BACKGROUND: During the first COVID-19 outbreak in 2020 in the Netherlands, the incidence of pulmonary embolism (PE) appeared to be high in COVID-19 patients admitted to the intensive care unit (ICU). This study was performed to evaluate the incidence of PE during hospital stay in COVID-19 patients not admitted to the ICU.
METHODS: Data were retrospectively collected from 8 hospitals in the Netherlands. Patients admitted between February 27, 2020, and July 31, 2020, were included. Data extracted comprised clinical characteristics, medication use, first onset of COVID-19-related symptoms, admission date due to COVID-19, and date of PE diagnosis. Only polymerase chain reaction (PCR)-positive patients were included. All PEs were diagnosed with computed tomography pulmonary angiography (CTPA).
RESULTS: Data from 1,852 patients who were admitted to the hospital ward were collected. Forty patients (2.2%) were diagnosed with PE within 28 days following hospital admission. The median time to PE since admission was 4.5 days (IQR 0.0-9.0). In all 40 patients, PE was diagnosed within the first 2 weeks after hospital admission and for 22 (55%) patients within 2 weeks after onset of symptoms. Patient characteristics, pre-existing comorbidities, anticoagulant use, and laboratory parameters at admission were not related to the development of PE.
CONCLUSIONS: In this retrospective multicenter cohort study of 1,852 COVID-19 patients only admitted to the non-ICU wards, the incidence of CTPA-confirmed PE was 2.2% during the first 4 weeks after onset of symptoms and occurred exclusively within 2 weeks after hospital admission.

OBJECTIVE: This retrospective study determined the storage time of finished infusion in each hospital ward and assessed whether the storage time of finished infusion was within an acceptable range.
METHODS: The research object was the finished infusion (one bag of infusion with only one drug) that is centrally dosed at the Pharmacy Intravenous Admixture Service (PIVAS) of Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences. We used an automatic scanner to assess the placement time of finished infusion products in various wards of the hospital. We classified the drugs used in various wards, analyzed whether their placement times were reasonable, assessed the reasons for unreasonable placement times, and took intervention measures. Similarly, the storage time of finished infusion was deemed reasonable or unreasonable, the reasons for unreasonable storage times were analyzed, and intervention measures were taken.
RESULTS: In September 2021, the proportion of infusions stored for an unreasonable time was 12.69%, a decrease of 5.37% compared with August 2021, indicating the effectiveness of intervention measures.
CONCLUSIONS: By using statistical analysis and intervention measures, our PIVAS improved the standardized use of finished infusion products and ensured the safety of medication for patients.

To prevent respiratory infections between patients and medical workers, the transmission risk of airborne pollutants in hospital wards must be mitigated. The ventilation modes, which are regarded as an important strategy to minimize the infection risk, are challenging to be systematically designed. Studies have considered the effect of ventilation openings (inlets/outlets) or infected source locations on the airflow distribution, pollutant removal, and infection risk mitigation. However, the relationship (such as relative distance) between ventilation openings and infected sources is critical because it affects the direct exhaust of exhaled pollutants, which has not been thoroughly studied. To explore pollutant removal and infection prevention in wards, different ventilation modes (with varying ventilation openings) and infected patient locations must be jointly considered. This study investigated displacement ventilation (DV), downward ventilation (DWV), and stratum ventilation (SV) with 4, 6, and 10 scenarios of ventilation openings, respectively. The optimal ventilation mode and relative distance between outlets and infected patients were analyzed based on the simulated pollutant concentration fields and the evaluated infection risk. The pollutant removal effect and infection risk mitigation of SV in the ward were largely improved by 75% and 59% compared with DV and DWV, respectively. The average infection risk was reduced below 7% when a non-dimensional relative distance (a ratio of the actual distance to the cubic root of the ward volume) was less than 0.25 between outlets and infected patient. This study can serve as a guide for the systematic ventilation system design in hospitals during the epidemic.

Nutrition and mobility risks include complex and interrelated physiological, medical, and social factors. A growing body of evidence demonstrates that the built environment can affect patients\' well-being and recovery. Nevertheless, the relationship between the built environment, nutrition, and mobility in general hospitals is largely unexplored. This study examines the implications of the nutritionDay study\'s results for the architectural design of hospital wards and nutrition environments. This one-day annual cross-sectional study uses online questionnaires in 31 different languages to collect ward-specific and patient-specific variables. The main findings relevant to the design of hospital wards were: (1) 61.5% of patients (n = 48,700) could walk before hospitalization and (2) this number dropped to 56.8% on nutritionDay (p < 0.0001), while the number of bedridden patients increased from 6.5% to 11.5% (p < 0.0001), (3) patients who needed more assistance had a much longer mean LOS than mobile patients, (4) mobility was associated with changes in eating, and (5) 72% of units (n = 2793) offered additional meals or snacks, but only 30% promoted a positive eating environment. The built environment may indirectly affect hospitalized patients\' mobility, independence, and nutritional intake. Possible future study directions are suggested to further investigate this relationship.

The use of air cleaners indoors has increased with the increase in indoor activities driven by the COVID-19 outbreak. In this study, the indoor air quality was determined at the location of each patient\'s respirator in a four-bed hospital ward equipped with a ventilation system and curtains, by varying the position of one air cleaner. By operating the air cleaner alone without the ventilation system, it was confirmed that it is better to place the air cleaner close to the center of the ward, regardless of whether curtains are used. It was further identified that the farther away the air cleaner is from the center, the worse the age of air could be, compared to the case of operating it in the center. Moreover, the situation where the ventilation system and air cleaner were operated simultaneously in the hospital ward was considered. It was discovered that operating the air cleaner close to the ventilation inlets in the absence of curtains helps to improve the indoor air quality. Furthermore, it was found that the age of the air is generally low near the location where the air cleaner is operated in the presence of curtains. Selecting an optimal position for the air cleaner can improve the air quality at the location of each bed in a four-bed hospital ward.

There is an increasing interest in the role of the arts, particularly music, in healthcare. Music seems an attractive non-pharmacological intervention for older patients to improve postoperative outcomes. Although live music elicits more meaningful responses from an audience than recorded music, the use of live music is still rare on hospital wards. In view of the positive effects of recorded music on older surgical patients, we designed, in collaboration with a conservatoire, an innovative practice named Meaningful Music in Health Care (MiMiC). The aim is to determine whether live bedside music implements into daily practice and allows improves patient outcomes.
This manuscript provides an overview of a trial evaluating if live bedside music can improve postoperative outcomes in older patients. The MiMiC initiative is a non randomized controlled trial study among older surgical patients on three hospital wards. Live bedside music is performed by professional musicians, once a day for six or seven consecutive days. The primary outcome is experienced pain; secondary outcomes are anxiety, relaxation and physical parameters (heart rate, heart rate variability, blood pressure, respiratory rate and oxygenation). Measurements of these variables are collected before the intervention, 30 min afterwards and again after three hours. Daily evaluations determine whether this innovative practice can be implemented in daily practice.
This manuscript describes a new practice, live bedside music by professional musicians, on surgical hospital wards aiming to improve patient outcomes. It offers a new field of interprofessional collaboration for the benefit of patients. Further research must be conducted focussing on patient outcomes, including cost-effectiveness and the experiences of patients and healthcare professionals.

The transmission and deposition of pathogenic bioaerosols and the subsequent contamination of the air and surfaces is well recognized as a potential route of hospital cross-infection. A full-scale experiment using Bacillus subtilis and computational fluid dynamics were utilized to model the bioaerosol characteristics in a two-bed hospital ward with a constant air change rate (12 ACH). The results indicated that the bioaerosol removal efficiency of unilateral downward ventilation was 50% higher than that of bilateral downward ventilation. Additionally, health care workers (HCWs) and nearby patients had lower breathing zone concentrations in the ward with unilateral downward ventilation. Furthermore, a partition played a positive role in protecting patients by reducing the amount of bioaerosol exposure. However, no obvious protective effect was observed with respect to the HCWs. Only 10% of the bioaerosol was deposited on the surfaces in the ward with unilateral downward ventilation, while up to 35% of the bioaerosol was deposited on the surfaces in the ward with bilateral downward ventilation during the 900 s. The main deposition locations of the bioaerosols were near the wall on the same side of the room as the patient\'s head in all cases. This study could provide scientific evidence for controlling cross-infection in hospital wards, as well as several guidelines for the disinfection of hospital wards.

OBJECTIVE: The aim of this study was to evaluate the outcomes of implementing a sepsis screening (SS) tool based on the quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and the presence of confirmed/suspected infection. The implementation of the 6-h bundle was also evaluated.
METHODS: Interrupted times series with prospective data collection.
METHODS: Five hospital wards in a developing nation, Argentina.
METHODS: A total of 1151 patients (≥18 years) recruited within 24-48 h of hospital admission.
METHODS: The qSOFA-based SS tool and the 6-h bundle.
METHODS: The primary outcome was the timing of implementation of the first 6-h bundle element. Secondary outcomes were related to the adherence to the screening procedures.
RESULTS: Of 1151 patients, 145 (12.6%) met the qSOFA-based SS tool criteria, among them intervention (39/64) patients received the first 6-h bundle element earlier (median 8 h; 95% confidence interval (CI): 0.1-16) than baseline (48/81) patients (median 22 h; 95% CI: 3-41); these times, however, did not differ significantly (P = 0.525). Overall, 47 (4.1%) patients had sepsis; intervention patients (18/25) received the first 6-h bundle element sooner (median 5 h; 95% CI: 4-6) than baseline patients (15/22) did (median 12 h; 95% CI: 0-33); however, times were not significantly different (P = 0.470). While intervention patients were screened regularly, only one-third of patients who required sepsis alerts had them activated.
CONCLUSIONS: The implementation of the qSOFA-based SS tool resulted in early, but not significantly improved, provision of 6-h bundle care. Screening procedures were regularly conducted, but sepsis alerts rarely activated. Further research is needed to better understand the implementation of sepsis care in developing settings.

Natural ventilation enables personal control, and occupant behaviors in window opening play a decisive role on natural ventilation performance, indoor air quality (IAQ), and/or airborne infection risk in a hospital setting. The occupant behaviors differ significantly from different building types with different functions and living habits. Based on a one-year field measurement in two general hospital wards in Nanjing, China, the effects of air quality (i.e. indoor CO2 concentration and outdoor PM2.5 concentration) and the climatic parameters (i.e. indoor/outdoor temperature, relative humidity, and outdoor wind speed, wind direction and rainfall) on window opening/closing behaviors are analyzed. Indoor air temperature or relative humidity is found to be a dominant factor for window opening behaviors. Seasonal differences are observed for the different influences of physical factors. The outdoor temperature is found to be associated with the window opening probability negatively during the cooling season, but positively during the transition and heating seasons. The indoor relative humidity positively affects the window opening probability during the transition season while a negative impact appears during the cooling and heating seasons. Based on the seasonal variation of window opening behaviors, Logistic regression models in different seasons (cooling, transition and heating seasons) are developed to predict the window opening/closing state and are verified to be promisingly adaptable with results of accuracy bigger than 70%.

OBJECTIVE: To develop, validate and test a ward environment assessment tool (WEAT) for post-occupancy evaluation of hospital wards from the perspectives of ward nurses, using Person-Environment fit theory.
BACKGROUND: It is argued that as the needs and expectations of various user groups of healthcare facilities would vary, so would the tools to measure the suitability of the architectural design features of these healing environments for different groups of users. However, a review of relevant literature revealed that there is a dearth of assessment tools to appraise the adequacy of healthcare facilities for nursing staff.
METHODS: Extant literature was reviewed to construct WEAT. Twenty ward nurses were interviewed to obtain user perspectives on the ward environment. Post-occupancy evaluation of three hospital wards was undertaken to validate and test WEAT.
RESULTS: WEAT: A new post-occupancy evaluation tool was created.
CONCLUSIONS: WEAT measures the impacts of ward environment on nurses in four personal constructs; namely physical, cognitive, sensory and universal.
CONCLUSIONS: WEAT is an innovative management decision-making tool for ward managers, who may use its results to argue for workspace redesign with facilities managers, explore job readjustments with occupational health nurses and review job description with human resource managers.