7. Management of outpatient department
With the spread of the epidemic, the number of outpatients was
significantly increasing.
The
outbreak of infectious diseases has become a major concern for Emergency
Departments (EDs) worldwide as they are frequently the first point of
care irrespective of the severity of symptoms. A series of modifications
were applied to the patient pathways while visiting the outpatient
department or
being
admitted as in-patients. Every medical center should encourage patients
with mild illness to seek medical treatment through the internet
platform to avoid outpatient department crowding and reducing the risk
of cross infection. Smartphone application software can be used in
remote consultation and online training during the epidemic. Medical
staffs may be infected easily by the patients, especially the potential
asymptomatic patients that have a wide range of contacts with the
medical staff. Therefore, the physician should take precautions before
receiving a patient for hospitalization and fully prepared for admission
and hospitalization. The hospital wards and medical staff should be
dedicated specifically to the confirmed cases to reduce or avoid risk of
cross-contamination across patients and health wokers. All of the
medical staff wear protective clothing, including goggles, surgical
masks, and gloves. Change the gloves and disinfect your hands in time
after contact with body fluids or pollutants of patients. At the same
time, remind all of the patients and their families to wear masks
properly.
Each medical center should strictly implement outpatient appointment
system and established a screening procedure to minimize cross
infection. During the reception process, all patients should enter the
ward in turn and keep a distance of 1 m and avoid contact with each
other. The attending physician should closely monitor the patient’s
temperature, collect the epidemiological history of the patients, the
families, caregivers, and visitors during the previous 14 days and
complete the physical examination carefully. It is necessary to be wary
of the COVID-19 symptoms such as fever, dry cough and dyspnea. At the
same time, we should carefully identify asymptomatic carriers or
patients with atypical symptoms (diarrhea, abdominal pain) and
distinguish this condition from other viral or bacterial infections
diseases. the patients whose family member or caregivers are exposed to
any infected person shall be considered as the suspected cases and
admitted to a single isolation room for further diagnosis. If the
patient is critically ill, ambulance transport shall be launched which
was organized by the public health emergency management department and
The transport team members should be well trained with the knowledge and
skills about prevention and control of COVID-19. It is suggested that
blood routine examination (C-reactive protein (CRP) and erythrocyte
sedimentation rate (ESR), and normal procalcitonin) and chest imaging
examination should be included as a routine examination. And RT-qPCR is
known as the gold standard for accurate and fast quantification of
nucleic acid sequences. We should actively report suspected or confirmed
cases to the experts’ committee for further precise treatment. And the
suspected or confirmed patients should be isolated immediately according
to the regulations on prevention of infectious diseases.
Equipment or instruments in the consulting room should be strictly
disinfected. A growing body of evidence showed that wiping the medical
devices by sodium hypochlorite disinfectant can significantly inhibit
the activity of the virus. And timely dispose of medical waste to
maintain environmental hygiene. The infrastructure of the ventilation
system and isolation capacity of rooms was subject to be updated. The
ward should keep air circulation and purify in time. After the
outpatient service, the consulting room should be sterilized by
ultraviolet irradiation or ultra-low volume spray thoroughly.
8.Prevention
and Control
Since Dec. 2019, the outbreak of novel coronavirus pneumonia began from
Wuhan. Hubei Province has brought disaster to the country, and even
around the world.
WHO
declared the COVID-19 outbreak as the sixth public health emergency of
international concern, following H1N1 (2009), polio (2014), Ebola in
West Africa (2014), Zika (2016), and Ebola in the Democratic Republic of
Congo (2019)(Gulland;
Sohrabi et al., 2020). And then, the
infected disease has been categorized as Class B infectious disease
stipulated in the law of the People’s Republic of China on the
prevention and control of infectious diseases for the first time, and is
managed as Class A infectious disease. All of the provincial-level
divisions in China mainland have launched the highest level of
responding mechanism for major public health emergency which means that
the provincial headquarters shall organize and coordinate the emergency
response work according to the decision deployment and unified command
of the State Council. Therefore, the government, health workers, and the
public quickly cooperated globally and entered a state of fighting
against the new infectious to prevent its spread. Chinese health
departments upgraded their disease prevention and control system by
summing up their experience of fighting SARS. We had made notable
improvements in surveillance, cases reporting system, multidisciplinary
research and cross-sectoral collaboration, and enhance public awareness
about the disease.
The focus of the anti-epidemic work should be more inclined to
prevention and control. Isolation is still the most effective means of
containing COVID-19. Effective surveillance and early identification and
diagnosis of COVID-19 is the prerequisite for blocking the source of
infections and interrupting the chain of transmission. The health
administration departments, medical institutions and social
organizations shall provide guidance for patients and close contact
families for disease prevention. Comprehensive medical institutions and
designated hospital were set up to accept the suspected or confirmed
COVID-19 patients and ensure the severe and critical cases can be
diagnosed and treated effectively. The government taken compulsory
measures to shut down all outbound transportation channels, suspended
public transportation restricts and cancels all kinds of congregations
consecutively. Avoidance behaviors, such as cancelling or postponing
social events, reducing use of public transport, keeping children out of
school, keeping away from crowded places and avoiding visiting hospitals
due to fear of virus transmission occur frequently during pandemic
outbreaks. They also ensured the supply of the clinical supplies, living
resources, especially the sufficient supply of surgical masks,
disinfectants, and other protective materials on the market. Stations,
airports, port and so on gave particular attention to screening
procedures to detect the body temperature of passengers entering or
leaving the area and implement observation/registration for the
suspicious patients. We should strengthen public health surveillance and
cases reporting system, and make improvement in multidisciplinary
research, cross-sectoral collaboration, hygiene knowledge publicity and
laboratory and surveillance capacity.