Structural reconstruction of wards
Hospitalization wards for patients with severe mental illness are generally closed or semiclosed. This arrangement cannot prevent the spread of COVID-19, and it is difficult to effectively isolate and treat infected or suspected patients. Therefore, ward reconstruction is an essential step.
The existing ward layout can be retrofitted based on the current ward layout of infectious disease hospitals. Reconstructed wards have a structure consisting of “three areas and two access points.” The “three areas” include a clean area, a semicontaminated area, and a contaminated area, and the “two access points” include a contaminated access for medical waste and the transfer of infected patients and a clean access, which allows access for medical personnel and daily clinical work. Under the premise that no specific therapeutic drugs or vaccines exist for COVID-19, isolation is still the most effective means of containing COVID-19 in institutions.
Reallocation of ward functions
Before the COVID-19 outbreak, psychiatric wards were generally designed according to the characteristics of conventional psychiatric services, comprising a dementia ward, a depression ward, and a substance dependence ward, for example. During the outbreak, all impairment-specific settings were replanned to allow for the most effective prevention and control of COVID-19, and the functions of the psychiatric wards were reallocated according to the following plan9: (1) a ward for confirmed COVID-19 patients: this ward is used for the treatment of COVID-19 patients, and the patients are classified and managed according to disease severity; secondary protections should be implemented. (2) A ward for suspected COVID-19 patients: this ward is used for patients with negative nucleic acid test results but with clinical and imaging manifestations similar to those of COVID-19 patients; secondary protections should be implemented. (3) An isolation observation ward: this ward is used for the temporary isolation and observation of patients who are newly admitted to the hospital and have no symptoms of pulmonary infection; secondary protections should be implemented. During this isolation period, patients are screened, confirmed patients are transferred to the ward for confirmed COVID-19 patients, suspected patients are transferred to the ward for suspected COVID-19 patients, and clean (uninfected) patients are treated in this ward. (4) A rehabilitation ward: this ward is used for the medical isolation and observation of patients who have been cured or meet the discharge criteria during the rehabilitation period; primary protection should be implemented. (5) A general ward: this ward is used for the centralized and closed management of patients who have not been affected by COVID-19; primary protection should be implemented. The admission and treatment of new patients is not allowed, and medical staff should be managed in an “inpatient” manner, with regular shift changes and restrictions of movement to prevent cross-infection.
Optimization of resource allocation
Due to the lack of awareness of virus transmission routes, in the early stage of a COVID-19 outbreak, the following issues will inevitably occur in institutions: (1) serious staff shortages due to the infection and isolation of medical staff; and (2) shortages of protective equipment. If these problems are not addressed in a timely manner, they can lead to continued aggravation of a COVID-19 outbreak at a hospital.
It is urgent to utilize all available resources for self-help according to the following recommendations: (1) shortages of first-line medical staff can be reduced by reorganizing wards, sending non-frontline health workers to work in the ward, and recruiting new medical staff. (2) If nosocomial infection occurs in the early stage of the outbreak, the hospital should be temporarily closed and stop admitting new patients. After the nosocomial infection is under control, diagnosis and treatment procedures should be reorganized in accordance with the requirements for preventing and treating infectious diseases. (3) Facing the difficulties of a shortage of protective equipment hospitals, it is necessary to actively establish a wide range of social connections, accept social donations, strengthen communication and coordination with the government, and request material assistance.
Ensure good liaison consultation, admission, and referral of patients
Liaison consultation, admission, and referral of patients according to their infection conditions are important factors in determining the success or failure of the fight against COVID-19. Hospital management must establish a team of experts to assess COVID-19 patients according to the guidelines for the diagnosis and treatment of COVID-19 in China10 and assign patients to inpatient wards according to their conditions (Fig. 1). Regarding the expert team, in addition to professional psychiatric medical staff, infectious disease experts are also responsible for guiding the transformation of wards and the control of in-hospital transmission of the epidemic. Respiratory disease experts are responsible for assessing the severity of lung infections, providing in-depth guidance on the treatment of infections, and ultimately deciding whether a patient needs to be referred for treatment.
Prevention and effective control of nosocomial infections
The importance of controlling and preventing nosocomial infections cannot be overemphasized in the fight against COVID-19. In psychiatric specialty institutions, psychiatric staff have insufficient experience in the prevention and control of nosocomial infections. The following efforts must be made under the guidance of an infectious disease physician:
Effectively redesign the overall layout of the hospital for the prevention and control of COVID-19: the entire hospital, including the outpatient and inpatient wards, must have clean and contaminated accesses to prevent cross-infection.
Provide emergency training of staff for the prevention and control of nosocomial infections: this training includes performing hand hygiene, wearing and removing protective clothing, division of functional areas, protection levels and protective measures in different areas, disinfection of different environments, daily life of staff, methods to transfer patients with different diseases, methods to manage patients in different wards, and methods to dispose of medical waste.
Provide training in the prevention and control of nosocomial infections to workers in the ward, including doctors, nurses, and cleaning staff, to ensure that each staff member can perform standardized operations.