Infection Control Strategy Using a Hybrid Resuscitation Room System During the COVID-19 Pandemic in Tokyo, Japan.

To the Editor:

For April 6 through May 25, 2020, the government of Japan issued a coronavirus disease 2019 (COVID-19) emergency declaration. Our institution, the largest advanced tertiary critical care facility in Tokyo, was requested by the governor of Tokyo to accept COVID-19 patients and to also strengthen our nosocomial infection control system. Because plain chest computed tomography (CT) had been reported as beneficial in screening for COVID-19 infection, , we performed screening chest CT scans in a hybrid resuscitation room (RR) system. This consisted of a resuscitation room equipped with a CT scanner with air conditioning equivalent as regular operating rooms (Figure ). , During initial assessments in the hybrid RR system, CT scans could be performed without transferring the patient to the CT scan suit.

Figure

Flow after acceptance of a tertiary emergency request at our institution (prepandemic). E-CPR, Extracorporeal cardiopulmonary resuscitation; RR, resuscitation room.

In the emergency medical system in Japan, the fire department selects a hospital according to the severity of the patient’s condition and requests acceptance. The hospital decides whether to accept the patient, depending on the availability of appropriate resources. As shown in the Figure (prepandemic), patients who did not meet the criteria for the hybrid RR system were taken to 1 of 2 conventional resuscitation rooms, making it possible to receive 3 ambulances simultaneously. However, during the declaration, all patients except for those with unwitnessed cardiopulmonary arrest were brought directly to the hybrid RR system. Thus, only one ambulance at a time was accepted. Patients brought into the hybrid RR system undergo initial resuscitation and CT scanning. Patients with symptoms such as fever and respiratory symptoms or positive chest CT findings were considered to be at high risk of having COVID-19. These patients received a polymerase chain reaction test.

This strategy contributed to avoidance of nosocomial infection; however, it reduced the capacity to accept patients. During the study period, no hospitalwide outbreak of COVID-19 nosocomial infection occurred. On a monthly average, we accepted 97.8% of the emergency requests (165 patients out of 173 requests) in 2019. This was reduced to 63.2% (147 out of 233) during the declaration period. In contrast, the proportion of patients admitted directly to the hybrid RR system increased from 28.0% to 52.2%.

During the declaration period, the hybrid RR system was used more than usual to detect COVID-19 high-risk patients immediately after admission of the patient from the ambulance. This minimized the contamination of the facility and medical staff. Because no new ambulance could be accepted while a patient was being evaluated in the hybrid RR system, the proportion of patients who were accepted significantly decreased. Although the relevant data are not yet available, this strategy must have resulted in a significant burden on emergency medical services in Tokyo because they had to deal with patients who had been refused by our hospital. Given the concern about a possible second wave of infection, it is necessary to consider measures that can accommodate multiple patients simultaneously while taking steps to prevent nosocomial infections in a tertiary emergency facility. We may require additional isolated resuscitation rooms with negative-pressure air conditioning to accept added patients with a high risk of COVID-19 infection.