I. Management of the isolation area 1 reception area for patients with fever
1.1 Layout (1) Health care institutions must provide a separate emergency room for patients with fever, including a separate entrance to the hospital, with a clear sign.
(2) The movement of people follows the principle of "three zones and two pathways": the contaminated zone, the potentially contaminated zone and the clean zone. The boundaries of these three areas are clearly marked. The contaminated area and potential contaminated area are separated by a buffer zone.
(3) Separate lanes must be provided for the transfer of contaminated items: for this purpose, a one-way transfer area from the service room (potentially contaminated area) to the isolation ward (contaminated area) is designated.
(4) Develop standardized procedures for medical staff regarding the donning and doffing of personal protective equipment. Charts of the different zones must be prepared, full-size mirrors must be available, and transfer routes must be clearly observed.
(5) To prevent contamination, technicians from the prevention and infection control department should be designated to supervise medical staff as they put on and take off PPE.
(6) It is strictly prohibited to take unsterilized items out of the contaminated area.
1.2 Layout of the zone
(1) Examination rooms, laboratories, wards and intensive care units must be located in separate rooms. (2) Establish a pre-screening and triage area to pre-diagnose patients.
(3) Separate the diagnostic department from the treatment department: patients with unfavorable epidemiologic histories, fever, and/or respiratory symptoms should be referred to a designated area for patients with suspected neo-coronary-.
Patients with fever but no unfavorable epidemiologic history or other obvious signs should be referred to the area designated for such patients.
1.3 Management
(1) Surgical medical masks should be worn by febrile patients.
(2) To avoid overcrowding, only patients should be allowed into the waiting area.
(3) The patient's time in the facility should be limited as much as possible to avoid nasal infections. (4) It is important to educate patients and their families about the early signs and symptoms of the disease and means of prevention.
1.4 Screening, Hospitalization, and Determination of Noninfection (1) All health care facilities should be well informed about the epidemiology and clinical signs of new coronavirus infection COVID-19 and screen patients according to the following criteria (see Table 1). (2) Patients suspected of being infected based on screening results should undergo nucleic acid amplification (NAT) testing. (3) Follow-up and comprehensive diagnosis are recommended for patients who do not exhibit signs at screening and do not have a confirmed epidemiologic history, but whose symptoms do not exclude the presence of COVID-19, especially on the basis of CT findings. (4) Any patient with a negative test result must be retested after 24 hours. Two negative nucleic acid amplification (NAT) tests and the absence of clinical symptoms indicate the absence of new coronavirus infection and the patient can be discharged. If COVID-19 infection cannot be ruled out due to clinical symptoms, additional nucleic acid amplification (NAT) testing is performed every 24 hours until infection is ruled out or confirmed. (5) Patients with a confirmed diagnosis and a positive nucleic acid amplification test (NAT) are hospitalized with other patients with the same diagnosis (infectious disease ward or intensive care unit), depending on the severity of their condition.
Table 1. Screening criteria for patients with suspected new coronavirus infection COVID-19
Epidemiologic history (1) The patient has visited or resided in an area or country with an unfavorable epidemiologic situation within 14 days prior to the onset of illness. (2) Patient had contact with a SARSCoV-2 infected person (positive NAT test) within 14 days prior to onset of illness. (3) The patient had direct contact with a person with fever or respiratory disease in a country with an unfavorable epidemiologic situation within 14 days before onset of illness. (4) Cluster effect (2 or more patients with fever or respiratory illness at home, work, classroom, or elsewhere in the past 2 weeks). Patient has 1 sign based on epidemiologic history and 2 clinical signs without epidemiologic history, but all three clinical features are present without epidemiologic history but with 1 or 2 clinical signs and no CT scan to rule out infection.
Clinical signs (1) Fever and/or respiratory abnormalities. (2) The patient is found to have the following signs of new coronavirus infection by CT scan: multiple focal shadows and interstitial changes in the early stages of the disease, especially in the periphery. This was followed by multiple "frosted glass" thickenings and infiltrations in both lungs. In particularly severe cases, pulmonary consolidation and pleural effusion may occur (rare). (3) The white blood cell count is normal or decreases early in the disease, and the lymphocyte count increases over time. (The dangerous point is that it is not informative and most lethal patients have declining lymphocyte counts).
Suspicion of infection is is a specialist consultation
2 Infectious Disease Areas
2.1 Scope Infectious Disease Areas include observation areas, isolation rooms and intensive care isolation areas. The layout and organization of the building should comply with the relevant requirements of the technical regulations for isolating patients in the hospital environment. Healthcare facilities with negative pressure rooms use standardized procedures in accordance with applicable requirements. Access to isolation rooms should be strictly limited.
2.2 For the layout, see Admission wards for patients with fever.
2.3 Ward Requirements (1) Patients with suspected coronavirus and confirmed patients must be placed in separate rooms. (2) Patients with suspected coronavirus should be accommodated in separate single rooms. Each such room must be equipped with a separate toilet and such patients must not leave the isolation ward. (3) Confirmed patients may be placed in a single room with beds at least 1.2 meters (4 feet) apart. This room must be equipped with sanitary facilities and patients must not leave the isolation room.
2.4 Patient Management
(1) Family members are not allowed to visit the patient. Patients are allowed to have their own communication devices to communicate with their loved ones.
(2) Patients must be educated on how to prevent further transmission of new coronavirus infections by teaching them how to use surgical masks, wash their hands properly, cover their mouths when coughing, and comply with medical supervision and isolation requirements.
II.Personnel management1 Organization of work (1) Before starting work in the emergency department, fever ward or infected ward, staff must be fully trained and examined to fully understand the technique of donning and doffing personal protective equipment (PPE). Passing such an examination should be a prerequisite for working on such wards. (2) Staff should be divided into shifts. Each shift should not exceed four hours in the infectious disease ward. However, shifts in infectious disease wards (contaminated areas) should not overlap and should be worked there at different times. (3) Preparation, inspection and disinfection should be carried out in groups on each shift to limit access to the isolation room. (4) Staff should wash and use other personal hygiene products prior to the end of their shifts to avoid possible infections in the respiratory tract or mucous membranes.2 Healthcare Facilities (1) Staff in direct contact with infected persons in the infection control area, including medical staff, medical technicians, and AHU staff, must be housed in the isolated room and not be allowed to leave without permission.3 (2) Staff should not be allowed to leave the isolation room without permission.4 (3) Staff should be allowed to stay in the isolation room until the end of their shift. (2) Healthy diets should be provided to medical staff to increase immunity. (3) The health status of all staff should be monitored and recorded, the health status of staff in direct contact with infected patients should be checked, including temperature checks and identification of respiratory illnesses, and appropriate specialists should be involved to address their psychological and physiological problems. (4) If a staff member develops any symptoms of illness, such as fever, he or she should be isolated immediately and PCR testing should be performed. (5) When healthcare workers, medical technicians and AHU staff who have had direct contact with infected patients have completed their work in the infection control area, they should first be tested for SARS-CoV-2 by PCR before resuming normal life. If the results are negative, medical follow-up is discontinued after 14 days of group isolation.
III.Personal protective equipment to prevent new coronavirus infections with COVID-19
Levels of protectionProtective measures
Level 1 protection - Disposable medical caps
- Disposable surgical masks
- Coveralls
- Disposable latex gloves and/or, if necessary,
- Disposable Protective Clothing
Level 2 Protection - Disposable Medical Cap - Medical Protective Mask (N95 or FFP Level 3)
- Coveralls
- Disposable Medical Protective Clothing
- Disposable Latex Gloves
- Protective Eyewear
Level 3 Protection - Medical Cap - Disposable Medical Cap - Medical Mask (N95 or FFP level 3) (this item contradicts the last item in this column - note).
- Coveralls - Disposable medical gowns - Disposable latex gloves - Respiratory protection (HEPA) with a P100 protection rating covering the entire face or a filtered respirator with pressurized air supply
Note: 1. All healthcare workers must wear surgical medical masks. 2. All healthcare workers who are in the Emergency Department, Infectious Disease Clinic, Respiratory Disease Clinic, Dental or endoscopy (gastrointestinal endoscopy,