Abstract:

In order to better prevent novel coronavirus (2019-nCoV) healthcare-associated infection, ensure the safety of health care workers(HCWs) and other staff in medical institutions, and rationally use personal protective equipment(PPE), Healthcare-associated Infection Control Branch of Chinese Preventive Medicine Association, Healthcare-associated Infection Management Committee of Chinese Hospital Association, and Chinese Journal of Infection Control jointly organize domestic experts (including some experts on the frontline of anti-epidemic in Wuhan) to jointly formulate this consensus. This consensus is mainly applicable for medical institutions which receive and cure both patients with coronavirus disease 2019 (COVID-19) and common patients; guide frontline HCWs, non-frontline HCWs, and other staff in medical institutions to rationally and effectively use protective equipment. This consensus determines personal protection standards of staff at different locations and with different working posts through assessment on risk of exposure to COVID-19 among staff in medical institutions. The main contents of this consensus also include introduction and application scope of PPE, putting on and taking off process of three level protection, prevention and emergency treatment of abnormal PPE, treatment process of occupational exposure to COVID-19. At the same time, this consensus particularly emphasizes the rational division of medical institutions during COVID-19 epidemic period, arrange experienced clinicians of departments of infectious or respiratory diseases participate in triage at key triage location, which are the prerequisite requirements of risk assessment; for the selection of PPE, we should not only prevent inadequate protection, but also avoid abuse and overuse, so as to prevent HAI on the premise of ensuring the safety of staff.

Abstract:

Coronavirus disease 2019 (COVID-19) has become a global public health emergency worldwide. Computerized tomography (CT) is very important for the diagnosis and differential diagnosis of COVID-19, understan-ding the imaging manifestation of COVID-19 will help to improve the accuracy of diagnosis. The main lung imaging manifestation of COVID-19 is ground-glass opacity, this paper describes the imaging manifestation of lung infectious diseases mainly shown as ground-glass opacity, imaging differences in pneumonia caused by coronaviridae, non-coronaviridae and other pathogens were compared, so as to help radiologists and clinicians make better clinical diagnosis and differential diagnosis.

Abstract:

Objective To evaluate clinical and epidemiological characteristics of patients who were confirmed with coronavirus disease 2019 (COVID-19) in Gansu Province. Methods Clinical data of 91 patients who were confirmed with COVID-19 in Gansu Province between January 23 and February 20, 2020 were collected, epidemiology, clinical manifestations and imaging features were analyzed. Results 91 patients with COVID-19 were distributed in 11 prefectures and cities in the whole province, and 13 were clustering cases, peak interval of occurrence of COVID-19 in Gansu Province was between January 25 and February 10, 2020. Clear epidemiological history was found in 62 cases, 10 patients (14.1%) were from Hubei epidemic area, 52 cases (73.2%) were clustering onset due to close contact with COVID-19 patients. 76 cases were mild type and common type, 15 were severe type and critically severe type; by the end of February 20, 2020, 65 cases (71.4%) were cured, 24 (26.4%) were under treatment, and 2 (2.2%) died. Among 71 cases with complete clinical and imaging data, 32 (45.1%) were male, with a median age of 45 (1-94) years and a median incubation period of 6 (1-13) days. The main clinical symptoms included:fever (n=60, 84.5%), cough (n=65, 91.5%), expectoration (n=23, 32.4%), fatigue (n=25, 35.2%), and shortness of breath (n=10, 14.1%). Characteristic changes in CT image included:ground-glass opacity and/or patchy opacity (n=65, 91.5%), air bronchogram and/or consolidation opacity (n=18, 25.4%), halo sign or reversed halo sign(n=15, 21.1%), 20 patients (28.2%) had combined CT image changes, including ground-glass opacity and/or patchy opacity combined with air bronchogram and/or consolidation opacity (n=11, 15.15%), and ground-glass opacity and/or patchy opacity combined with halo sign or reversed halo sign(n=9, 12.7%). Conclusion Most cases of COVID-19 in Gansu Province have clear epidemiological characteristics, mainly are imported and clustered cases, there is no gender difference in incidence of the disease, people are generally susceptible, imaging features of chest CT are conductive to clinical diagnosis.

Abstract:

Objective To analyze clinical and epidemiological characteristics of patients with coronavirus disease 2019 (COVID-19), further enhance the understanding on COVID-19. Methods Clinical data of 80 patients who were confirmed with COVID-19 in Zhuzhou City from January 20 to February 27, 2020 were analyzed retrospectively, including epidemiological condition, clinical characteristics, treatment and outcome. Clinical characteristics of patients in mild, common, severe and critically severe groups were compared. Results Of 80 confirmed patients, 22 (27.5%) were from Hubei epidemic areas, 58 (72.5%) were not from Hubei epidemic areas, 45(56.3%) of whom definitely contacted with infection sources and 13 (16.3%) had no definite contact history. There were 17 clustering epidemic involving 55 cases, 4 clustering epidemic imported from Hubei involving 9 cases, including 3 familial clustering; 13 local clustering epidemic involving 46 cases, including 10 familial clustering, 2 popular social gathering, and 1 friends' dinner gathering. The median age of 80 patients was 47.5 years; ratio of male to female was 1:1; 22 patients (27.5%) complicated with underlying diseases, the top three underlying diseases were hypertension, diabetes and coronary heart disease; there were 8(10.0%) mild cases, 55(68.8%) common cases, 11(13.8%) severe cases, and 6(7.5%) critically severe cases. The main clinical symptoms were fever, cough, expectoration, fatigue, headache, muscle ache and diarrhea. Compared with patients in mild and common groups, patients in severe and critically severe groups were older, with a higher proportion of diabetes and hypertension, and a higher proportion of dyspnea and respiratory frequency>24 times/minute, differences were all statistically significant(all P<0.05). 78 patients (97.5%) had normal or decreased white blood cell count, 20 (25.0%) had lymphocyte count <1.0×10⁹/L; lymphocyte count, lymphocyte percentage, hemoglobin and albumin in patients in severe and critically severe groups were all lower than those in mild and common groups (all P<0.05), differences in several blood indicators were all statistically significant. Nine patients(11.3%) had no pneumonia manifestations, 15 patients (18.8%) had unilateral lung involvement, 56 patients (70.0%) had bilateral lung involvement, all 17 patients (100.0%) in severe and critically severe groups had bilateral lung involvement. Conclusion Novel coronavirus(2019-nCoV) infection presents familial clustering, the proportion of older age and underlying diseases is higher in severe and critically severe groups, lymphocyte count of most severe patients decreased significantly, which can be used as a clinical early warning indicator.

Abstract:

Objective To analyze the initial symptoms and epidemiological characteristics of confirmed cases of coronavirus disease 2019 (COVID-19), provide theoretical basis for formulating prevention and control measures for epidemic of COVID-19. Methods 90 patients confirmed with COVID-19 in Yongchuan Hospital of Chongqing Medical University were chosen, they were performed retrospective epidemiological survey according to Epidemiological survey program of COVID-19 cases formulated by National Health Commission of the People's Republic of China. Results None of the 90 COVID-19 confirmed patients in this hospital had a history of contacting with wild animals, 29 cases (32.22%) had a history of sojourning in Wuhan and its surrounding areas (type A epidemiological history); 49 (54.44%) had a history of contacting with COVID-19 patients, 12 (13.33%) had a history of contacting with patients with fever or respiratory symptoms reported in community, all had type B epidemiological history. 73 cases (81.11%) were clustering onset of disease. Patients' age was 3-89 years, the average age was (48.19±17.85) years. Type A epidemiological history mainly concentrated on patients of 18-60 years, mainly migrant workers; proportion of patients ≥ 60 years in type B epidemiological history cases was higher than that of type A epidemiological history cases, mainly farmers; there were significant differences in age and occupation between two groups of patients(both P<0.05). The initial symptoms were fever and chills (n=43, 47.78%), cough (mainly dry cough, n=27, 30.00%). 73 cases (81.11%) took medicine by themselves at the beginning of the disease. The total average score of premorbid behavioral and psychological status of patients was (15.16±7.64). Patients with type A epidemiological history were better than those in type B epidemiological history in terms of awareness on 2019-nCoV, understanding protective measures, awareness on windowing ventilation and indoor disinfection, diffe-rences were all statistically significant (all P<0.05); patients with type B epidemiological history were better than those with type A epidemiological history in terms of knowing not to go to densely populated areas, difference was statistically significant (P<0.05). Conclusion COVID-19 is highly infectious with early sporadic, late clustering onset and person-to-person transmission. The middle-aged and the elderly are the high incidence population, COVID-19 is closely related to occupational exposure, peoples are generally susceptible to it. Early diagnosis, early isolation, comprehensive treatment and active control of chronic underlying diseases are essential for controlling COVID-19.

Abstract:

Objective To evaluate the feasibility of fecal specimens for screening coronavirus disease 2019 (COVID- 19) suspected or confirmed patients. Methods Novel coronavirus (2019-nCoV, SARS-CoV-2) ORF1ab, N gene and human cell housekeeping gene ribonuclease P (RNase P) in sputum and faecal specimens of 15 patients with COVID-19 after treatment were detected by real time RT-PCR, positive rates of sputum and faecal specimens were compared. Results Among sputum and faecal specimens of 15 patients, human cell housekeeper gene RNase P all showed typical and obvious amplification signal curve. Two patients were both positive for 2019-nCoV nucleic acid test of sputum and faecal specimens, while 4 patients were only sputum or fecal specimens positive respectively; among sputum positive specimens of 6 patients, only 2 were amplified ORF 1ab gene and N gene simultaneously, among fecal positive specimens of 6 patients, only 4 were all amplified ORF 1ab gene and N gene simultaneously. Conclusion Negative detection result of 2019-nCoV nucleic acid test of respiratory tract specimens as criterion for excluding and curing COVID-19 should be prudent, negative detection result of 2019-nCoV nucleic acid test for fecal specimens can be considered.

Abstract:

Objective To understand epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) confirmed cases and excluded cases, and provide recommendations for clinical diagnosis and treatment. Methods Patients with suspected COVID-19 staying in a hospital were studied, those who were with positive 2019-nCoV nucleic acid test were as confirmed case group, those who were with negative 2019-nCoV nucleic acid test for at least two times, and excluded after consultation by Jing'an District expert group of Shanghai were as excluded case group, differences in epidemiology, clinical manifestation, laboratory examination and imaging data between two groups were compared. Results Of 14 confirmed cases, male-female ratio was 1.33:1, median age was 51.5 years (38.3, 63.0), 10 cases (71.43%) had a clear epidemiological exposure history; of 84 excluded cases, male-female ratio was 0.95:1, median age was 37 years (29.0, 59.75), 14 cases (16.67%) had a clear epidemiological exposure history; there were both significant differences in age distribution and epidemiological exposure history between two groups (both P<0.05), but no significant differences in gender distribution, residence distribution and clinical manifestations (all P>0.05). The percentage of patients with normal or decreased leukocytes in confirmed case group was higher than that in excluded case group (92.86% vs 72.62%, P<0.001), percentage of patients with decreased lymphocyte was lower than that in excluded case group (P=0.001). Comparison of chest CT of two groups showed that the percentage of ground glass exudation shadow and spot exudation shadow in confirmed case group was higher than that in excluded case group, difference was statistically significant (P<0.05); the median time from scattered or multiple pneumonia to ground glass pneumonia in confirmed case group was 3 (2, 5) days. Conclusion Characteristic factors for COVID-19 are age, clear epidemiological history, leukocyte count, percentage of lymphocyte, and CT manifestations of ground glass-like lung, clinicians should discriminate in diagnosis and treatment, further improve diagnosis accuracy of COVID-19.

Abstract:

Objective To optimize the allocation of personal protective equipment (PPE) and disinfection supplies for dispatched medical teams under the extreme shortage of PPE and disinfection supplies for the prevention and control of coronavirus disease 2019 (COVID-19), and ensure a balanced allocation of PPE and disinfectant supplies between the hospital and their dispatched medical team members. Methods 85 members in 7 batches of medical teams dispatched from a tertiary first-class hospital in Shenyang City to different cities during prevention and control period of COVID-19 epidemic were surveyed. The initial allocation plan of PPE and disinfection supplies for medical team was determined firstly, WeChat application program was used, questionnaire for the actual consumption of each initially allocated PPE and disinfection supplies was designed, medical team members were surveyed by electronic questionnaire through WeChat. Results 80 available questionnaires were obtained, 38.75% (n=31) assisted hospitals of the surveyed team members could provide PPE and disinfection supplies as required, 50.00% of which could provide PPE as required, 57.50% could provide disinfection supplies as required, only 38.75% of the assisted hospitals could fully provide PPE and disinfection supplies, 3.75% of the assisted hospitals couldn't provide PPE and disinfection supplies. The total consumption and initial allocation of surgical mask, latex glove, long latex glove, medical goggles, pail, packaged sanitary and disinfection wipes, individually packed sanitary and disinfection wipes, cleaned gauze, alcohol-based hand rub(100 mL/bottle), and effervescent chlorine disinfectant tablet in three assisted areas were all statistically different(all P<0.05). Consumption of surgical mask, medical protective clo-thing, long latex glove, medical goggles, face shield, non-joined work clothes, white coat, work shoes, and pail in different assisted areas were all significantly different(all P<0.05). Conclusion The initial minimum allocation plan of protective and disinfection supplies was based on high-risk occupational exposure and full work load of 8 hours a day, which can meet the actual needs of dispatched team members at the early stage, there is no obvious deviation between the expected plan and actual demand, the allocation of protection resources between hospitals and dispatched medical team members during the period of shortage of PPE and disinfection supplies is balanced, it is the basis and key to ensure the effective implementation of disinfection, isolation and protection measures by both hospital and medical team members.

Abstract:

Objective To investigate the psychological stress of health care workers(HCWs) in isolation wards during the pandemic period of coronavirus disease 2019 (COVID-19), and provide scientific basis for targeted psychological intervention at the later stage. Methods Psychological stress of HCWs in the isolation wards of a tertiary first-class general hospital in Sichuan Province was surveyed by using Questionnaire Star, questionnaire include basic information and psychological stress-related scale. Results Comparison in score of anxiety factors for infection:nurses were more anxious than doctors(t=2.471,P=0.007). Comparison in fatigue factor score:HCWs who having given birth was higher than not having given birth(t=2.474,P=0.016); nurses were higher than doctors(t=2.714,P=0.009); non-infection specialty was higher than infection specialty(t=-2.513,P=0.015). Comparison in work load factor score:working years ≥ 20 years was higher than<20 years (t=-5.236, P<0.001). Comparison in work motivation factor score:working years ≥ 20 years was higher than<20 years(t=-2.039, P=0.046); work motivation factor score of HCWs who obtained knowledge about COVID-19 through different number of ways was significantly different(F=4.673,P=0.013). Comparison in support system factor score:infection specialty was higher than non-infection specialty (t=2.371,P=0.021); protection according to protective level was higher than protection not by protective level (t=2.153,P=0.035). Overall psychological stress score of HCWs who obtained knowledge about COVID-19 through different number of ways was sifnificantly different(F=6.668, P<0.001). Conclusion In order to make frontline HCWs in isolation wards (especially nurses, HCWs who have given birth, and HCWs of non-infection specialty) to cope with the pandemic at minimum stress in a favorable working environment, knowledge on COVID-19 should be updated and provided timely, psychological support should be given.

Abstract:

Coronavirus disease 2019 (COVID-19) mainly transmits through close range droplets and close contact, masks can reduce the risk of infection and the probability of transmission. Due to the limited capacity of production of medical masks, local governments encourage enterprises to produce non-medical masks to meet public needs for the prevention and control of COVID-19 epidemic. This article introduces the relevant standards of non-medical masks in China, compares and analyzes the protective performance requirements such as bacterial filtration efficiency and particle filtration efficiency, proposes important indicators of non-medical masks for protecting against novel coronavirus (2019-nCoV). 102 enterprise standards of non-medical masks announced in each province in China from January 27 to February 25, 2020 were analyzed, standardization of non-medical masks for epidemic prevention and control are put forward in order to provide assistance to relevant departments, enterprises and general population.

Abstract:

Objective To assess the method and efficacy of infection risk management of a medical team which rush to the rescue of Wuhan. Methods During the epidemic period of coronavirus disease 2019 (COVID-19), one health care worker was infected with COVID-19 in a designated hospital, a Wuhan medical team which rushed to the rescue of this hospital sought risk points through risk identification, assessed the risk of team members by online questionnaire tool, and took countermeasures against risk according to risk assessment results. Results Through sorting out the work and life process of health care workers in medical team, exposure risk identification form was formulated. Online questionnaire was used to evaluate the risk of team members, and 4 team members were found to have exposure risk. 4 team members were interviewed again, judged comprehensively, and all were excluded from high risk exposure, infection prevention and control measures were strengthened. After 14 days of observation, by the end of February 22, none of the medical team members had been infected. Conclusion During the epidemic period, management on risk can effectively control the risk of infection.

Abstract:

Objective To explore the method of quickly mastering the process of personal protective equipment (PPE) putting on and taking off by health care workers(HCWs), so as to provide reference for further standardized training. Methods From January to February 2020, 344 HCWs were divided into two groups and received the skill training of PPE putting on and taking off process. 209 HCWs in group 1 were from other clinical departments, 135 HCWs in group 2 were from medical team aid to Hubei, fever clinic, and isolation wards. The common training subjects of both groups were theoretical knowledge learning, video learning and manipulate training, on this basis, group 2 added simulation training examination and on-site teaching subject in isolation wards, qualified rates and learning curves of PPE putting on and taking off in two groups of HCWs were compared and analyzed. Results The qualified rate of PPE putting on and taking off in group 2 was higher than that in group 1 (90.37% vs 69.86%), difference was statistically significant (P<0.05). In group 2, the learning curve of PPE putting on and taking off process skill entered a stable period after 9 times of manipulation, correct rate of manipulation continued to rise with the increase of manipulation times; when manipulation training reached 15 times, it entered the proficiency period; in group 1, the learning curve needed 13 times of manipulation to enter the stable period, and 21 times of manipulation to enter the proficiency period. Conclusion Learning curve of PPE putting on and taking off skill of HCWs can be shortened by adding simulation training examination and on-site teaching subject in isolation wards, which is helpful for HCWs to master PPE putting on and taking off skill as soon as possible, and reduce the risk of coronavirus disease 2019 (COVID-19).

Abstract:

Objective To explore the anti-fogging effect of several anti-fogging methods on medical goggles. Methods Goggles were treated with four methods:anti-fogging spray (swimming goggle special use), iodophor smearing, hand sanitizer smearing, and detergent smearing, 10 pairs of goggles were treated with each anti-fogging method respectively, health care workers(HCWs) began to work in COVID-19 isolation ward after wearing treated goggles, fogging of goggles after 2, 4 and 6 hours of work was investigated, anti-fogging effect of four methods was compared. Results Fogging status of four anti-fogging methods in different periods was significantly different (all P<0.05). Anti-fogging spray method was not ideal, HCWs wore goggles for 2 hours and 7 pairs of goggles fogged, wore goggles for 6 hours and 10 pairs of goggles all fogged; iodophor smearing was slightly better, HCWs wore goggles for 2 hours and 2 pairs of goggles fogged, wore goggles for 6 hours and 7 pairs of goggles fogged; hand sanitizer and detergent smearing had better anti-fogging effect, HCWs wore goggles for 2 hours, no goggles fogged, wore goggles for 6 hours, 3 and 2 pairs of goggles fogged respectively. Conclusion Hand sanitizer and detergent smearing can be used to prevent fogging of medical goggles.

Abstract:

Objective To analyze epidemiological and clinical characteristics of novel coronavirus (2019-nCoV) infection in patients in fever clinic, understand the causes and clinical manifestations of fever, and povide basis for disease prevention and treatment. Methods Medical records of patients with fever in fever clinic of a large general hospital from January 17 to February 2, 2020 were analyzed, including general information, epidemiological history, 2019-nCoV nucleic acid test and other laboratory test results. Results There were 1 770 patients, 888 were males and 882 were females, 61.24% of whom were aged 21-40 years. Laboratory examination showed 2019-nCoV nucleic acid test was positive in 15 patients, mainly white blood cell count was normal or decreased, lymphocyte count decreased, accounted for 100.00% and 40.00% respectively. Of 857 chest CT scan reports, 822(95.92%) were positive. Conclusion Setting up fever clinic is conducive to the rapid and effective screening of fever patients, virus infection is most common among patients in fever clinic, mainly young and middle-aged people, positive of chest CT examination is high in patients with positive of 2019-nCoV nucleic acid test.

Abstract:

Effective prevention and control of novel coronavirus (2019-nCoV) outbreak is a serious challenge to the government, the public and each health professional. During the outbreak of 2019-nCoV, World Health Organization released "Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak", which provides instructional recommendations on the use of medical masks for public health and infection prevention and control professionals, health care managers, health care workers and community health workers. This article interprets the advice, puts forward suggestion on the wearing and management of medical masks in the community, during home care and in health care settings, aiming to provide scientific basis for rational and correct use of medical masks, avoiding unnecessary cost.

Abstract:

From the end of December 2019, there has been an outbreak of novel coronavirus (2019-nCoV) pneumonia in Wuhan, Hubei Province, by February 20, 2020, more than 70 000 cases of infection have been found in China, 2019-nCoV spread rapidly and influence considerablely. In order to understand the occurrence and development course of 2019-nCoV infection as soon as possible, this paper makes a review on related research on 2019-nCoV infection, so as to further understand its pathogenesis, take scientific and rational diagnosis and treatment measures, actively prevent and control the epidemic.