188: The Hospital-in-Hospital Model for COVID-19 in a Montreal Community Hospital

Abstract

INTRODUCTION: At the beginning of pandemia,community hospitals had to adapt rapidly while dealing with limited resources to deal with the rapid inflow of patients with SARS-CoV-2 While university hospitals have access to a vast amount of resources, such as negative pressure rooms We therefore had to look for alternative solutions to provide care for C19 patients without contaminating healthcare workers and non-C19 patients The first premise of our model is that, during a pandemic, we have to be able to provide equal healthcare for C19 and non-C19 patients while not contaminating patients being hospitalized for reasons unrelated to C19 Secondly,since there is no certainty about the timing for a vaccine, we had to design a model that could be viable for years and still be safe and effective for both categories of patients Finally, with the global shortage of personal protective equipment (PPE),it was crucial to minimise it's consumption METHODS: Our model: a circuit with one entry and one exit to avoid healthcare workers going from a contaminated area to a non-C19 one It is essential to identify which patient should go into which section of the hospital Every patient admitted in the emergency room (ER) is classified in three categories: 1) with no suspicion (green): admission to the non-C19 hospital, 2) suspicion of C19 (yellow):await their test result in a separate section of the ER and 3) with a positive test or very high pre-test probability (red) admitted into the C19 hospital Those admitted to the non-C19 section were tested for C19 and isolated until a negative result We tested all asymptomatic patients and think that this decision played a significant role on our low rate of in-hospital acquired C19 At the entrance, PPE staff supervised health care workers putting on their equipment RESULTS: During the first wave of the pandemics, we have treated more than 250 C19 patients In our hospital, only 1,4% acquired the virus in the non c19 section without mortality or severe disease Other hospitals in Montreal had a hospital acquired incidence of 15 to 50% resulting in significant morbidity and mortality Although 22% of the C19 in Montreal occurred in healthcare workers, only one in our unit contracted the virus CONCLUSIONS: ?Hospital in hospital? model reduced contamination importantly