On May 6, the joint prevention and control mechanism of the State Council held a press conference, and Wu Liangyou, deputy director of the Disease Control Bureau of the National Health Commission, said that from April 30 to May 5, the average daily reported infection of nearly 5,800 cases nationwide, down 80% from the peak period.
Previously, Sun Xiaodong, deputy director of the Shanghai Municipal Center for Disease Control and Prevention, said on April 26 that the Aomi Kerong variant strain is highly hidden, especially the proportion of asymptomatic infected people is high, and the proportion of asymptomatic infected people in Shanghai has reached about 90%.
Even if there are symptomatic cases, the symptoms are relatively mild, mainly runny nose, sneezing, sore throat, etc., patients often mistakenly think that this is a common cold or seasonal flu, resulting in failure to seek medical treatment in time, which causes the early stage of the epidemic, the number of cases that medical institutions can find in time is greatly reduced, and even after a long time to find the epidemic.
The Omicron, which is easy to cause hidden sexual transmission, makes the prevention and control of hospital sense face great pressure, and completely avoiding hospital sense has become an extremely difficult task.
There are reports that even if medical staff wear tertiary protective clothing, there is still a possibility of infection; some medical technology departments have also seen positive cases.
In the face of the Omiljung epidemic, do the previous standards for the prevention and control of hospital infection still apply? Is the Wuhan experience (and other experiences dealing with the original virus) partially obsolete? How can hospitals "put in place" the prevention and control of hospital infection and reduce the risk of the spread of the new crown virus in the hospital?
According to this, the health community interviewed Lu Hongzhou, president of the Third People's Hospital of Shenzhen, academician of the American Academy of Microbiology, and head of the first Shenzhen Public Health Expert Group on Epidemic Prevention and Control.
Health sector: Under the epidemic situation in Omikerong, the number of cases has increased rapidly, and fever clinics in some parts of the country have not played their due role?
Lu Hongzhou: In the screening of patients with infectious diseases, fever clinics play a very important role as "sentinel points". In the process of the prevention and control of the new crown epidemic, according to the requirements, the fever clinic is a patient with an epidemiological history or one of the ten major symptoms of the new crown, and we can see that many local cases are triaged to the fever clinic.
However, there are also some cases of COVID-19 in medical institutions that have not undergone a fever clinic, which may be related to the ability to pre-test triage, or it may be that some patients do not accurately describe their clinical symptoms, or that patients have no symptoms in the early stages of infection with the new crown virus. In particular, judging from the patients of the Semikron strain admitted to our hospital, many of them are asymptomatic infected. Therefore, the role of fever diagnosis cannot be denied.
Health community: There are reports that in this round of the epidemic, wearing a three-level protective clothing, there is still a possibility of infection; some medical technology departments have also appeared positive cases, why?
Lu Hongzhou: When the hospital sets the protection level for an infectious disease, it is mainly based on the transmission route of the infectious disease.
When medical staff work in isolation wards, it is generally secondary protection, and only when performing exposure risks, such as invasive operations, surgery, and diagnosis and treatment of children with poor compliance, is the third level of protection. Therefore, the situation of three-level protection is not common.
In the process of close contact with patients with confirmed COVID-19 infection, if there is a lack of respiratory protective measures, the use of ineffective respiratory protective measures (such as the use of masks that do not meet the requirements of the norms), the damage of respiratory protective measures (such as loose masks, falling off, etc.), or the contact of hands with the mouth and nose contaminated by the new crown virus, etc., it will lead to occupational exposure to the new crown.
The reason why some high-risk workers in China have been infected is that there has been an "omission of protective measures" in the process of work, resulting in direct exposure of the respiratory tract or mucous membrane to the virus.
Inspectors working in the medical technology department are also in an environment with a virus, so if there is an omission of protective measures, there is a possibility of infection. In addition, the new crown specimen laboratory test will be inactivated first, if the inactivation step is not done well, resulting in subsequent test operators mistakenly think that inactivation is effective and reduce the compliance of protection, or lax disinfection and isolation will also lead to an increase in the risk of infection.
For the new crown occupational exposure, in principle, it is necessary to do: early detection, early assessment, early treatment, and full tracking.
Therefore, it is necessary to scientifically carry out the prevention and control of hospital infection. Although the virus is cunning, at present, as long as we strictly do a good job of protective measures, most of our medical staff can protect themselves well.
Health: In this round of the epidemic, completely avoiding hospital feeling is an extremely difficult task. Does this mean that the original hospitality standard is no longer applicable? Is the Wuhan experience (and other experiences dealing with the original virus) partially obsolete?
Lu Hongzhou: Completely avoiding hospital sense is indeed an extremely difficult task, but it is not an impossible task, and the key is that our various hospital sense measures must be implemented in place.
In the nearly three years since we responded to the epidemic, the measures for the prevention and control of hospital infection have been continuously improved, but there has been no major adjustment such as the level of protection.
The hospital infection prevention and control plan is not optimal or optimal, and must be adjusted at different times and places, such as when dealing with the Delta strain, our hospital began to treat patients in partitions; in response to the Aumechjong strain, we appropriately adjusted the level of protection for key groups such as children.
The Wuhan experience is the first lesson we have learned from dealing with the new crown virus, which is very valuable, but it is not universal. The virus is constantly mutating, so it is also necessary to continuously improve the prevention and control measures of hospital infection according to its characteristics in order to better respond to the epidemic.
Health sector: How to deal with sudden accidents (including violent injuries) in the treatment areas of people infected with COVID-19?
Lu Hongzhou: If an accident occurs in the new crown treatment area, such as self-harm, suicide, violent injury to the doctor, destruction of public property, violation of epidemic prevention regulations, etc., it should be handled in four steps:
1. The medical staff in the ward should immediately do a good job of secondary protection, clean up the on-site personnel, and judge whether the patients and medical staff have personal safety and exposure risks.
2. Under the premise of personal protection, the doctor and nurse on duty arrive at the scene of the accident to check, properly dispose of and comfort the patient. After the initial assessment of the development trend of the situation, immediately report to the section director and the head nurse. The head of the department and the head nurse arrived at the scene as soon as possible, and after re-evaluation, they reported to the medical department, the nursing department, and the hospital's infection department, and contacted the psychiatrist at the first time. If the patient is still unable to be reassured, the Medical Department immediately starts the psychological counseling process in the outer hospital.
3. The head of the department evaluates the dynamics of the incident, and if there is a risk of further aggravation, call the hospital security number. Security personnel arrived at the scene with secondary protection, cleaned up the surrounding environment of the scene again, and worked with medical staff to deal with emergencies. The department reported to the leaders of the duty hospital and the leaders of the hospital where the incident occurred.
4. If the incident is further expanded, if there is a risk of personal injury to the patient or medical staff, the department will immediately report to the police and report to the hospital's sensory department. Police personnel are accompanied by hospital security personnel, wear protective equipment with the help and supervision of hospital infection department personnel, and enter the department for disposal. The results of the processing were reported to the leaders of the hospital.
Health community: At present, antigen detection as a supplement has been applied by the majority of medical institutions, if a positive case is found to be detected by antigen testing, how should it be dealt with?
Lu Hongzhou: According to the requirements of the "Notice on Printing and Distributing the Application Plan for the Detection of New Coronavirus Antigens (Trial)" (Joint Prevention and Control Mechanism Comprehensive Issuance [2022] No. 21), our hospital has specially formulated an emergency plan for closed-loop managers to test positive for new coronavirus antigens.
The concentrated residents of the new crown isolation ward (including those who are isolated before the end of the closed loop and the persons isolated by occupational exposure) should be tested for new crown antigens every day before going to work, and can only go to work after a negative result, and when a positive result appears, it is carried out in accordance with the principle of "timely reporting, rapid sampling, timely circulation, and scientific disposal". The processing process is:
Timely reporting: After the testing personnel test positive, the person in charge of the hospital's infection department and the head of the department are reported to the person in charge of the hospital's infection department and the head of the department at the first time; the person in charge of the hospital's infection department reports to the main leader of the hospital, and the head of the department reports to the person in charge of the functional department of the personnel (such as the doctor reports to the medical department, the nurse reports to the nursing department, and the logistics personnel reports to the general affairs department) and arranges other staff to take over their work.
Rapid sampling: The hospital sensibility department notified the nursing department to sample the new crown nucleic acid positive personnel to the centralized residence hotel room, and the laboratory department immediately began to test after sampling.
Rapid circulation: The full-time staff of the isolation ward of the hospital infection department carries out the circulation adjustment and feedback the results to the person in charge of the hospital infection department.
Scientific disposal: If the staff's new crown nucleic acid test result is positive, start the emergency disposal process in the hospital; if the nucleic acid result is negative, treat the new crown patient, continue to isolate in a single room, closely observe, and conduct nucleic acid testing for 2 consecutive times. Isolation can only be lifted after medical experts have been arranged by the Medical Affairs Department to assess the situation.
Health community: How should COVID-19 patients suffer from serious diseases other than COVID-19?
Lu Hongzhou: In the process of patient admission, there are more special groups of patients, such as children, pregnant women, the elderly or other comorbid patients, combined with hypertension, diabetes, tumors and other diseases. The treatment principle of our hospital is: strictly follow the core medical system to treat patients, and do not delay treatment because patients are infected with the new crown virus.
In order to improve the treatment of such patients, the leading group for the treatment of new crown patients should establish a "mechanism and process for dealing with serious diseases other than new crown", and at the same time, led by the medical department, clarify the emergency consultation personnel of each specialty - in principle, the personnel with the title of chief treatment or above, to ensure that the 24-hour mobile phone communication is smooth and can enter the treatment ward of the new crown patient at any time to participate in the rescue.
The department in the area where the new crown patient is admitted should clarify the patient's condition, and if other specialist consultations are required, the head of the department shall clarify and follow the following process:
Emergency consultation: After the consent of the head of the department where the new crown patients are admitted, an application is issued to the emergency consultation personnel of each specialty, and it is implemented in accordance with the relevant system of emergency consultation. If the patient is critically ill, immediately report to the specialist COVID-19 patient treatment team.
General consultation: The head of the department admitted to the new crown patient will contact the members of the new crown expert treatment team directly by telephone to complete the consultation.
Multidisciplinary consultation: If the patient's condition is complex and multidisciplinary consultation is required, the head of the new crown patient admission department will report to the secretary of the new crown patient treatment leading group for organization and implementation.
Health community: In the past two years, the number of infection control personnel has been greatly expanded, how long does it take for new recruits to go through a training cycle to reach industry standards?
Lu Hongzhou: In August 2021, the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council issued the Notice on Further Strengthening the Management of Infection Control Personnel in Medical Institutions, which made clear requirements for the allocation of infection control personnel, which was not available before.
The sensor control work involves a wide range of aspects and the work content is complex. Therefore, it is required that full-time infection control personnel in medical institutions at or above the second level should have public health expertise.
From non-hospital sense posts to full-time hospital sense posts, it is necessary to enter the training and assessment before they can take up their posts. For new hires, it takes at least half a year of training to meet industry standards.
Our current concept of infection control is "everyone is a practitioner of hospital sense, everyone is a hospital sense supervisor", and our hospital requires everyone to know the sense of hospital and implement various measures.
Health community: Under the epidemic caused by the Omikeron mutation, how should hospitals do a good job of infection control?
Lu Hongzhou: Hospital infection prevention and control work is always on the road. Each hospital is different, the patients are not the same, and the level of medical staff is different, so the measures for the prevention and control of hospital infection are also different.
Under normal circumstances, hospitals with a total of more than 100 inpatient beds shall establish a "Hospital Infection Management Committee" and an independent hospital infection management department; hospitals with less than 100 inpatient beds shall designate a department in charge of hospital infection management.
Each clinical department shall set up a "infection control team", which shall be served by the head of the department, the head nurse, the infection control doctor and the infection control nurse, and the infection control supervision team shall be established to be responsible for the daily infection control supervision work.
Hospitals with less than 500 beds need to have at least 10-15 infection control supervisors; hospitals with 500-1000 beds need to have at least 10-15 infection control supervisors; hospitals with more than 1,000 beds need to have at least 20 or more infection control supervisors.
In addition, in order to implement real-time supervision with wide coverage around the clock, treatment sites and designated medical institutions should establish a 24-hour "SCI" video supervision model, that is, through all-round uninterrupted video supervision, to help staff find errors in the process of putting on and taking personal protective equipment and disinfection and isolation, hand hygiene, medical waste disposal and other links and timely remind, supervise corrections, and minimize the risk of infection.
In case of error, you should take a photo or take a video in time to keep it. For cases that require reconfirmation, you should review it carefully through playback.
24-hour "SCI" video supervision - occupational exposure emergency response linkage mechanism:
1. On-site reminder: Once the supervision team members find that the staff has suspected occupational exposure during the video viewing process, they must remind the intercom device at the first time to stop the wrong behavior, and guide the staff to correctly dispose of it and leave the buffer area as soon as possible.
2. Isolation measures: Remind staff to carry out standardized disposal in accordance with the "Occupational Exposure Treatment Process for Novel Coronavirus" and immediately isolate in a single room.
3. Risk assessment: The video supervision team members should immediately send the video, photos and other on-site information to the designated occupational exposure management personnel, who will request the expert group to conduct a comprehensive assessment of the risk degree of occupational exposure.
4. Intervention: Prophylactic medication will be guided by the expert group.
Specific to our hospital, the hospital infection prevention and control strategy adopted includes "five precise, six strict, and two special":
Five precisions:
First, precise partitioning: strict implementation of patient isolation management.
The second is the precise layout: at the macro level to achieve comprehensive prevention and control of time, space, people flow, logistics, air flow; at the micro level to carry out the transformation of the ward clean and polluted streamline.
The third is precise disinfection: formulate terminal disinfection processes in various regions and increase the frequency of disinfection supplies replacement. The fourth is precise protection: the use of visual supervision system to ensure that there is no dead end in prevention and control.
Fifth, accurate personnel management: classified management of medical staff, patients, escorts, and other personnel.
Six strict:
Strictly implement closed-loop management of staff;
Strictly implement the management of key links;
Strict closed-loop personnel behavior management;
Strictly implement the supervision mechanism;
Strict nucleic acid testing of personnel;
Strict training and assessment.
Two special:
First, special groups such as child patients,
The second is the occupational exposure staff in high-risk positions, which are targeted at these two groups for special hospital infection prevention and control.
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Written by | Valley Will
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