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Logistic and organizational aspects of a dedicated intensive care unit for COVID-19 patients
Critical Care volume 24, Article number: 237 (2020)
On 31 March, the World Health Organization (WHO) reported 750,890 confirmed globally confirmed cases of COVID-19 . COVID-19 cases are dramatically increasing in several countries with heterogenous and unpredictable distributions . Patients with COVID-19 have resulted in high rates of hospitalization and ICU admissions . On 6 April, the worldwide ICU admission rate of COVID-19 patients was 3% ranging from 1% of total cases in Africa to 4% of total cases in Europe . According to this heterogenous and unpredictable geographic distribution of COVID-19, several countries are increasing their ICU capacity response by converting general ICU in dedicated COVID-19 facilities . Dedicated ICUs for COVID-19 patients were suddenly created on the whole Italian territory . Based on the high contagiousness of the 2019 novel CoV virus , the logistics and the staff organizations are the fundamental principles to avoid the in-hospital spread of the virus while creating dedicated COVID-19 facilities. From 10 March, our ICU is completely dedicated to COVID-19 patients, and actually, it is one of the largest cohorted ICU in the south of Italy admitting 12 positive critically ill patients (Fig. 1). The ICU is divided into green, yellow, and red areas (Fig. 1). Each ICU bed is equipped with a full monitoring of vital parameters and a mechanical ventilator. Each monitor is duplicated in the centralized control unit equipped with microphones and glasses to allow the communications between the staff. Inside the ICU, we have a laboratory section including two dedicated ultrasound machines, disposable fiberoptic bronchoscopes, video laryngoscopes, point-of-care arterial blood gas and coagulation analyses, transport ventilator, and emergency cart with a defibrillator.
During the 12-h shift, the nursing and medical working is organized as follow:
The most experienced ICU physician is the work shift coordinator and stays in the green area to control the compliance of the staff with the procedures and to check the patients from the centralized monitoring area.
Medical staff review the medical records of each patient, and then a briefing with the whole staff is made to plan the actions of the shift.
All the therapies are prepared in a dedicated area outside the ICU boxes to minimize the time spent inside.
The nursing and medical staff performed the first entry in the ICU boxes and stay inside for 4 h. After that, only two nurses and one medical doctor continue to stay inside for an additional 2 h while the other personnel rest themselves and fulfill the medical records.
After that, the nurses and the medical doctor are replaced by other 3 colleagues for another 2 h.
The transition from the red to the green area must be preceded by the staff decontamination in the yellow area.
The disinfection of the different areas is performed three times during the shift.
According to our experience, a simple logistic project and clear organizational plan may be the keys to the success of surging the ICU capacity with dedicated facilities during the COVID-19 outbreak.
Availability of data and materials
Coronavirus disease 2019 (COVID-19) situation report – 71. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200331-sitrep-71-covid-19.pdf?sfvrsn=4360e92b_6.
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European CDC. Situation update worldwide. Last updated 8th April, 11:30.
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy early experience and forecast during an emergency response. JAMA. Published online March 13, 2020. doi:https://doi.org/10.1001/jama.2020.4031.
Ashoiur HM, Elkhatib WF, Rahman MM et al. Insights into the recent 2019 novel coronavirus (SARS-CoV-2) in light of past human coronavirus outbreaks. Pathogens 2020;9(3). doi: https://doi.org/10.3390/pathogens9030186.
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Vargas, M., De Marco, G., De Simone, S. et al. Logistic and organizational aspects of a dedicated intensive care unit for COVID-19 patients. Crit Care 24, 237 (2020). https://doi.org/10.1186/s13054-020-02955-x