Site identification, selection and survey
The choice of a site will determine future problematic issues that could be encountered, such as infiltration, drainage, access, extension and acceptance. Take the necessary time to carefully choose the site that is as adequate as possible, rather than the first one seen.
It is important to define the expected potential scale (e.g. size, duration) of the outbreak from the beginning.
- Ensure good access and guaranteed security for patients, visitors and staff of COVID-19 Hospital.
- Ensure COVID-19 Hospital proximity to the outbreak epicentre.
- Ensure proximity to existing health-care facilities to facilitate external referral pathways for people who test negative for 2019-nCoV but who require medical care for different medical conditions.
- Avoid all flood areas and choose a site at least 30 metres away from rivers and other bodies of water.
- Ensure COVID-19 Hospital site is flat and level.
- Ensure COVID-19 Hospital site is geologically stable and consolidated, preferably without organic or stony material.
- Ensure COVID-19 Hospital site is easy to dig, without the danger of landslides, and with the capacity for drainage.
- Avoid areas with a high groundwater table.
- Choose a sufficiently large plot of land so the centre can be extended if necessary
- Be aware of seasonal periods affecting the construction (e.g. rainy/dry periods). Be able to adjust the design to accommodate different climatological conditions.
- Take into account prevailing winds for the control of smoke and odours.
- Take into account sun orientation for improved shadow zones.
- Consider the use of permanent buildings and existing hospital isolation or unused wards.
- Evaluate water resources in the area of COVID-19 Hospital, with special focus on the analysis of capacity, quality and availability.
- If available, have the option to connect to local basic services for water, electricity and communications.
- Before arrival of main supplies, prepare or identify a storage area.
The proposed layout of COVID-19 Hospital is based on the clinical definition of a person with SARI, suspected nCoV, the clinical syndromes associated with nCoV infection, and related medical condition categories: mild, moderate, severe and critical illness.
Figure 25. Basic layout of severe acute respiratory infection treatment centre
The rationales behind this layout are as follows:
- Medical care should be provided as soon as possible, even before laboratory confirmation, in order to avoid medical conditions worsening.
- People with different medical conditions present different risks; for example, people with severe SARI might need an aerosol-generating procedure.
- Ensure a clear demarcation and separation between patient and staff areas in order to reduce the risk for health-care workers and allow a rational use of PPE.
- The centre should be divided into two zones – a staff area for health-care workers and a patients’ area (Figures 25 and 26). The patients’ area is further divided into three zones (mild and moderate, severe and critical) according to the medical conditions of the patients. Patient categorization should follow the definition of clinical syndromes associated with nCoV infection (Table 10) (29). It is the responsibility of the case management department to decide on categorization (30).
Figure 26. Severe acute respiratory infection treatment centre zone categorization
Minimum requirements for converting an existing building into a severe acute respiratory infection treatment centre
An existing building may be repurposed into a SARI treatment centre if the minimum requirements are met:
- minimum ventilation rate of 60 litres per second per patient for mild and moderate wards;
- minimum ventilation rate of 160 litres per second per patient for severe wards and intensive care units;
- airflow from clean to dirty zones;
- patient and staff flow can be clearly defined and distances respected;
- all finishes, furniture and patient care equipment can be effectively cleaned and are compatible with the facility’s disinfectants (see below).
Recommended characteristics for selecting finishes and furniture
The recommended characteristics for selecting finishes and furniture are summarized in Table 11 (32).
Table 11. Recommended characteristics for selecting finishes and furniture for a severe acute respiratory infection treatment centre
|Cleanable||• Avoid items with hard-to-clean features, such as crevasses
• Do not use carpets in patient care areas
• Select material that can withstand repeated cleaning
|Easy to maintain and repair||• Avoid materials prone to cracks, scratches or chips, and quickly patch or repair if they do occur
• Select materials that are durable or easy to repair
|Resistant to microbial growth||• Avoid materials that hold moisture, such as wood and cloth, as these facilitate microbial growth
• Select metals and hard plastics
|Nonporous||• Avoid items with porous surfaces, such as cotton, wood and nylon
• Avoid porous plastics, such as polypropylene, in patient care areas
|Seamless||• Avoid items with seams
• Avoid upholstered furniture in patient care areas
Figures 27–33 show the ideal layout and flows for patients and staff for a SARI treatment centre.
Figure 27. Layout of services and facilities in a severe acute respiratory infection treatment centre
Figure 28. Patient flow, from entry to sampling, in a severe acute respiratory infection treatment centre
Figure 29. Patient flow after sampling patients are divided by severity in a severe acute respiratory infection treatment centre
Figure 30. Patient flow for negative, mild and moderate patients in a severe acute respiratory infection treatment centre
40 41 Figure 31. Patient flow for worsening patients in a severe acute respiratory infection treatment centre
Figure 32. Patient flow for recovering patients in a severe acute respiratory infection treatment centre
42 43 Figure 33. Staff flow in a severe acute respiratory infection treatment centre
Citation: Severe acute respiratory infections treatment centre: practical manual to set up and manage a SARI treatment centre and SARI screening facility in health care facilities. Geneva: World Health Organization; 2020 (WHO/2019-nCoV/SARI_treatment_center/2020.1). Licence: CC BY-NC-SA 3.0 IGO