Editor’s Note: Search for the latest Medscape COVID-19 news and guidance Coronavirus Resource Center.
There was no hand sanitizer in the hospital’s mental ward, fearing the patient would drink. They slept together in the futon of the communal room and the windows were closed suicide Attempts — All conditions that created the perfect environment for the rapid spread of potentially deadly viruses.
This scenario may sound like a horror movie, report Last month, a British newspaper IndependentAfter COVID-19 was attacked, it was a reality in the mental ward of Dae Nam Hospital in South Korea. In the end, health authorities closed the ward, which did not take much longer by then, but two of the 103 patients in the unit were virus positive.
To avoid similar catastrophes, Israeli hospital staff created what they call the “world’s first” psychiatric inpatient-only COVID-19 unit.
Clinicians at Tel Haviv’s Shiva Medical Center, Tel Aviv, a national hospital in Israel, said the 16-bed unit, officially opened on March 26, could pose a problem to the social distance of psychiatric inpatients from the virus. Therefore, we believe that it can prevent the transmission of other people. In the ward.
“Psychotic patients will be as sick with the coronavirus as any other person.”
Dr. Mark Weiser
Mark Weiser, MD, head of the institution’s psychiatry department, Medscape Medical News. “But we are concerned that COVID-19-positive patients in the psychiatric ward may have psychotic, mania, cognitive impairment, or poor judgment … It makes it difficult to maintain the desired distance, and very quickly the entire ward is infected.
“Therefore, a basic public health problem is how one psychiatric patient who is hospitalized and positive for COVID-19 can prevent anyone else from getting sick,” he added.
Unique challenges, quick response
Adapting an existing mental ward to a ward for exclusive use by inpatients at COVID-19 required significant planning, coordination and modification to ensure patient and staff well-being.
First, the ward air conditioning system was redesigned to be separate from the main hospital system. There was also a dedicated entrance for infected psychiatric inpatients.
In addition, an interactive TV camera was installed in the patient’s room to maintain a constant flow of communication and enable treatment sessions and family visits. All of these changes were completed within a week.
“Under normal circumstances, we have cameras in public areas of the ward, but we do not have cameras in the rooms to respect the privacy of people.
“On the other hand, in this ward, we have a camera in the room so if you need to look more closely at the patient, you can do it remotely without exposing your staff to the virus. Some people are looking at the screen. To see what’s going on all the time and see what the patient is doing. ”
Personal protective equipment (PPE) and staff clothing were tailored to the unique challenges presented by the patient population in the ward.
“Of course, you need to wear clothes to protect yourself from the virus,” Weiser said. “But sometimes our patients can get agitated and violent, so you can protect yourself from it.”
With this in mind, all personnel working in the ward should wear an additional layer of PPE and a tear-resistant robe. The agency also implements a strict protocol that dictates the order in which PPE is worn and dismounted.
“It has to be done very carefully and in a very specific way,” Weiser said. “We’ve made it all up with posters that explain what needs to be removed or worn, and the sequence.”
For institutions considering a similar unit, Weiser said it was important to be in close proximity to an active care hospital with the ability to provide emergency care.
“We are psychiatrists. We are not good at treating acute respiratory illnesses, so patients with significant respiratory illness need a place where they can get appropriate care promptly,” he said. Said.
Weiser said there were still some obstacles to installing the unit. For example, some hospital staff were concerned about the risk of getting a virus, despite the many protections and safety measures implemented by the facility.
To address these concerns, hospital leadership invited infectious disease specialists to educate hospital staff about the risks of viruses and infections.
“They told our staff that given all the precautions we took, there was little risk of someone else becoming infected,” Weiser said.
Despite the many challenges, Weiser said he was excited about the dedicated ward and the positive reaction it received.
“My colleague and the directors of psychiatric hospitals across the country are very pleased with this because they do not hospitalize infected patients. They are very pleased that we can address this issue. “He said.
“There is no easy solution”
Comments on the initiative Medscape Medical NewsDr. John M. Oldham, head of the Menninger Clinic at Baylor College of Medicine in Houston, Texas, raised some questions.
“Is it really a treatment unit, or is it a quarantine unit? If you don’t have an established and effective treatment for these patients, they’ll be in another place where they are. Just take them and you will suffer from both illnesses, “he warned.
Still, Oldham recognized that the question of how to treat a psychiatric patient who tested positive for the COVID-19 test was complex.
“We are still working on that problem at Menninger. We have created an enclosed section of the inpatient area reserved for this possibility.
“If any patients test positive, place them immediately in one of these rooms in the isolation section. Staff will then use protective equipment to treat them.”
However, he admitted that the psychiatric hospital was not in a position to treat patients who developed severe illness from COVID-19.
“We are certainly worried about that,” he said, “how many of the common medical units being hospitalized have markedly symptomatic COVID-19 patients who were hospitalized for acute suicide. Do you want to take it? There is no easy solution. “
For more news about Medscape Psychiatry, Facebook And twitter
