Hygiene Management // Standard Care
15.05.2020

The new normal

At the moment, routine operations are gradually being carried out again – even the outpatient departments are filling up more and more. The German Society for General and Visceral Surgery (DGAV e.V.) has given recommendations on how to prevent so-called “nosocomial infection clusters”. Ward modules help to manage the different groups of patients.

With courses of infection that come in waves and different infection frequencies in the general population – as long as there is no vaccine available, COVID-19 patients are part of everyday hospital life. Healthcare facilities will have to live and work with the risk of nosocomial spread of SARS-CoV-2 in the near future. The German Society for General and Visceral Surgery (DGAV e.V.) has issued recommendations that summarize how infections can be prevented as far as possible during the gradual return to standard care.

Ward management during the COVID-19 pandemic

The new normal – working with the coronavirus: Clinics must prepare to treat patients who have different issues or who are not affected by COVID-19 at all – and at the same time keep an eye out for the risk of a nosocomial coronavirus outbreak. Even a single cluster of patients within a hospital can paralyze an entire clinic.

At organizational level, the DGAV experts are suggesting different ward modules for caring for different groups of patients. Depending on the size of the clinic, these can be organized as separate units or as isolation areas within a specialist department. The different units correspond to the groups of patients affected by other issues or not affected by COVID-19: In addition to the isolation area for COVID-19 patients, having wards for COVID-19 positive patients, but also for COVID-19 asymptomatic patients (i.e. those patients who come into hospital treatment due to other indications) are useful. In addition, wards for patients without COVID-19 will have to be managed. The concept reflects the diversity of patient care during the coronavirus pandemic and, at the same time, makes it possible to provide risk-adapted infection protection.

Ward modules or units in specialist departments:

  • The holding area
    New admissions wait for their swab results in the admission unit for inpatients. The patients and all employees shall wear face masks. If the swab is negative, the patients can be admitted by the respective specialist units.
  • The suspected COVID-19 ward
    Here the patients are cared for exclusively under consideration of the barrier care.
  • Ward for patients who test positive for COVID-19
    Isolation ward with barrier care. Depending on the leading clinical symptoms, the isolation ward can be further divided into subareas:
    - internal (COVID-19 patients) or e.g.
    - surgical department (patients who are also COVID-19 positive)
  • Patients without COVID-19
  • Intensive care unit/intermediate care
    - COVID-19 isolation
    - COVID-19 negative area

Furthermore, the professional association recommends that occupancy should not be based on the number of beds available. Rather, the possible capacity of surgical and interventional units (e.g. endoscopy, catheter laboratory, radiology) should be taken as a basis. The number of patients admitted daily is adjusted to the daily capacities. If a renewed increase of COVID-19 patients is noted, this should be included in the overall occupancy planning.


Source:
German Society for General and Visceral Surgery (DGAV e.V.) COVID-19 recommendations. Friday, April 24, 2020. https://www.awmf.org Last accessed on 05/14/2020

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