Holistic integration of human, processes, equipment and space critical in battling against infectious diseases.
by Khurram Majeed
Four months into 2020 and the world is still reeling from the disruptions brought on by the COVID-19 pandemic. At the time of this writing (6 April 2020), more than 200 countries have confirmed coronavirus cases; while across the ASEAN region, there has been rapid escalation1 with over 8,000 cases detected.
The ASEAN healthcare system has been pushed to its limits. Thailand has turned a dormitory to a 308-bed facility for non-critical coronavirus patients,2 as has Indonesia, where an athlete’s village has been converted into an emergency hospital to cope with the rising number of infected cases.3 More than 400 buildings and sites such as public universities, community colleges and hotels across Malaysia4 had been gazetted by the government to be converted into temporary quarantine stations or field hospitals. Singapore’s Ministry of Health raised caution about the need to preserve5 the nation’s buffer capacity in its healthcare system.
As the number of cases continue to soar within the region, what measures should hospitals adopt in the fight against the fast-spreading contagion?
The U.S. Centers for Disease Control and Prevention, a government public health agency, has identified a checklist6 to help hospitals assess and improve their preparedness for responding to a community-wide outbreak of COVID-19. This includes prompt identification and isolation of patients with possible infection and providing information to the correct facility staff and public health authorities; and the prevention of the spread of respiratory diseases including COVID-19 within the facility. Hospitals also need to be able to maintain adequate care for other patients while attending to patients in an escalating outbreak.
Building hospitals is a complex business, made even more so with setting up an emergency infectious disease facility within a short time period. It’s essential to consider four elements: human empowerment, processes, equipment and space; and the holistic interplay between them. The facility has to be properly equipped with the requisite analysis, monitoring, control and emergency response capabilities to treat infected cases and handle public emergencies.
The human element underpins any hospital operations. The extensiveness and agility of collaboration among various specialist divisions should be considered. The proper integration of data, network, and building technologies into a centralised command platform allows seamless facility-wide co-ordination involving different units, departments and their corresponding supplies.
Communication plays a key role. In today’s fluid environment, it’s important to keep emergency communications lines open to facilitate multi-party dialogue, information dissemination and decision-making.
Technology and artificial intelligence (AI) would improve medical workers’ efficiency and effectiveness. Medical teams could leverage information technology to enhance the accuracy and speed of their diagnostic capabilities. AI could also help medical teams in risk management, where the technology could analyse threat types, threat severity as well as the likelihood of occurrence, and integrates the insights with the hospital’s assets and resources to determine the overall risk levels.
Process digitalization and workflow optimization are crucial in improving institutional response to emergency situations. Insights gained from digitalization (which enables efficient analysis of the volume of data amassed) and workflow optimization (such as early warning and control management) could be re-channelled into the healthcare system and adopted as best practices.
Smart technology could boost the process of contact tracing and monitoring in the region. Automated alerts bypass the need for a manual contact centre, while human intervention would only be needed for onsite verification of those whom need to be quarantined.
The use of AI technology would speed up the screening process. An infrared body temperature screening instrument is able to quickly detect people with a fever within a fast-moving crowd for initial disease screening. This is useful in reducing staff pressure, improving efficiency and accuracy, while minimizing direct contact and avoiding transmission. Once fever is detected in a patient, the system could be synced with security video surveillance to achieve location tracking. Through advanced algorithms, people who had been in close contact with affected patients could be tracked and alerted of their risk level. Real-time data could be used to analyse the developmental trends of similar cases and to determine if the cases are homologous.
Hospitals in ASEAN and around the world would benefit from integrated solutions that provide comprehensive situational awareness on operational aspects. Take bed capacity optimization for instance. Given that hospitals are operating at close to capacity, we could leverage smart technology for automated discharge of recovered patients. The system could identify when a patient is suitable for discharge — by using inputs on vital signs from the patient’s monitors to verify his/her well-being against specific parameters. The discharge could then be confirmed via a healthcare professional. Subsequent follow up could be done via SMS over a 30-day monitoring period to determine the patient’s health status, and to ascertain if there’s a need for readmission or deployment of doorstep consultation.
Hospital workflows could benefit from data analytics. The technology could provide insights on personnel movements, including medical staff, within the compound. Real-time analysis on the operational status of each hospital sub-system is critical to ensure the smooth-running of the medical facility.
Overview on Equipment and Resources
It’s important to have a comprehensive overview of hospital resources, especially during a crisis. An integrated platform on the status of people, processes, equipment and space enables visual trend analysis and predictive management based on real-time and historical data.
The practice of good hygiene within the healthcare facility is critical to containing outbreaks. An estimate7 by the World Health Organization showed that only half of countries around the world have a national infection prevention and control program and WASH (water, sanitation and hygiene) standards in all healthcare facilities. To address this issue, smart washrooms solutions, which track usage and replenishment of consumables and monitors air quality, could be implemented in hospitals in this region.
An integrated command centre ensures round-the-clock monitoring of negative pressure wards in infectious disease hospitals. Air pressure in these special rooms is lower than that of ambient air to prevent the release of contaminated air. The pressure difference between the public corridor, the corridor for medical personnel and the buffer area has to be maintained at a certain reading. The command centre monitors the negative pressure for these wards and nursing calls to protect the medical workers from unnecessary contact.
Good space management cannot be overlooked. Proper time and space management such as route planning for quarantine areas and processes, is important to ensuring public safety in hospitals.
Smart technology could help in hospital waste management. Intelligent logistics robots could be deployed to handle and process medical waste, thus reducing exposure and risk of transmission to humans. For manual work that is still necessary, spatial movements could be controlled through route designation for transporting clean and contaminated items, thereby avoiding a crossover.
A “three-zones-two-channels” layout is recommended for more effective containment of infectious diseases. The “three zones” refer to clean zones, semi-contamination zones, and contamination zones. The air between the zones should flow unidirectionally from the clean zone to the semi-contaminated zone to the contaminated zone, in accordance to varied pressure levels.
The “two channels” refers to the routes for medical personnel and patients. A buffer room between the corridor for medical personnel and patients’ ward ensures a separation of movement between medical personnel and patients. There should be a special double-layered window between the ward and the corridor for medical personnel. The windows on either side cannot be opened at the same time, which effectively prevents transmission.
Properly ventilated buildings are critical to improve air quality and prevent the spread of disease and secondary infection. Guidelines8 from the World Health Organization further underscore its importance, and it’s essential to maintain these systems and keep them in service where people continue to live and work.
We’re in This Together
In the face of today’s prolonged pandemic, technology could take on greater role alongside healthcare workers to care for patients. For instance, robots9 could help take vital signs, deliver medicine, disinfect the facility and entertain quarantined patients. Internet of Things (IoT) could monitor the daily temperatures of high-risk patients on quarantine via their mobile devices and upload the data to the cloud for analysis. This allows more data to be collected efficiently and reduce cross-infection with the patients.
Private sector involvement in times of health crises is not uncommon. Businesses across the world are developing creative solutions to help battle the novel coronavirus, and to plug gaps in medical supplies. Some examples include repurposing factories to produce medical essentials such as rubber gloves, surgical masks and diagnostic tools, to using 3D printing to make ventilator valves.
Building technology providers, such as Johnson Controls, have enabled hospitals in China10 to rapidly expand their capacity in line with stipulated guidelines and standards. Its quick-build heating, ventilation and air-conditioning (HVAC) equipment helped mobilize facilities by converting unused infrastructure to isolation rooms, for instance. Cloud-based access controls and video surveillance technology from the company has further enabled remote monitoring to maximize safety for healthcare staff and patients.
The accelerated spread of COVID-19 has exposed structural problems in the global and regional healthcare system. The crisis demonstrates the importance of rapid capacity scalability in response to the outbreak. Putting the right built technology to work to speed the building of healthcare facilities within ASEAN, and to connect all four elements of human, processes, equipment and space, will help address capacity issues in the region, going forward. [APBN]
- COVID 19. Who.int. (2020). Retrieved 13 April 2020, from https://www.who.int/southeastasia/outbreaks-and-emergencies/novel-coronavirus-2019.
- First Covid-19 field hospital opens Wednesday. https://www.bangkokpost.com. (2020). Retrieved 13 April 2020, from https://www.bangkokpost.com/thailand/general/1884745/first-covid-19-field-hospital-opens-wednesday.
- Indonesia turns athlete’s village to emergency hospital as coronavirus cases rise. The Straits Times. (2020). Retrieved 13 April 2020, from https://www.straitstimes.com/asia/se-asia/indonesia-turns-athletes-village-to-emergency-hospital-as-coronavirus-cases-rise.
- Lim, I. (2020). Local architects asked to help convert gazetted buildings into Covid-19 quarantine stations | Malay Mail. Malaymail.com. Retrieved 13 April 2020, from https://www.malaymail.com/news/malaysia/2020/03/26/local-architects-asked-to-help-convert-gazetted-buildings-into-covid-19-qua/1850346.
- MOH | News Highlights. Moh.gov.sg. (2020). Retrieved 13 April 2020, from https://www.moh.gov.sg/news-highlights/details/statement-by-mr-gan-kim-yong-minister-for-health-at-parliament-on-the-update-on-whole-of-government-response-to-covid-19.
- Coronavirus Disease 2019 (COVID-19). Centres for Disease Control and Prevention. (2020). Retrieved 13 April 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-hospital-checklist.shtml.
- WHO Director-General’s opening remarks at the Mission briefing on COVID-19 – 19 March 2020. Who.int. (2020). Retrieved 13 April 2020, from https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19—19-march-2020.
- Ventilation and airborne diseases. World Health Organization. (2020). Retrieved 13 April 2020, from https://www.who.int/sustainable-development/health-sector/health-risks/airborne-diseases/en/.
- Research, A. (2020). COVID-19 Pandemic Impact: A Surge in Proven Mobile Robotics Use Cases for Disinfection, Monitoring, Surveillance, and Delivery Will Propel the Market to US$23 Billion by 2021. Prnewswire.com. Retrieved 13 April 2020, from https://www.prnewswire.com/news-releases/covid-19-pandemic-impact-a-surge-in-proven-mobile-robotics-use-cases-for-disinfection-monitoring-surveillance-and-delivery-will-propel-the-market-to-us23-billion-by-2021-301033661.shtml.
- Johnsoncontrols.com. (2020). Retrieved 13 April 2020, from https://www.johnsoncontrols.com/media-center/news/press-releases/2020/03/20/mission-critical-essential-products-services-and-personnel-during-ongoing-covid-19-pandemic.
About the Author
Vice President Asia Pacific & Managing Director Growth Markets