Maintaining distance in acute hospitals
Sir, – Most people, including young children, now understand physical (social) distancing and it is part of the national lexicon. However, we always knew that keeping our distance helped prevent infection. When confronted previously by somebody sneezing or coughing, most of us knew instinctively to keep our distance. In hospitals, we have separated those with transmissible infections by using single rooms, including those acquired in the community, eg tuberculosis, and those with a hospital “superbug”, such as MRSA. We have also used single rooms to protect those vulnerable to infection, such as patients after organ transplantation.
We do not have sufficient isolation rooms in public hospitals, many patients are too close together on our wards, and we do not have sufficient acute hospital beds for ongoing care.
Nightingale wards, that is multiple beds in a large room, recently used for large numbers of patients with Covid-19, have proven useful during this crisis. However, we still routinely use such wards in some Irish hospitals but they are not suitable for complex patients, sometimes with different infections. Infections such as norovirus (winter vomiting bug) can quickly spread on such wards.
In 2009, I contributed to a multidisciplinary group that produced building guidelines for hospitals as part of a national strategy to control antimicrobial resistance. This group recommended that all new acute hospitals should have 100 per cent single rooms, a minimum space for each bed, surge capacity, and that rooms with multiple beds should have three or fewer patients. The emphasis was on adequate space to minimise transmission, to provide single rooms for most patients, and the reconfiguration of existing facilities. There are also instances where controlled ventilation is required in single rooms, but elsewhere fresh air may assist in clearing bugs from enclosed spaces.
The successful efforts of the health service to provide surge capacity during the pandemic have been impressive. It reveals that providing additional bed capacity is possible. Too many patients in too small a space, with inadequate numbers of single rooms, contributed to some patients and hospital staff acquiring Covid-19.
The coming months and years will be challenging at all levels. Nonetheless, we must do better to protect patients but also healthcare staff, by caring for the carers. I strongly believe we need to have adequate space in acute hospitals, move to near 100 per cent single rooms, and to be able to provide surge capacity, if required again.
Many more single beds and more space will help prevent all infections among patients, protect staff, and leave us better prepared for another pandemic. Preventing all infections in hospital will lead to greater efficiency, by reducing additional days in hospital. Finally, such an approach will ensure greater privacy and dignity for sick patients, some of whom may sadly never leave the hospital alive. – Yours, etc,
Professor of Clinical
Royal College of Surgeons