The outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 exposed the urgent need to enhance the infection control facilities in public hospitals in order to combat the possible resurgence of SARS in future. An improvement plan was drawn up immediately to list out all necessary alteration and improvement works to enhance the infection control facilities of 6 acute hospitals, namely Pamela Youde Nethersole Eastern Hospital, Prince of Wales Hospital, Princess Margaret Hospital (PMH), Queen Elizabeth Hospital, Queen Mary Hospital and Tuen Mun Hospital.

Despite the constraints of extremely tight time frame, the requirement of maintaining ongoing service of the hospitals and the limitations of the physical layout of existing ward areas, we were able to complete all the improvement works as scheduled.

Enhancing the infection control facilities
	Creation of negative pressure in isolation rooms or cubicles in relation to surrounding areas;
	Dilution of bioload by having air flowing from lower to higher risk areas with sufficient air change rates;
	Installation of HEPA filters for air purification;
	Prevention of cross-contamination by minimizing air turbulences and setting proper compartmentation;
	Providing more gowning/de-gowning areas for proper fitting and appropriate removal of personal protective equipment and hand-washing facilities for promoting hand hygiene to guard against transmission of the disease by contact
	Providing shower facilities for washing off respiratory secretions, body fluids or excreta of patients

Solving the critical problems encountered
	The improvement works to 6 acute hospitals were started in July 2003 and completed in March 2004
	It involved a total of 28,616 m2 floor areas and 927 beds were enhanced exceeding the original scope of 890 beds, which including 59 isolation beds in ICU, 868 beds in Isolation Wards
	Existing site configurations were found smaller than the planned one and redesign works were required to suit the site constraint
	Ongoing medical services should be maintained which imposed the need for a decanting programme
	Services diversion works were required to support the decanting of wards
	Most of the work had to be carried out at night time to suit the operational needs of the hospitals whilst at the same time mitigation works were required to minimize nuisance to patients
	Defective pipework and building conditions required urgent repair and rectification works prior to conversion into isolation rooms
	Insufficient power supply to support the new air-conditioning and mechanical ventilation systems in the isolation wards required new transformers and emergency generators
	Insufficient chilled water supply to support the new air-conditioning system required the installation of new chillers