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SARI CRITICAL CARE TRAINING
SARI FACILITIES:
DESIGNING AND OPERATING A SARI TREATMENT CENTRE [STC]
MODULE 1: OVERVIEW OF BASIC OPERATIONAL AND
IPC PRINCIPLES IN COVID-19 CONTEXT
MARCH 2020
HEALTH

EMERGENCIES
programme

Learning objectives
By the end of this lecture, you will be able to:
•

Describe the public health objectives at all stages of the preparedness and response
plan;

•

Identify ventilation and exhausted air treatment as IPC measures within a COVID19 context; and

•

Explain the different modes of transmission and apply a rational use of PPE
...


HEALTH

EMERGENCIES
programme

Module: 1A

Module 1A

Public health objectives and strategic priorities by scenario

HEALTH

EMERGENCIES
programme

Epidemic phases

Four transmission scenarios are observed:

Epidemic phases and response interventions
...
WHO, 2018

HEALTH

EMERGENCIES
programme

Epidemic phases

Four transmission scenarios are observed:
• Countries with no cases (no cases);

Epidemic phases and response interventions
...
WHO, 2018

HEALTH

EMERGENCIES
programme

Epidemic phases

Four transmission scenarios are observed:
• Countries with no cases (no cases);
• Countries with one or more cases, imported or locally acquired (sporadic cases);

Epidemic phases and response interventions
...
WHO, 2018

HEALTH

EMERGENCIES
programme

Epidemic phases

Four transmission scenarios are observed:
• Countries with no cases (no cases);
• Countries with one or more cases, imported or locally acquired (sporadic cases);
• Countries experiencing clusters of cases in time, geographic location, or common exposure (clusters of cases);

Epidemic phases and response interventions
...
WHO, 2018

HEALTH

EMERGENCIES
programme

Epidemic phases

Four transmission scenarios are observed:
• Countries with no cases (no cases);
• Countries with one or more cases, imported or locally acquired (sporadic cases);
• Countries experiencing clusters of cases in time, geographic location, or common exposure (clusters of cases);
• Countries experiencing larger outbreaks of local transmission (community transmission)
...
Managing epidemics: Key facts about major
deadly diseases
...
Set up screening and triage
...
Set up COVID-19 designated wards in
health facilities
...
Managing epidemics: Key facts about major
deadly diseases
...
Set up screening and triage
...
Set up COVID-19 designated wards in
health facilities
...
COVID-19 designated treatment area
...
Managing epidemics: Key facts about major
deadly diseases
...
Set up screening and triage
...
Set up COVID-19 designated wards in
health facilities
...
COVID-19 designated treatment area
...
Repurpose existing buildings
...
Community facilities
...
Managing epidemics: Key facts about major
deadly diseases
...
Set up screening and triage
...
Set up COVID-19 designated wards in
health facilities
...
COVID-19 designated treatment area
...
Repurpose existing buildings
...
Community facilities
...
New COVID-19 facilities
...
Managing epidemics: Key facts about major
deadly diseases
...


HEALTH

EMERGENCIES
programme

Community facilities
Where health facilities can no longer manage patients
with mild or moderate disease, isolate patients who
are not at high risk for severe disease (< 60 years of
age, no co-morbid diseases) either in community
facilities (e
...
stadium, gymnasium, hotel or tent)
with access to rapid health advice (i
...
via adjacent
dedicated COVID-19 health post, telemedicine) or at
home according to WHO guidance
...
who
...


Planning for surge capacity should allow for progressive scale-up of activities
over several stages, with clearly defined activation thresholds for each stage
...


HEALTH

EMERGENCIES
programme

Module: 1B

Module 1B

Ventilation and exhausted air treatment as IPC measures
within a COVID-19 context

HEALTH

EMERGENCIES
programme

Ventilation
The purpose of ventilation is to provide healthy air for breathing by both diluting the pollutants
originating in the building and removing the pollutants from it
...

Atkinson, J
...
, Pessoa-silva, C
...
, Jensen, P
...
Natural Ventilation for
Infection Control in Health-Care Settings Edited by : WHO Publ
...


HEALTH

EMERGENCIES
programme

Ventilation
There are three methods that may be used to ventilate a building:
Natural ventilation

Mechanical ventilation

Hybrid ventilation

Natural forces (e
...
winds) drive

Mechanical fans drive mechanical

Hybrid (mixed-mode) ventilation

outdoor air through the building

ventilation
...
It uses mechanical

trickle ventilators
...


ventilation flow rate is too low
...
, Chartier, Y
...
L
...
& Li, Y
...
(2009)
...


Area or service

Proposed ventilation

Proposed exhausted

Staff area
Triage
Waiting room
Sampling room

system
Natural ventilation
Natural ventilation
Natural ventilation
Natural ventilation

air treatment
Dilution
Dilution
Dilution
Dilution

Mild and Moderate cases ward
Severe and critical cases ward

Hybrid ventilation
Natural ventilation
Hybrid ventilation

HEPA filter
Dilution
Dilution

Mechanical ventilation

HEPA filter

Natural ventilation
Natural ventilation

Dilution
Dilution

Waste zone
Morgue

Atkinson, J
...
, Pessoa-silva, C
...
, Jensen, P
...
Natural Ventilation for Infection Control
in Health-Care Settings Edited by : WHO Publ
...

[1]

For a safe dilution the air should be exhausted directly to the outside away from air-intake vents, persons, and animals

HEALTH

EMERGENCIES
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Ventilation – Hybrid ventilation
Top-down ventilation (fan-assisted
stack plus a wind tower)
The air extractor will easily allow for
control of the ventilation rate,
meeting the ACH standard required
and assuring a constant
unidirectional top-down airflow
...

For the this reason, it is essential
that air extractor is turned on
whenever the room is occupied
...
It’s essential to exhaust air away from air-intake vents, persons, and
animals
...
97%) of the droplet nuclei
...
centre for Disease Control and Prevention
...

(2017)
...
It is an
acronym

for

"high

Wind tower

efficiency

particulate air [filter]"
...
97% of dust,
pollen, mold, bacteria, and any

Extraction fan

airborne particles with a size of
0
...

HEPA filter
CDC
...
Chapter 7-Tuberculosis Infection Control
...


HEALTH

EMERGENCIES
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Exhausted air treatment – portable HEPA
In order to simplify the installation,
reducing the construction time and
assuring

proper

air

Wind tower

treatment,

facilities may benefit from the use of
a portable HEPA filter unit equipped
with the proper fittings/ducting to
exhaust air from a selected room to
create the required ventilation flow
rate and exhausted air treatment as
well
...
centre for Disease Control and Prevention
...

(2017)
...


Wind turbines

UVGI is not recommended as standalone system but only as complementary
to

HEPA

filtration

recirculation
...
G
...
Public Health
Reports vol
...


HEALTH

EMERGENCIES
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Module: 1C

Module 1C

Modes of transmission and rational use of PPE

HEALTH

EMERGENCIES
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Modes of transmission

For

infection

to

spread,

all links must be connected
...


http://ottawapublichealth
...
and
...
of
...
aspx

HEALTH

EMERGENCIES
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Modes of transmission
Direct Vertical

An infectious agent may be transmitted
from its natural reservoir to a susceptible
host

in

different

ways
...


Indirect

contaminated

contact

inanimate

intermediate

object,

usually

By inhalation of infective small particles (< 5 µ)

Airborne

which once dispersed remain suspended in the air
...
g
...


secretions or blood from infected patients

Vehicle

Water borne

Transmission through contaminated water

Food borne

Transmission through contaminated food

HEALTH

EMERGENCIES
programme

Modes of transmission
Direct Vertical

Mother to child

Direct

Transmission

contact

Direct Horizontal

Direct physical transfer between one susceptible

Transmission

host and an infected/colonized person

Contact

Personal contact between a susceptible host and a

COVID-19

Indirect

contaminated

contact

inanimate

intermediate

object,

usually

By inhalation of infective small particles (< 5 µ)

Airborne

which once dispersed remain suspended in the air
...
g
...

By inhalation of infective large particles via close

Droplet

contact with an infected patient sneezing or
coughing
Contact (e
...
stings, bites) with insects, arthropods

Vector

and other parasites contaminated by excreta,
secretions or blood from infected patients

Vehicle

Water borne

Transmission through contaminated water

Food borne

Transmission through contaminated food

HEALTH

EMERGENCIES
programme

Modes of transmission
Direct Vertical

Mother to child

Direct

Transmission

contact

Direct Horizontal

Direct physical transfer between one susceptible

Transmission

host and an infected/colonized person

Contact

Personal contact between a susceptible host and a

COVID-19

Indirect

contaminated

contact

inanimate

intermediate

object,

usually

By inhalation of infective small particles (< 5 µ)

Airborne

which once dispersed remain suspended in the air
...
g
...


secretions or blood from infected patients

Vehicle

Water borne

Transmission through contaminated water

Food borne

Transmission through contaminated food

HEALTH

EMERGENCIES
programme

Rational use of PPE
• Use physical barriers to reduce exposure to the virus, such as glass or
plastic windows
...


Katwa ETC, North Kivu, D
...
Congo, 2019

HEALTH

EMERGENCIES
programme

Rational use of PPE
• Use physical barriers to reduce exposure to the virus, such as glass or
plastic windows
...

• Restrict healthcare workers from entering the rooms of SARI patients if
they are not involved in direct care
...
g
...

HEALTH

EMERGENCIES
programme

26 March 2020

Bibliography
• World Health Organization(WHO)
...
WHO Guidel
...

• World Health Organization
...
1–3 (2020)
...
WHO Guidelines on Hand Hygiene in Health Care First Global Patient Safety Challenge Clean Care is Safer Care
...

• Michigan Occupational Safety & Health
...
(2017)
...
Home care for patients with suspected novel coronavirus ( nCoV ) infection presenting with mild symptoms and management of contacts
...

• World Health Organization
...
12 (2020)
...
B
...
Front
...
Eng
...
3389/fmech
...
00004
...
, Chartier, Y
...
L
...
& Li, Y
...
(2009)
...
centre for Disease Control and Prevention
...
(2017)
...
Ultraviolet germicidal irradiation handbook: UVGI for air and surface disinfection
...

• Tseng, C
...
& Li, C
...
Inactivation of virus-containing aerosols by ultraviolet germicidal irradiation
...
Technol
...

• Welch, D
...
Far-UVC light : A new tool to control the spread of airborne-mediated microbial diseases
...
Rep
...
1038/s41598-018-21058-w
...
Inactivation of three emerging viruses – severe acute respiratory syndrome coronavirus , Crimean – Congo haemorrhagic fever virus and Nipah virus – in platelet concentrates by
ultraviolet C light and in plasma by methylene blue plus visible light
...
- Int
...
Blood Transfus
...
1111/vox
...


HEALTH

EMERGENCIES
programme

26 March 2020

Thank you
Luca Fontana – WHO - WASH/IPC Highly Infectious Pathogens Expert
Anna Silenzi – WHO - Architect

HEALTH

EMERGENCIES
programme



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