Abstract
Background:The Singapore COVID-19 multi-ministry taskforce commissioned community care facilities (CCFs) as a hospital-sparing strategy amidst rising coronavirus disease 2019 (COVID-19) cases. An exhibition centre was repurposed within ten days as an ad-hoc 3200-bed medical facility (CCF@EXPO) to isolate and treat infected patients amidst concerns of potential COVID-19 transmissions to healthcare staff. This paper deconstructs the implementation of the CCF@EXPO infection prevention and control (IPC) innovation and elicits critical factors which enabled zero transmission of COVID-19 to staff during 100 days of operation using an implementation science framework.Methods:This study employed retrospective analysis using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The CCF@EXPO IPC innovation comprised five key elements: (a) physical environment, (b) work practices, (c) tools and technology, (d) staff training, and (e) audits. Contextual assessment was conducted for baseline and 100thday of CCF@EXPO operations. Actions taken to improve scores between these timepoints were mapped against the Expert Recommendations for Implementing Change (ERIC) tool to surface key implementation strategies.Results:Positive shifts were observed in all constructs of the i-PARIHS framework, between baseline and 100thday. The largest shifts were in work practices, tools and technology, and staff training. Key implementation strategies used included: rapid Plan-Do-Study-Act (PDSA) cycles, identifying champions, team building, creating a culture of collaborative learning, multi-disciplinary teamwork, transparency in communications and decision-making, and skillful facilitation.Conclusions:Rapid PDSA cycles anchored by principles to ensure staff safety, was the key approach used in implementation of the CCF@EXPO IPC innovation. Retrospective analysis using the i-PARIHS framework is useful to elicit success factors and to inform preparedness planning of future pandemics.
Highlights
Many countries have repurposed pre-existing public venues or infrastructure as community care facilities (CCFs) to provide treatment for those infected with coronavirus disease 2019 (COVID-19), reserving hospital care for patients with serious sequelae.1-3 An inherent challenge in using non-healthcare public venues, is to ensure adaptations to layout, infrastructure, workflows, and work practices are designed to support infection prevention and control (IPC) for staff and patient safety
We developed an assessment rubric based on the i-PARIHS framework for a systematic retrospective deconstruction of the CCF@EXPO IPC innovation (EL, WEC)
By the 100th day, protecƟve equipment (PPE) compliance had improved from 97% to 100% and from 93% to 98%, respectively, for healthcare and non-healthcare staff
Summary
Many countries have repurposed pre-existing public venues or infrastructure as community care facilities (CCFs) to provide treatment for those infected with coronavirus disease 2019 (COVID-19), reserving hospital care for patients with serious sequelae. An inherent challenge in using non-healthcare public venues, is to ensure adaptations to layout, infrastructure, workflows, and work practices are designed to support infection prevention and control (IPC) for staff and patient safety. Many countries have repurposed pre-existing public venues or infrastructure as community care facilities (CCFs) to provide treatment for those infected with coronavirus disease 2019 (COVID-19), reserving hospital care for patients with serious sequelae.. The COVID-19 multi-ministry taskforce commissioned CCFs to be rapidly set-up as a hospital-sparing strategy in April 2020 amidst rising cases, to provide care for patients with mild symptoms.. The Singapore COVID-19 multi-ministry taskforce commissioned community care facilities (CCFs) as a hospital-sparing strategy amidst rising coronavirus disease 2019 (COVID-19) cases. An exhibition centre was repurposed within ten days as an ad-hoc 3200bed medical facility (CCF@EXPO) to isolate and treat infected patients amidst concerns of potential COVID-19 transmissions to healthcare staff. This paper deconstructs the implementation of the CCF@EXPO infection prevention and control (IPC) innovation and elicits critical factors which enabled zero transmission of COVID-19 to staff during 100 days of operation using an implementation science framework.
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