North Shore Hospital has converted an entire elective surgery building into Covid-19 unit to best prepare for an outbreak and also manage those needing urgent or emergency medical care. Video / Supplied
Tents and portable cabins will remain at hospitals but other facilities rapidly converted to treat Covid-19 patients are returning to normal use.
DHBs around the country completed urgent and sometimes around-the-clock construction work to ready themselves for what was expected to be a much greater surge of Covid cases. Buildings and wards were set aside, and walls and ventilation systems put in to isolate patients.
An entire building at North Shore Hospital - the elective surgery centre - was set up for the dedicated treatment of Covid-19 patients. It's now reverted to its original purpose of elective surgeries and procedures, but according to the DHB can be converted to a "Covid-only" site again within 24 to 48 hours.
Wards similarly dedicated for coronavirus treatment have now gone back to normal use. Cabins set up outside North Shore and Waitākere Hospitals to screen everyone arriving at emergency departments continue to be used. On arrival, patients and visitors are assessed and given a coloured wristband to indicate Covid-19 status and direct them to different areas (separate zones were set up for anyone with respiratory illness).
Tents set up outside Auckland City Hospital's emergency department and oncology building to screen arriving patients remain in place. Special routes to move potentially infectious patients through the hospital remain, as do spaces dedicated for the putting on and removal of personal protective equipment (PPE).
A portable building was put outside Middlemore Hospital to be used as a Covid-19 information centre, and partitioning put into ED to help control air pressure and flow. Parts of the ICU were made into isolation pods.
In total, about $600,000 was spent on modifications, a Counties Manukau spokeswoman said.
"Of most significance was the work undertaken within two weeks to create hospital capacity for 160 negative pressure beds. This was achieved by modifying the ventilation system of the top three levels of the Scott Building. Although this space has not yet needed to be used, it can be easily converted again in the future should the need arise."
Negative pressure rooms use lower air pressure to prevent internal air from reaching the rest of the hospital, allowing patients with infectious conditions to be isolated.
Taranaki DHB's Cameron Grant-Fargie, who led the facilities upgrade at Taranaki Base and Hāwera hospitals, said six negative pressure rooms were built "almost overnight" in intensive care, and new walls put in to separate patients.
More negative pressure rooms were built elsewhere, and portacoms installed near the ED to triage patients. Community testing centres were set up within 10 days, including the conversion of a former New Plymouth ambulance station.
"The speed in which all of this has been done is amazing and a true credit to our staff. The facilities changes undertaken will remain."
Dr Sue Nightingale, Canterbury DHB's Covid-19 incident controller, said rapid changes within hospitals were particularly a credit to maintenance, engineering and redevelopment teams. A large Portacom was put outside the ED and was used to screen patients three days after alert level 4 lockdown began.
Spaces were quickly converted into negative pressure facilities, including an ED trauma room, two rooms in intensive care, and two operating theatres. Construction of a new Christchurch Hospital Hagley facility was brought forward, including new ICU beds, and a 36-bed acute medical assessment unit converted to assess and triage suspected Covid cases.
Nelson Hospital's entire renal dialysis unit was relocated, intercoms and temporary walls constructed elsewhere and seven portacabins set up at Nelson and Wairau hospitals to let other areas be changed into isolation wards.
Engineers made rapid improvements to Wellington Hospital's ICU - converting a new six-bed extension into a large negative pressure room and building two new air locks in a few days. Such work could normally take months from planning to completion. Similar speed was seen in the construction of a seven-bed "surge unit" to increase the capacity of Hutt Hospital's ICU.
Waikato DHB increased ICU capacity from 16 to 36 beds and negative pressure rooms from 19 to 45 as part of work that included ramping up laboratory testing capacity.
Bus stops were moved and sections of road closed to traffic to clear the way for emergency and Covid-related drop-offs, and staff stationed at entrance points to monitor visitors.
"Some of our wards have been returned to normal functions as we start doing more elective surgery. We have reduced the number of negative pressure facilities and increased the number of working operating theatres," a DHB spokeswoman said.
"However, the changes we made have been designed to allow scaling up or down as required if Covid-19 returns or a similar pandemic occurs."
Documents obtained by the Weekend Herald before Covid-19 emerged showed more than half of the country's 20 DHBs identified infrastructure issues as a major risk to the treatment and safety of patients. The Treasury has estimated about $14 billion will need to be invested in health infrastructure in the next decade.
