Table 3.

City Hospital SOP for critical care management of special pathogen patients

Conventional patient care: 1–2 patients (and anticipate limited scope)

1. Due to availability of anterooms and appropriate equipment, provide all patient care (including critical care) in bone-marrow transplant (BMT) unit rooms [2]

2. See PPE guidance from infection control for special pathogens and agent-specific information from infectious disease on-call physician

3. Assure staff and patient/visitor PPE compliance, minimize number of caregivers. Trainees should not provide patient care

4. Initiate staff exposure tracking

5. PPE changed between patient contacts

Contingency patient care: 3– 43 patients (limited source/volume incident, e.g., SARS)

1. Utilize MICU 1 (5 beds) as isolation area using single entrance in addition to BMT rooms. Post doors as infectious exposure area. Facilities should establish temporary anteroom/changing area off hallway (2 h). Facilities should isolate ventilation to unit and change to 50% supply, 100% exhaust. Step-down care may be provided in MICU prior to transfer to floor negative pressure rooms

2. Open Surgery and Procedure center as isolation stepdown/critical care isolation area in consultation with incident manager if necessary (>7 patients or more anticipated). Ventilation is already exhausted from this area; elective surgical volumes should be reduced during event. Use locker rooms as clean/infectious transition zones for PPE donning/doffing. May use operating suites for ICU level care in cooperation with anesthesia. Capacity 36 beds including 24 in waiting/recovery and 12 operating room/procedure rooms

3. PPE used by staff continuously in infectious area

Crisis patient care (catastrophic event, e.g., pandemic influenza)

1. Using the standard surge capacity worksheet as a tool, determine with incident management which patient care areas to use as infectious patient cohort care depending on the current and anticipated event scope. Cohort areas to may expand and contract during the course of the event

2. Facilities should assist with construction of temporary anterooms for PPE changing adjacent to each cohort area and assure exhaust ventilation for these areas. Supply may not be able to be manipulated for large areas

3. Hospital should implement access control and staff screening/monitoring plans

4. PPE used by staff continuously in infectious/cohort area, potentially hospital-wide depending on scope of the event and transmissibility

Sample core infectious disease critical care capacity elements for ‘City Hospital.’ Note that this plan reflects specific adaptations for the facility and that each facility should identify a phased approach to these patients. Space concerns are only one element of an overall infectious disease response plan and guidance for specific disease management, infection control, staff screening, behavioral health, visitor and access control policies, Emergency Department screening and cohorting, and patient transport planning (use of elevators, etc.) policies all should be included in the institutional plan

City Hospital SOP for critical care management of a special pathogen: this guideline applies ONLY to pathogens that are transmitted by airborne or suspected airborne routes AND have a high likelihood of transmission and severe morbidity/mortality (may include SARS, pandemic influenza, some hemorrhagic fevers). These patients require careful and comprehensive use of personal protective equipment (PPE) by staff caregivers