We hereby carried out a simplified reconstruction (SIR) protocol of “Two Areas and One Passage” to meet the quarantine requirements for respiratory infectious diseases. In our solution, the entrance buffering room and doors would be all shut and sealed, thus turning YA in STR protocol into GA thanks to no direct communication with RA. The unnecessary connecting doors in the ward are to be blocked, as shown in Fig. 3. The "Two Areas" refer to the GA and the RA. The doors and buffering room between GA and YA in STR protocol could be eliminated. Consequently, the whole office area would become a fully independent GA. In this design, the medical staff would only need to wear Level 1 PPE while dealing with paperwork and nursing management activities. The “One Passage” implies that staff would enter and exit the ward through one pathway, i.e., the undressing and corresponding buffering rooms. Medical staff would need to put on Level-3 PPE in GA before entering the undressing passage to enter the ward (Fig. 3). The passage would be kept disinfected by 24-hours ultraviolet lights and static electricity absorptive air sterilizer to minimize the risk of cross-infection between different rooms. Furthermore, we modified our working protocol according to One Passage structure. While entering the ward through the passage, medical staff would be required to finish the following assignments: 1) carrying medical items, medicines, and other necessities into the RA; 2) checking the consumption of sterilizing supplies, including hand sanitizer, moist towelettes and paper towels in the undressing room, and reminding the next shift to replenish the supply in time; 3) collecting waste in each undressing room and carrying it to RA for centralized delivery and processing; 4) supervising the undressing procedures of the off-duty medical staff from RA to prevent opportunistic infection due to inappropriate undressing process after 4-hour work.
Once proposed, this reconstruction and working protocol have been widely accepted by all the experts from the Center for Disease Control of China and infection control staff at our temporary hospital for five main reasons: 1) The reconstruction was simple, executable, and achievable in two days. It saved a lot of time because there was no need to create an entrance buffering room, trash room, additional storage room, and dressing room. During the epidemic, saving the reconstruction time means that the hospital could be immediately put into operation, thus saving more lives, and improving the epidemic control. 2) The office area of the medical staff was greatly expanded. Only one storage room and one dressing room were needed, and there was no need for any buffering room between GA and YA as in the STR protocol. The space these three rooms would occupy was saved, making the work of medical staff much more convenient. 3) At least 50% of PPE were preserved with the SIR protocol compared to the STR protocol, as staff in GA did not need to wear PPE doing paperwork and nursing management work. 4) The labor force was greatly reduced as to the SIR working protocol because there was no need to arrange any shifts to collect waste from undressing rooms or to specially supervise the undressing process. Staff did not need to wear Level-3 PPE while doing paperwork and nursing management, so that their shift lasted up to 8 h, thus greatly reducing working personnel requirement. 5) This reconstruction and working protocol effectively prevented air in the undressing room and GA from being contaminated by that in RA, because the only passage connecting RA and GA was the undressing passage. The two buffering rooms and two undressing rooms were adequate for disinfection and sedimentation of pathogens in this passage.
During the outbreak of COVID-19, the admission of confirmed patients not only posed higher requirements for epidemic control facilities but also put heavier mental stress to everyone. This was another critical advantage of this reconstruction and working protocol due to a lack of medical staff during that period. The ratio of medical staff to patients was nearly 1:1 for more than 50 days when our temporary hospital received confirmed patients in Wuhan. It is a great challenge to set-up a workforce-saving strategy for all medical staff, especially for nurses in this special circumstances9. The infection risk of medical staff was minimized when “Two Areas and One Passage” protocol was applied for the transformation of a general hospital to an infectious disease hospital. The long undressing passage also gave all medical staff enough confidence to protect themselves10. This might be an optimal solution for public hospitals to respond to the pandemic receiving infectious patients quickly. It took 50 days from the admission of the first group of patients to leave our temporary hospital in Wuhan, where a total of 1,765 confirmed patients were treated. No hospital-acquired infection of medical staff occurred. After the evacuation, all the medical staff was quarantined for 14 days, and no infection or asymptomatic infection was identified by the two nucleic acid tests and the COVID-19 antibody test, thus fully supporting the rationality of this reconstruction and working protocol under such circumstances.