Expanding ICU facilities in an epidemic: recommendations based on experience from the SARS epidemic in Hong Kong and Singapore

Abstract

Epidemics have the potential to severely strain intensive care resources and may require an increase in intensive care capability. Few intensivists have direct experience of rapidly expanding intensive care services in response to an epidemic. This contribution presents the recommendations of an expert group from Hong Kong and Singapore who had direct experience of expanding intensive care services in response to the epidemic of severe acute respiratory syndrome. These recommendations cover training, infection control, staffing, communication and ethical issues. The issue of what equipment to purchase is not addressed. Early preparations should include fit testing of negative pressure respirators, training of reserve staff, sourcing of material for physical modifications to the ICU, development of infection control policies and training programmes, and discussion of triage and quarantine issues.

SARS, Bird Flu and other scares—epidemic and pandemic preparedness in intensive care

“…13 This is an opinion supported by others who also concluded that adequately trained staff was likely to be the limiting factor in providing ventilatory support in a pandemic. 6 Let us briefly examine why this is so.…”

“…13 In practical terms, an 'ICU bed' is a unit made up of a physical space containing a bed with attendant power, gas supplies and life-support equipment, serviced by specialist doctors, nurses and allied health staff. This unit can only function well with much additional support, including radiology, physiotherapy, laboratory and laundry SASA Refresher Text services.…”

“…13 This estimate was based on the consideration that specialist staff, particularly the availability of trained nursing staff, would be the critical factor limiting functional expansion. More relaxed nursing ratios suggested in a second consensus document might allow marginally greater expansion.…”

“…Of course, affected staff should be fully informed of the nature and intended use of such lists. 13 Surgical and operating theatre staff may be the most appropriate non-intensive care trained group to recruit. Anaesthesiologists and operating theatre nursing staff are familiar with caring for unconscious ventilated patients and are likely to be underutilised during a pandemic as elective surgery will almost certainly be suspended.…”

“…Both concentrate primarily on recommendations for the expansion of existing units and the commissioning of extra ICU beds to deal with the expected surge of patients who will require ICU care. 12,13 In principle, the following key aspects of preparedness require attention: the need for expansion of ICU capacity to deal with the increased number of patients, the need to protect patients and staff from cross-infection, the need to maintain staff morale, and the need to meet acceptable ethical standards of practice. It is also important to remember that given the ever-present financial constraints of the real world, funds to support such preparation will be limited.…”