Decommissioning and recommissioning a regional hospital in response to a COVID-19 outbreak.

Colleen Cheek,Maxine Wooler,Tara Anderson,Trent Baxter,Hayley Elmer

doi:10.22605/rrh6256

Abstract

The COVID-19 outbreak at the North West Regional Hospital (NWRH) site in Tasmania, Australia in April 2020 was both rapid and tragic. Within 10 days of identification of the first healthcare worker infection, both hospitals had closed, and all patients were discharged or decanted to other facilities within the state. The entire hospital staff (approximately 1300 people) and their households (approximately 3000-4000 people) were furloughed for 14 days to halt the spread of infection. During the furlough period, a decommissioning, terminal clean and recommissioning process was undertaken alongside recovery and reorientation of the workforce to personal protective equipment. Within 4 days of closure, an Australian Defence Force and Australian Medical Assistance Team team opened the prioritised emergency department to provide emergency care for the local community, supported by modified diagnostic services. The decommissioning and cleaning rolled on over the ensuing month, in a predetermined priority order. As staff returned from quarantine, they recommissioned their clinical areas. The final ward, a modified medical isolation wing, reopened on day 29. Disaster management activities may be grouped under four main headings: prevention, preparedness, response and recovery. There are many opportunities for improvement and learning, and this article focuses on the local response and recovery, describing the process undertaken from the perspective of a small management group. Authors CC, HE, TB and MW were on the ground during the decommissioning process, then managed aspects of the cleaning and recommissioning remotely from furlough. Authors TA and TC provided specialist IPC support and developed education remotely. Almost 2 months on, no new COVID-19 infections had been reported. The aim of this article is to provide a foundation for site-specific adaptation to include in pandemic escalation plans in other regional and rural settings.

Highlights

Preparations were made for decluttering – notification to laundry services of the increase in cleaning items and cleaning (Fig1), including: (mops, rags scrubs) and agreement of a 24-hour turnaround preparation and use of a checklist to guide disposal of consumables (open packaged items, disposable curtains), items that could be preserved but stored, items for removal (signage), and clearance of horizontal environmental surfaces storage and security of medications security of patient ward files and removal of patient information from whiteboards powering down of electronic devices removal of perishable items from kitchens diversion of meal delivery services to a supporting hospital collection and storage of unopened personal protective equipment transfer of switchboard services to a local receiving hospital use of an authorised script for switchboard operators to provide consistent messaging to callers confirmation all medical gases were off and secure confirmation that fire panel notifications would be automatically received by the local fire station planned collection of management laptops, web cams, mobile internet dongles and headsets to enable quarantined staff to work from home (not achieved) provision of a substantial and ongoing supply of personal protective equipment, cleaning equipment (trolleys, mop heads and handles, cleaning cloths), clinical waste bags, alginate bags for declutter and decanting scrubs and cleaning chemicals to prevent delays in cleaning
As the epicentre of an outbreak where the challenges experienced by staff are ongoing, it is hoped a focus of any research will be its contribution to rebuilding community and healthcare worker trust and confidence in managing essential health services for the region, as well as furthering knowledge about pandemic response in rural areas
We acknowledge the staff who continued to work to provide patient care and reinstate essential services at the most trying of times, those staff who unwittingly contracted the disease, Ambulance Tasmania and the Australian Defence Force and Australian Medical Assistance Team who came to our aid unreservedly and were exceptional, and those staff at the receiving hospital required to stand up an unplanned response, provide ongoing care for patients caught in an unfolding tragedy, and contain the outbreak

Summary

Introduction

Preparations were made for decluttering – notification to laundry services of the increase in cleaning items and cleaning (Fig1), including: (mops, rags scrubs) and agreement of a 24-hour turnaround preparation and use of a checklist to guide disposal of consumables (open packaged items, disposable curtains), items that could be preserved but stored, items for removal (signage), and clearance of horizontal environmental surfaces storage and security of medications security of patient ward files and removal of patient information from whiteboards powering down of electronic devices removal of perishable items from kitchens diversion of meal delivery services to a supporting hospital collection and storage of unopened personal protective equipment transfer of switchboard services to a local receiving hospital use of an authorised script for switchboard operators to provide consistent messaging to callers confirmation all medical gases were off and secure confirmation that fire panel notifications would be automatically received by the local fire station planned collection of management laptops, web cams, mobile internet dongles and headsets to enable quarantined staff to work from home (not achieved) provision of a substantial and ongoing supply of personal protective equipment, cleaning equipment (trolleys, mop heads and handles, cleaning cloths), clinical waste bags, alginate bags for declutter and decanting scrubs and cleaning chemicals to prevent delays in cleaning.

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Conclusion