A number of cases of nosocomial infections have been reported! Doctors and patients seek help online

How to plug the upper house sense loophole?

Written by | Yan Xiaoliu, Wang Hang

Source | "Medical Community" public account

The new crown pneumonia epidemic is breaking out in many places and many places on the mainland. At 0-24:00 on April 8, there were 1,334 new locally confirmed cases and 23,815 cases of asymptomatic infected people in the mainland.

At the same time, infections in medical institutions occur frequently.

"In the past few days, patients and nurses have been infected in our own wards, and the rapid growth has reached more than ten people in two days." A nurse at a hospital in Shanghai said that on April 4, two nurses in the hospital's ward were positive for nucleic acid.

On April 5, the hospital sent people out to sample in the case of positive staff in the hospital, and there was no disinfection and epidemic prevention in the hospital.

The next day, one ward was almost wiped out.

On the 8th, the hospital issued a closed-loop management notice. On the same day, the nurse posted that her ward had received the first batch of protective equipment. Prior to this, his ward had been "naked" for many days. "During this period, other departments treated us as an epidemic area. But we are not sealed here, and people come and go freely. ”

The "medical community" noted that the area where the hospital is located was fully statically managed since the early hours of April 1. In order to facilitate work and avoid affecting the family, all nurses in the ward have been living in the ward, sharing toilets with patients and family members, and eating at the nurses' desk. Some people do not stock up on any daily necessities, and they rely on colleagues for support such as sanitary napkins.

"We want hospitals to transfer and properly place positive patients, or to arrange isolation for us to be closely related to medical care." Otherwise, if one patient is yang, the whole ward will be yang. It's only a matter of time. ”

The same happened at another hospital in Shanghai.

A nurse at the hospital posted on Weibo that she was the sixth Corey to be notified positive. After his diagnosis, the hospital notified the department not to go to work and closed the door to eliminate the killing. At this time, it has been 2 days since the first medical staff of the hospital reported positive.

A family member of a patient in the hospital confirmed to the "medical community" that his 86-year-old grandfather was admitted to the hospital for stroke on March 29, and the old man was diagnosed positive on April 7. The 85-year-old grandmother is in the hospital closed-loop escort, and the nucleic acid test results since April 6 are unknown.

"I first swiped the message on Weibo, saying that there may be an infection in the hospital. When my grandfather was diagnosed, my grandmother said that the situation was quite serious. Patients and family members can only stay in the ward, the doctor will send food to the door, and can only go out of the room once a day to get hot water. The patient's family asked for help on Weibo, saying that they did not know whether they could transfer the elderly to the cabin with the ability to treat the patient, and whether the grandmother's nucleic acid results were not out, and whether they could go to the cabin with grandpa.

On the same day that the above-mentioned news of the request for help came out, the Shanghai Municipal Commission for Discipline Inspection reported that the Pudong Branch of the Shanghai Huangpu District Mental Health Center had problems of lax management and poor handling in the epidemic prevention and control work, causing many patients and employees to be infected. Zhou Baoguo, deputy secretary of the party branch and president of the Shanghai Huangpu District Mental Health Center, was dismissed from his post. This is the first hospital president in Shanghai to be publicly dismissed in this round of the epidemic.

A few days before the hospital's in-hospital infection incident was made public, many hospital doctors and staff spoke out online to seek assistance.

Under the epidemic situation, hospital sense incidents occur frequently

If the time span is set since the normalization of epidemic prevention, the hospital sense events are also endless. The hospitals involved include the Sixth Hospital of Zhengzhou, the Eighth People's Hospital of Guangzhou, the Gaocheng People's Hospital of Shijiazhuang City, the Xinle City Hospital of Traditional Chinese Medicine, the Chest Hospital of Qingdao, the Fifth People's Hospital of Qingdao, the First Affiliated Hospital of Harbin Medical University, and the Affiliated Hospital of Yangzhou University.

On April 5 this year, the Loudi Central Hospital in Hunan Province notified two cases of new coronavirus infection, namely nurses and doctors in the independent infectious disease area. The hospital is the only designated hospital for covid-19 treatment in Loudi City.

The "medical community" combed through the above-mentioned related events and reports, and found that the new crown hospitalization incident mainly stemmed from 4 aspects: First, the implementation of the regulations was not enough or the management was lax, such as the Shijiazhuang Gaocheng People's Hospital did not "due diligence" for inpatients and accompanying personnel, the phenomenon of entering the ward first and then doing testing was common, and the ward management was chaotic, and the residence permit could be used interchangeably.

Second, the hospital's architectural design and hardware conditions do not meet the requirements. For example, qingdao chest hospitalized patients with new crown and patients in the general ward share a CT room (there is only one CT room in the hospital).

Third, in the recent hospitalization incidents in several medical institutions, problems such as the neglect of protection of vulnerable people have been exposed. In addition to infection and emergency treatment, medical staff in some outpatient and inpatient departments face insufficient protective materials.

Fourth, after the positive cases were found, they were not immediately transferred to the square cabin isolation or single room isolation, resulting in the expansion of infection. According to the Reflection on the Management of Nosocomial Infections of Medical Personnel under the Novel Coronavirus Pneumonia Epidemic and Its Countermeasures, the mainland is still facing the problem of insufficient reserves for the prevention and control of professional infectious diseases and the treatment capacity for critical and severe diseases. The surge in cases, the increase in severe disease, and the large scale, crossover, close distance and long time of infection exposure of medical staff have led to infection of medical staff in multiple departments of some hospitals.

"The vast majority of hospitals in the mainland have established infection management departments and formulated a series of rules and regulations. But the COVID-19 pandemic is like a magnifying glass, showing and amplifying the shortcomings and loopholes in hospital infection management. Zhang Ge of the Occupational Safety and Health Research Center of the National Health Commission is the author of "Reflections on the Management of Nosocomial Infections of Medical Staff under the Novel Coronavirus Pneumonia Epidemic and Its Countermeasures". He wrote that in the face of the new crown virus and other possible new infectious diseases in the future, it is necessary to adhere to the problem orientation and further strengthen the management of nosocomial infections among medical staff.

Zhang Ge gave a series of countermeasures and thoughts in the text.

First, increase investment in hospital infection, guarantee prevention and control infrastructure, places, funds, manpower, materials, etc., and strengthen the education and training of medical personnel, which is the basis for the prevention and control of hospital infection.

Second, improve the ability to accurately control the source of infection. The hospital adheres to and improves the management system of pre-examination triage, strictly manages fever diagnosis, strictly manages the escort and visitation of inpatients, implements the responsibility system of the first doctor, and immediately reports, isolates and medical observations when abnormalities are found.

Third, multiple measures should be taken to cut off the transmission route. The hospital adheres to the management of "three districts and two channels" for the normalization of key areas, and the personnel protection is strictly partitioned and graded prevention and control to avoid cross-infection. Strengthen the control of environmental infections, do a good job in cleaning and disinfecting various working and living environments and items such as wards, medical examination equipment, and sewage systems, strengthen ventilation management, and correctly wear masks when entering the hospital. Strengthen the personal protection of medical personnel, accelerate the construction of the occupational health system for medical personnel and the development of the standard system of safety protection products, pay attention to hand hygiene, and adhere to standard prevention in diagnosis and treatment activities.

Fourth, categorical measures are taken to protect susceptible people. Do a good job of emergency response plans after occupational exposure of various groups of people to minimize the harm to medical personnel.

Fifth, strive to maintain the physical and mental health of medical personnel, comprehensively consider factors such as medical staff working hours, mental and physical load, medical risks, management and scientific research, strengthen basic research on the mental health of medical personnel and intervene in relief, and avoid reducing immunity due to physical exertion, psychological depression and other factors.

In response to the current epidemic situation, Zhang Wenhong, director of the Department of Infectious Diseases at Huashan Hospital affiliated to Fudan University, told The Paper on April 9 that this wave of Opmi Kerong attacks came quickly and violently, causing an impact on the medical system, especially the normal medical order.

He believes that in this wave of dynamic zeroing process, the greater enlightenment is that we should make more adequate preparations for the next stage of anti-epidemic, and should make more active construction in strengthening injection vaccination, drug reserves, nucleic acid detection capabilities, isolation ward construction, and hierarchical diagnosis and treatment system for the elderly. If a strong anti-epidemic system is not built, even if the social clearance is achieved this time, tomorrow will still face problems of one kind or another.

Source:

1. Reflections on the management of nosocomial infections among medical staff under the novel coronavirus pneumonia epidemic and their countermeasures. Chinese Journal of Tuberculosis and Respiratory. 2021,44(1) : 74-76. DOI: 10.3760/cma.j.cn112147-20200722-00829

Source: Medical community

Editor-in-charge: Xu Liyan

Proofreader: Zang Hengjia

Plate making: Xue Jiao