新型冠状病毒肺炎疫情期间肿瘤内科感染管理实践

肿瘤患者对新型冠状病毒具有更高的易感性,感染后病情重,预后差。肿瘤患者临床表现复杂,增加了疑似病例的筛查难度。本文探讨了新型冠状病毒肺炎疫情期间肿瘤内科的感染管理措施,从工作人员、患者、环境、工作流程、应急预案、临床路径优化等方面进行感染防控和总结。     

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...     

疫情期间儿童医院手术室防控管理策略

目的 探讨儿童医院手术室手术期间有效防控新型冠状病毒肺炎（COVID-19）的措施,减少手术过程中新型冠状病毒传播的风险。方法 2020年2—3月,湖南省儿童医院手术室运用系列管理方法针对儿科手术室建立了相应的应急管理制度,根据应急管理制度编制应急手术指引,手术室人员统一培训,儿科手术室全员参与疑似COVID-19患儿接待应急模拟演练,针对疑似患儿配合实施全程护理。结果 湖南省儿童医院手术室对手术室接收的疑似COVID-19患儿实施了相应的管理方案,并做到了全程护理,科学、有效、快速地配合医师顺利完成手术,且手术患儿术后并未引起其他并发症;医务人员手术过程中并未出现交叉感染。结论 湖南省儿童医院手术室系列应急管理方案在手术护理过程中可以有效地降低新型冠状病毒感染的风险,是疫情期间手术室正常运转的重要保障。     

新型冠状病毒肺炎疫情下麻醉科护士在隔离病区的作用与体会

2019年末,新型冠状病毒肺炎（Coronavirus Disease 2019,COVID-19,以下简称“新冠肺炎”）开始流行并迅速蔓延至全球。疫情期间,如何快速高效的救治患者,确保临床护理工作安全、有序无疑是一项重大的挑战。麻醉科护士参与日常手术室工作,同时在与麻醉医生的插管配合以及危重病人的抢救工作上有丰富的配合经验及熟练的操作技能,在对新冠肺炎患者的救治中发挥着重要的作用。本文拟阐述麻醉科护士新冠肺炎隔离病区重症监护室的岗位职责及工作经验,以期为广大麻醉护理工作者提供有效的参考和帮助。     

血液科新型冠状病毒肺炎疫情应急防控实践

本文主要介绍了新型冠状病毒肺炎疫情防控期间血液科在预防新型冠状病毒肺感染的应急防控策略,包括成立负责疫情期病区管理及人员调配的应急管理小组,加强病房消毒管理,建立特殊时期应急管理程序及患者分流方案等,以期通过合理有效的防控策略,提高病区对新型冠状病毒肺炎疫情的防控能力,从而保证患者的治疗工作得到有序开展。     

突发新型冠状病毒肺炎疫情期间男护士应急现状调查分析

随着护理事业的不断发展和职业需求,越来越多的男性投身于护理队伍,形成一股不可忽视的力量。男护士在紧急情况下往往能够随机应变,能够更沉着地应对突发事件,寻找解决方案,能够对全局进行把控,婚前婚后受家庭影响较小[1]。另外,男性病人十分青睐男护士进行护理工作。男女护士搭配工作,提高了病人及医护人员的满意度和工作效率,明显提高了团队协作能力,在灾害及突发事件中更有力地起到救援作用[2]。     

新型冠状病毒肺炎疫情防控期间放疗科的应对策略与思考

新型冠状病毒肺炎疫情属于突发公共卫生事件,严重威胁人类健康,肿瘤患者是新型冠状病毒感染的高危人群。放疗作为肿瘤治疗的重要手段之一,在疫情期间成为重要的替代或延缓手术的治疗手段。北京协和医院放疗科在疫情防控期间通过制定严密而科学的防控管理体系,保证了放疗工作的顺利开展。本文对防控管理相关策略进行总结与思考,为突发公共卫生事件期间开展放疗工作提供经验参考。     

新型冠状病毒肺炎疫情防控期间放疗科的应对策略与思考

新型冠状病毒肺炎疫情属于突发公共卫生事件,严重威胁人类健康,肿瘤患者是新型冠状病毒感染的高危人群.放疗作为肿瘤治疗的重要手段之一,在疫情期间成为重要的替代或延缓手术的治疗手段.北京协和医院放疗科在疫情防控期间通过制定严密而科学的防控管理体系,保证了放疗工作的顺利开展.本文对防控管理相关策略进行总结与思考,为突发公共卫生...     

新型冠状病毒感染防控护理质量指标体系的构建

[目的]探讨初步构建一套科学、全面、客观的防控新型冠状病毒感染的护理质量指标体系。[方法]通过文献检索、国家政策指引等在三维质量结构理论基础上初步拟定护理质量指标,应用德尔菲专家函询法及层次分析法对指标进行初筛并确定指标权重,最终建立新型冠状病毒感染防控的护理质量指标体系。[结果]经过两轮函询,各级指标专家意见趋于一致,最终确定新型冠状病毒感染防控护理质量指标一级指标3项(结构指标、过程指标和结果指标),二级指标26项,三级指标102项。[结论]该指标体系的构建可规范管理新型冠状病毒感染防控各项工作,为各医疗机构评价新型冠状病毒感染防控护理工作提供客观、可量化依据。     

新型冠状病毒肺炎CT检查应急预案的建立与应用

目的建立新型冠状病毒肺炎CT检查应急预案,以期为提高医疗机构突发事件应急处置能力提供保障。方法从环境管理、CT检查前管理、CT检查中管理、CT检查后管理等方面构建了新型冠状病毒肺炎CT检查应急预案并试用1个月。结果2020年2月发热门诊专用CT检查共92例患者,每例CT检查时间大约需要5?10min,消毒时间大约1h,无一例医护人员感染。结论新型冠状病毒肺炎CT检査应急预案的应用,既避免了院内传染的发生,又可加快诊治过程,为明确诊断提供了可靠的线索,同时为按病情实施不同等级防护措施提供依据。     

新型冠状病毒肺炎疫情防控期间无偿献血的防护方案

新型冠状病毒肺炎(COVID-19)的暴发和流行,给医疗机构的采供血和血液的安全保障提出了更高的要求。因此,中国人民解放军长海血站制定疫情防控期间无偿献血的防护方案。根据新型冠状病毒(SARS-CoV-2)的相关特性,即潜伏期较长、感染症状多样且隐匿、飞沫及接触传播为主要传播途径,对献血者及工作人员采取必要的防护措施、对献血场所进行合理消毒,降低交叉感染的风险。增加对献血者回访、对采集血液实施14 d“隔离”,将病毒经输血传播的风险降到最低。     

术前筛查预案在新型冠状病毒肺炎疫情期间非急诊手术患者术前筛查中的应用

目的探讨术前“两筛两核对”筛查预案在新型冠状病毒肺炎(COVID-19)疫情期间非急诊手术患者术前筛查中的应用及重要性。方法回顾性分析2020年2月17日~2月28日经我院完成的262例非急诊手术。分为预案筛查后(A组)和预案筛查前对照组(C组)。根据术前筛查预案记录其流行病学史、体温、临床症状、白细胞计数及淋巴细胞计数、胸部CT异常情况。探讨此“两筛两核对”预案对COVID-19筛查前后病例合格率的影响。结果与2月17日筛查不合格率相比较,2月18日和2月19日手术筛查不合格率差异无统计学意义(P>0.05),2月20日~2月28日手术筛查不合格率均较低,差异有统计学意义(P<0.05)。结论术前“两筛两核对”筛查预案提高了非急诊手术术前筛查合格率,此预案有利于患者术前COVID-19的筛查。     

医院感染控制在急诊科预防新型冠状病毒肺炎感染中的作用观察

摘要：目的 了解医院感染控制在急诊科预防新型冠状病毒肺炎感染中的作用。方法 采用回顾性调查方法,观察通过制定医院感染控制的相关制度并有效落实,比较急诊科就诊患者和医务人员在新冠肺炎预防中被传染情况;医务人员医院感染控制相关要求掌握情况。结果从2020年1月20日至2020年3月20日,至急诊科就诊患者1.23万人及医务工作人员 52人均未被传染新冠肺炎,医务人员全部掌握医院感染控制相关要求。结论 高度重视、统一认识、认真培训、规范执行、严格督查是保证预防新冠肺炎传染的有力措施。     

Changes in diagnostic usefulness of the JRS scoring system in COVID-19 pneumonia by SARS-CoV-2 vaccination

IntroductionThe Japanese Respiratory Society (JRS) scoring system is a useful tool for the rapid presumptive diagnosis of atypical pneumonia in non-elderly (aged <60 years) patients. As SARS-CoV-2 vaccination progresses, COVID-19 in elderly people has markedly reduced. We investigated changes in diagnostic usefulness of the JRS scoring system in COVID-19 pneumonia between the Delta variant group (vaccination period) and non-Delta variant group (before the vaccination period).MethodsThis study was conducted at five institutions and assessed a total of 1121 patients with COVID-19 pneumonia (298 had the Delta variant). During the vaccination period, the Delta variant has spread and replaced the Alfa variant. We evaluated the vaccination period as the Delta variant group.ResultsAmong the six parameters of the JRS scoring system, matching rates of two parameters were higher in the Delta variant group than the non-Delta variant group (pre-vaccination period): age <60 years (77.5% vs 42.2%, P < 0.0001) and no or minor comorbid illness (69.1% vs 57.8%, p = 0.0007). The sensitivity of the diagnosis of atypical pneumonia in patients with COVID-19 pneumonia was significantly higher in the Delta variant group compared with the non-Delta variant group (80.2% vs 58.3%, p < 0.0001). When the diagnostic sensitivity was analyzed for different ages, the diagnostic sensitivities for the Delta variant and non-Delta variant groups were 92.6% and 95.5% for non-elderly patients and 39.1% and 32.5% for elderly patients, respectively.ConclusionsOur results demonstrated that the JRS scoring system is a useful tool for distinguishing between COVID-19 pneumonia and bacterial pneumonia in the COVID-19 vaccination period, but not before the vaccination period.     

Diagnostic significance of secondary bacteremia in patients with COVID-19

ObjectivesWe investigated the occurrence of non-respiratory bacterial and fungal secondary infections, causative organisms, impact on clinical outcomes, and association between the secondary pathogens and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19).MethodsThis was a retrospective cohort study that included data from inpatients with COVID-19 from multiple centers participating in the Japan COVID-19 Taskforce (April 2020 to May 2021). We obtained demographic, epidemiological, and microbiological data throughout the course of hospitalization and analyzed the cases of COVID-19 complicated by non-respiratory bacterial infections.ResultsOf the 1914 patients included, non-respiratory bacterial infections with COVID-19 were diagnosed in 81 patients (4.2%). Of these, 59 (3.1%) were secondary infections. Bacteremia was the most frequent bacterial infection, occurring in 33 cases (55.9%), followed by urinary tract infections in 16 cases (27.1%). Staphylococcus epidermidis was the most common causative organism of bacteremia. Patients with COVID-19 with non-respiratory secondary bacterial infections had significantly higher mortality, and a multivariate logistic regression analysis demonstrated that those with bacteremia (aOdds Ratio = 15.3 [5.97–39.1]) were at higher risk of death. Multivariate logistic regression analysis showed that age, male sex, use of steroids to treat COVID-19, and intensive care unit admission increased the risk for nosocomial bacteremia.ConclusionsSecondary bacteremia is an important complication that may lead to poor prognosis in cases with COVID-19. An appropriate medical management strategy must be established, especially for patients with concomitant predisposing factors.     

Decreased number of inpatients with community-acquired pneumonia during the COVID-19 pandemic: A large multicenter study in Japan

The COVID-19 pandemic has shaped the dynamics of many diseases. This study aims to assess how the pandemic affected community-acquired pneumonia admission of all age groups among Japanese hospitals with various size and availability of COVID-19 wards. Our findings revealed a 44%–53% reduction in community-acquired pneumonia admission among 82 hospitals in Japan, from April through September of 2020, compared to the same period of 2019. Decreases were consistently found among hospitals with and without COVID-19 wards. The most significant decrease was found in the age group <20 years old. COVID-19 preventive measures and personal hygiene are considered to be effective measures to prevent the spreading of this disease. As vaccination progresses and the public gradually become less attentive to infection countermeasures, incidence of community-acquired pneumonia may increase in the coming season. Continued monitoring is required.     

Necessary problems in re-emergence of COVID-19

The ongoing pandemic of coronavirus disease 2019 poses a great threat to human beings. Although numerous patients have recovered, re-positive cases have been reported in several countries. Till now, we still know very little about the disease and its pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, more attention should be paid to the following aspects, such as post-discharge surveillance, asymptomatic infection, re-evaluation of influenza-like symptoms, and dynamic monitoring of genomic mutation of SARS-CoV-2.     

COVID-19 Susceptibility in chronic obstructive pulmonary disease

In barely nine months, the pandemic known as COVID-19 has spread over 200 countries, affecting more than 22 million people and causing over than 786 000 deaths. Elderly people and patients with previous comorbidities such as hypertension and diabetes are at an increased risk to suffer a poor prognosis after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although the same could be expected from patients with chronic obstructive pulmonary disease (COPD), current epidemiological data are conflicting. This could lead to a reduction of precautionary measures in these patients, in the context of a particularly complex global health crisis. Most COPD patients have a long history of smoking or exposure to other harmful particles or gases, capable of impairing pulmonary defences even years after the absence of exposure. Moreover, COPD is characterized by an ongoing immune dysfunction, which affects both pulmonary and systemic cellular and molecular inflammatory mediators. Consequently, increased susceptibility to viral respiratory infections have been reported in COPD, often worsened by bacterial co-infections and leading to serious clinical outcomes. The present paper is an up-to-date review that discusses the available research regarding the implications of coronavirus infection in COPD. Although validation in large studies is still needed, COPD likely increases SARS-CoV-2 susceptibility and increases COVID-19 severity. Hence, specific mechanisms to monitor and assess COPD patients should be addressed in the current pandemic.