Plan, staff Organise and Develop an

Isolated Inpatient ward of 50 beds

ISOLATION WARD
An isolation ward is a separate ward used to isolate patients suffering from infectious
diseases. Several wards for individual patients are usually placed together in an isolation
unit.
ISOLATION
Isolation refers to separation of individuals who are ill and suspected or confirmed of
communicable disease. All suspect cases detected in the containment/buffer zones (till a
diagnosis is made), will be hospitalized and kept in isolation in a designated facility till such
time they are tested negative. Persons testing positive for illness will remain to be
hospitalized till such time 2 of their samples are tested negative or as discharge policy.
USES
Isolation wards are used to isolate patients who pose a risk of passing a potentially harmful
infection on to others. Such infections can range in severity widely, from diseases such as
influenza to ebola, , covid although more precautions are generally taken with diseases of a
higher mortality rate. Outside major hospitals, isolation wards can be set up to control
infection in crowded places, or those lacking substantial medical facilities. Many major
passenger ships contain separate wards which can be converted for use in isolating patients.

The planning and designing of an inpatient care unit is a very vital step in hospital planning.
Following factors should be considered broadly whet1 planning is being done:
a) Policy or the hospital
b) Physical facilities: Location and area, Size, Shape, Design, Ancillary accommodation,
Water, Electricity supplies and air-conditioning, Auxiliary accommodation, staffing.

Policy of the Hospital

The policy of hospital is very important for, designing inpatient care area, it should be
considered whether the hospital will be a general with all facilities grouped into or it be a
super speciality or specific hospital, e.g., Neuro-Sciences Centre, Maternity & Child Centre,
Psychiatric Hospital, etc.
Bed strength of hospital influences on planning and designing of hospital structure. A
hospital with less than 200 beds is generally planned as horizontal where it saves lot of time
in internal movement than in vertical (multistorey complex).

Physical Facilities
Location and Area
The inpatient area should be located away from main roads and from OPD area, to avoid
disturbance and ptilinal source of cross infection. However, the inpatient area should be
approachable from supportive services (Imaging, Laboratory, Blood Bank, CSSD, etc.) and a
good intramural transportation should be planned for effective and efficient and efficient
movement of patient and staff within the hospital. Inpatient area covers approximately 35-
50% of total hospital area. The arca per bed within the ward is 70-90 sq, It (about 7 sq. 111.)
but in acute obstetrics ward and orthopaedics wards it is 100-120 sq. It whereas 1CU the
area requirement is 120-150 sq. 8. per bed. Single bed rooms should have a minimum size of
125 sq, fi. Space left between two rows oI beds is 5 It. Distance between 2 beds is 3% to 4 ft.
Clearance between bed and wall should be 1 R and between side of the bed and wall about
2 ft. Standard dimension of hospital bed is 6'6"~ 3'x3" and so the minimum width of 20 for
dormitory type ward is optimum.

USES
Isolation wards are used to isolate patients who pose a risk of passing a potentially harmful
infection on to others. Such infections can range in severity widely, from diseases such as
influenza to ebola, , covid although more precautions are generally taken with diseases of a
higher mortality rate. Outside major hospitals, isolation wards can be set up to control
infection in crowded places, or those lacking substantial medical facilities. Many major
passenger ships contain separate wards which can be converted for use in isolating patients.
DESIGN
In an isolation unit, several measures must be implemented in order to reduce the spread of
infection. The units are generally placed away from the main hospital, and staff often only
work in that unit. In some hospitals, the unit is placed in a separate building. Ventilation is
important to reduce the transmission of airborne spores, and the most severely affected
patients are placed in separate wards.[1][2] However, in some circumstances, especially in
areas experiencing a major epidemic, makeshift isolation wards can be constructed.
ISOLATION WARD:
Suggested site: 4th, 5th and 6th floor of SSB

Shift: 6 hours  Staff pattern: 2 nursing staff + 2 GDA + 1 scavenger + 1 doctor (for each
floor in each shift)
PGTs from suggested departments (general medicine, chest medicine, pharmacology,
anatomy) to be posted there.
Equipments: stethoscope, BP machine, SpO2 probe, CBG machine, Oxygen cylinder, Bi-pap
machine, pen, paper.
Scope of work:

• Nursing staff: monitoring vitals 6 hourly, IV cannulation, administration of

medication as per doctor’s advice, general care.
• GDA: general care (especially oxygenation) and shifting of patients as and when
needed in CCU/positive ward/quarantine.
• Scavengers: scavenging waste materials.
• Doctors: twice daily round and emergency on call.
Throat swab collection: to be done by doctors from Microbiology once daily at 1pm as per
roster (roster to be provided by microbiology dept to administration)
Collection of blood: to be done by technician from central laboratory once daily.
Designated Doffing and Donning area with mirror and proper washing basins with elbow
taps and washrooms. Allocations for observers at that area.
Duty rooms for doctors with drinking water facilities.
Treatment guideline as per Appendix 3
Plan from mobilising patients from isolation ward:
I. COVID +ve: shift to Positive ward.
II. COVID –ve consecutive 2 times 24 hours apart:
1. Patient stable: Discharge
2. Patient symptomatic or coming out to be H1N1 positive or other medical
ailments: shift to other state medical college hospital.
III. Shift the patient to the CCU if patient deteriorates and meets criteria for RED
category.
SETTING UP ISOLATION FACILITY/WARD

• Post signages on the door indicating that the space is an isolation area.

• Remove all non-essential furniture and ensure that the remaining furniture is easy to
clean, and does not conceal or retain dirt or moisture within or around it.

• Patients should be housed in single rooms.

• However, if sufficient single rooms are not available, beds could be put with a spatial
separation of at least 1 meter (3 feet) from one another.

• To create a 10 bed facility, a minimum space of 2000 sq. feet area clearly segregated from
other patientcare areas is required. So for 50 bedded hospital minimum space required is
10, 000 sq. feet

• Preferably the isolation ward should have a separate entry/exit and should not be co-
located with post-surgical wards/dialysis unit/SNCU/labour room etc.

• It should be in a segregated area which is not frequented by outsiders.

• The access to isolation ward should be through dedicated lift/guarded stairs.

• There should be double door entry with changing room and nursing station. Enough PPE
should be available in the changing room with waste disposal bins to collect used PPEs .Used
PPEs should be disposed as per the BMWM guidelines.

• Stock the PPE supply and linen outside the isolation room or area (e.g. in the change
room). Setup a trolley outside the door to hold PPE. A checklist may be useful to ensure that
all equipment is available.

• Place appropriate waste bags in a bin. If possible, use a touch-free bin. Ensure that used
(i.e. dirty) bins remain inside the isolation rooms.

• Place a puncture-proof container for sharps disposal inside the isolation room/area and
bio-medical waste should be managed as per the BMWM guidelines.

• Keep the patient’s personal belongings to a minimum. Keep water pitchers and cups,
tissue wipes, and all items necessary for attending to personal hygiene within the patient’s
reach.

• Non-critical patient-care equipment (e.g. stethoscope, thermometer, blood pressure cuff,

and sphygmomanometer) should be dedicated for the patient, if possible. Any patient-care
equipment that is required for use by other patients should be thoroughly cleaned and
disinfected before use.

• Place an appropriate container with a lid outside the door for equipment that requires
disinfection or sterilization.
• Ensure that appropriate hand washing facilities and hand-hygiene supplies are available.
Stock the sink area with suitable supplies for hand washing, and with alcohol-based hand
rub, near the point of care and the room door.

• Ensure adequate room ventilation. If room is air-conditioned, ensure 12 air changes/ hour
and filtering of exhaust air. A negative pressure in isolation rooms is desirable for patients
requiring aerosolization procedures (intubation, suction nebulisation). These rooms may
have standalone air-conditioning. These areas should not be a part of the central air-
conditioning.

• If air-conditioning is not available negative pressure could also be created through putting
up 3-4 exhaust fans driving air out of the room.

• In district hospital, where there is sufficient space, natural ventilation may be followed.
Such isolation facility should have large windows on opposite walls of the room allowing a
natural unidirectional flow and air changes. The principle of natural ventilation is to allow
and enhance the flow of outdoor air by natural forces such as wind and thermal buoyancy
forces from one opening to another to achieve the desirable air change per hour.

• The isolation ward should have a separate toilet with proper cleaning and supplies.

• Avoid sharing of equipment, but if unavoidable, ensure that reusable equipment is

appropriately disinfected between patients.

4 • Ensure regular cleaning and proper disinfection of common areas, and adequate hand
hygiene by patients, visitors and care givers .Keep adequate equipment required for
cleaning or disinfection inside the isolation room or area, and ensure scrupulous daily
cleaning of the isolation room or area.

• Visitors to the isolation facility should be restricted /disallowed. For unavoidable entries,
they should use PPE according to the hospital guidance, and should be instructed on its
proper use and in hand hygiene practices prior to entry into the isolation room/area.

• Ensure that visitors consult the health-care worker in charge (who is also responsible for
keeping a visitor record) before being allowed into the isolation areas. Keep a roster of all
staff working in the isolation areas, for possible outbreak investigation and contact tracing.

• Doctors, nurses and paramedics posted to isolation facility need to be dedicated and not
allowed to work in other patient-care areas.

• Consider having designated portable X-ray and portable ultrasound equipment.

• Corridors with frequent patient transport should be well-ventilated.

• All health staff involved in patient care should be well trained in the use of PPE.

• Set up a telephone or other method of communication in the isolation room or area to

enable patients, family members or visitors to communicate with health-care workers. This
may reduce the number of times the workers need to don PPE to enter the room or area
GUIDELINES FOR PPE KIT
Wearing and removing Personal Protective Equipment (PPE)
Before entering the isolation room or area:

• Collect all equipment needed;

• Perform hand hygiene with an alcohol-based hand rub (preferably when hands are not
visibly soiled) or soap and water;

• Put on PPE in the order that ensures adequate placement of PPE items and prevent self-
contamination and self-inoculation while using and taking off PPE; an example of the order
in which to don PPE when all PPE items are needed is hand hygiene, gown, mask or
respirator, eye protection and gloves Leaving the isolation room or area

• Either remove PPE in the anteroom or, if there is no anteroom, make sure that the PPE will
not contaminate either the environment outside the isolation room or area, or other
people.

• Remove PPE in a manner that prevents self-contamination or self-inoculation with

contaminated PPE or hands.
General principles are: –

• remove the most contaminated PPE items first;

• perform hand hygiene immediately after removing gloves;
• remove the mask or particulate respirator last (by grasping the ties and discarding in
a rubbish bin); – discard disposable items in a closed rubbish bin;
• put reusable items in a dry (e.g. without any disinfectant solution) closed container;
an example of the order in which to take off PPE when all PPE items are needed is
gloves (if the gown is disposable, gloves can be peeled off together with gown upon
removal), hand hygiene, gown, eye protection, mask or respirator, and hand hygiene
• Perform hand hygiene with an alcohol-based hand rub (preferably) or soap and
water whenever un-gloved hands touch contaminated PPE items.
COVID-19 Management Protocol

STAFFING
Using A ‘Brick’ System of Staffing and Duty Rotation for Optimal Utilization of Manpower
and Reducing Attrition of Health Care Workers in An Isolation Ward During the Covid19
Pandemic
MATERIALS AND METHODS: DEVELOPING THE NEW STAFFING SYSTEM Routine working
scenario As per the Indian Nursing Council Norms,7 01 nurse is recommended for every 6
patient beds in a regular ward. For a normal, 100 bedded ward, under routine
circumstances, the recommended number of nursing staff is between 45 to 48.7,8 Under
normal circumstances, the nursing staff at our centre follow a 6-6-12 schedule. A mandatory
weekly off ensures the physical, mental and emotional well being of the staff while keeping
the average working hours per week below the mandatory limit of 48 Hrs (see table 1
European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 7, Issue 3, 2020
622 – normal scenario). This enables a minimum staff availability of 14 per shift for 100 beds
or 7 for 50 beds.

Proposed staffing roster With the consideration of these above factors, and ensuring the
most optimal utilization of the limited manpower resources, we formulated a ‘brick’ system
of duty rotation plan for HCWs in our 100 bedded isolation ward. The 100 bedded ward
would function as 2 separate wards of 50 beds each (confirmed positive ward and suspected
cases ward). The patients and HCWs of the two wards will not mix or mingle. The available
manpower of 48 nurses would be divided and will work into 12 “bricks” of 4 HCWs each. A
working day of 24 hours would be divided into four shifts of six hours each in a day starting
from 0800 hrs and finishing at 0800 hrs the next morning. In every shift, each ward would
be manned by one brick each. Considering 80% of the patients (40) are likely to be
asymptomatic or mildly symptomatic and the critically ill patients will be shifted to the
isolation ICU, this number should suffice in delivering optimal care. After working for one
shift, each brick would get a break of 12 hours before their next shift. During working and
resting hours, each brick will maintain social distancing from members of other bricks and
will avoid close interaction without PPE outside of their brick. For the period of 14 days, 3
bricks each (total 6) will be active in both wards. The remaining 6 bricks will be kept in
reserve. After a working period of 14 days, the first 6 bricks will go into a period of home
quarantine for 14 days, while the second set of 6 bricks will start their rotation of duties for
the next 14 days. The cycle can continue with the 2 sets of 6 bricks each replacing each
other every 2 weeks.