Saturday, November 27

DHBs increase oxygen supply capacity in ICU wards, Covid-19 wards


There are a total of 34 intensive care unit beds available at the Waikato, Bay of Plenty and Lakes district health boards, which house more than 800,000 people.

However, most patients who need hospital care for Covid-19 will not need an ICU bed, says a DHB leader.

HOUSTON, TX - DECEMBER 10: (EDITORIAL USE ONLY) Medical staff members Diana Escalante, left, and Stephanie, right, clean a patient in the COVID-19 intensive care unit (ICU) at United Memorial Medical Center on December 10, 2020 in Houston, Texas.

Covid-19 intensive care unit. (File photo).
Photo: Getty Images 2020

Waikato DHB currently has 16 ICU beds investigated with the ability to increase this to 22 ICU-level beds.

A DHB spokesperson said it could expand to 33 ventilation beds, combining ICU and high dependency beds, for the Covid-19 response.

“Additional staff have received training as part of our plan to assist with resourcing these beds, should a situation arise where we need to use them.”

The spokesperson did not specifically say whether anesthetists or operating room nurses were trained, but said another 17 beds in the post-anesthesia evaluation unit were available for intensive care if needed.

“Additional staff have been trained to assist with resource allocation for additional beds and can be redeployed from other areas of the hospital as needed.”

Those who do not need treatment in the ICU, which provides the patient with a single-patient specialist nurse, would be admitted to a general ward. This room would focus on Covid-19 positive patients when the time comes, the Waikato DHB spokesperson said.

Beds in the room can be fully insulated and have negative pressure capability.

Covid-19 Sentinels

Wards like these would be paramount for the care of Covid-19 patients, Bay of Plenty DHB COO Bronwyn Anstis said.

He said the larger capacity of ward beds for Covid-19 patients was more important than the number of beds in the ICU.

“In Auckland’s experience, many patients who have been admitted to the hospital are not cared for with a ventilator, they can manage without the ventilator, which is a good thing.”

An orthopedic ward at Tauranga Hospital is currently being renovated to ensure it is fit for purpose when positive cases arrive, he said.

“It’s good to have this too, we currently have other negative pressure areas within the hospital, but this gives us more capacity.

“It is quite disturbing to do these Covid jobs, but I think overall we will be very glad we did.”

The 24-bed room would have an additional oxygen supply and better air management. Areas of the intensive care unit were also being upgraded.

“Work in this room is being carried out to provide an area for the treatment of Covid-19 patients where high volumes of oxygen and high performance air management systems can be available.

“These changes will improve patient care and improve staff safety, should the need arise.”

He said additional training had been carried out for the nurses in the ward and, in the first instance, people admitted to the hospital with Covid-19 would be cared for by people with respiratory experience.

“We need to think about the patients who are admitted, potentially with Covid, in the future they could have any other type of comorbidities or they could arrive with trauma. All nurses should know how to care for a patient with Covid.”

Like Waikato, Anstis said anesthetists would “definitely” be part of the team.

Lakes DHB Faces ICU Nurse Shortage

Lakes DHB is improving its ICU ventilation system in line with the Bay of Plenty DHB work.

It has a total of six beds and nine fans.

Chief Operating Officer Alan Wilson said the hospital’s medical unit could also isolate itself in two areas, physically and by the ventilation system, creating a 22-bed area for Covid-19 patients.

However, Wilson admitted there was a shortage of ICU nurses.

“We have several nursing vacancies in the ICU and critical care unit currently, but we also have many nurses in other roles who are also experienced in ICU nursing and who would help with Covid patients if needed.

“With the new treatment regimens, many patients across the country admitted to the ICU with Covid will not need ventilation, but will be treated with other equipment.”

He said anesthetists, anesthesia technicians and some operating room nurses were trained for ventilated patients.

Wilson said Lakes DHB’s ability to care for patients would depend on the rate at which the virus evolved locally – a gradual build-up or a sudden influx.

“Currently, the DHB vaccination rate, while increasing rapidly, is still too low.”

He said vaccinated patients would have milder cases and would be cared for outside of the hospital.

“For unvaccinated patients who contract Covid, the situation is very different. A large number will need hospitalization in a medical ward, a large number will need intensive care, and a significant number will die.

“The Lakes DHB’s ability to handle an outbreak in the local population will be determined by the percentage of the population that is vaccinated or not.”

Despite the changes made to the Bay of Plenty and Waikato hospitals, the ICU and wards were only the tip of the iceberg in the opinion of a prominent Waikato physician.

Fear of virus transmission in the hospital.

Australasian College of Emergency Medicine President John Bonning said that up to eight times more people would access emergency departments compared to those in the ICU with Covid-19.

“No person will go into intensive care without going through the emergency department.

“Often with Covid you don’t necessarily get seriously ill very quickly, you get sick and then gradually deteriorate. Possibly the most important message we have is that we want Covid to be managed in the community, at least initially.”

At the Waikato DHB, where Bonning practices, the children’s emergency room has become a separate Covid-19 stream from the department.

The hope is to minimize the risk of transmission, but he said the risk was still there.

“It has been 18 difficult months and we know that we have three to six difficult months in this new stage.

“One figure I heard was that 20 per cent of UK patients with Covid contracted it in hospital, so yeah, cross-transmission is very concerning.”

Oxygen supply, upgrade of environmental systems

The Health Ministry confirmed that the Lakes and Bay of Plenty DHB improvements were part of the Covid-19 Response.

Work was also underway to upgrade air and oxygen treatment systems at DHBs in Canterbury, Capital and Coast, Manukau, Hawke’s Bay, Hutt Valley, MidCentral, Northland, Tairāwhiti, Taranaki and Waitematā counties.

“The nature and scale of the work varies from hospital to hospital, and the focus is to improve oxygen and air handling systems when prudent,” said a ministry spokesperson.

That meant minimizing the spread of Covid-19 through the hospital and allowing designated wards to be “better equipped” when treating Covid-19 positive patients, the spokesperson said.

“The ministry is working with these DHBs to improve air handling, filtration and ventilation and minimize the risk of virus transmission.

“Possible oxygen supply and use scenarios were considered at the beginning of the program, resulting in more supply planning protocols and on-site improvements to the oxygen storage, conversion and crosslinking systems.”

Health Minister Andrew Little said last week that the number of people currently in ICU and HDU was about two-thirds of capacity.

He said the capacity of ICU and HDU beds across the country can be increased to 550 beds.


www.rnz.co.nz

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