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Preparing Intensive Care Unit for COVID-19

Objective: To communicate interim guidelines on the preparation of intensive care unit (ICU) for coronavirus disease of 2019 (COVID-19) patients.

As the COVID-19 has become pandemic, the ICUs need to prepare for a potential surge of critically ill patients and counter the high transmissibility of SARS-CoV-2. All healthcare institutions adopted a common strategy of containment, with isolation of all suspected or confirmed cases of COVID-19 in negative-pressure rooms. Preparation of ICUs for patients with COVID-19 had numerous other requirements. Such as:

  1. Infection control- Does not only involve strict adherence to personal protective equipment for the individual, but also involved changes in group dynamics. Avoid cross-contamination and enhance surveillance among healthcare workers (HCW). Educate and train about personal protective equipment (PPE) and use of powered air-purifying respirators. Strongly emphasis on good hand hygiene for all.
  2.  Resuscitation and code blue response- Provide guidelines on personal protective equipment (PPEs) and use of powered air-purifying respirators in ISO wards and normal wards during resuscitation.
  3. Dissemination of information to HCW- Robust system of dissemination of information (changing policies, workflows, etc.). Email and meetings alone are insufficient to operationalize urgent changes in practice. Rapid and regular communications with large, disparate groups of clinicians.
  4. Advanced ICU services- Provide clear thresholds for transfers of deteriorating cases and efficient and safe delivery of ICU bronchoscopy. Re-examination for specific ICU services.
  5. Psychological stress and burnout of HCW- Factors include:
  • increased workload due to implementation of strict infection control measures
  • uncertainty over the effectiveness of PPE
  • anxiety over the lethality of any infection
  • concern for the well-being of their family members and public stigmatization.

Reference:  Liew, M.F., Siow, W.T., MacLaren, G. et al. Preparing for COVID-19: early experience from an intensive care unit in Singapore. Crit Care 24, 83 (2020).