On December 31, 2019, the World Health Organization declares that an unknown disease has been observed in a cluster of patients affected by a viral pneumonia, admitted to a hospital in Wuhan, a city of the Hubei province in China. During the following days, the number of patients with similar symptoms increases and it is identified a new type of virus belonging to the Betacoronavirus genus, which is proven to be transmissible between humans. In a few weeks the virus, which is named SARS-CoV-2, begins to spread throughout the world and on March 11, with over 118,000 cases and 4,000 deaths in 114 countries, the Director General of WHO declares a global pandemic. One of the most affected countries outside of China is Italy, where, despite measures to quarantine the population, there is a sudden increase in cases of COVID-19 – as the disease caused by the virus is called – and the National Health System risks collapse. Hospitals have to face an extremely complicated situation, characterized by the lack of human, physical and structural resources to guarantee assistance to a staggering number of patients, many of them in critical conditions. In this scenario, fundamental is the role of all the professionals, both medical and non-medical, who, since the beginning of March, have been working tirelessly in exhausting conditions to contain the damage of the virus as much as possible. Among these are the clinical engineers, thanks to whom it has been possible to manage the exponential increase in the demand for medical equipment, mainly intended for setting up intensive care units, and to carry out transformations of hospital spaces and rooms in order to reorganize care pathways and increase the number of beds for intensive and semi-intensive care. This thesis is based on a formative traineeship carried out at the Clinical Engineering Service of the Humanitas Gavazzeni Hospital in Bergamo, which was one of the first hospitals to deal with the epidemic events caused by the spread of the SARS-CoV-2 virus. The objective of the thesis is to provide an example of the reaction of an Italian hospital engaged in the front line during the health emergency, describing the measures adopted and the changes made in order to convert the structure to a COVID-19 facility, and to analyze the contribution of the clinical engineer within this scenario, in order to enhance the work of this professional figure in the fight against the pandemic. The first chapters of the thesis represent two distinct contextualizations: the first one related to the history of clinical engineering and the main functions of the Clinical Engineering Service of Humanitas Gavazzeni, while the second one concerns the main events of the COVID-19 pandemic occurred in the first months of 2020, worldwide and in Italy. The attention is then shifted to the actual experience of Humanitas Gavazzeni during that period, through a description of the internal transformations it underwent, and the role played by clinical engineering, both in general in dealing with the emergency, and specifically within the hospital as Clinical Engineering Service. The last chapter of the thesis focuses instead on the most relevant measure introduced in Humanitas Gavazzeni, namely the realization of the Emergency Center, a building detached from the main structure designed to be used as a Department of Emergency and Acceptance (DEA) in ordinary situations, while as a center of containment of infectious diseases in emergency situations. Its functionality, internal organization, technical and structural peculiarities, and innovations are described. Even in this context is highlighted the contribution of the Clinical Engineering Service in the realization of the new center, which was mainly involved in the careful selection of equipment and machinery used in the setting up of the various departments, their purchase and the testing and verification procedures to ensure total safety.
Il 31 dicembre 2019 l’Organizzazione Mondiale della Sanità dichiara che una malattia sconosciuta è stata osservata in un gruppo di pazienti affetti da polmonite virale, ricoverati in un ospedale di Wuhan, una città della provincia di Hubei in Cina. Nei giorni seguenti aumenta il numero di pazienti con sintomi simili e viene individuato un nuovo tipo di virus appartenente al genere Betacoronavirus, del quale viene dimostrata la trasmissibilità tra esseri umani. In poche settimane il virus, che viene denominato SARS-CoV-2, inizia a diffondersi in tutto il mondo e l’11 marzo, con oltre 118.000 casi e 4 mila decessi in 114 Paesi il Direttore Generale dell'OMS dichiara lo stato di pandemia globale. Uno dei Paesi colpiti più duramente al di fuori della Cina è l’Italia, dove, nonostante misure di quarantena della popolazione, si assiste ad un repentino incremento dei casi di COVID-19 – così viene denominata la malattia causata dal virus – e il Sistema Sanitario Nazionale rischia il collasso. Le strutture ospedaliere devono affrontare una situazione estremamente complicata, caratterizzata dalla mancanza di risorse umane, fisiche e strutturali per garantire assistenza ad un numero sconcertante di pazienti, molti dei quali in condizioni critiche. In questo scenario, fondamentale è il ruolo di tutti i professionisti, sanitari e non sanitari, che da inizio marzo hanno lavorato incessantemente in condizioni di lavoro estenuanti per contenere il più possibile i danni del virus. Tra questi rientrano gli ingegneri clinici, grazie ai quali è stato possibile gestire l’incremento esponenziale nella richiesta di strumentazione medica, principalmente destinata all’allestimento di unità di Terapia Intensiva, e realizzare trasformazioni degli spazi e dei locali ospedalieri al fine di riorganizzare i percorsi di cura e aumentare il numero di posti letto per degenze intensive e semi-intensive. Questa tesi si fonda su un tirocinio formativo svolto presso il Servizio di Ingegneria Clinica dell’ospedale Humanitas Gavazzeni di Bergamo, che è stata una delle prime strutture ospedaliere a dover affrontare gli eventi epidemici causati dalla diffusione del virus SARS-CoV-2. L’obiettivo dell’elaborato è di fornire un esempio della reazione di un ospedale italiano impegnato in prima linea durante l’emergenza sanitaria, descrivendone le misure adottate e le modifiche apportate a fine di destinare la struttura a presidio COVID-19, e di analizzare il contributo dell’ingegnere clinico all’interno di questo scenario, al fine di valorizzare il lavoro di questa figura professionale nella lotta contro la pandemia. I primi capitoli della tesi rappresentano due contestualizzazioni distinte: la prima relativa alla storia dell’ingegneria clinica e alle principali funzioni del S.I.C di Humanitas Gavazzeni, mentre la seconda riguarda gli eventi principali della pandemia di COVID-19 avvenuti nei primi mesi del 2020, nel mondo e in Italia. L’attenzione viene quindi spostata sull’esperienza vera e propria di Humanitas Gavazzeni durante quel periodo, tramite una descrizione delle trasformazioni interne subite, e sul ruolo svolto dall’ingegneria clinica, sia in generale nell’affrontare l’emergenza, sia nello specifico all’interno della struttura ospedaliera come Servizio di Ingegneria Clinica. L’ultimo capitolo della tesi si concentra invece sulla misura più rilevante introdotta in Humanitas Gavazzeni, ovvero la realizzazione dell’Emergency Center, un edifico distaccato dalla struttura principale progettato per essere impiegato come Dipartimento di Emergenza e Accettazione (DEA) in situazioni ordinarie, mentre come centro di contenimento di malattie infettive in situazioni di emergenza. Ne vengono descritte le funzionalità, l’organizzazione interna, le peculiarità tecniche e strutturali e le innovazioni apportate. Anche in questo contesto viene evidenziato il contributo del Servizio di Ingegneria Clinica nella realizzazione del nuovo centro, che si è occupato principalmente della selezione accurata delle apparecchiature e dei macchinari con i quali allestire i vari reparti, del loro acquisto e delle procedure di collaudo e verifica per garantirne la totale sicurezza.
COVID-19 e riorganizzazioni sanitarie : il ruolo dell'ingegneria clinica e l'esperienza di Humanitas Gavazzeni
Andreini, Riccardo
2019/2020
Abstract
On December 31, 2019, the World Health Organization declares that an unknown disease has been observed in a cluster of patients affected by a viral pneumonia, admitted to a hospital in Wuhan, a city of the Hubei province in China. During the following days, the number of patients with similar symptoms increases and it is identified a new type of virus belonging to the Betacoronavirus genus, which is proven to be transmissible between humans. In a few weeks the virus, which is named SARS-CoV-2, begins to spread throughout the world and on March 11, with over 118,000 cases and 4,000 deaths in 114 countries, the Director General of WHO declares a global pandemic. One of the most affected countries outside of China is Italy, where, despite measures to quarantine the population, there is a sudden increase in cases of COVID-19 – as the disease caused by the virus is called – and the National Health System risks collapse. Hospitals have to face an extremely complicated situation, characterized by the lack of human, physical and structural resources to guarantee assistance to a staggering number of patients, many of them in critical conditions. In this scenario, fundamental is the role of all the professionals, both medical and non-medical, who, since the beginning of March, have been working tirelessly in exhausting conditions to contain the damage of the virus as much as possible. Among these are the clinical engineers, thanks to whom it has been possible to manage the exponential increase in the demand for medical equipment, mainly intended for setting up intensive care units, and to carry out transformations of hospital spaces and rooms in order to reorganize care pathways and increase the number of beds for intensive and semi-intensive care. This thesis is based on a formative traineeship carried out at the Clinical Engineering Service of the Humanitas Gavazzeni Hospital in Bergamo, which was one of the first hospitals to deal with the epidemic events caused by the spread of the SARS-CoV-2 virus. The objective of the thesis is to provide an example of the reaction of an Italian hospital engaged in the front line during the health emergency, describing the measures adopted and the changes made in order to convert the structure to a COVID-19 facility, and to analyze the contribution of the clinical engineer within this scenario, in order to enhance the work of this professional figure in the fight against the pandemic. The first chapters of the thesis represent two distinct contextualizations: the first one related to the history of clinical engineering and the main functions of the Clinical Engineering Service of Humanitas Gavazzeni, while the second one concerns the main events of the COVID-19 pandemic occurred in the first months of 2020, worldwide and in Italy. The attention is then shifted to the actual experience of Humanitas Gavazzeni during that period, through a description of the internal transformations it underwent, and the role played by clinical engineering, both in general in dealing with the emergency, and specifically within the hospital as Clinical Engineering Service. The last chapter of the thesis focuses instead on the most relevant measure introduced in Humanitas Gavazzeni, namely the realization of the Emergency Center, a building detached from the main structure designed to be used as a Department of Emergency and Acceptance (DEA) in ordinary situations, while as a center of containment of infectious diseases in emergency situations. Its functionality, internal organization, technical and structural peculiarities, and innovations are described. Even in this context is highlighted the contribution of the Clinical Engineering Service in the realization of the new center, which was mainly involved in the careful selection of equipment and machinery used in the setting up of the various departments, their purchase and the testing and verification procedures to ensure total safety.| File | Dimensione | Formato | |
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https://hdl.handle.net/10589/173546