After-action Review of Hospital Environments Exploring the ‘New Normal,’ Focusing on Structural Management Aspects and Bacterial Culture in Thai Hospitals Amid the COVID-19 Pandemic
Keywords:
hospital environment, the new normal, COVID-19, bacterial cultureAbstract
OBJECTIVE This study aimed to explore the management of hospital environments during the COVID-19 pandemic, focusing on the structural aspects of ‘new normal’ health services delivery practices and bacterial culture in hospital rooms.
METHODS This study employed a cross-sectional design that involved the evaluation of hospital environment management, the detection of indoor bacterial colonies in hospitals, and interviews with healthcare administrators on the ‘new normal’ measures.
RESULTS The evaluation form was completed by 543 healthcare division heads from 30 hospitals. Respondents in each group reported that hospitals where they worked had effectively implemented new normal measures, making changes to the structure, processes, and personnel management components in line with the ‘new normal’ concept. The majority of the hospitals investigated, accounting for 71.7%, were found to have pathogenic bacterial counts lower than the permissible limits. The statistical analysis identified a significant association between ventilation, structural management under the ‘new normal’, and bacterial counts (p < 0.05).
CONCLUSIONS The incorporation of the structural aspects of new normal practices for managing the workplace environment should be a routine and integral part of efforts to control healthcare-associated infections in hospitals.
References
Liao J, Fan S, Chen J, Wu J, Xu S, Guo Y, et al. Epidemiological and clinical characteristics of COVID-19 in adolescents and young adults. Innovation (Camb). 2020;1(1):100001. PubMed PMID: 33554183.
Fears AC, Klimstra WB, Duprex P, Hartman A, Weaver SC, Plante KS, et al. Persistence of severe acute respiratory syndrome coronavirus 2 in aerosol suspensions. Emerg Infect Dis. 2020;26:2168-71.
Harvey AP, Fuhrmeister ER, Cantrell ME, Pitol AK, Swarthout JM, Powers JE, et al. Longitudinal monitoring of SARS-CoV-2 RNA on high-touch surfaces in a community setting. Environ Sci Technol Lett. 2020;8:168–75.
Hyttinen M, Rautio A, Pasanen P, Reponen T, Earnest GS, Streifel A, et al. Airborne infection isolation rooms–a review of experimental studies. Indoor Built Environ. 2011;20:584-94.
Li Y, Qian H, Hang J, Xuguang C, Cheng P, Ling H, et al. Probable airborne transmission of SARS-CoV-2 in a poorly ventilated restaurant. Build Environ. 2021;196:107788 PubMed PMID: 33746341
Huangsuwan S, Aumnuaiworachai K, Sommaneedoung S, Roopkaew S. COVID-19: Prevention and Control of Epidemic in Thailand. EAU Heritage Journal Social Science and Humanity. 2022;12:16-29.
Division of disease control in emergency situation. Coronavirus disease 2019 (COVID-19) situation, public health measures and obstacles to disease prevention and control in travelers. Department of Disease Control, Ministry of Public Health (Thailand) [Internet]. 2021 [cited 2022 Nov 15]. Available from: https://ddc.moph.go.th/uploads/files/ 2017420210820025238.pdf
Division of Communicable Diseases. The guidelines for COVID-19 vaccination in the outbreak situation 2021 Thailand (1st update). Department of Disease Control, Ministry of Public Health (Thailand) [Internet]. 2021 [cited 2022 Oct 15]. Available from: https://tmc.or.th/covid19/download/pdf/covid-19-public-Vaccine-040664.pdf
Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. Risk factors of healthcare workers with coronavirus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China. Clin Infect Dis. 2020;71(16):2218-21.
Abbas M, Nunes TR, Martischang R, Zingg W, Iten A, Pittet D, et al. Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers. Antimicrob Resist Infect Control. 2021;10:7. PubMed PMID: 33407833.
World Health Organization. Thailand Launches ‘New Normal’ Healthcare System To Build Back Better After COVID-19. World Health Organization [Internet]. 2020 [cited 2021 Nov 15]. Available from: https://www.who.int/thailand/news/feature-stories/detail/thailand-launches-new-normal-healthcare-system-to-build-back-better-after-covid-19
Harris PB, McBride G, Ross C, Curtis L. A place to heal environmental sources of satisfaction among hospital patients. J Appl Soc Psychol. 2002;32:1276-99.
Dagger TS, Sweeney JC, Johnson LW. A hierarchical model of health service quality: scale development and investigation of an integrated model. J Serv Res. 2007;10:123-42.
Berwick DM. Choices for the “New Normal”. JAMA. 2020;323:2125-6.
Bohmer R, Shand J, Allwood D, Wragg A, Mountford J. Learning systems: managing uncertainty in the new normal of COVID-19. NEJM Catal Innov Care Deliv. 2020;1:1-10.
Occupational Safety and Health Administration (OSHA). Guidance on Preparing Workplaces for COVID-
U.S. Department of Labor Occupational Safety and Health Administration. OSHA [Internet]. 2020 [cited 2020 May 9]. Available from:https://www.osha.gov/sites/default/files/publications/OSHA3990.pdf
ASHRAE Standard Project Committee. ASHRAE Standard Thermal Environmental Conditions for Human Occupancy. ANSI/ASHRAE [Internet]. 2004 [cited 2019 May 9]. Available from: http://www.ditar.cl/archivos/Normas_ASHRAE/T0080ASHRAE-55-2004 ThermalEnviromCondiHO.pdf
The National Institute for Occupational Safety and Health (NIOSH). Bioaerosol sampling (Indoor Air). Culturable organisms: bacteria, fungi, thermophilic actinomycetes, NIOSH Manual of Analytical Methods 4th Edition [Internet]. 1998.[cited 2019 March 20]. Available from: https://www.cdc.gov/niosh/docs/2003-154/pdfs/0800.pdf
Begun JW, Jiang HJ. Health Care Management during covid-19: insights from complexity science. NEJM Catal Innov Care Deliv. 2020;1:1-12.
Marome W. Facility management: space/place management for the future environment. Journal of Architectural/Planning Research and Studies (JARS). 2002;1:223-42.
World Health Organization. Infection prevention and control of epidemic and pandemic-prone acute respiratory infections in health care WHO guideline. World Health Organization [Internet]. 2014 [cited 2020 Mar 12]. Available from: https://apps.who.int/iris/bitstream/handle/10665/112656/97892?sequence=1
Hobday RA, Dancer SJ. Roles of sunlight and natural ventilation for controlling infection: historical and current perspectives. J Hosp Infect. 2013;84:271-82.
World Health Organization. Contact tracing in the context of COVID-19: Interim guidance. World Health Organization [Internet]. 2020 [cited 2022 Jan 15]. Available from: https://apps.who.int/iris/bitstream/handle/10665/332049/WHO-2019-nCoV-Contact_Tracing-2020.1-eng.pdf?sequence=1&isAllowed=y
King LA, Hothi SS. Re-modelling elective hospital services in the COVID-19 era designing the new normal. Future Healthc J. 2020;7(3):e60-63. PubMed PMID:33094258
Kaur R, Kant S, Bairwa M, Kaur A, Dhakad S, Dwarakanathan V, et al. Risk stratification as a tool to rationalize quarantine of health care workers exposed to COVID-19 cases: evidence from a tertiary health care center in India. Asia Pac J Public Health. 2021;33:134-7.
World Health Organization. Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19) Interim guidance. World Health Organization [Internet]. 2020 [cited 2022 Jan 15]. Available from: https://iris.who.int/bitstream/handle/10665/331497/WHO-2019-nCoVIHR_Quarantine-2020.2-eng.pdf?sequence=1&isAllowed=y
Wei J, Li Y. Airborne spread of infectious agents in the indoor environment. Am J Infect Control. Am J Infect Control. 2016;44(Supplement_9):S102-8.
Wu S, Wang Y, Jin X, Tian J, Liu J, Mao Y. Environmental contamination by SARS-CoV-2 in a designated hospital for coronavirus disease 2019. Am J Infect Control. 2020;48:910−4.
Memarzadeh F, Xu W. Role of air changes per hour (ACH) in possible transmission of airborne infections. Build Simul. 2012;5:15-28.
