新型冠状病毒肺炎疫情期间2309家医院输血科(血库)生物安全防护调查分析

目的 研究新型冠状病毒肺炎疫情期间各级各类医院输血科(血库)实验室生物安全防护情况。方法 通过"互联网+微信问卷星"平台对全国除港澳台外其他各省市2 309家医院输血科(血库)进行调查。结果 2 309家医院输血科(血库)实验室中房屋具备对外通风采光窗户功能1 876家(占81.25%),生物安全二级实验室1 042家(占45.13%),配备生物安全柜和具有生物安全功能自动脱盖型离心机分别597家(占25.86%)和224家(占9.7%)。实验室操作台面采用具有渗透功能材料1 498家(占64.88%)。从业人员达到一级生物安全防护用品使用率88.7%～95.8%,而达到二级生物安全防护用品使用率只有23.45%～56.08%。检测后血标本盖上试管盖和使用两层黄色垃圾袋包裹密封分别为2 039家(占88.31%)、2 000家(占总数86.32%),血标本保存7天有1 229家(占53.23%)。结论 通过本次互联网+调查研究,应认识到输血科(血库)实验室生物安全防护工作任重而道远。     

2019新型冠状病毒肺炎防控期间临床输血血型血清学实验室生物安全防护指南(第二版)

正《中华人民共和国传染病防治法》规定新型冠状病毒肺炎已纳入乙类传染病,并采取甲类传染病的预防、控制措施。为了保障新型冠状病毒肺炎防控工作期间实验室生物安全,国家卫生健康委员会组织制定了诸多新型冠状病毒实验室生物安全指南和防控方案等~([1-5]),指导各级各类医疗机构规范开展相关实验活动。通过对疾病认识的不断深入和临床输血医学经验的积累,我们在已制定《2019新型冠状病毒肺炎防控期间临床输血血型血清学实验室生物安全防护指南(第一版)》     

输血科应对新型冠状病毒的生物安全措施和流程优化

目的探讨并制定应对新型冠状病毒,武汉三甲医院输血科生物安全措施的改进和标本检测的流程优化,为输血科实验室提供行之有效的安全防护。方法参考《实验室生物安全通用要求》、《新型冠状病毒肺炎防控方案(第四版)》、《新型冠状病毒肺炎实验室检测技术指南(第四版)》、《新型冠状病毒实验室生物安全指南(第二版)》和《2019新型冠状病毒肺炎防控期间临床输血血型血清学实验室生物安全防护指南(第二版)》等技术规范和专家共识,结合本科室结构设施和实验条件,制定了相关生物安全防护措施和检测流程。结果制定了输血科实验室生物安全分区,标本的接收、检测和灭菌流程,以及工作人员进出实验室防护流程等,均符合新型冠状病毒相关法律法规和技术规范,且切实可行,作为新型冠状病毒防治定点医院期间,输血科工作有条不紊进行且无医务人员感染。结论结合输血科设施条件,并按相关法律法规和技术规范改进生物安全防护措施和标本检测流程可有效预防控制新型冠状病毒的感染,保护医务人员的健康。     

上海市临床检验中心组织开展新型冠状病毒核酸检测测量审核活动

在当前严峻的疫情形势下,为了配合新型冠状病毒肺炎疫情的防控工作,上海市临床检验中心(以下简称“中心”)承担起新型冠状病毒核酸检测的质量保障任务。2020年3月,中心为符合生物安全要求,且有资质开展基因扩增检验项目的实验室免费提供新型冠状病毒核酸检测的测量审核。来自全国21个省市的60家实验室参加了活动,其中医学检验实验室45家,各级医院实验室15家。此次活动在中心领导的支持下,由质量管理部和分子生物学检测实验室协同完成。     

四川省新型冠状病毒相关实验室检测及生物安全操作专家共识

2019年底湖北武汉爆发了新型冠状病毒感染,并迅速蔓延到全国及国外100余国家和地区。截至2020年3月初,我国新型冠状病毒肺炎确诊病例已超过八万例,导致三千多人死亡。新型冠状病毒肺炎的相关实验室检测,包括核酸检测,为该病的诊断和治疗提供重要依据。为提高四川省新型冠状病毒肺炎相关实验室检验流程的规范化,并保障我省检验人员安全,四川省临床检验中心联合四川省质控中心、四川省医学会检验专委会,组织我省检验领域专家,制订新型冠状毒肺炎的相关实验室检验和生物安全防护专家共识。该共识内容包括适用范围、新型冠状病毒肺炎的病原学及流行病学特点,实验室安全原则,生物安全防护,标本的采集、转运、标接收和前处理,检测流程,检测后标本及相关废弃物处理,生物安全意外事故的处理等11个方面的内容,旨在指导四川省临床实验室建立新型冠状病毒相关实验室检测和实验室生物安全标准流程。     

新型冠状病毒肺炎的实验室分子诊断及生物安全

该文就新型冠状病毒肺炎的病原体核酸检测及生物安全等方面进行了概述,包括病例定义、检测适应证、标本类型和标本采集、标本包装和运输、标本处理和核酸提取、病毒分子检测和结果判读,以及实验室生物安全,旨在提升临床实验室的检测质量,保障生物安全。     

新型冠状病毒肺炎定点医院确诊患者隔离病区污染区护理小组防控体会

南昌大学第一附属医院作为省级新型冠状病毒肺炎(新冠肺炎)定点救治医院之一,承担了江西省危重症感染患者和大量普通型感染患者的救治工作,防控工作面临着前所未有的巨大挑战和压力。通过合理病区环境与布局、岗前二级防护用品穿脱流程的培训等感染防控措施落实,同时科学小组管理模式有效缓解疫情初期防护用品供应不足,高效、安全开展各项救治工作,保障了新冠肺炎患者得到良好救治和医护人员安全。     

移动微生物检测车支援核酸检测的生物安全与感控管理

目的 远程支援新型冠状病毒核酸检测时需搭建临时实验室,该文探寻临时实验室感染控制(简称感控)思路,为今后移动微生物检测车远程支援新型冠状病毒核酸检测的生物安全与感控管理提供参考。方法 该院支援哈尔滨核酸检测医疗队带领8辆移动微生物检测车支援哈尔滨市全员核酸检测工作,首先进行黑龙江省病原微生物实验室及实验活动备案、黑龙江省临床基因扩增检验实验室技术申请,开展感控相关技能及流程培训,根据实验室不同区域的生物安全风险等级实施适当的个人防护,进行样本接收、转运、准备、处理及处理后的感控工作,开展环境监测及处理医疗垃圾。结果 支援哈尔滨新型冠状病毒核酸检测17 d里,医疗队克服客观条件限制,寻找替代方案,保证作业标准化,顺利完成任务。结论 应从临时实验室的场地布局、人员工作职责、制度、流程及应急演练、培训等全方面落实生物安全与感控的管理,保障队员身心健康。     

二级医疗机构抗击新型冠状病毒肺炎疫情的做法与探讨

自从新型冠状病毒肺炎疫情发生以来,各级医疗机构成了抗击疫情的主战场。承担着不同程度的防控与救治工作,一级医疗机构主要承担着疫情的防控任务,三级医院主要承担着新型冠状病毒肺炎的救治任务,二级医疗机构处于中间层,有发热门诊,但隔离病房等设施设备又不完备,在抗击疫情面前,都要挺身而出,承担着各种风险与压力。本文针对当前疫情二级医疗机构的做法进行综述。     

新型冠状病毒核酸检测实验室的生物安全防护探讨

2019年12月底,武汉市发现由新型冠状病毒(SARS-CoV-2)感染引起的新型冠状病毒肺炎病例,随后感染人数不断上升,SARS-CoV-2核酸检测可及时对急重症及疑似患者的诊断提供直接证据。由于SARS-CoV-2可能存在气溶胶传播途径,检测人员在实验过程中存在较大的感染风险。因此,加强检测实验室生物防护显得极为重要。该文结合相关文献及在SARS-CoV-2核酸检测中的工作经验,从实验室生物安全防护、个人生物安全防护、核酸检测过程生物安全防护等各个环节进行深入探讨,为SARS-CoV-2检测实验室生物安全防护提出相关措施和参考依据。     

深圳市医疗卫生机构实验室生物安全现况调查

目的了解深圳市医疗卫生机构实验室生物安全现状,为实验室生物安全建设提供参考。方法采用问卷调查方式,对该区25家各类医疗卫生机构实验室生物安全情况进行了调查。结果该区13所公立医院和1所疾病预防控制中心拥有生物实验室25间,均为BSL-2实验室;11所民营医院共有BSL-2生物实验室3间,其他均没有BSL-2实验室。实验室工作人员不同职称人员比例适当,配置合理;实验室使用频率均较高。BSL-2实验室软硬件建设较好,非BSL-2实验室相对较差。结论深圳市医疗卫生机构生物安全实验室的生物安全情况总体较好,但民营医疗机构需完善和加强生物安全建设与管理。     

新型冠状病毒肺炎疫情基层医疗机构防控探讨

2019年末新型冠状病毒肺炎作为一种新发传染病迅速在全球各地蔓延,我国新疆地区也经历了 3次大的疫情挑战.自治区和兵团疫情防疫领导组及时成立了专项督导组并多次深入基层,通过现场督查的方式,对发热门诊预检分诊的布局流程、工作人员防护用品的使用、手卫生执行、环境清洁与消毒、医疗活动过程等环节了解感染管理及控制现状,旨在最大...     

新型冠状病毒监测网络省市级疾控实验室核酸检测室间质评

  目的  对全国32个省市级疾控机构新冠监测网络实验室新型冠状病毒（新冠病毒）变异株核酸检测能力进行室间质评,同时对常规所用新冠病毒核酸检测试剂性能进行评价。  方法  制备新冠病毒武汉株及4个关切变异株、人冠状病毒OC43（HCoV-OC43）和H3亚型流感病毒（H3N2）核酸样本,发放给全国31个省、自治区及直辖市和新疆生产建设兵团疾病预防控制中心新冠监测网络实验室进行室间质评。 每个实验室的考核样本盘包括两种不同Ct值（～35、～30）的新冠病毒武汉株、关切变异株（α和γ或β和δ）、HCoV-OC43、流感病毒核酸样本共10支。 根据反馈结果计算检测符合率并对检测结果进行深入分析。 同时,收集各考核实验室常用的新冠病毒核酸检测试剂盒进行检测性能验证。  结果  全国省市级疾控机构新冠监测网络实验室室间质评总体达标率为100%（32/32）,总体优秀率72%（23/32）;初测中,新冠病毒、HCoV-OC43核酸样本检测总符合率为99.7%（319/320）、89%（57/64）。 对32个考核实验室送检的新冠病毒核酸检测试剂盒进行性能验证,66%（33/50）的试剂盒检测限与说明书相符,92%（11/12）的受检试剂盒特异性达标。  结论  32个省市疾控机构实验室新冠病毒核酸检测能力全部达标,均能检测新冠病毒武汉株及阿尔法、贝塔、伽马和德尔塔变异株;送检的部分核酸检测试剂检测限与说明书不符,检测性能有待改进。     

A retrospective analysis of clinical efficacy of ribavirin in adults hospitalized with severe COVID-19

IntroductionCoronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swept rapidly throughout the world. So far, no therapeutics have yet proven to be effective. Ribavirin was recommended for the treatment of COVID-19 in China because of its in vitro activity. However, evidence supporting its clinical use with good efficacy is still lacking.MethodsA total of 208 confirmed severe COVID-19 patients who were hospitalized in Wuhan Union West Campus between 1 February 2020 and 10 March 2020 were enrolled in the retrospective study. Patients were divided into two groups based on the use of ribavirin. The primary endpoint was the time to clinical improvement. The secondary endpoints included mortality, survival time, time to throat swab SARS-CoV-2 nucleic acid negative conversion, and the length of hospital stay.Results68 patients were treated with ribavirin while 140 not. There were no significant between-group differences in demographic characteristics, baseline laboratory test results, treatment, and distribution of ordinal scale scores at enrollment, except for coexisting diseases especially cancer (ribavirin group vs no ribavirin group, P = 0.01). Treatment with ribavirin was not associated with a difference in the time to clinical improvement (P = 0.48, HR = 0.88, 95% CI = 0.63–1.25). There were also no significant differences between-group in SARS-CoV-2 nucleic acid negative conversion, mortality, survival time, and the length of hospital stay.ConclusionsIn hospitalized adult patients with severe COVID-19, no significant benefit was observed with ribavirin treatment.     

Three SARS-CoV-2 PCR-negative cases of COVID-19 diagnosed using isothermal amplification methods

Coronavirus disease (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 can be detected by polymerase chain reaction (PCR) and isothermal nucleic acid amplification tests, including loop-mediated isothermal amplification (LAMP) and nicking endonuclease amplification reaction (NEAR) tests. Although PCR is the most sensitive and specific method and is generally considered to be the gold standard, it is time-consuming and costly. Isothermal nucleic acid amplification tests have lower sensitivity and specificity than PCR, but are less time-consuming and costly. We encountered three cases of SARS-CoV-2 infection in which the isothermal amplification test was positive but the PCR test was negative on the day of admission; however, the PCR test was positive the next day. These cases showed that some COVID-19 patients can test negative by PCR but positive using isothermal nucleic acid amplification methods. As PCR tests have the possibility of false-negative results, tests that use isothermal amplification methods which can be performed in a shorter time and at a lower cost than PCR tests, may be able to diagnose patients who have false negative PCR results.     

Implementation of a COVID-19 cohort area resulted in no surface or air contamination in surrounding areas in one academic emergency department

IntroductionAs a result of the COVID-19 pandemic and highly contagious nature of SARS-CoV-2, emergency departments (EDs) have been forced to implement new measures and protocols to minimize the spread of the disease within their departments. The primary objective of this study was to determine if the implementation of a designated COVID-19 cohort area (hot zone) within a busy ED mitigated the dissemination of SARS-CoV-2 throughout the rest of the department.MethodsIn an ED of a tertiary academic medical center, with 64,000 annual visits, an eight room pod was designated for known COVID-19 or individuals with high suspicion for infection. There was a single entry and exit for donning and doffing personal protective equipment (PPE). Health care workers (HCW) changed gowns and gloves between patients, but maintained their N-95 mask and face shield, cleaning the shield with a germicidal wipe between patients. Staffing assignments designated nurses and technicians to remain in this area for 4 h, where physicians regularly moved between the hot zone and rest of the ED. Fifteen surface samples and four air samples were taken to evaluate SARS-CoV-2 contamination levels and the effectiveness of infection control practices. Samples were collected outside of patient rooms in 3 primary ED patient care areas, the reception area, the primary nurses station, inside the cohort area, and the PPE donning and doffing areas immediately adjacent. Samples were recovered and analyzed for the presence of the E gene of SARS-CoV-2 using RT-PCR.ResultsSARS-CoV-2 was not detected on any surface samples, including in and around the cohort area. All air samples outside the COVID-19 hot zone were negative for SARS-CoV-2, but air samples within the cohort area had a low level of viral contamination.ConclusionA designated COVID-19 cohort area resulted in no air or surface contamination outside of the hot zone, and only minimal air, but no surface contamination, within the hot zone.     

新型冠状病毒肺炎相关性急性胰腺炎：证据，挑战与思考

由新型冠状病毒（SARS-CoV-2）感染引起的新型冠状病毒肺炎（COVID-19）自2019年12月发病以来,现已全球大流行。COVID-19除影响呼吸系统外,还可造成全身多系统、多脏器的损害。目前关于COVID-19累及胰腺的证据十分有限,COVID-19患者中急性胰腺炎（AP）的发病率存在不确定性,其临床特征和发病机制也存在诸多疑问。在全球COVID-19流行仍未得到完全控制的背景下,由于目前对COVID-19与AP之间相互作用知之甚少,我们必须警惕他们之间可能存在的联系。临床上诸多治疗程序需要合理化,应采取有效的防护措施,在科学诊治患者的同时有效避免医护人员SARS-CoV-2感染。     

新型冠状病毒感染的临床表现及其实验室检测技术进展

新型冠状病毒(SARS-CoV-2)属于冠状病毒属,是一种主要通过呼吸道传播的RNA病毒,具有极高传染性,被世界卫生组织列为对人类危害最严重的病毒之一。目前尚无批准上市的用于预防SARS-CoV-2的疫苗,该病毒导致的2019年新型冠状病毒肺炎(COVID-19)需要通过实验室检测才能明确。为了解SARS-CoV-2的研究进展,该文综述了该病毒的特征、感染的流行病学、实验室检测技术,以期为诊断和防控新型冠状病毒病提供参考。     

The combined therapy of a traditional Chinese medicine formula and Western medicine for a critically ill case infected with COVID-19

ObjectivePresentation of a case illustrating the benefits of traditional Chinese medicine (TCM) for treatment of Coronavirus disease 2019 (COVID-19) in critically ill patients.Clinical features and outcomeA 58-year-old woman presented with cough, fever, dizziness, chest tightness, polypnea and poor appetite. She was admitted to Guizhou Provincial People’s hospital, and diagnosed with critically ill type of COVID-19 in February 2020. According to the patient's symptoms and signs, the TCM syndrome differentiation was qi deficiency, dampness-stasis and toxin accumulation. Then she received the combined therapy of a modified Chinese herbal formula and Western medicine. During a twelve-day period of treatment, her respiratory distress and appetite quickly improved. Abnormal laboratory indicators were resumed in time and lung lesions in CT scan largely absorbed. No side effects associated with this Chinese herbal formula were found. Before discharge, two consecutive nasopharyngeal swabs were shown to be negative for severe acute respiratory coronavirus 2 (SARS-CoV-2).ConclusionsOur case report suggests that collaborative treatments with traditional Chinese medicine prove beneficial in the management of COVID-19 in critically ill patients. In order to give optimal care for this COVID-19 crisis for the whole world, Chinese medicine practitioners and Western medical doctors should work together in frontline.