Markham Stouffville Hospital has built a new emergency department – without “negative pressure rooms” in the intensive care area


Paramedics walked through the emergency doors.

Patient in respiratory distress. COVID-19 suspected infection. Nurses and doctors take over. The patient needs an intubation to breathe, an invasive procedure known to spread an infectious disease through droplets expelled, sometimes violently, from the mouth and nose.

In most emergency departments built after SARS, the patient was transported to a large “negative pressure” room in the intensive care section just inside the door of the ambulance bay. Any virus expelled during the patient’s treatment would be retained by the room’s negative pressure system. Then it would be removed by a special ventilation system.

But not at Markham Stouffville Hospital, one of the GTA hospitals that has seen a large number of COVID-19 cases. Somehow, in the $ 400 million for the design and construction of a new emergency department and other hospital wings, completed in 2014, no treatment rooms under negative pressure (also called airborne isolation) was only built in the intensive care section. The hospital has four smaller negative pressure rooms in one area of ​​its emergency department designed to treat the least ill patients, but they are not adjacent to the ambulance bay.

Why it happened, the hospital won’t tell. Staff raised concerns with the Toronto Star.

Hospital management did not agree to be interviewed. However, in email correspondence between the Star and the hospital in the past two weeks, the hospital said there was a change during the design phase that left the hospital. without negative pressure treatment rooms in the red zone – the intensive care section of the emergency room.

“While it is correct to say that there have been, over the years, post-construction discussions about a desire for additional negative pressure rooms in the red zone of our emergency department – because these rooms are bigger and more space is always useful for any procedural doctor – it’s incorrect to say that staff and patients are at risk, “said Dr. Andrew Arcand, chief of emergency medicine at Markham Hospital Stouffville, in a press release sent by email.

The proper wearing of personal protective equipment (PPE) is what ensures the safety of staff and patients, said Arcand.

“It is important to note that this is not (a) a negative pressure chamber that protects healthcare workers or patients against COVID-19 during an aerosol generation procedure such as intubation: it is proper use of PPE, “said Arcand. “Let me emphasize again that the number of negative pressure rooms and their location in the emergency department does not pose a risk to the safety of patients or staff,” said Arcand.

Other hospitals built after SARS – a contagious virus that hit Ontario and its hospitals hard in the early 2000s and revealed gaps in the health care system – chose to spend dollars on negative pressure rooms in the intensive care areas of their new emergency departments. Medical experts around the world agree on the importance of negative pressure environments, with their sealed doors and their special air circulation system that maintains a contained contagion and then suppresses it.

Resuscitating a patient or placing a breathing tube in the throat (intubation) is known as aerosol-generating procedures, which can easily spread a virus.

The Star polled other hospitals with emergency rooms built after SARS, which said they included negative pressure rooms in their intensive care sections.

An attendant in full protective gear helps people at the entrance to the Sunnybrook Hospital Assessment Center on March 18.

Sunnybrook Hospital has “two negative pressure resuscitation rooms” in the intensive care section of their emergency department, said spokesman Craig Duhamel. There are seven other negative pressure rooms in other parts of the emergency department. Construction began in 2009 on the $ 62 million project.

The Humber River Hospital completed its hospital in 2015 and the $ 1.6 billion complex has five negative pressure treatment rooms in its emergency department – two in the intensive care or “acute” sector and three in the next level of treatment (subacute).

Spokesman Joe Gorman said Humber spent a lot of time making sure the design was correct, making sure each of these pieces worked independently of the next piece. An alarm system will sound if for any reason the “pressure differential falls below what is required”.

The new Oakville Trafalgar Memorial Hospital opened in late 2015 ($ 2.7 billion in new construction). Its emergency department has three negative pressure rooms, one of which is in the intensive care area adjacent to the entrance to the ambulance bay, said Trish Carlton, spokesperson for Halton Healthcare.

The Milton District Hospital, which is also part of Halton Healthcare, received a major expansion in 2017 ($ 512 million) which included a new emergency department. Like Oakville Trafalgar, it has three negative pressure chambers, one immediately inside the arrival area of ​​the ambulance bay.

Markham Stouffville Hospital serves Markham, Stouffville and Uxbridge. Infrastructure Ontario’s redevelopment of the hospital has doubled the size of the original hospital.

The shortage of negative pressure treatment rooms in the intensive care area of ​​Markham Stouffville Hospital is of concern to the nurses and doctors who work there. Staff who spoke to Star about this matter would only do so as long as their identity was protected, as they feared they would be avenged from the hospital. Markham Stouffville was the subject of a Deloitte LLP investigation on behalf of the hospital’s board of directors in 2016, which revealed many shortcomings in the management of the $ 400 million hospital construction project, including the lack of internal controls over the supply of supplies.

A healthcare worker at Markham Stouffville hospital wearing a surgical mask.

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The new sections of Markham Stouffville Hospital include an emergency department three times larger than the previous service, which has been converted to another use. The hospital website reports that 360 patients tested positive for COVID-19 during the pandemic.

In correspondence with The Star on the issue of negative pressure, the hospital did not answer specific questions as to why it planned to have negative pressure rooms in the intensive care section at the start of the project, and then abandoned it. Originally, the hospital planned for eight rooms for treating negative pressure, but it ended up with four, all in smaller rooms in the emergency department where less critical patients are hospitalized.

Rebecca Mackenzie, hospital spokesman, said Markham Stouffville exceeds Canadian building guidelines for negative pressure rooms. A minimum of one negative pressure room is required by the emergency room, the spokesperson said. Mackenzie said the hospital has 36 other “airborne isolation rooms” across the hospital in other areas. (Other hospitals studied by the Star also have multiple negative pressure rooms in other wings.)

However, Mackenzie said the hospital knew that staff were concerned about this issue and that there had been no comprehensive response to staff concerns.

“It is clear that (the hospital) could have communicated more effectively to ensure that all hospital staff and doctors were aware that a change had occurred between the planning phase of the new hospital service. emergency and final construction, “said Mackenzie in one of several statements to the star.

“As we learn from our management of COVID-19 patients and receive feedback from our front-line providers, we will consider, among other things, whether there is a need for hospital rooms. ‘additional airborne isolation.’

Kevin Donovan


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