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.