfully completed the telerobotic ultrasound. Lung ultrasound indicated signs of pneumonia with varying degrees in all cases and mild pleural effusion in one case. No abnormalities of cardiac structure and function and blood volume were detected. Remote consultation on the issue of manipulation practice, and the diagnosis in one case was conducted. The cardiopulmonary information was delivered to the frontline clinicians immediately for further treatment. The practice of teleultrasound protocol makes early diagnosis and repeated assessment available in the isolation ward. Ultrasound specialists can be protected from infection, and personal protective equipment can be spared. Quality control can be ensured by remote consultations among doctors. This protocol is worth consideration as a feasible strategy for early imaging assessment in the COVID-19 pandemic.

Highlights • Cases of COVID-19 may be housed outside isolation wards prior to detection. • A bundle of infrastructural enhancements, improved PPE and social distancing was implemented. • Of 253 staff close-contacts and 45 patient close-contacts of 28 index cases, one patient contact tested positive. • Environmental sampling was positive for SARS-CoV-2 in 5 out of 28 cases. • An infection control bundle mitigated COVID-19 transmission in a general ward setting., Background During an ongoing outbreak of COVID-19, unsuspected cases may be housed outside of dedicated isolation wards. Aim At a Singaporean tertiary hospital, individuals with clinical syndromes compatible with COVID-19 but no epidemiologic risk were placed in cohorted general wards for COVID-19 testing. To mitigate risk, an infection control bundle was implemented comprising infrastructural enhancements, improved personal-protective-equipment (PPE), and social distancing. We assessed the impact on environmental contamination and transmission. Method Upon detection of a case of COVID-19 in the dedicated general ward, patients and healthcare workers (HCWs) contacts were identified. All patient and staff-close contacts were placed on 14-day phone surveillance and followed-up for 28 days; symptomatic contacts were tested. Environmental samples were also obtained. Findings Over a 3-month period, 28 unsuspected cases of COVID-19 were contained in the dedicated general ward. In 5 of the 28 cases, sampling of the patient's environment yielded SARS-CoV-2; index cases who required supplemental oxygen had higher odds of environmental contamination (p=0.01). A total of 253 staff close-contacts and 45 patient close-contacts were identified; only 3 HCWs (1.2%, 3/253) required quarantine. On 28-day follow-up, no patient-to-HCW transmission was documented; only one symptomatic patient close-contact tested positive. Conclusion Our institution successfully implemented an intervention bundle to mitigate COVID-19 transmission in a multi-bedded cohorted general ward setting.

Aim To explore an effective personalized training model for nurses working in emergency isolation wards of COVID‐19 in a short period. Design This study is a longitudinal study from 24 January 2020 to 28 February 2020. Methods There are 71 nursing staff working in the emergency isolation wards of Sichuan Provincial People's Hospital that participated in this study. The questionnaires were conducted with Likert scale. The operation assessment teachers have received standardized training. The self‐rating anxiety scale (SAS) and self‐rating depression Scale (SDS) were applied to assess the mental state of nurses. Results After short‐term training, these nurses can handle the emergency tasks in a timely manner. The pass rate of nurse theory and operation assessment is 100%. The 111 suspected patients admitted to the emergency isolation ward have been scientifically diagnosed and treated, the three confirmed patients have received appropriate treatment. No nurses have been infected. Conclusions In this study, the personalized emergency training mode was feasible in the emergency isolation ward during the COVID‐19 epidemic, which rapidly improved the rescue ability of nurses and effectively avoid the occurrence of cross‐infection. This mode can provide a valuable reference for the emergency training of nurses in the future.

Background Severe COVID‐19 patients typically test positive for SARS‐CoV‐2 RNA for extended periods of time, even after recovery from severe disease. Due to the timeframe involved, these patients may have developed humoral immunity to SARS‐CoV‐2 while still testing positive for viral RNA in swabs. Data are lacking on exposure risks in these situations. Here, we studied SARS‐CoV‐2 environmental contamination in an ICU and an isolation ward caring for such COVID‐19 patients. Methods We collected air and surface samples in a hospital caring for critical and severe COVID‐19 cases from common areas and areas proximal to patients. Results Of the 218 ICU samples, an air sample contained SARS‐CoV‐2 RNA. Of the 182 isolation ward samples, nine contained SARS‐CoV‐2 RNA. These were collected from a facemask, the floor, mobile phones, and the air in the patient room and bathroom. Serum antibodies against SARS‐CoV‐2 were detected in these patients at the beginning of the study. Conclusions While there is a perception of increased risk in the ICU, our study demonstrates that isolation wards may pose greater risks to healthcare workers and exposure risks remain with clinically improved patients, weeks after their initial diagnoses. As these patients had serum antibodies, further studies may be warranted to study the utility of serum antibodies as a surrogate of viral clearance in allowing people to return to work. We recommend continued vigilance even with patients who appear to have recovered from COVID‐19.

In order to accurately admit children with COVID-19 to an isolation ward, our study retrospectively analyzed the clinical characteristics of children in isolation wards during the COVID-19 epidemic. It was found that 55 cases (83.3%) had fever and 48 cases (72.7%) coughed in the isolated area, 31 cases (47%) had a history of exposure, 26 cases (39.4%) had a decrease in lymphocytes (LYM), more than half had an increase in lactate dehydrogenase and creatine kinase isoenzyme, 14 cases (21.2%) had positive SARS-CoV-2 nucleic acid, 58 cases (87.9%) had abnormal chest computed tomography (CT), and 11 cases (16.7%) had sinus arrhythmia. Therefore, for some suspected children with COVID-19, we can make a comprehensive judgment through clinical symptoms, epidemiological history, LYM number, myocardial enzyme spectrum, chest CT, and electrocardiogram; put these children in an isolation ward for treatment; and then transfer them to a general ward for treatment after excluding COVID-19.

Objective:Here, we present an overview of how a tertiary hospital responded to maintain necessary activities and protect patients and staff from the coronavirus disease (COVID-19) outbreak.Methods:Gil Medical Center, a tertiary hospital in Incheon, has operated a special response team since January 21, 2020. All visitors were assessed for body temperature and respiratory symptoms, and screened for recent overseas travel. Suspected COVID-19 patients were taken to a screening clinic. All febrile patients with or without respiratory symptoms were taken to a respiratory safety clinic. An isolation ward, which consisted of 10 negative-pressure rooms, was used to treat confirmed cases. More than 120 beds were prepared for the outbreak, and patients with pneumonia were preemptively isolated.Results:By May 5, 480 960 visitors were assessed at the control station, 3350 patients visited the triage center, and 1794 were treated in the respiratory safety clinic. Seventeen confirmed cases were admitted to the negative isolation ward, and 350 patients with pneumonia were preemptively isolated. A total of 2977 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction tests were performed.Conclusions:While tertiary hospitals play an important role in treating both COVID-19 patients and non-COVID-19 patients, hospital staff have to protect themselves from unexpected in-hospital transmission. A multifaceted response must be undertaken to protect tertiary hospitals and their staff during the COVID-19 epidemic.

Reliable methods to detect the presence of SARS-CoV-2 at venues where people gather are essential for epidemiological surveillance to guide public policy. Communal screening of air in a highly crowded space has the potential to provide early warning on the presence and potential transmission of SARS-CoV-2 as suggested by studies early in the epidemic. As hospitals and public facilities apply varying degrees of restrictions and regulations, it is important to provide multiple methodological options to enable environmental SARS-CoV-2 surveillance under different conditions. This study assessed the feasibility of using high-flowrate air samplers combined with RNA extraction kit designed for environmental sample to perform airborne SARS-CoV-2 surveillance in hospital setting, tested by RT-qPCR. The success rate of the air samples in detecting SARS-CoV-2 was then compared with surface swab samples collected in the same proximity. Additionally, positive RT-qPCR samples underwent viral culture to assess the viability of the sampled SARS-CoV-2. The study was performed in inpatient ward environments of a quaternary care university teaching hospital in Singapore housing active COVID-19 patients within the period of February to May 2020. Two types of wards were tested, naturally ventilated open-cohort ward and mechanically ventilated isolation ward. Distances between the site of air sampling and the patient cluster in the investigated wards were also recorded. No successful detection of airborne SARS-CoV-2 was recorded when 50 L/min air samplers were used. Upon increasing the sampling flowrate to 150 L/min, our results showed a high success rate in detecting the presence of SARS-CoV-2 from the air samples (72%) compared to the surface swab samples (9.6%). The positive detection rate of the air samples along with the corresponding viral load could be associated with the distance between sampling site and patient. The furthest distance from patient with PCR-positive air samples was 5.5 m. The airborne SARS-CoV-2 detection was comparable between the two types of wards with 60%-87.5% success rate. High prevalence of the virus was found in toilet areas, both on surfaces and in air. Finally, no successful culture attempt was recorded from the environmental air or surface samples. National Medical Research Council (NMRC) An unrestricted educational grant from Freepoint Commodities, Pvt Ltd, Singapore supported the laboratory work, biosafety level 3 procedures and consumables and equipment, manpower, sample collection, and NMRC grant MOH-000411 supported the air samplers, associated consumables, protocol development, and RNA extraction work (PI Stephan Christoph Schuster). Bintou A Ahidjo was supported by NMRC/CG/M009/2017-NUH/NUHS. Chee Keng Mok is supported by NMRC/CG/M009/2017-NUH/NUHS.

Introduction: Once a patient is diagnosed with COVID-19 infection, they are required to stay in isolation for some period of time without any social interaction whether be at home or in a hospital setting. The fear of contagion, stigmatization of COVID-19, the social isolation and fear of disease complication has undeniably brought lots of stress and other mental health problems among the infected patients. The main aim of this study is to find the prevalence of anxiety among patients staying in the isolation ward of a tertiary care center. Methods: This was a descriptive cross-sectional study conducted among 147 COVID-19 patients admitted in the isolation ward of a tertiary care center in Nepal from 20 June to 25 July 2021. Ethical approval was taken from Nepal Health Research Council (Reference number 3546). Convenient sampling method was used. Analysis of the data was done using Microsoft Excel and Software Statistical Package for Social Sciences version 26.0. Point estimate at 95% Confidence Interval was done and frequency and percentage were calculated. Results: Out of 147 participants, 29 (19.74.%) (95% Confidence Interval= 13.31-26.17) experienced some form of anxiety symptoms during their stay in isolation. Conclusions: Anxiety among COVID-19 patients in this study is similar to other studies done in similar settings. Anxiety among COVID-19 patients is quite high as compared to non COVID-19 patients, therefore assessment of mental health conditions like anxiety, insomnia, depression in patients admitted with COVID-19 should be performed along with the management of physical symptoms.

COVID-19 is a disease that is caused by a highly transmissible and pathogenic novel coronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). All of the COVID-19 positive cases in Bhutanese travellers returning via the Phuentsholing point of entry, the local population, and Indian nationals were isolated in the Phuentsholing COVID-19 isolation ward, Bhutan. This study aimed to identify the risk factors for developing symptoms among COVID-19 positive patients in this ward. A retrospective cohort study was conducted using the data regarding COVID-19 positive cases in the Phuentsholing COVID-19 isolation ward from 28 May 2020 to 31 May 2021. The Cox proportional hazards regression model was used to identify the risk factors of developing COVID-19 symptoms. There were 521 patients in the study, 368 (70.6%) were males and 153 (29.4%) were females. The mean age was 32 years (with a range of 1–78 years), and 290 (56.0%) reported at least one symptom. The median length of isolation was eight days (with a range of 3–48 days). The common symptoms were: cough (162, 31.0%), fever (135, 26.0%), and headache (101, 19.0%). In the multivariable Cox regression, vaccinated patients were 77.0% (p = 0.047) less likely to develop symptoms compared to those who were not vaccinated. The front line workers and the mini-dry port (MDP) workers were 15 (p = 0.031) and 41 (p &lt, 0.001) times more likely to be symptomatic compared to returning travellers. The young and economically active population group was most commonly affected by COVID-19. The presence of risk factors, such as being front line workers, MDP workers, or not being vaccinated against COVID-19, meant that patients had a higher probability of developing symptoms of COVID-19.

The dynamically changing epidemiological situation caused by the SARS-CoV-2 virus is associated with the increased burden and fatigue of medical personnel. The aim of the study was to evaluate: (1) oxygen and carbon dioxide blood pressure and saturation levels in medical personnel caring for patients isolated due to SARS-CoV-2 in ICUs, (2) adverse symptoms reported by medical personnel after leaving the isolation zone. Design: A Prospective Cohort Study. Methods: The project was implemented in the first quarter of 2021. Medical personnel working with patients isolated due to SARS-CoV-2 in the ICU of three hospitals were eligible for the study. The participants of the study were subjected to two analyses of capillary blood by a laboratory diagnostician. Results: In the studied group of medical personnel (n = 110) using FFP2/FFP3 masks, no significant differences (p &gt, 0.05) were found between the parameters of geometric examination performed before and after leaving the isolation ward of the hospital. After working in the isolation ward, nurses reported malaise (somnolence, fatigue, sweating, dizziness) more often than paramedics (44% vs. 9%, p = 0.00002). The risk of ill-being in nurses was approximately nine times higher than in paramedics (OR = 8.6, Cl 95%: 2.7 to 26.8) and increased with the age of the subjects (OR = 1.05, Cl 95%: 1.01 to 1.08). Conclusion: FFP2/FFP3 filter masks did not worsen blood oxygenation in medical staff caring for patients isolated due to SARS-CoV-2 in the ICU. The presence of subjective symptoms such as fatigue may be due to lack of adequate hydration.

According to the discussion of the design method and operational effect for Wuhan Huoshenshan Hospital, this paper summarized the design control points of indoor and outdoor environment of COVID-19 emergency hospital. Based on the design of Wuhan Huoshenshan Hospital, this paper analyzed and discussed the site design, building layout, three-zones and two-passages, the design scheme of the ventilation and air conditioning system for negative pressure ward and negative pressure isolation ward, air distribution, as well as some other key designs for COVID-19 emergency hospital. The design points were summarized and refined. The design methods and technology requirements of the COVID-19 emergency hospital were provided in this study, such as ventilation and air conditioning system setting, ventilation quantity of wards, pressure gradient control measures among different areas, upper and lower air distribution, filter setting mode and distance of air inlet and outlet, which could benefit to provide references for the design of similar projects in the future.

The challenges presented by the Coronavirus disease 2019 (COVID-19) pandemic to the National Health Service (NHS) in the United Kingdom (UK) led to a rapid adaptation of infection disease protocols in-hospital. In this paper we report on the optimisation of our wearable ambulatory monitoring system (AMS) to monitor COVID-19 patients on isolation wards. A wearable chest patch (VitalPatch®, VitalConnect, United States of America, USA) and finger-worn pulse oximeter (WristOx2® 3150, Nonin, USA) were used to estimate and transmit continuous Heart Rate (HR), Respiratory Rate (RR), and peripheral blood Oxygen Saturation (SpO2) data from ambulatory patients on these isolation wards to nurse bays remote from these patients, with a view to minimising the risk of infection for nursing staff. Our virtual High-Dependency Unit (vHDU) system used a secure web-based architecture and protocols (HTTPS and encrypted WebSockets) to transmit the vital-sign data in real time from wireless Android tablet devices, operating as patient data collection devices by the bedside in the isolation rooms, into the clinician dashboard interface available remotely via any modern web-browser. Fault-tolerant software strategies were used to reconnect the wearables automatically, avoiding the need for nurses to enter the isolation ward to re-set the patient monitoring equipment. The remote dashboard also displayed the vital-sign observations recorded by the nurses, using a separate electronic observation system, allowing them to review both sources of vital-sign data in one integrated chart. System usage was found to follow the trend of the number of local COVID-19 infections during the first wave of the pandemic in the UK (March to June 2020), with almost half of the patients on the isolation ward monitored with wearables during the peak of hospital admissions in the local area. Patients were monitored for a median of 31.5 [8.8, 75.4] hours, representing 88.1 [62.5, 94.5]% of the median time they were registered in the system. This indicates the system was being used in the isolation ward during this period. An updated version of the system has now also been used throughout the second and third waves of the pandemic in the UK.

In the article presented data about organization of the medical care over a period of 10 months at the Municipal Public Dental clinic in the metropolitan city such as Saint-Petersburg to the patients diagnosed with new coronavirus infection.Organization of the medical ambulatory care to the patients diagnosed with new coronavirus infection.Layout decisions were utilized that enabled to organize the reception of patients infected with SARS-CoV-2 without disrupting the scheduled mode of treatment of the dental patients. Saint Petersburg Budgetary Healthcare Facility «Municipal Dental Clinic N 33» provided dental service to 191 patients with COVID-19.Whereas 159 patients were admitted for treatment at the contagious isolation ward, 89 patients were consulted via the use of telehealth technology and among them 39 received telemedical assistance service. Mean age of the patients treated in the isolated ward: children 8.6±3.6, adults 39.1±13.8 years. People of active working age comprised 72% of all adult patients. Males filed for dental assistance more than females (54%). ICD K04.5 was established diagnosis in 52% of cases.We managed to demonstrate high efficiency in utilizing telehealth technology. An issue of organizing medical dental care at the II level healthcare institution for adult population and for children diagnosed with new coronavirus infection COVID-19 in the heavy populated metropolis was solved.В статье представлены данные об организации медицинской помощи пациентам с новой коронавирусной инфекцией на базе городской стоматологической поликлиники в мегаполисе (на примере города Санкт-Петербурга в течение 10 мес.).Организация медицинской амбулаторной помощи пациентам с новой коронавирусной инфекцией.Были применены планировочные решения, которые позволили организовать возможность осуществления приема пациентов, инфицированных вирусом SARS-CoV-2, а также продолжить прием стоматологических пациентов в плановом режиме. СПб ГБУЗ «Городская стоматологическая поликлиника №33» оказало помощь 191 пациенту с COVID-19.В бокс поступило на лечение 159 человек, 89 человек были проконсультированы с использованием телемедицинских технологий, и для 32 пациентов таким способом была оказана телемедицинская помощь. Возраст пациентов, прошедших лечение в боксе, составил: детей 8,6±3,6 года, взрослых 39,1±13,8 года. При этом лица трудоспособного возраста составили 72% от общего количества взрослых граждан. Мужчины среди обратившихся преобладали — 54%. В 52% случаев был установлен диагноз «апикальный периодонтит» (К04.5).Нами была показана высокая эффективность применения телемедицинских технологий. В крупном мегаполисе решен вопрос по организации медицинской стоматологической помощи для взрослого населения, и для детей, имеющих подтвержденный диагноз новой коронавирусной инфекции COVID-19 в учреждении II уровня.

This article reflects on some radical changes made in mental health services in China which include the implementation of the initial triage system and the special isolation ward, the early screening and testing for both patients and staff, the smaller teams working on rotating shifts on-site, and the adequate provision of PPE. These measures would be of great value as a reference to the effective delivery of mental health services in other countries through this pandemic.

ObjectiveThe COVID-19 pandemic is a care crisis of unknown duration which has seemingly not yet reached its peak in many countries. A significant number of elderly and frail people and those with underlying serious illness will continue to develop severe forms of the COVID-19 infection. Most of them are not eligible for intensive care treatment but can still expect palliative care — in many cases provided by a Hospital Palliative Care Team (HPCT). Several teams have already gained experience in caring for these patients and their families, others are preparing for it.MethodWe report on a COVID-19 patient with pre-existing acute myeloid leukemia who was looked after by a HPCT until death. We discuss the challenges and difficulties while caring for COVID-19-positive palliative patients in a non-ICU setting.ResultsHospitalization of the patient in an isolation ward caused an enormous burden for the dying patient and his family. Symptom control was particularly difficult because of rapid deteriorating dyspnea and the scarce presence of medical staff in the patient's room.Significance of resultsCOVID-19 patients who are not eligible for ICU treatment may have a particularly high need for palliative care. Since beds in specialist palliative care units are limited, the HPCT should be prepared to care for these patients. They may offer support in decision-making, optimize symptom control, and provide psychosocial care for patients and their families. Visiting restrictions aimed to protect the general public must be weighted against the patient's and family's suffering.

Aim To investigate nurses' core emergency competencies for handling the coronavirus disease-19 (COVID-19) and analyse the factors associated with those competencies. Background COVID-19 has become a major global public health event. Nursing staff have played an important role in COVID-19 prevention and control. Understanding their emergency competencies for handling COVID-19, and the potential disadvantages will help governments to develop targeted training policies and improve nurses' capacities in relation to pandemics and emergency preparedness. Introduction COVID-19 is a disastrous infectious disease, but the competencies of nurses in China to handle COVID-19 have not been well documented. Methods We conducted a cross-sectional survey on nurses from 22 provinces of China in February 2020. The scores of self-report questionnaires were used to analyse their competencies for core emergency care, and linear regression analysis was used to explore influential factors. Results A total of 2570 nurses participated. The study revealed that nurses had a good grasp of COVID-19 knowledge, but the majority of nurses lacked experience in isolation ward work and emergency training. We found that age, professional title, work department, major work content, total work time, disaster rescue history, emergency training and infectious disease training were associated with core emergency competencies. Conclusions Chinese nurses were qualified for handling COVID-19 but still need to strengthen the accumulation of practical experience. Implications for nursing Nurses should actively participate in emergencies to strengthen their operational capacity, whether in training or actual practice. Implications for nursing/health policy Managers should improve relevant policies to ensure that nurses have more opportunities to participate in the practical training of health emergencies and explore effective training methods to improve the ability of nurses to respond to these.

Background: The world faced crises of prevention and control and shortage of medical resources during the COVID-19 (Corona Virus Disease 2019) outbreak. The establishment of temporary integrated isolation wards in hospitals, which is universal and representative in China, is one of the most-effective strategies in solving these problems according to China's experiences.Aim: To conduct a preliminary study on the establishment of a temporary integrated isolation ward during the outbreak of COVID-19 and to evaluate related impact.Methods: SWOT analysis was used to analyze the advantages, disadvantages, opportunities, and risks in the establishment of the temporary integrated isolation ward, and corresponding corrective measures were made according to the analysis results.Findings: The ward has formulated more than 10 related work procedures and prevention and control measures. A total of 93 patients with 18 critically ill patients were admitted for treatment and isolation. They were all evaluated based on established procedures and protocols. Twenty-four supplementary nucleic acid tests were ordered and conducted. One new patient with COVID-19 was confirmed and was successfully transferred to the designated COVID-19 infectious control hospital. There were no missed diagnosis or misdiagnosis, no cross-infection of patients, no cluster outbreak, and no infection of medical workers during the entire process.Conclusion: SWOT analysis is helpful in guiding the establishment of a temporary integrated isolation ward and the formulation of prevention and control measures in Hebei General Hospital during the COVID-19 outbreak. It provides the guidance and reference of significance for the establishment of similar types of wards in the future.

In order to explore the rational use of nursing resources in the epidemic situation of COVID-19, we optimized the shift arrangement in COVID-19 isolation area and constructed a reasonable nursing schedule under the condition of limited human resources. Seventy-eight nurses were arranged in COVID-19 isolation area to work for 1 week according to 3 different shifts: 4 + 4 h, 6 h and 6 h (overlapping by 1 h). Through the form of questionnaire, the comprehensive job satisfaction of 3 different models were compared, and the nursing quality and the consumption of protective equipment under 3 different modes were analyzed. The results showed that the comprehensive job satisfaction and nursing quality of nurses in 6 h (overlapping by 1 h) shift mode were better than those in other shift modes, and the consumption of protective equipment was lower.

Isolation of confirmed or suspected coronavirus disease 2019 (COVID-19) cases is essential but, as symptoms of COVID-19 are non-specific and test results not immediately available, case identification at admission remains challenging. To inform optimization of triage algorithms, patient flow and patient care, we analyzed characteristics of patients admitted to an isolation ward, both severe acute respiratory syndrome coronavirus 2019 (SARS-CoV-2) positive patients and patients in which initial suspicion was not confirmed after appropriate testing.Data from patients with confirmed or suspected COVID-19 treated in an isolation unit were analyzed retrospectively. Symptoms, comorbidities and clinical findings were analyzed descriptively and associations between patient characteristics and final SARS-CoV-2 status were assessed using univariate regression.Eighty three patients (49 SARS-CoV-2 negative and 34 positive) were included in the final analysis. Of initially suspected COVID-19 cases, 59% proved to be SARS-CoV-2-negative. These patients had more comorbidities (Charlson Comorbidity Index median 5(interquartile range [IQR] 2.5, 7) vs 2.7(IQR 1, 4)), and higher proportion of active malignancy than patients with confirmed COVID-19 (47% vs 15%; P = .004), while immunosuppression was frequent in both patient groups (20% vs 21%; P = .984). Of SARS-CoV-2 negative patients, 31% were diagnosed with non-infectious diseases.A high proportion of patients (59%) triaged to the isolation unit were tested negative for SARS-CoV-2. Of these, many suffered from active malignancy (47%) and were immunosuppressed (20%). Non-infectious diseases were diagnosed in 31%, highlighting the need for appropriate patient flow, timely expert medical care including evaluation for differential diagnostics while providing isolation and ruling out of COVID-19 in these patients with complex underlying diseases.

Introduction and importance Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness. But there are few studies that explain the clinical features of COVID-19 patients with active primary tuberculosis. In a low-resource setting, it is difficult to distinguish the clinical characteristics of COVID-19 from other respiratory diseases. Here, we briefly report the first case of COVID-19 with active primary tuberculosis in our low-resource institution. Case presentation A fourty two year old diabetic Indonesian male was admitted to emergency department in November 2020 due to vertigo-like dizzines for one week, tension type headache, shivering, cough with sputum, abdominal pain, and night sweats. Xpert MTB-RIF Assay G4 detect Mycobacterium Tuberculosis Bacteria (MTB) without rifampicin resistance, but the Tubex test for antibody IgM anti-O9 was negative. Patient admitted to isolation ward for suspected COVID-19 with separate rooms due to tuberculosis, until 24 hours evaluation of nasopharyng and oropharyng swab test performed. On the second day, the evaluation swab test was positive for COVID-19. Clinical discussion Limited or no protection against COVID-19 is one of the problems that leads to co-infection. Now, there is no recommendation treatment for COVID-19 sufferer with tuberculosis co-infection or vice versa. Ventilation support and intensive care for infectious patient must be accessible, yet still unavailable in our institution. Conclusion A low resource setting has its own challenges in handling COVID-19. Further studies are needed to address the clinical characteristics, diagnosis and management in COVID-19 patients with active tuberculosis., Highlights • COVID-19 and active primary tuberculosis should be admitted to an isolation ward. • Further studies are needed to address the clinical characteristics and management. • Satisfying outcome was observed.

Patients admitted to the isolation ward during the COVID-19 outbreak face multiple psychosocial stressors including the disruptive experience of being in quarantine, anxiety over contracting a newly emerging infectious disease and limited access to their healthcare team. This quality improvement project aims to leverage on technology to improve patients’ access to, and experience of, care while in isolation.Patients admitted to two isolation wards in Singapore General Hospital (SGH) between 28 February and 19 March 2020 were each provided an iPad loaded with the MyCare application (app), curated materials and mobile games. During this period, 83 of them accessed the device and the app. MyCare app is an app developed by the nursing team in SGH as part of an existing interprofessional collaboration to help patients navigate their care during their inpatient stay. In response to COVID-19, MyCare app was supplemented with materials to address affected patients’ informational and psychosocial needs. These materials included an information sheet on COVID-19, interviews with previous severe acute respiratory syndrome survivors, psychosocial support materials, and uplifting literature, illustrated storybooks and artwork.This paper describes the process of planning for, and executing, the intervention and reports the initial results of its effect. Initial feedback indicated a positive response to the intervention. 9 out of 10 respondents (90%) rated their hospital experience with a maximum of five stars and all 10 respondents (100%) rated the psychosocial support materials with five stars. Doctors managing the patients also observed a reduction in the number of commonly asked questions following the deployment of the iPad.This quality improvement project is ongoing with plans for further research to determine how to better support the psychosocial needs of patients in isolation during a novel disease outbreak. This report is written based on the Standards for Quality Improvement Reporting Excellence guidelines.

Coronavirus disease 2019 (COVID-19) is still developing worldwide. The prognosis of the disease will become worse and mortality will be even higher when it is combined with cardiovascular disease. Furthermore, COVID-19 is highly infectious and requires strict isolation measures. For acute coronary syndromes (ACS), a common cardiovascular disease, infection may aggravate the occurrence and development of ACS, making the management of more difficult. It will be an enormous challenge for clinical practice to deal with ACS in this setting of COVID-19. Aim to reduce the mortality of ACS patients during the epidemic of COVID-19 by standardizing procedures as much as possible. Pubmed and other relevant databases were searched to retrieve articles on COVID-19 and articles on ACS management strategies during previous influenza epidemics. The data was described and synthesized to summarize the diagnosis and management strategy of ACS, the preparation of catheter laboratory, and the protection of the medical staff in the context of COVID-19. Ethical approval is not required in this study, because it is a review with no recourse to patient identifiable information. Standardized diagnosis and treatment advice can help reduce the mortality of COVID-19 patients with ACS. In the absence of contraindications, the third generation of thrombolytic drugs should be the first choice for thrombolytic treatment in the isolation ward. For patients who have to receive PCI, this article provides detailed protective measures to avoid nosocomial infection.

Patients with COVID-19 have revealed a massive outbreak around the world, leading to widespread concerns in global scope. Figuring out the transmission route of COVID-19 is necessary to control further spread. We analyzed the data of 43 patients in Baodi Department Store (China) to supplement the transmission route and epidemiological characteristics of COVID-19 in a cluster outbreak. Incubation median was estimated to endure 5.95 days (2–13 days). Almost 76.3% of patients sought medical attention immediately uponillness onset. The median period ofillness onsetto hospitalization and confirmation were 3.96 days (0–14) and 5.58 days (1–21), respectively. Patients with different cluster case could demonstrate unique epidemiological characteristics due to the particularity of outbreak sites. SRAS-CoV-2 can be released into the surrounding air through patient’s respiratory tract activities, and can exist for a long time for long-distance transportation. SRAS-CoV-2 RNA can be detected in aerosol in different sites, including isolation ward, general ward, outdoor, toilet, hallway, and crowded public area. Environmental factors influencing were analyzed and indicated that the SARS-CoV-2 transportation in aerosol was dependent on temperature, air humidity, ventilation rate and inactivating chemicals (ozone) content. As for the infection route of case numbers 2 to 6, 10, 13, 16, 17, 18, 20 and 23, we believe that aerosol transmission played a significant role in analyzing their exposure history and environmental conditions in Baodi Department Store. Aerosol transmission could occur in some cluster cases when the environmental factors are suitable, and it is an indispensable route of COVID-19 spread.

Background As the coronavirus disease 2019 (COVID-19) epidemic in the UK emerged and escalated, clinicians working in mental health in-patient facilities faced unique medical, psychiatric and staffing challenges in managing and containing the impact of the virus and, in the context of legislation, enforcing social distancing. Aims To describe (a) the steps taken by one mental health hospital to establish a COVID-19 isolation ward for adult psychiatric in-patients and (b) how staff addressed the challenges that emerged over the period March to June 2020. Method A descriptive study detailing the processes involved in changing the role of the ward and the measures taken to address the various challenges that arose. Brief clinical cases of two patients are included for illustrative purposes. Results We describe the achievements, lessons learned and outcomes of the process of repurposing a mental health triage ward into a COVID-19 isolation facility, including the impact on staff. Flexibility, rapid problem-solving and close teamwork were essential. Some of the changes made will be sustained on the ward in our primary role as a triage ward. Conclusions Although the challenges faced were difficult, the legacy they have left is that of a range of improvements in patient care and the working environment.

The COVID-19 outbreak has rapidly progressed worldwide finding the health system, scientists and society unprepared to face a little-known, fast spreading, and extremely deadly virus. Italy is one of the countries hardest hit by the pandemic, resulting in healthcare facilities bearing heavy burdens and severe restrictive measures. Despite efforts to clarify the virus transmission, especially in indoor scenarios, several aspects of SARS-CoV-2 spread are still rudimentary. This study evaluated the contamination of the air and surfaces by SARS-CoV-2 RNA in the COVID-19 isolation ward of a hospital in Milan, Italy. A total of 42 air and surface samples were collected inside five different zones of the ward including contaminated (COVID-19 patients' area), semi-contaminated (undressing room), and clean areas. SARS-CoV-2 RNA detection was performed using real time reverse transcription polymerase chain reaction. Overall, 24.3% of swab samples were positive, but none of these were collected in the clean area. Thus, the positivity rate was higher in contaminated (35.0%) and semi-contaminated (50.0%) areas than in clean areas (0.0%; P, Graphical abstract Unlabelled Image, Highlights • Air and surface samples were collected in the COVID-19 ward of an Italian hospital. • SARS-CoV-2 RNA detection was performed using RT-PCR. • Positive swab samples were found in the semi-contaminated and contaminated areas. • Viral RNA was found in the air of intensive care unit and corridor for patients. • No positive samples were found in the clean areas of the ward.

ObjectivesWe performed an environmental sampling study to investigate the environmental contamination of SARS-CoV-2 by COVID-19 patients with prolonged PCR positive status of clinical samples.MethodsWe sampled the air from rooms for nine COVID-19 patients with illness or positive PCR > 30 days, before and after nasopharyngeal/oropharyngeal swabbing and before and after nebulization treatment. We also sampled patients’ surroundings and healthcare workers’ personal protection equipment (PPE) in a non-ICU ward. SARS-CoV-2 was detected by PCR.ResultsEighty-eight samples were collected from high-touch surfaces and floors in patient rooms and toilets, with only the bedsheets of two patients and one toilet positive for SARS-CoV-2. All air samples (n = 34) were negative for SARS-CoV-2. Fifty-five samples collected from PPE were all negative.ConclusionContamination of near-patient surroundings was uncommon for COVID-19 patients with prolonged PCR positive status if environmental cleaning/disinfection were performed rigorously. Airborne transmission of SARS-CoV-2 was unlikely in these non-ICU settings.

At the direction of Governor Phil Scott, the Vermont National Guard rapidly erected a 400-bed alternative healthcare facility field hospital to increase the state’s medical capacity early in the COVID-19 pandemic when information was limited and cases were rapidly rising across the country. This case study reviews the preparation and management of the alternative healthcare facility’s first COVID-19-positive patient assigned to the 50-bed COVID-19 isolation ward. Despite austere conditions with rudimentary improvements to a nonstandard facility, the ad hoc team composed entirely of members of the Vermont National Guard successfully oversaw patient care from admission to discharge while maintaining a zero-percent transmission rate to staff. While the local civilian medical infrastructure was never overwhelmed and patient census at the facility remained low, this case study highlights the capability of the National Guard enterprise as a community response to pandemic crises.

Background The outbreak of Coronavirus disease (COVID-19) pandemic has become the most serious global health issue. Isolation policy in hospitals is one of the most crucial protocols to prevent nosocomial infection of COVID-19. It is important to monitor and assess the physical conditions of the patients in isolation. Methods Our institution has installed the novel non-contact wireless sensor for vital sign sensing and body movement monitoring for patients in COVID-19 isolation ward. Results We have collected and compared data between the radar record with the nurse’s handover record of two patients, one recorded for 13 days and the other recorded for 5 days. The P value by Fisher’s exact test were 0.139 (temperature, P > 0.05) and 0.292 (heart beat rate, P > 0.05) respectively. Conclusions This is the first report about the application experience of this equipment. Therefore we attempted to share the experience and try to apply this equipment in COVID-19 patients in future to offer the more reliable and safe policy. Electronic supplementary material The online version of this article (10.1007/s10916-020-01637-z) contains supplementary material, which is available to authorized users.

The implementation effect of the 24-hour Supervise-Correct-Improve (SCI) supervision model was investigated in COVID-19 isolation ward in putting on and taking off process of personal protective equipment. As shown in results, the error rate of taking off process was significantly reduced (P < 0.001) by applying the 24h "SCI" mode. Staffs over 40 years old and workers were more likely to make mistakes. Through uninterrupted supervision and protection, application of this mode is proved to be effective.

The recent outbreak of COVID-19 has infected a large number of patients, increasing the importance of adequate disinfection of the hospital environment. We conducted this study to explore environmental virus contamination and the effect of terminal disinfection in the isolation ward of patients with COVID-19. A swab kit was used to sample various surfaces in the isolation and observation wards using the smear method. The samples were immediately sent to the PCR department of the laboratory for nucleic acid detection of COVID-19. We analyzed 31 high-frequency contact sites in three isolation wards of actively sick patients, of which seven were positive (22.58%, 7/31). Positive sites included the transfer window, bed rail, buffer room door handle, toilet door handle, and toilet faucet. All 55 samples taken from the wards of cured patients and the wards after terminal disinfection were negative. Virus contamination in areas frequently touched by patients in the isolation ward was high, so the awareness of correct disinfection must be increased. Use of 1,000-2,000 mg/L chlorine-containing disinfectant in the isolation ward was effective.

Although it has been well recognized that the virus SARS-CoV-2, the causative agent of COVID-19, can be acquired by exposure to fomites, surprisingly, the contamination of patients’ surroundings by SARS-CoV-2 is largely unknown, as there have been few studies. We performed an environmental sampling study for 13 laboratory-confirmed COVID-19 patients and found extensive contamination of patients’ surroundings. In particular, we found that asymptomatic COVID-19 patients contaminated their surroundings and therefore imposed risks for other people. Environment cleaning should be emphasized in negative-pressure rooms. The findings may be useful to guide infection control practice to protect health care workers., The contamination of patients’ surroundings by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains understudied. We sampled the surroundings and the air of six negative-pressure non-intensive care unit (non-ICU) rooms in a designated isolation ward in Chengdu, China, that were occupied by 13 laboratory-confirmed coronavirus disease 2019 (COVID-19) patients who had returned from overseas travel, including 2 asymptomatic patients. A total of 44 of 112 (39.3%) surface samples were positive for SARS-CoV-2 as detected by real-time PCR, suggesting extensive contamination, although all of the air samples were negative. In particular, in a single room occupied by an asymptomatic patient, four sites were SARS-CoV-2 positive, highlighting that asymptomatic COVID-19 patients do contaminate their surroundings and impose risks for others with close contact. Placement of COVID-19 patients in rooms with negative pressure may bring a false feeling of safety, and the importance of rigorous environment cleaning should be emphasized. IMPORTANCE Although it has been well recognized that the virus SARS-CoV-2, the causative agent of COVID-19, can be acquired by exposure to fomites, surprisingly, the contamination of patients’ surroundings by SARS-CoV-2 is largely unknown, as there have been few studies. We performed an environmental sampling study for 13 laboratory-confirmed COVID-19 patients and found extensive contamination of patients’ surroundings. In particular, we found that asymptomatic COVID-19 patients contaminated their surroundings and therefore imposed risks for other people. Environment cleaning should be emphasized in negative-pressure rooms. The findings may be useful to guide infection control practice to protect health care workers.

Summary Since cases first emerged in December 2019, COVID‐19 (a type of coronavirus) has rapidly become pandemic. This fast‐tracked paper (published quickly) from China on COVID‐19 is written by dermatologists at the epicentre of the outbreak in Wuhan. Dermatology clinic staff may be at risk because protective equipment is not routinely available, and skin lesions might possibly transmit the virus indirectly. These authors suggest preventive measures based on experience in this and previous coronavirus outbreaks. Online consultation for non‐urgent patients reduces the numbers of patients attending clinics. Nurse‐led triage, to identify patients with possible COVID‐19, at the entrances of hospital and skin clinics directs patients with a cough or fever to a specific COVID‐19 area and a dermatologist is consulted if the fever might be related to skin disease. Clinic staff wear N95 masks and observe hand hygiene during consultations. Patients are admitted to a ward only if routine blood tests and chest CT scans exclude COVID‐19. Triage will not detect patients who are showing no symptoms but who are developing the disease, so the hospital should provide an on‐call expert team to discuss inpatients suspected or diagnosed with COVID‐19 and refer them to radiology, respiratory or intensive care colleagues as required. Confirmed cases are managed following local policies. Skin disorders in COVID‐19 inpatients can usually be managed remotely using photographs, email and teleconferencing. If necessary a multidisciplinary team (a team of medical staff from different specialties) can meet in the clean area of the isolation ward. If the dermatologist must see the patient, all records should be provided in advance to minimise exposure time. With these precautions, as of 20th February 2020 no infected patients were detected in the Wuhan Dermatology Department. This is a summary of the study: Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department, Linked Article: Tao et al. Br J Dermatol 2020; 182:1477–1478

Recent studies have reported that surfaces and objects in the rooms of infected patients that are frequently touched by both medical staff and patients could be contaminated with SARS-CoV-2. In December 2019, Wuhan China suffered the earliest from this COVID-19 pandemic, and we took that opportunity to investigate whether the SARS-CoV-2 RNA exists in the ward environment after a long time from exposure. We found that on the 28th day following the discharge of COVID-19 patients, SARS-CoV-2 RNA could still be detected on the surfaces of pagers and in drawers in the isolation wards. Thorough disinfection of the ward environment was subsequently performed, after which these surfaces in the isolation wards tested negative for the presence of SARS-CoV-2 RNA. The findings remind us that the contaminated environment in the wards may become potential infectious resources and that despite a long time from exposure, the thorough disinfection in the COVID-10 units after is still necessary.