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COVID-19 Pandemic: Perspective of an Italian Tertiary Care Pediatric Center

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COVID-19 Pandemic: Perspective of an Italian Tertiary Care Pediatric Center healthcare Communication COVID-19 Pandemic: Perspective of an Italian Tertiary Care Pediatric Center Daniele Donà 1,*, Carlo Giaquinto 1, Eugenio Baraldi 2, Alessandra Biffi 3, Piergiorgio Gamba 4, Anna Maria Saieva 5, Luca Antoniello 4, Paola Costenaro 1 , Susanna Masiero 6, Laura Sainati 3, Liviana Da Dalt 6 and Giorgio Perilongo 7 1 Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy; [email protected] (C.G.); [email protected] (P.C.) 2 Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy; [email protected] 3 Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy; alessandra.biffi@unipd.it (A.B.); [email protected] (L.S.) 4 Pediatric Surgery Unit, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy; [email protected] (P.G.); [email protected] (L.A.) 5 Medical Staff Affairs, University Hospital of Padua, Padua, Via Giustiniani 3, 35128 Padua, Italy; [email protected] 6 Pediatric Emergency Department Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy; [email protected] (S.M.); [email protected] (L.D.D.) 7 Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Via Giustiniani 3, 35128 Padua, Italy; [email protected] * Correspondence: [email protected] Received: 18 July 2020; Accepted: 28 August 2020; Published: 1 September 2020 Abstract: Since February 2020, Italy has been faced with the dramatic spread of novel Coronavirus SARS-CoV-2. This impetuous pandemic infection forced many hospitals to reorganize their healthcare systems. Predicting a rapid spread of the SARS-CoV-2 virus within our region, the Department for Women’s and Children’s Health promptly decided (i) to revise the distribution of the clinical areas in order to create both designated COVID-19 and COVID-19-free areas with their own access, (ii) to reinforce infection prevention control (IPC) measures for all healthcare workers and administrative staff and (iii) to adopt the new “double-gate approach”: a phone call pre-triage and nasopharyngeal swab for SARS-CoV-2 detection before the admission of all patients and caregivers. Between 21 February 2020 till 04 May 2020, only seven physicians, two nurses and two of the administrative staff resulted positive, all during the first week of March. No other cases of intra-department infection were documented among the healthcare workers since all the preventive procedures described above were implemented. It is predicted that similar situations can happen again in the future, and thus, it is necessary to be more prepared to deal with them than we were at the beginning of this COVID-19 pandemic. Keywords: COVID-19; children; pediatric department; hospital; infection prevention and control 1. Introduction On 21 February 2020, the first COVID-19 positive case in a 76-year old man in Vo, a small town in the province of Padua, Italy, was reported. The same evening, his two grandchildren were evaluated Healthcare 2020, 8, 311; doi:10.3390/healthcare8030311 www.mdpi.com/journal/healthcare Healthcare 2020, 8, x 2 of 7 1. Introduction Healthcare 2020, 8, 311 2 of 7 On 21 February 2020, the first COVID-19 positive case in a 76-year old man in Vo, a small town in the province of Padua, Italy, was reported. The same evening, his two grandchildren were in the Pediatric Emergency Room of Padua University Hospital due to household exposure and that evaluated in the Pediatric Emergency Room of Padua University Hospital due to household exposure represented the first contact with the SARS-CoV-2 virus in our hospital. and that represented the first contact with the SARS-CoV-2 virus in our hospital. The Department for Women’s and Children’s Health (W and CHD) of Padua is one of the eight The Department for Women’s and Children’s Health (W and CHD) of Padua is one of the eight departments according to which the hospital is articulated; functionally it is a “Children’s Hospital departments according to which the hospital is articulated; functionally it is a “Children’s Hospital within a Hospital”, functioning as a tertiary pediatric care center. It is composed of 16 Divisions within a Hospital”, functioning as a tertiary pediatric care center. It is composed of 16 Divisions servingserving thethe VenetoVeneto Region, Region, an an area area of of 4,700,000 4,700,000 inhabitants inhabitants of of which which the the 13.5% 13.5% represent represent the the cohort cohort of childrenof children aged aged 0–14 0–14 years. years. It counts It counts 211 beds 211 ofbeds which of which 104 (49%) 104 are (49%) dedicated are dedicated to the di fftoerent the pediatricdifferent unitspediatric (of which units (of 8 are which for Pediatric 8 are for IntensivePediatric Care),Intensive 75 (36%)Care), to 75 the (36%) neonatal to the areas neonatal (of which areas 31(of arewhich for Neonatal31 are for Intensive Neonatal Care) Intensive and 32Care) (15%) and to 32 the (15%) various to pediatricthe various surgical pediatric divisions surgical (Figure divisions1). The (Figure sta ff of1). the The Department staff of the isDepartment composed ofis composed 222 physicians of 222 (including physicians 100 (including residents), 100 330 residents), nurses and 330 75 nurses other personnel.and 75 other In personnel. 2019 the hospital In 2019 admissionsthe hospital had admissio been 10,428,ns had been the outpatient 10,428, the visits outpatient 180,000, visits births 180,000, 2820 andbirths accesses 2820 and to the accesses Pediatric to Emergencythe Pediatric Department Emergency (PED) Department slightly over (PED) 24,000. slightly Considering over 24,000. that everyConsidering child entering that every the child W and entering CHD is the accompanied W and CH byD is at accompanied least 1 caregiver, by at the least number 1 caregiver, of accesses the shouldnumber actually of accesses be doubled. should Theactually clinical be wardsdoubled. for theThe inpatientclinical wards activity for and the ambulatory inpatient activity services and are hostedambulatory in a five services story are high hosted main buildingin a five exceptstory hi forgh themain Onco-Hematology building except for and the Stem Onco-Hematology Cell Transplant Unit,and Stem the Surgical Cell Transplant Divisions Unit, and the NeonatalSurgical Divisions Units which and are the operating Neonatal in Units satellite which buildings are operating attached in tosatellite the main buildings one (Figure attached1). to the main one (Figure 1). FigureFigure 1.1. Distribution of clinical wards withwith theirtheir own single access and nasopharyngeal swab (NPS) station:station: aa representativerepresentative map.map. PredictingPredicting aa rapid rapid spread spread of theof SARS-CoV-2the SARS-CoV-2 virus virus within within our region, our region, in the afternoon in the afternoon of February of 24thFebruary the Chief 24th Executive the Chief O ffiExecutivecer (CEO) Officer of Padua (CEO) University of Padua Hospital University called for Hospital an emergency called meeting for an withemergency all the departmentmeeting with chairmen all the department and the mandates chairmen received and the were: mandates received were: • toto ensureensure thethe protectionprotection ofof thethe healthcarehealthcare workers, workers, as as the the top top priority; priority; •• toto rigorouslyrigorously implement all all the the conventional conventional rules rules emanated emanated by by the the WHO WHO for forpreventing preventing the • theinfection infection • to minimize the risk of admitting into hospital asymptomatic COVID-19 positive patients; to minimize the risk of admitting into hospital asymptomatic COVID-19 positive patients; •• to adapt/transform some hospital areas in order to be able to admit and treat to adapt/transform some hospital areas in order to be able to admit and treat suspected/confirmed; • suspected/confirmed; COVID-19 pediatric patients COVID-19 pediatric patients To ensure continuity of treatment when appropriate and needed. •Healthcare 2020, 8, x; doi: www.mdpi.com/journal/healthcare Healthcare 2020, 8, 311 3 of 7 This impetuous pandemic infection put a tremendous amount of stress on many hospitals which were forced to reorganize their healthcare systems [1]. In just 10 days, the Chinese government built two hospitals in Wuhan for treating confirmed COVID-19 cases. As time passes, China and other countries completely reorganized their healthcare systems by rapidly building new temporary hospitals [2,3]. In our setting, the most rapid and efficient strategy was to completely reorganize pre-existing hospital areas in order to face with the emergency. Therefore, to fulfill all the given tasks, the W and CHD promptly decided: - To revise the distribution of the clinical areas in order to create both designated COVID-19 and COVID-19-free areas with their own access. - To reinforce infection prevention control (IPC) measures for all healthcare workers and administrative staff - To reinforce IPC measures for patients with a new “double-gate approach”: a phone call pre-triage and nasopharyngeal swab (NPS) for SARS-CoV-2 detection before the admission of all patients and caregivers. One of the key elements, among the many, which composed the comprehensive overall policy the University Hospital of Padua adopted to contain the COVID-19 epidemic, was to free the request of diagnostic NPSs on a 24/7 basis. Importantly, the routes to request NPS were highly facilitated and a very fast track (within three hours) was also made available to handle critical clinical situations. Despite the fact that it was predicted that children could have been less frequently and less severely affected than adults [4], it also highly affected tertiary care pediatric institutions such as the W and CHD.
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