新冠肺炎疫情医院内流行病学调查及思考

Epidemiological investigation and reflection on COVID-19 in hospital

摘要:

新冠肺炎疫情暴发以来，已经蔓延至160多个国家，造成了世界范围的大流行，给全球医疗系统带来了巨大冲击，造成了巨大的经济损失。新型冠状病毒基因组不断发生变异，其免疫逃逸能力更高、传染性更强，感染者趋向于轻症的特点，给疫情防控带来了更大的挑战。中国疫情防控经历了4个阶段，取得了举世瞩目的成绩，证明了中国疫情防控模式的先进性、科学性。快速、强大的病原体检测能力和快速精准的流行病学调查能力是此次新冠疫情能在中国被有效控制的法宝。在医疗机构特别是新冠肺炎定点医院，出现新冠肺炎疫情时及时、高效、规范的流行病学调查是医院内疫情防控的关键。精准的流行病学调查，是医院内对涉疫人群和涉疫区域实施分级管控的前提和基础，是防止疫情在医院内扩散和防止医务人员非战斗减员的保障。医院内新冠疫情的流行病学调查与社会面的流行病学调查相比有其特殊性，需要在小范围内进行更为精准的流行病学调查，既要防止疫情的扩散，又要尽可能的保障普通患者的就医需求。如何开展医院内(重点区域内)疫情流行病学调查将成为疫情防控的新课题。在新冠疫情的医院防控中，中南大学湘雅医院始终坚持在疾病预防控制中心指导下以自身力量为主导完成医院内新冠肺炎疫情流行病学调查，形成了医院流调的湘雅模式。本文结合医院内流行病学调查之湘雅经验，介绍新冠肺炎疫情医院内流行病学调查的意义、方法、主体，以及新形势下医院感染面临的挑战及展望。

Abstract:

Since the outbreak of COVID-19, it has spread to more than 160 countries, causing a pandemic worldwide, bringing a huge impact on the global medical system and causing huge economic losses. The genome of SARS-CoV-2 is constantly mutating, with higher immune escape ability and stronger infectivity, and the infected people tend to have mild symptoms, which brings greater challenge to epidemic prevention and control. The epidemic prevention and control in China has gone through four stages and achieved remarkable results, which proves the advanced and scientific nature of Chinese epidemic prevention and control mode. Rapid and powerful pathogen detection capabilities as well as rapid and precise epidemiological investigation capabilities are the magic weapons for the effective control of COVID-19 in China. In medical institutions, especially in designated hospitals for COVID-19, timely, efficient and standardized epidemiological investigation is the key to the prevention and control of COVID-19 in hospital. Precise epidemiological investigation is the premise and basis for the implementation of hierarchical management and control of epidemic-related populations and epidemic-related areas in the hospital, and is the gua rantee to prevent the spread of epidemic in hospital and prevent the non-combat reduction of medical personnel. Com pared with the epidemiological investigation of the social aspect, epidemiological investigation of COVID-19 epidemic in hospital has its particularity, it is necessary to conduct a more precise epidemiological investigation in a small area, not only prevent the spread of the epidemic, but also meet the medical needs of patients as much as possible. How to carry out epidemiological investigation of the epidemic in the hospital (in key areas) will form a new topic of epidemic prevention and control. In the hospital prevention and control of COVID-19, Xiangya Hospital of Central South University has always insisted on completing the epidemiological investigation of COVID-19 with its own strength under the guidance of the Center for Disease Control and Prevention, forming a Xiangya mode of in-hospital epidemiological investigation. This article introduces the significance, methods and investigators of COVID-19 in-hospital epidemiological investigation, as well as the challenge and prospect of healthcare-associated infection under the new situation based on Xiangya's experience in epidemiological investigations in hospitals.