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Facilities ; 41(44958):65-80, 2023.
Article in English | Scopus | ID: covidwho-2240730


Purpose: The purpose of this study was to examine how data from the World Health Organization, United States Environmental Protection Agency and Center for Disease Control have evolved with relation to engineering controls for heating, ventilation and air-conditioning (HVAC) systems to mitigate the spread of spread of aerosols (specifically related to the COVID-19 pandemic) in occupied buildings. Design/methodology/approach: A document analysis of the pandemic-focused position documents from the aforementioned public health agencies and national HVAC authorities was performed. This review targeted a range of evidence from recommendations, best practices, codes and regulations and peer-reviewed publications and evaluated how they cumulatively evolved over time. Data was compared between 2020 and 2021. Findings: This research found that core information provided early in the pandemic (i.e. early 2020) for engineering controls in building HVAC systems did not vary greatly as knowledge of the pandemic evolved (i.e. in June of 2021). This indicates that regulating agencies had a good, early understanding of how airborne viruses spread through building ventilation systems. The largest evolution in knowledge came from the broader acceptance of building ventilation as a transmission route and the increase in publications and ease of access to the information for the general public over time. Originality/value: The promotion of the proposed controls for ventilation in buildings, as outlined in this paper, is another step toward reducing the spread of COVID-19 and future aerosol spread viruses by means of ventilation. © 2022, Emerald Publishing Limited.

Open Forum Infectious Diseases ; 8(SUPPL 1):S325, 2021.
Article in English | EMBASE | ID: covidwho-1746548


Background. Constraints on resources require healthcare systems to implement alternative and innovative means for delivering care. The COVID-19 pandemic amplified this issue throughout the world, leading to shortages of ventilators, hospital beds, and healthcare personnel. We report the results of an Acute Care at Home Program (ACHP) response to COVID-19, providing in-home hospital-level care to patients with mild symptoms, preserving in-hospital beds for more serious illness. Methods. Patients with COVID-19 were selected for ACHP after undergoing risk stratification for severe disease, including oxygen evaluation, time course of illness, and evaluation of comorbidities. Patients admitted to ACH met inpatient criteria, required oxygen supplementation of ≤4 liters, and received insurance approval. Services were provided consistent with best practice of inpatient care, including 24/7 provider availability via TeleMedicine, bedside care provided by paramedics and nurses, respiratory therapy, radiology and laboratory services, pulse oximetry monitoring, and administration of medications. Protocols existed for patient transfer to hospital in the event of clinical deterioration. Results. Our initial cohort included 62 patients enrolled October 1, 2020 - May 31, 2021. Of these, 57 patients were discharged successfully from ACHP. Patients presented with initial oxygen requirements of 0-4 liters. Average length-of-stay in ACHP was 5.4 days. Five patients required hospitalization after enrollment in ACHP;one subsequently expired, two were discharged home, one returned to ACHP after inpatient hospitalization, and one remains hospitalized. One additional patient that was successfully discharged home from ACHP was later readmitted and expired in a subsequent hospitalization. The patients that expired had significant immunocompromising conditions that may have contributed to their outcomes. Conclusion. ACHP can provide care equivalent to hospitalization for select COVID-19 patients. Immunocompromised hosts with COVID-19 may represent a subset of patients in which in-house hospitalization must be carefully considered, even with mild oxygen requirements. Health systems should consider ACHP as a substitution for hospitalization for COVID-19 patients with mild symptoms.