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The rapid spread of coronavirus disease 2019 (COVID-19) required swift preparation to protect healthcare personnel (HCP) and patients, especially considering shortages of personal protective equipment (PPE). Due to the lack of a pre-existing biocontainment unit, we needed to develop a novel approach to placing patients in isolation cohorts while working with the pre-existing physical space.
To prevent disease transmission to non–COVID-19 patients and HCP caring for COVID-19 patients, to optimize PPE usage, and to provide a comfortable and safe working environment.
An interdisciplinary workgroup developed a combination of approaches to convert existing spaces into COVID-19 containment units with high-risk zones (HRZs). We developed standard workflow and visual management in conjunction with updated staff training and workflows. The infection prevention team created PPE standard practices for ease of use, conservation, and staff safety.
The interventions resulted in 1 possible case of patient-to-HCP transmission and zero cases of patient-to-patient transmission. PPE usage decreased with the HRZ model while maintaining a safe environment of care. Staff on the COVID-19 units were extremely satisfied with PPE availability (76.7%) and efforts to protect them from COVID-19 (72.7%). Moreover, 54.8% of HCP working in the COVID-19 unit agreed that PPE monitors played an essential role in staff safety.
The HRZ model of containment unit is an effective method to prevent the spread of COVID-19 with several benefits. It is easily implemented and scaled to accommodate census changes. Our experience suggests that other institutions do not need to modify existing physical structures to create similarly protective spaces.
Ventilator-associated pneumonia (VAP) is a frequent complication of severe burn injury. Comparing the current ventilator-associated event-possible VAP definition to the pre-2013 VAP definition, we identified considerably fewer VAP cases in our burn ICU. The new definition does not capture many VAP cases that would have been reported using the pre-2013 definition.
Physiologic changes of the respiratory system occur with aging; for example, the chest wall stiffens, airway size decreases, and the diaphragm becomes less efficient. However, these changes alone should not cause significant breathing difficulties unless there is an underlying disease process. The most commonly encountered pulmonary diseases in the geriatric patient population are obstructive lung diseases, pneumonia, pulmonary embolism, interstitial lung diseases, nontuberculous mycobacterium infections, and sleep disorders. Due to their increased likelihood of comorbidities, older patients have numerous special diagnosis and treatment considerations. Practitioners should focus on utilizing the most effective therapies to optimize lung function while minimizing potential harm to the patient.
Most of the pulmonary diseases present in the elderly also exist in younger patients; however, the incidence and presentation of these diseases can differ greatly between these two age groups. Elderly patients tend to have other comorbidities that can increase the difficulty with which diagnoses are made and interfere with recovery. This is particularly true when disease processes advance to cause respiratory failure.
PHYSIOLOGICAL CHANGE WITH AGING
Changes to the respiratory system occur with aging that have an impact on pulmonary reserve and decrease the respiratory system's ability to respond to physiological stress and disease. These “normal aging” changes are mild and usually not clinically relevant in the healthy state. The changes discussed later should never limit a patient's usual activity or cause significant dyspnea at rest in the absence of lung disease.
As a patient ages, elastic tissue in the lung is replaced by collagen. This change results in smaller airway size. Airway diameter decreases significantly after the fourth decade, resulting in increased air trapping as small airways collapse at end expiration. The alveolar–arterial oxygen gradient increases with advancing age because of a number of factors including increased collagen deposition in the walls of alveoli, changes in alveolar structure, and decreased alveolar surface area. The thoracic cage and respiratory muscles also change with age. Arthritis of the costovertebral joints, kyphoscoliosis, and calcification of intercostal cartilage result in decreased chest wall compliance and increased stiffness.
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