Engineering Controls and Technologies to Enhance Safety in the COVID-19 Pandemic Landscape: Lessons for Laboratories and Non-Laboratories.

Introduction: The global SARS-CoV-2 pandemic ushered in a new way of life in a short time, with many lasting impacts that have yet to be fully realized. This pandemic threat landscape resulted in massive efforts to increase safety, minimize person-to-person transmission, and rethink how society approaches personal and collective health issues. The buildings and environments in which we live, work, and learn now became environments that pose new risks. As a result, many institutions began asking what improvements could be made to those environments to reduce the spread of infection of SARS-CoV-2 and other infectious diseases. Methods: The authors conducted a review of past projects and emerging technologies to evaluate which applications in containment laboratories could represent an example of how engineering controls can improve safety by protecting the workers inside the laboratories as well as the public interfacing the laboratories. Discussion: Engineering controls, technology, and safety systems are hallmarks of modern containment laboratories that may provide some context into extrapolating these elements into non-laboratory environments, providing there is coordination with a risk assessment methodology. In this study, the authors explore new technologies proposed for controlling SARS-CoV-2 in heating, ventilation, and air conditioning systems, and potential impacts to the operations and maintenance of those systems.

Nomad Librarianship: Outreach Challenges and New Horizons in the Remote Hospital Library Setting

The article presents the discussion on outreach and remote hospital librarianship. Topics include clinical librarian showing new territory for the author causing moments of pause and concern navigating the most effective outreach methods working from home;and COVID-19 pandemic amplifying the need for virtual services and resources best serving the fluctuating workforce and patron base of hospital libraries.

Crumbling NHS hospital buildings: why mental health is at the back of the funding queue: Dilapidated buildings and outdated designs unfit for modern nursing mean mental health trusts need urgent capital investment – but competition for money is fierce

When rain falls heavily on Lynfield Mount Hospital in Bradford, West Yorkshire, sewage swells up through its bathroom sinks, and seeps under doors and onto the wards.

Designing for Effective and Safe Multidisciplinary Primary Care Teamwork: Using the Time of COVID-19 as a Case Study.

Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While co-locating staff has been shown to increase communication, successful designs balance four teamwork needs: face-to-face communications; situational awareness; heads-down work; perception of teamness. However, precautions for COVID-19 make it more difficult to conduct face-to-face communications. In this paper we describe a model for understanding how layout affects these four teamwork needs and describe how the perception of teamwork by staff changed after COVID-19 precautions were put in place. Observations, interviews and two standard surveys were conducted in two primary care clinics before COVID-19 and again in 2021 after a year of precautions. In general, staff felt more isolated and found it more difficult to conduct brief consults, though these perceptions varied by role. RNs, who spent more time on the phone, found it convenient to work part time-from home, while medical assistants found it more difficult to find providers in the distanced clinics. These cases suggest some important considerations for future clinic designs, including greater physical transparency that also allow for physical separation and more spaces for informal communication that are distanced from workstations.

The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic.

To determine if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019. DESIGN: This was a Before-After study, with coronavirus disease 2019-induced ICU reorganization as the intervention. A retrospective chart review of adult patients admitted to a reorganized ICU during the coronavirus disease 2019 surge (from March 23, 2020, to May 06, 2020: intervention group) was compared with patients admitted to the ICU prior to coronavirus disease 2019 surge (from January 10, 2020, to February 23, 2020: before group). SETTING: High-intensity cardiac, medical, and surgical ICUs of a community hospital in metropolitan Missouri. PATIENTS: All patients admitted to the ICU during the before and intervention period were included. Patients younger than 18 years old and those admitted after an elective procedure or surgery were excluded. Patients with coronavirus disease 2019 were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified a total of 524 eligible patients: 342 patients in the before group and 182 in the intervention group. The 28-day mortality was 25.1% (86/342) and 28.6% (52/182), respectively (p = 0.40). The ICU length of stay, ventilator length of stay, and ventilator-free days were similar in both groups. Rates of patient adverse events including falls, inadvertent endotracheal tube removal, reintubation within 48 hours of extubation, and hospital acquired pressure ulcers occurred more frequently in the study group (20 events, 11%) versus control group (12 events, 3.5%) (p = 0.001). CONCLUSIONS: Twenty-eight-day mortality, in patients who required ICU care and were not infected with coronavirus disease 2019, was not significantly affected by ICU reorganization during a pandemic.