**4. Discussion**

When community cases of COVID-19 increase:


3.Hospitals reduce elective surgical activity, merge specialized ICUs, and increase costs due to the need to have more staff available for the care of critical patients. The monitoring of patient flows between departments is optimized and the communication of news about patients' conditions to family members is simplified [16].

In addition to the macro-processes, the micro-processes are completely revised, involving all the Operational Units of the Hospital. New equipment such as beds and mechanical fans is provided in specific areas. PPE and reagents for laboratory tests are purchased. Medical, nursing and paramedical personnel, even newly recruited, are diverted to critical departments and trained for emergencies. Common areas such as canteen, laundry and sanitation are organized with access scheduling. Suppliers are diverted to different areas of the building. In addition, monitoring and critical patient management guidelines are introduced. [17]. Kadri and colleagues present findings from a nationally representative cohort of 144,116 hospitalized patients cared for in 558 hospitals to understand the effect of COVID-19 surges on patient outcomes. Nearly 1 in every 4 deaths and almost 6000 total deaths may have been attributable to hospital strain due to COVID-19 [18]. However, Kadri and colleagues' analyses may not capture the tightrope that many of us walk today as we balance COVID-19 and non– COVID-19 care. Shared learning platforms to understand how hospitals are managing COVID-19 care could be launched [17].

An interesting programme was the Mi-COVID-19 initiative in Michigan, where Blue Cross Blue Shield of Michigan and Blue Care Network, the Michigan Health & Hospital Association, the Society of Critical Care Medicine, and 40 hospital systems came together to improve COVID-19 care [19]. The Mi-COVID-19 initiative served as an amalgam for clinicians and hospital leaders across the state to tackle important questions ranging from therapeutic strategies and excess antibiotic use to provider wellbeing and long-term outcomes of COVID-19 survivors [20, 21].

Besides patients, there are other victims when COVID-19 strikes hospitals: health care workers. And although some have raised their voices asking for change [22], surveys suggest that many are considering leaving the field after being battered by wave after wave of COVID-19 [23].

Measures to control SARS-CoV-2 infections include active surveillance for early identification of the positive subject, with his/her isolation in dedicated rooms and the systematic use of PPE; and passive surveillance for the tracking of potential secondary cases (perhaps asymptomatic) [24–27].

Effective infection control measures against SARS in 2003 were less successful against SARS-CoV-2 [28], due to the greater number of asymptomatic (but infectious) cases, and the presence of a peak of viral load with the presentation of symptoms. Therefore, the systematic screening of patients and healthcare staff by RT-PCR reduces the risk of outbreaks in hospitals [29]. The risk of hospital transmission increases if asymptomatic COVID-19 patients are placed in non-AIRI rooms, and/or in high-flow oxygen or non-invasive ventilation [30]. Therefore, the use of PPE by healthcare personnel and inpatients should be applied to reduce the risk of SARS-CoV-2 droplet transmission [31]. Universal masking in the community also reduced the incidence of COVID-19 in the general population [32]. Also, appropriate use of PPE is associated with a decreased risk of COVID-19 [33]. The huge number of patients admitted to the COVID-19 Hospital also greatly increases the risk of expansion of the nosocomial epidemic. In China (Singapore), Hong Kong, UK, USA, temporary hospitals have been built (using tents or existing buildings such as conference

or exhibition halls) to cope with a sudden increase in COVID-19 cases [34–36]. During the SARS-CoV-2 pandemic in Italy, some hospitals became fully COVID-Hospitals, while in most others, parts of the hospital were converted or created to treat COVID-19 patients. In the latter cases, other parts of the hospital, "no-Covid-19" departments, treated COVID-negative patients. Bo et al. reported their experience within a COVIDfree department, with asymptomatic patients or with negative RT-PCR tests. During the study, a proportional increase in surveillance tests against SARS-CoV-2 was adopted based on the increase in the community spread of COVID-19, together with the use of PPE. Their findings demonstrate that there is a not negligible risk of "hospital-acquired" SARS-CoV-2 infection, both for patients and hospital staff, particularly within overcrowded supposed no-COVID-19 wards [37].

In our hospital, the winning strategy was to avoid the spread of SARS-CoV-2 infection with modular surveillance models on the course of the pandemic: increased surveillance tests (RT-PCR tests) with the worsening of the pandemic curve. Also important were the systematic adoption of PPE, the use of passive surveillance tests (with contact tracing, both for patients and healthcare personnel) in the face of an alleged case of COVID-19 or contact [38] and, where possible, patient isolation and safe distancing.

### **5. Conclusions**

During Phases 1 and 2 of the SARS-CoV-2 pandemic that struck Italy in the months from February to April 2020, the re-organization of the hospital structure with strict containment rules and surveillance with RT-PCR tests allowed it to remain a hospital free of SARS-CoV-2, with zero infections.

The admissions activity at our hospital was referable only to urgent patients with admissions to the Departments of Orthopedics, Physiotherapy and Medicine. The outpatient activity was only possible for patients with various specialties of an urgent nature or with priority evaluation within 7 days.

The subsequent pandemic waves, faced with the same methodological approach, have allowed the Giovanni XXIII Hospital to remain a COVID-free Hospital.

### **Acknowledgements**

We thank all the staff working at the Microbiology Laboratory and Service of the Giovanni XXIII Hospital in Monastier di Treviso for their unwavering commitment to the fight against COVID-19. We also thank Gabriele Geretto and Massimo Calvani (respectively CEO and President of our Hospital) for the commendable organizational support during the pandemic*.*

### **Conflict of interest**

The authors declare no conflict of interest.

*SARS-COV-2 Pandemic: How to Maintain a COVID-free Hospital DOI: http://dx.doi.org/10.5772/intechopen.107060*
