新型冠状病毒肺炎疫情防控期间麻醉科工作建议

新型冠状病毒肺炎(简称新冠肺炎)于2019年12月在湖北省武汉市首发,随后逐渐蔓延至全国,扩散至全球多个国家。现已证实新冠肺炎的致病病毒为一种新型冠状病毒,2020年1月30日,WHO建议将新型冠状病毒感染的肺炎命名为“2019-nCoV acute respiratory disease”。河南省是人口大省,防止院内感染是目前新冠肺炎防控工作的重点。麻醉科室承当了全院的手术室内麻醉、手术室外麻醉、麻醉重症监护病房(anesthesia intensive care unit,AICU)及麻醉后监测治疗室(postanesthesia care unit,PACU)、急救气管插管、麻醉门诊等多个区域的工作,参与人员多、流动性大,一个环节处理不当就极易造成院内交叉感染。为此,河南省麻醉质控中心专家委员会制定了《新型冠状病毒肺炎疫情防控期间麻醉科工作建议》,建议各医疗机构麻醉科室在从事麻醉各项诊疗过程中严格按照流程,采取有效的预防措施,切实做好防控工作。     

新型冠状病毒肺炎疫情期间PICC维护门诊感染控制与管理

总结新型冠状病毒肺炎疫情期间PICC维护门诊感染控制与管理的经验。调整PICC维护门诊的开放时间,完善维护门诊人员工作要求,建立维护门诊专区预检分诊流程,加强维护门诊环境管理,做好患者知识宣教,以及依托"互联网+护理"提供线上咨询。2020年2月3日至28日共维护PICC导管500余例次,单日最高维护量达40例次,期间患者、陪同人员、医护人员无一例发生新型冠状病毒。     

新型冠状病毒肺炎疫情期间病房管理实践

总结了新型冠状病毒肺炎疫情期间神经外科病房的管理经验,为最大程度地降低院内感染新型冠状病毒肺炎的风险提供保障.其主要措施包括遵循院部统一调度指挥机制;优化入院与住院制度;合理安排人力、物资、场地等保障各项疫情防治任务的落实.最终在神经外科患者、家属及工作人员(包括医生、护士、工勤人员)中未发生疑似或者确诊感染新型冠状病...     

ICU医院感染病原菌分析及感染管理

目的研究ICU(重症监护病房)医院感染的病原菌及耐药性，为合理使用抗生素提供依据，探讨有效的感染管理措施，预防和控制耐药菌的传播。方法对2003年送检的Icu患者各种标本分离的菌株进行分析统计。结果所有的病原菌中，G^-杆菌占58．1％，其中鲍曼不动杆菌占18．1％，铜绿假单孢菌16．4％，嗜麦芽窄单孢菌13．6％，药敏显示各菌耐药水平较高；G 球菌占27．2％，金黄色葡萄球菌10．3％，94．6％为耐甲氧西林金黄色葡萄球菌(MBSA)，表皮葡萄球菌11．9％，100％为耐甲氧西林表皮葡萄球菌(MRSE)；真菌占14．7％。结论加强ICU感染管理和对细菌耐药性的监测，合理使用抗菌药物，是减少和延缓耐药菌株产生的关键。应制定有效的对策，从而达到降低医院感染的目的。     

新型冠状病毒感染疫情期间某医院重症监护病房医院感染目标性监测

目的 了解新冠病毒感染疫情期间医院重症监护病房(ICU)住院患者医院感染特征,为ICU医院感染管理提供循证依据。方法 采取前瞻性调查法,对某医院ICU新冠病毒感染患者进行医院感染目标性监测。结果 共监测该医院ICU住院患者90例,医院感染发病率14.44%,医院感染发生部位以下呼吸道为主。ICU患者呼吸机相关性肺炎(VAP)发病率21.93‰,导管相关尿路感染(CAUTI)发病率3.42‰,导管相关血流感染(CRBSI)发病率为0.00‰。检出率居前2位的病原菌是鲍曼不动杆菌和肺炎克雷伯菌,构成比分别为60.87%和13.04%。抗菌药物使用居前4位的是卡泊芬净(11.58%)、多黏菌素(10.53%)、替加环素(8.42%)和哌拉西林/他唑巴坦(8.42%)。结论 该医院ICU在新冠病毒感染疫情期间,住院患者医院感染以下呼吸道感染为主,VAP发病率高。科学规范呼吸机管理,严格实施CAUTI和CRBSI集束化干预策略、加强手卫生质量管理和恰当应用抗菌药物治疗是减少ICU院内感染的关键。     

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。     

新型冠状病毒疫情期间肿瘤专科医院病房管理策略

针对肿瘤专科医院的诊疗管理特点,围绕制订制度优化流程、设置住院通道"四级"管控、实施"四级"预检防控、开展网格化培训模式、设置隔离病房、分类管理防护物资、合理排班等方面,深入总结新冠肺炎疫情期间的病房管理经验,以期为其他专科医院开展传染病防控等相关工作提供参考。     

新型冠状病毒肺炎期间PACU管理建议

麻醉复苏阶段是患者术后并发症的高发期[1],麻醉恢复室(PACU)作为麻醉科的独立医疗单元,承担患者从严密监护的手术室转回普通病房的衔接工作,对保障术后早期的患者安全、提高手术室效率等起到非常重要的作用。新型冠状病毒肺炎(COVID-19)疫情期间,PACU不允许收入疑似或确诊患者,因PACU的床位设置具有集中、开放的特点;医护人员相对聚集,患者流动性大且周转快速,小儿或特殊患者可能需要家属陪伴;存在术后患者病情发生变化,需紧急气管插管的可能,这些均增加了PACU中的感染风险[2]。因此,本文针对PACU的工作特点和COVID-19疫情期间感染控制要求做以下管理建议,供麻醉同行参考。     

ICU医院感染的特点和护理对策

重症监护病房（ICU）是一个集中救治危重患者的特殊场所，ICU患者发生医院感染的危险性要比普通病房患者高5～10倍，这主要与患者病情危重、自身抵抗力和免疫力均低下、侵入性操作多、大量应用广谱抗生素等因素有关。随时处于发生感染的危险之中，如果一旦感染则会加重原发病，使病情恶化复杂，给治疗及护理工作带来极大的困难，同时由于ICU患者流动性大，常会随着患者的传播而造成在医院内的感染流行，采取有效地管理措施和护理干预以控制和减少ICU的医院感染，显得越来越迫切。     

加强ICU护工管理 有效控制医院感染

重症监护病房（ICU）是集中危重症患者病情监测和治疗的科室,也是医院易感人群和感染因素集中的场所,其感染发生概率均比其他科室高。护工是医院工作人员的特殊群体,虽缺乏医学知识,但又发挥着不可缺少的作用。我院ICU护工主要承担患者生活护理,各种标本的送检、物品器械清洗,患者出入院的终末处理,医疗废物的回收、运送等。     

Decreased hospital admissions through emergency departments during the COVID-19 pandemic

Study objectiveEmergency Department (ED) visits decreased significantly in the United States during the COVID-19 pandemic. A troubling proportion of this decrease was among patients who typically would have been admitted to the hospital, suggesting substantial deferment of care. We sought to describe and characterize the impact of COVID-19 on hospital admissions through EDs, with a specific focus on diagnosis group, age, gender, and insurance coverage.MethodsWe conducted a retrospective, observational study of aggregated third-party, anonymized ED patient data. This data included 501,369 patient visits from twelve EDs in Massachusetts from 1/1/2019–9/9/2019, and 1/1/2020–9/8/2020. We analyzed the total arrivals and hospital admissions and calculated confidence intervals for the change in admissions for each characteristic. We then developed a Poisson regression model to estimate the relative contribution of each characteristic to the decrease in admissions after the statewide lockdown, corresponding to weeks 11 through 36 (3/11/2020–9/8/2020).ResultsWe observed a 32% decrease in admissions during weeks 11 to 36 in 2020, with significant decreases in admissions for chronic respiratory conditions and non-orthopedic needs. Decreases were particularly acute among women and children, as well as patients with Medicare or without insurance. The most common diagnosis during this time was SARS-CoV-2.ConclusionOur findings demonstrate decreased hospital admissions through EDs during the pandemic and suggest that several patient populations may have deferred necessary care. Further research is needed to determine the clinical and operational consequences of this delay.     

新型冠状病毒肺炎疫情期间临床一线护士日常工作防护要点

本文总结新型冠状病毒肺炎疫情期间临床一线护士日常工作中的防护要点,包括帽子、口罩、防护镜/防护面屏、防护服、鞋套的穿脱;病房空气消毒、物品消毒;治疗接触过程中的行为隔离;个人防护要点。     

Importance of infection control and continence management plans in assisted living communities during the COVID-19 pandemic

A robust and comprehensive infection control plan in a senior living community is a must. Delirium manifestations of Covid-19 and or Urinary Tract Infections, may be confused or misdiagnosed with dementia symptoms in memory care residents. A robust incontinence care program is a key pillar of infection control to reduce symptoms causing hospitalization. Misdiagnosis, transfer infections, acute treatment dementia challenges, worsening incontinence are all risks of residents being hospitalized. A comprehensive incontinence assessment, plan, and education program are all paramount to seeing a reduction in hospitalizations and misdiagnosis of Covid-19 and other symptoms.     

新型冠状病毒肺炎疫情下我国医疗机构感染控制工作的思考

医疗机构是特殊的公共场所,也是某些重大公共卫生事件的关键环节,通过改进医疗机构感染防控（感控）工作,可进一步做好疾病预防控制工作,并更好地应对突发性公共卫生事件。 回顾新型冠状病毒肺炎（COVID-19）疫情以来我国相关医疗机构感染事件与应对策略,探讨如何通过改进感控环节,更好应对突发性公共卫生事件。 从疫情防控的重点环节,分析医疗机构感控工作的现状和不足;总结与医疗机构感控工作密切相关的入境隔离点、社区中存在的问题,从公共卫生角度,建议进一步完善医疗机构传染病监测预警和监督工作,充分发挥医院哨点作用,并将医院感染监测系统纳入疾病预防控制体系;建议医疗机构将感染防控工作“关口前移”常态化,做好辖区社区管控和入境隔离点防控对接。     

Medical research during the COVID-19 pandemic

The current pandemic of coronavirus disease 2019 (COVID-19) which was first detected in Wuhan, China in December 2019 is caused by the novel coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The virus has quickly spread to a large number of countries leading to a great number of deaths. Unfortunately, till today there is no specific treatment or vaccination for SARS-CoV-2. Most of the suggested treatment medications are based on in vitro laboratory investigations, experimental animal models, or previous clinical experience in treating similar viruses such as SARS-CoV-1 or other retroviral infections. The running of any clinical trial during a pandemic is affected at multiple levels. Reasons for this include patient hesitancy or inability to continue investigative treatments due to self-isolation/quarantine, or limited access to public places (including hospitals). Additional barriers relate to health care professionals being committed to other critical tasks or quarantining themselves due to contact with COVID-19 positive patients. The best research approaches are those that adapt to such external unplanned obstacles. Ongoing clinical trials before COVID-19 pandemic have the potential for identifying important therapies in the long-term if they can be completed as planned. However, these clinical trials may require modifications due a pandemic such as this one to ensure the rights, safety, and wellbeing of participants as well as medical staff involved in the conduction of clinical trials. Clinical trials initiated during the pandemic must be time-efficient and flexible due to high contagiousness of severe acute respiratory syndrome coronavirus 2, the significant number of reported deaths, and time constraints needed to perform high quality clinical trials, enrolling adequate sample sizes. Collaboration between different countries as well as implementation of innovative clinical trial designs are essential to successfully complete such initiatives during the current pandemic. Studies looking at the long term sequalae of COVID-19 are also of importance as recent publications describe multi-organ involvement. Long term follow-up of COVID-19 survivors is thus also important to identify possible physical and mental health sequellae.     

新冠肺炎期间上海互联网医院APP使用现状分析

目的：调查新冠肺炎期间上海市互联网医院APP的使用情况及存在的问题。[方法] 采用纸质问卷填写及网上填写调查表的形式，包括问卷星的形式进行调查。[结果] 发送问卷300份，收回272份，其中有效问卷272份。调查结果显示，有67例（24.6%）被调查者曾使用过互联网医院APP就诊咨询。未使用互联网医院APP诊疗的主要原因为不了解互联网医院APP（102例，49.8%），其它原因包括不需要或使用互联网医院APP有困难及绑定医保卡不安全等。患者使用互联网医院APP遇到的主要问题是多个医院就诊需要下载多个APP（41例，61.2%），其它问题包括网络程序复杂、绑定医保卡困难、网络容易掉线、上传病史困难及支付费用不方便。[结论] 新冠肺炎期间互联网医院APP使用率较低，不同医院的互联网医院APP数据无法共享是目前存在的最主要的问题。     

The impact of family visitor restrictions on healthcare workers in the ICU during the COVID-19 pandemic

PurposeTo obtain information on how family visitor restriction during the COVID-19 pandemic has impacted the workplace experience of physicians and nurses in the medical intensive care unit, and to assess differences by profession.Materials and methodsWe developed a survey containing closed- and open-ended questions, applying both quantitative and qualitative analyses to our results.ResultsOf the 74 respondents, 29 (38%) were nurses and 45 (62%) were physicians. Nurses reported positive changes to daily workflow and the ability to provide medical care, while physicians reported negative changes in these areas. Both groups reported decreased comprehension and increased distress among families, and decreased ability to provide end-of-life care. For the qualitative analysis, eight themes were identified: the patient’s room as space, creation of a new space through virtual communication, time, increased complexity of care, challenges around the use of technology, adjustments to team roles and responsibilities, desire for families to return, and internal tension.ConclusionIntensive care physicians and nurses reported both positive and negative effects of family visitor restriction during the COVID-19 pandemic, with significant differences based on profession. Both groups expressed concern for an overall negative impact of visitor restriction on healthcare workers, patients, and their families.     

新型冠状病毒肺炎定点收治医院防控管理措施探讨

本文总结了新型冠状病毒肺炎定点收治医院的防控管理措施。新型冠状病毒肺炎疫情期间,医院成立了防控小组和医护人员救援队,建立预检分诊机制,设立发热门诊和隔离病房,加强医护人员及住院患者的心理疏导,规范各项制度及流程,严格各级人员的培训和宣教,严格把控消毒质量关,积极预防院内交叉感染的发生。     

Pediatric kidney transplantation during the COVID-19 pandemic

A waiting list for non-emergency transplant medical care was recommended in the first half of 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Hence, the number of kidney transplants temporarily declined. However, the waiting list for transplant medical care was lifted in the latter half of 2020 with the establishment of a polymerase chain reaction test system and the spread of infection prevention. The basic stance is to recommend vaccination to post-transplant recipients, recipients, and donors who are scheduled to undergo transplantation, and their families, with the start of vaccine therapy in 2021. The mortality rate of patients undergoing kidney transplants who had COVID-19 is slightly higher than healthy persons, and acute kidney injury was reported to lead to graft loss. However, pediatric cases of severe disease are rare and without deaths. Kidney transplantation medical care will be continuously provided by implementing infection prevention and treatments based on the latest evidence, promoting donated kidney transplantation, and hoping that pediatric patients with renal failure will grow up healthy, both physically and mentally, and become independent members of society, just like healthy children.     

Adapting NCLEX-RN remediation during the COVID-19 pandemic

AimRemediation is used by nursing programs to promote success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Evidence related to distance learning as a strategy for NCLEX-RN remediation is non-existent. The aim of this paper is to report the results of a remediation course converted to a virtual format from a traditional format due to the COVID-19 pandemic.MethodUsing an on-line meeting platform, at-risk students enrolled in a pre-licensure nursing program in the Midwest, United States, actively participated in a remediation course. Students met as a group and answered NCLEX-RN questions. The on-line platform allowed discussion among the instructor and students that promoted critical thinking related to nursing content and test-taking strategies. Students were also encouraged to complete NCLEX-RN questions outside of meeting times.ResultsStudents voiced satisfaction with the method of course delivery and felt the course increased their knowledge and confidence in answering questions. The NCLEX-RN pass rate for remediating students was 77.8%.ConclusionA remediation course offered through distance learning proved to be effective in promoting NCLEX-RN success among at-risk students.