The phrase “necessity is the mother of invention” has been in use for more than 360 years, but rarely has it been more relevant than the onset of the COVID-19 (coronavirus) pandemic.
Over the past several weeks, leadership and staff of the staff of Ralph H. Johnson VA Medical Center shifted from normal to modified operations, stood up an Incident Command Center, and actively prepared for the eventuality of a coronavirus-positive patient.
One of the first priorities was to identify space within the medical center to isolate patients suspected of having coronavirus and care for those who test positive.
Dane Friedman, Chief Engineer at the VAMC, was the driving force behind converting space on the fourth floor into a negative-pressure isolation unit designed to care for coronavirus patients while minimizing risk to the rest of the hospital.
The negative pressure unit was procured by VAMC Emergency Management personnel in 2009 following the H1N1 influenza outbreak. The team's forward thinking helped position the VAMC to respond to current and future pandemics.
The isolation unit has an entrance and exit sealed off from the rest of the hospital that allows it to maintain negative pressure. There is an enclosed “clean ante room” at the entrance where staff don personal protective equipment before crossing through another entrance to the isolation unit. Additionally, the unit has its own storage areas for linens and supplies that are isolated from the rest of the hospital.
“This unit is 100 percent self-sustaining,” said Friedman. “Pressure is monitored 24/7 through a Magnehelics system (a differential pressure monitor), which keeps our environment safe, keeps our patients safe and keeps our staff safe.”
The unit has 18 beds and is uniquely configured to prevent cross contamination from the heating and air conditioning system. Within the isolation unit, exhaust and return vents have been sealed off and new duct work was installed in a closed stairwell. This setup allows for a direction of flow that only allows clean air to come in and it’s not exposed the rest of the hospital.
Staff also leave through a special exit ante room, which allows them to leave PPE and potentially contaminated clothing or equipment in a secure room just outside the isolation unit.
Another priority for the medical center was to relocate its chemotherapy infusion clinic, which was on the fourth floor, to another part of the hospital. The move provides protection and continuity of care for high-risk, immunocompromised patients that are more vulnerable to illnesses like coronavirus.