Setting up 100 bed dedicated hospital for COVID-19 CONCEPT

Setting up 100 bed dedicated hospital for COVID-19

CONCEPT:

1. Scope:  This Document Details out the setup of 100 bed hospital to treat patients with severe acute respiratory infection (SARI) with a COVID-19 virus infection. WHO (World Health Organisation)  guidelines are extensively used in preparing this document, the same are available on WHO web site https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/patient-management

Document focus on one part on fight against COVID-19 virus, treatment of Infected cases only.  Quarantine, community screening and other aspects are out of the scope of this document.

1. COVID-19 virus, is a highly contagious (spread from one person to other) disease.  First Stage in treatment of this disease includes a system for assessing all patients at admission, allowing early recognition of possible 2019-nCoV infection and immediate isolation of people with suspected 2019 coronavirus disease (COVID-19) in an area separate from other patients, as this disease is highly contagious.  Symptom:  Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and death.
2. Why need a Dedicated Facility to Isolate and treat Infectious diseases: Patients infected with a highly contagious disease (especially with the diseases not having proven treatment protocol and medicines) need to be isolated, to prevent the spread of infection. In India, the concept of availability of large-scale isolation facilities at sub-District and District level has gained importance with the outbreak of the novel coronavirus pandemic.  It becomes very important to keep the infected (symptomatic and susceptible to infection included) patients isolated all the time and treat them in an environment that is scientifically designed to contain the further spread of infection and to facilitate faster recovery of such patients.  With the present state of infrastructure not adequately designed to cater to the pandemic and community level spread the care provisioning getting compromised and to compensate that the providers resort to a higher dosage of antibiotic/ antiviral medicine cover making the population drug-resistant.
3. What is an Isolation facility: Micro-organism can spread and infections can be transmitted by Air, Water, Droplets, Food, Clothes, physical contact, and other mediums and hence we have to take care of all the mediums while designing an Isolation facility for infectious diseases.
   1. Air: All the rooms should be having Negative-pressure so that particles do not leave the room when doors are opened. Needless to say, that the rooms should be first airtight to create any pressure differential. If a room is airtight we have to provide mechanical ventilation and a filtering system (HEPA filter) so that any expelled air is free of any microorganisms. Recirculation is not allowed and at the same time minimum air changes per hr to be achieved. The airlock to be provided between different zones in a facility.
   2. Individual Patient Rooms:  all the infected patients should be kept in separate rooms as they are at different stages of infection or recovery. Separate rooms reduce the biohazard load and can be easily sterilized. Restricted entry needs to be created.
   3. Health care Provider and housekeeping services: Doctors, Paramedic staff and cleaners/sweepers
      1. There should be minimum contact with an infected patient. One of the ways can be to have central monitoring of patients and use telemedicine tools.
      2. Appropriate PPE should be provided.
      3. Regular washing and disinfection infrastructure to be provided, eg washbasins in each isolation room. Only authorized persons allowed in restricted areas.
      4. Regular testing of healthcare workers.
   4. Waste Disposal: all the waste generated from infectious wards should be properly enclosed and sterilized before disposal, this will prevent the spread of disease through Biomedical waste.
   5. Sterilization and Disinfection:
      1. CSSD to be provided for the sterilisation of the reusable Inventory. As much as possible we should use disposable items.
      2. Equipment and instruments to be disinfected with suitable disinfectants regularly and when moved from one room to another.
      3. Floors, wall and other areas to be cleaned with disinfectants regularly.
      4. Culture to be done by taking samples from various parts of the health care facility. 
   6. Patient
      1. Patients’ hygiene and protection from cross-infection have to be ensured.
      2. Transportation of patients and the dead bodies have to follow exit and safety protocols duly embedded in infrastructure design  including a mortuary , disposal  and  handing over of cadavers  for cremation
      3. Adequate entertainment facility to be provided to help fight boredom and prevention of psychosomatic or psychiatric disorders as an effect of isolation.
      4. CCTV and video conferencing facilities can be provided for communication with relatives and friends.

Above mention, points give a highlight of what an isolation healthcare facility should have in addition to basic other needs of the healthcare facility.

1. Specification of Isolation Room: Source https://www.cdc.gov/

• a negative-pressure differential greater than 2.5 Pa (0.01 inch water gauge), or an airflow differential greater than 56 l/s (125 cfm) exhaust versus supply;
• clean-to-dirty airflow;
• sealing of the room, allowing approximately 0.046 m (0.5 square feet) leakage;
• more than 12 air changes per hour, no recirculation of Air (100 % fresh Air)
• an exhaust to the outside, Exhaust air should be HEPA filtered. Duct the exhaust directly to the outside discharging vertically at 10m/s. Exhaust duct should be 15 m Away from adjacent building and 5 m hither that nearest building.
• Sample layout and features are given in the proposal ahead.

F.Medica Equipment Planning Guidelines: as per WHO

Facility Zones

In-Patient Area:

3) Other Space : Major Spaces
a. Outpatient Department
i. Reception, Enquiry, Admission, and Discharge.
ii. Public Toilet, disabled toilet.
iii. Community health counselor.
iv. Pharmacy
b. Diagnostics Facility: shared with OPD, Emergency, and IPD
i. CT scan 4 Slice.
ii. Digital X-ray 300 Ma with a PACS system (for tele reporting).
iii. COVID Test Lab (PCR Testing facility to be provided by Government)
iv. Pathology Lab with 5 Part hematology analyzer, Electrolyte analyzer, Biochemistry analyzer, and other Pathology Instruments and equipment.
c. Operation Theatre (1 Nos)
i. Pre Post Op
ii. Staff Area.
iii. Clean and Dirty Utility
iv. Scrub
d. CSSD :
i. Receiving
ii. Autoclave
iii. Sterile and non-sterile Store
e. Administrative Spaces
i. Hospital administrator
ii. Medial records and reporting.
iii. Biomedical Waste treatment and disposal.
iv. Kitchen and pantry
v. Staff Changing and Dining area.
vi. Central CCTV and Fire Monitoring.
vii. Laundry Disinfection and Cleaning.
viii. Wayfinding and Disable provisions.
f. MEP Spaces
i. Electrical Room
ii. DG Spaces
iii. STP, ETP
iv. Fire fighting setup.
g. Mortuary: to be housed in an independent unit.

5) Isolation Room Group / Ward: Isolation rooms will be preferably arranged in a set of 8 beds Unit called ass Isolation Ward. Sample Layout can be as follows. The actual layout will vary as per the existing building.

Isolation Ward unit will ideally be made up of 8 Isolation Room units, with a central Nursing station and allide facilities of Mechanical Ventilation and filtering system. It will have clean utility, Dirty utility, Store and Gown area. Entry from the hospital corridor will be through an airlock system.

Mechanical Ventilation room will have an air suction unit, which is further connected to each room through a Duct to create negative pressure. The sucked air will go through an air cleaning/ Scrubbing system to clean out any microorganisms of >0.2 Micron, using a HEPA filter.

Crash cart trolley and other items which are to be shared with all the rooms will be provided here. There will be a central monitoring station (at the nurse station), which will be connected to an Individual patient monitor. 12-15 such units will be made to divide 100 beds into suitable, manageable units. 

• Schedule of Finish

• Equipment Schedule: Major items in Patient Room and wards.

• Telemedicine: it is recommended to provide services which can easily be given by using Information technology, Like Radiology reporting using PACS, Super specialist consultation using Digital Medical records, Tele ICU:

COMMERCIAL PROPOSAL:

1. Broad Costing for the project will be: + GST As applicable

1. Project Completion Time: 3 Months

1. Payment Terms:

1. 20 % Mobilisation Advance.
2. 15% of Payment every 15 days. Up to 90 % max, 20 % mobilisation advance to be adjusted prorate with each payment.

• 5% on project completion

1. 5% after 6 months of Defect liability and warranty period.

1. Scope of Government
   1. Provide suitable existing Building of 1,00,000 sqft. Floor to Beam soffit clear distance of 3 Mtr.
   2. Premises should be secured with boundary and gates, separate cost to be paid for constructing boundary and security gates.

• Transformer of 450 KVA with reliable electrical connection to be provided.

1. Drainage, where treated water from STP will be discharged.
2. Any Government Licences/ permissions to build Hospital.

1. Company Details

1. The same structure can be made in an open field using PUF panels. Project can completed in 1 months time.