China News Service, Shanghai, May 9 (Sun Guogen and Chen Jing) The Omicron variant popular in the current round of Shanghai's new crown pneumonia epidemic is highly occult, and the proportion of asymptomatic infections is high; even the symptomatic cases are mainly runny nose. , sneezing, sore throat, etc.
Patients often mistake it for the common cold or seasonal flu and fail to seek medical attention in time.
This is an important cause of occult transmission.
So, as a key place to treat and save people, how can hospitals further improve risk awareness?
How to pay close attention to the prevention and control of hospital infection to reduce the risk of the spread of the new coronavirus in the hospital?
To this end, on the 9th, the reporter interviewed Professor Lu Hongzhou, a well-known infectious disease expert in China, the president of Shenzhen Third People's Hospital, and an academician of the American Academy of Microbiology.
Reporter: Under the epidemic of the new coronavirus Omicron variant, the number of cases has increased rapidly. Are the fever clinics in some parts of the country not working as they should?
Lu Hongzhou
: In the screening of infectious disease patients, fever clinics play a very important "sentinel" role.
During the prevention and control of the new crown pneumonia epidemic, according to the requirements, the fever clinic admits patients with an epidemiological history or one of the top ten symptoms of the new crown. We can see that many local cases are triaged. found in fever clinics.
However, there are also new crown cases in some medical institutions that have not gone through a fever clinic. This may be related to the ability of pre-screening and triage, or it may be that some patients who seek medical treatment do not accurately describe their clinical symptoms, or they are infected with the new crown virus at a very early stage. The patient is asymptomatic.
In particular, judging from the patients admitted to the hospital infected with the Omicron variant, many of them were asymptomatic infections.
Therefore, the role of the fever clinic cannot be denied.
Reporter: There are reports that in this round of the epidemic, wearing level 3 protective clothing, there is still the possibility of being infected. Why?
Lu Hongzhou:
When a hospital assigns a protection level to a certain infectious disease, it is mainly based on the transmission route of the infectious disease.
For example, we clearly know that the main way of transmission of the new coronavirus is respiratory droplets and close contact, and it may also spread through aerosol transmission in a relatively closed environment and contact with contaminated items.
Then, our protective measures are to protect the respiratory tract and avoid close contact with people or objects infected with the virus without protection.
When medical personnel work in isolation wards, they are generally protected at the second level, and only when the risk of exposure is high, such as invasive operations, surgeries, and diagnosis and treatment of children with poor compliance, the third level of protection.
Therefore, the situation of three-level protection is not common.
In the process of being in close contact with a confirmed patient with new coronavirus infection, if there is a lack of respiratory protection measures, use of ineffective respiratory protection measures (such as using masks that do not meet the requirements of the specification), damage to respiratory protection measures (such as masks loosening, falling off, etc.), or being affected by the new crown virus Behaviors such as contact with the mouth and nose with virus-contaminated hands can lead to occupational exposure to the new crown.
The most important reason for the infection of some high-risk workers in China is that they have "oversights in protective measures" during their work, resulting in direct exposure of the respiratory tract or mucous membranes to a virus-containing environment.
The inspectors working in the medical technology department are also in a virus-containing environment. If there are omissions in protective measures, there is a possibility of infection.
In addition, the new crown specimens will be inactivated before laboratory testing. If the inactivation steps are not done well, the subsequent inspection operators will mistakenly believe that the inactivation is effective and reduce the compliance of protection, or the lax disinfection and isolation will also increase the risk of infection.
In principle, the occupational exposure to the new crown should be done: early detection, early assessment, early treatment, and full tracking.
Therefore, we must scientifically carry out hospital infection prevention and control.
Although the virus is cunning, from the current point of view, as long as strict protective measures are taken, most medical staff can protect themselves well.
Reporter: In this round of epidemic, it is an extremely difficult task to completely avoid hospital feeling. Does this mean that the original hospital feeling standard is no longer applicable?
Lu Hongzhou:
It is indeed an extremely difficult task to completely avoid hospital feeling, but it is not an impossible task. The key is that various measures for hospital feeling must be implemented in place.
In the nearly three years we have been responding to the epidemic, the measures for prevention and control of hospital infection have been continuously improved, but there has been no major adjustment in the level of protection.
There is no optimal or best plan for nosocomial infection prevention and control, and adjustments must be made at different times and locations. For example, when dealing with the delta variant, the hospital begins to treat patients in different areas; Further strengthen the behavior management of closed-loop personnel, emphasize that staff should not relax respiratory protection in public areas, and appropriately adjust the protection level of key groups such as child care.
The virus is constantly mutating, and it is necessary to continuously improve the prevention and control measures of hospital infection according to its characteristics in order to better respond to the epidemic.
Reporter: How to deal with unexpected incidents in the treatment ward of new crown patients?
Lu Hongzhou
: If a patient violates the epidemic prevention regulations and other unexpected events in the new crown treatment ward, the following four steps should be followed:
The first is on-site disposal: medical personnel in the ward quickly clean up the on-site personnel to determine whether patients and medical personnel have personal safety and exposure risks.
The second is to report in a timely manner: on the premise of personal protection, the doctors and nurses on duty will arrive at the scene of the incident to check, properly handle and comfort the patient.
Report to the head of the department and head nurse immediately after a preliminary assessment of the development trend.
The head of the department and the head nurse arrive at the scene as soon as possible, and after re-evaluation, report it to the medical department, nursing department, and hospital sensory department, and contact the psychiatrist as soon as possible.
If the patient still cannot be appeased, the medical department immediately starts the psychological counseling process in the outer hospital, and invites psychologists for remote psychological counseling.
The third is security intervention: the director of the department evaluates the dynamics of the event, and if there is a further risk of aggravation, call the hospital security phone.
Security personnel arrived at the scene with secondary protection, cleaned up the surrounding environment again, and worked with medical staff to deal with emergencies.
The department reports to the leader of the duty hospital and the leader of the hospital where the incident occurred.
Fourth, call the police when necessary: if the incident further expands, the hospital security personnel should accompany the police personnel, wear protective equipment under the help and supervision of the hospital infection department personnel, and enter the department for disposal.
The processing results shall be reported to the head of the hospital.
Reporter: At present, the antigen test has been used as a supplement by the majority of medical institutions. If a positive case is found in the antigen test, what should be done?
Lu Hongzhou:
According to the requirements of the document "Notice on Printing and Distributing the New Coronavirus Antigen Detection Application Plan (Trial) (Joint Prevention and Control Mechanism Zongfa [2022] No. 21)", our hospital has specially formulated an emergency plan for closed-loop management personnel who test positive for the new coronavirus antigen.
Staff in the new crown isolation ward (including those who are included in closed-loop management, those who are isolated before the end of the closed-loop, and those who are isolated from occupational exposure) should undergo a new crown antigen test before going to work every day, and can go to work after the result is negative. The principle of "timely reporting, rapid sampling, timely flow adjustment, and scientific disposal" is carried out.
The processing procedures are: 1. Timely reporting; 2. Rapid sampling; 3. Rapid flow adjustment; 4. Scientific disposal: that is, if the staff member's new crown nucleic acid test result is positive, the hospital emergency disposal process is initiated; if the nucleic acid result is negative, temporary isolation , Closely observe clinical symptoms, and conduct nucleic acid testing again at an interval of 24 hours. If the result is negative, the isolation can be released only after the medical department arranges medical experts to evaluate the situation.
Reporter: How should a person infected with the new coronavirus suffer from a serious disease other than the new crown?
Lu Hongzhou
: During the process of patient admission, there are many patients with special populations, such as children, pregnant women, the elderly or patients with other comorbidities, with hypertension, diabetes, tumors and other diseases.
In order to improve the treatment of such patients, the leading group for the treatment of patients with COVID-19 should establish a "treatment mechanism and process for serious diseases other than COVID-19", and at the same time, the medical department should take the lead to identify the emergency consultation personnel of various specialties - in principle, those with professional titles above the main treatment. , to ensure smooth mobile phone communication 24 hours a day and can enter the new coronavirus infection treatment ward at any time to participate in the rescue.
Reporter: How are the confirmed cases of the new coronavirus placed and managed? Can the family members of the infected person accompany or visit?
Lu Hongzhou
: Suspected cases of new coronavirus infection should be placed in a single room in isolation, and asymptomatic infections and confirmed patients should be placed in the same room according to different virus strains.
Confirmed patients should be placed in a negative pressure isolation ward first, and the room should be equipped with a separate toilet.
At the same time, a new coronavirus genotype undetermined screening ward should be established. After the genotype is determined, patients with different genotypes will be admitted to different areas for treatment, and special areas, specialized doctors, and specialized nursing management will be carried out.
Wards should provide patients with adequate personal protective equipment.
During this process, no escort is provided, visiting is prohibited, and video visits are encouraged.
If for special reasons, the suspected or confirmed person must be accompanied, the approval of the superior administrative department must be obtained and the prescribed procedures must be performed.
Reporter: In the past two years, the number of sensory control personnel has been greatly expanded. How long does it take for new personnel to go through the training cycle to reach the industry standard?
Lu Hongzhou
: In August 2021, the Comprehensive Team 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 clearly stipulated the allocation of infection control personnel.
Infection control work involves a wide range of tasks and complex work content. Therefore, full-time infection control personnel in medical institutions above the second level are required to master public health professional knowledge.
From a non-hospital sense position to a full-time sense of hospital position, you must go through training and assessment before you can take up the job.
For new recruits, at least half a year of training is required to reach industry standards.
The training team should be composed of personnel with rich experience in sensory control.
All staff in the isolation ward should complete uninterrupted training and assessment before, after and during their work. Among them, the pre-job training and assessment is the most important, and only after obtaining a certificate can they engage in isolation Ward work.
Our concept of sensory control should be: "everyone is a practitioner of sensory control, and everyone is a sensory control supervisor"; in order to make the concept of sensory control deeply rooted in the hearts of the people, "sense control in the heart, implementation in action" is a A staff request.