Fast-track ventilation strategy to cater for pandemic patient isolation surges.

BACKGROUND: The shortage of isolation facilities in hospitals was highlighted during the severe acute respiratory syndrome (SARS) pandemic in 2003. Yet, as the nature and scale of future pandemics cannot be adequately estimated, it is difficult to justify construction of sufficient isolation facilities. A fast-track and cost-effective ventilation strategy for the retrofitting of existing general wards could help hospitals deal with patient surges. AIM: This article reviews the effectiveness of a fast-track, makeshift isolation approach employed during the SARS outbreak which involved installing simple window-mounted exhaust fans to create negative-pressure airflow in hospital general wards. METHODS: Computational fluid dynamics (CFD) was used to assess by simulation whether the approach adopted meets US Centers for Disease and Control and Prevention requirements for properly constructed isolation wards. FINDINGS: CFD simulation revealed that this makeshift approach could match the ventilation standards of isolation rooms. The approach was certainly effective as no secondary infections were reported in hospitals that used it during SARS. CONCLUSIONS: When there is a shortfall in isolation facilities to accommodate a surge in patients, the proposed ventilation set-up could be quickly and widely implemented by existing general wards.

Short-stay in-patient rehabilitation of elderly patients with chronic obstructive pulmonary disease: prospective study.

OBJECTIVES: To evaluate the effectiveness of a short-stay in-patient rehabilitation programme. DESIGN: Prospective case-control cohort study. SETTING: Regional medical centre, Hong Kong. PATIENTS: One hundred and thirty symptomatic elderly patients with chronic obstructive pulmonary disease who had been treated for an acute respiratory illness in 1998. They were divided into two groups: the conventional treatment group, which received no rehabilitation (n=65), and the rehabilitation group (n=65). INTERVENTION: A short-stay in-patient rehabilitation programme was implemented, which included assessment, patient and caregiver education, an exercise regimen, physiotherapy, occupational therapy, and case conference. MAIN OUTCOME MEASURES: Length of stay, hospital re-admission rate, and admission-free interval. RESULTS: The mean length of stay in the rehabilitation ward was 6.2 days. The rate of hospital re-admission was significantly higher in the conventional treatment group than in the rehabilitation group, both within 28 days of discharge home (relative risk=3.33; 95% confidence interval, 2.32-4.56; P=0.019) and at 100 days after discharge (relative risk=2.47; 95% confidence interval, 1.78-3.48; P<0.001). The admission-free interval was significantly longer in the rehabilitation group than in the conventional treatment group (1.13 years vs 0.86 years; P<0.001). CONCLUSION: A short-stay in-patient rehabilitation programme is effective in reducing hospital re-admission rates. This type of rehabilitation service may be important for elderly patients, as well as for patients with more advanced disease and more functional deficits than others.