Technical Guide for Medical Establishments in the Prevention and Control of the Transmission of the Novel Coronavirus (1st Edition)

Promulgation Date: 2020-1-22
Title: 国家卫生健康委办公厅关于印发医疗机构内新型冠状病毒感染预防与控制技术指南（第一版）的通知
Document Number:国卫办医函〔2020〕65 号
Expiration date: 
Promulgating Entities: General Office of the National Health Commission
Source of text: http://www.nhc.gov.cn/yzygj/s7659/202001/b91fdab7c304431eb082d67847d27e14.shtml

To the health commissions of each province, autonomous region, directly-governed municipality, and of the Xinjiang production and construction corps.

In order to further perform well novel coronavirus infection prevention and control work, to effectively reduce the risk of transmission within medical establishments, and to ensure the quality and safety of medical treatment, this commission arranged for and formulated the "Technical Guide for Medical Establishments in the Prevention and Control of the Transmission of the Novel Coronavirus (1st Edition). We now print and circulate it to you and ask that local health administration departments at all levels appoint specific people to be responsible for the infection prevention and control work of medical establishments within your respective jurisdictions, and lower, to the greatest possible extent, the risk of the transmission of the novel coronavirus within medical establishments. Meanwhile, please report the details of the responsible persons of provincial-level health administration departments, including name, contact telephone number, division, and position, to the Commission’s Medical Administration and Regulation Bureau before 10 o’clock on 23 January 2020.

Contact: Bureau for Medical Administration; Zhang Wenbao, Wang Manli

Telephone numbers：010-68792730、68792733

General Office of the National Health Commission

January 22, 2020

(Information disclosure type: Proactive Disclosure)

Technical Guide for Medical Establishments in the Prevention and Control of the Transmission of the Novel Coronavirus (1st Edition)

This technical guide is specially drafted to further complete efforts to prevent and control the spread of the novel coronavirus, to effectively reduce the risk of transmitting the coronavirus in medical establishments, and to regulate the conduct of medical personnel.

I. Basic Requirements

(1) Draft emergency response plans and work procedures. Medical establishments shall strictly implement the "Notice on Further Strengthening Efforts on the Prevention and Control of Infection in Medical Establishments" (GuoWeiBanYiHan (2019) No. 480), and are to establish early warning mechanisms, emergency response plans, and work procedures, based on factors such as the novel form coronavirus's pathogenic features, sources of infection and transmission, vulnerable populations and treatment requirements,

(2) Train all personnel. Designate training material for different personnel based on their post and duties, especially giving key training to medical personnel in high-risk departments such as fever clinics, internal medicine clinics, pediatrics clinics, emergency rooms, ICUs, and respiratory wards, familiarizing them with knowledge, methods, and techniques on prevention and control of infection by the novel coronavirus, so that it is discovered, reported, quarantined, diagnosed, treated, and controlled early on.

(3) Protect medical personnel. Medical establishments should standardize disinfection, isolation and protection work and have in reserve ample protective materials that meet quality standards, such as disinfectant products and surgical masks, medical masks, isolation gowns, eye protection and other protective equipment, to ensure that the personal protection of medical personnel is as it should be. On top of strict application of standard precautions, strengthen the prevention and control of contact transmission, droplet transmission and airborne transmission. Correct selection and wearing of face masks and hand hygiene are key measures in the prevention and control of contagion.

(4) Pay attention to the health of medical personnel. Medical establishments should make reasonable arrangements in deploying human resources and organising shifts to avoid health workers becoming overly tired. They should provide nutritious meals to strengthen the immunity of health workers. Aimed at the specifics of different posts and the results of risk assessments, carry out active health monitoring including for body temperature and respiratory system symptoms etc. They should adopt multiple different measures to ensure that health workers are able to healthily provide medical services for patients.

(5) Strengthen monitoring of contagion. Carry out early warning and forecasting to good effect, strengthen supervision and guidance of infection prevention and control work, detect hidden dangers, and promptly make improvements. On discovering suspected or diagnosed novel coronavirus pneumonia patients, report promptly in accordance with relevant requirements and, within two hours, report the details upwards, and make the necessary work arrangements.

(6) Manage cleaning and disinfecting. In accordance with the Hospital Air Purification Management Guidelines, strengthen ventilation of diagnosis and treatment environments; medical establishments with the conditions to do so can carry out air disinfection, and recirculating air disinfection equipment can be installed. Strictly implement the Technical Guidelines for Medical Establishment Disinfection, ensure the correct cleaning and disinfection of diagnosis and treatment environments (air, surfaces, floors etc), medical instruments, articles used by patients, etc.; ensure strict handling of patient respiratory secretions, excretions, and vomit; and strictly carry out terminal disinfection.

(7) Strengthen management of patient treatment visits. Medical establishments should ensure proper management of consulting patients and do their best to reduce patient crowding to reduce the risk of hospital infection. On discovering patients suspected or diagnosed as infected with novel coronavirus, in accordance with law adopt isolation or transmission control measures and, according to regulations, adopt medical observation and other necessary preventative measures vis-à-vis persons accompanying such patients and others who have come into close contact with them. Those that do not have the capacity to offer treatment, should promptly refer patients to medical establishments that do have the capacity for treatment.

(8) Strengthen education of patients. Medical establishments should actively undertake to educate consulting patients and persons accompanying them, to help them become informed about protecting against novel coronavirus, guiding them as to correct hand-washing, cough etiquette, medical observation, home isolation and so on.

(9) Strengthen management of infection outbreaks. Strictly implement each item of in the regulatory framework to prevent and control infection in medical establishments, reducing the risk of an outbreak as much as possible. Strengthen sensitivity; as soon as suspected cases of novel coronavirus infection break out or once they have broken out, medical institutions must promptly report on them in accordance with regulations and, according to the relevant standards and procedures, set in motion emergency plans, and cooperate in ensuring work to investigate and handle cases is done effectively.

(10) Strengthen management of medical waste. Bring medical waste produced by patients diagnosed with or suspected as being infected with novel coronavirus under management for infectious medical waste, and carry out standard-compliant handling strictly in accordance with the related stipulations in the Regulations on Medical Waste Management and the Measures on the Management of Medical Waste by Medical and Health-Care Institutions.

II. Administration of Key departments

(1) Fever clinics.

1. The building arrangements and work procedures for fever clinics should be in keeping with the related requirements found in the Technical Guidelines for Hospital Isolation etc.

2. Observation rooms and emergency rooms should strengthen ventilation; if machine ventilation is being used, the direction of airflow should be controlled, from clean to contaminated.

3. Equip with ample numbers of requirement-compliant protective articles for medical personnel; fever clinic entrances and exits should install hand hygiene facilities such as alcohol-based hand rubs.

4. Medical personnel carrying out diagnosis and treatment work should implement standard protective measures. They should wear correctly surgical masks or medical protective masks; before putting on and after taking off a mask, hands should be washed or a hand hygiene disinfectant rub should be used. On entering and exiting fever clinics and observation wards, correctly put on or remove protective items strictly in accordance with the Procedures for Medical Personnel on the Wearing and Removal of Protective Items (see appended document).

5.Medical personnel should have a grasp of the particular epidemiological and clinical characteristics of novel coronavirus infection, undertake patient screening in accordance with diagnosis and treatment standards, and immediately adopt isolation measures for patients suspected or diagnosed and promptly report.

6. Once patients have been transferred conduct terminal handling in accordance with the Technical Guidelines on Disinfection in Medical Establishments.

7. Medical establishments should provide face masks for patients and those accompanying them, and guide them as to how to wear them correctly.

(2) Emergency rooms.

1. Implement pre-examination and triage systems, guide patients with fever to be seen in fever clinics and draw up and improve emergency plans for transfer and emergency care for patients with severe symptoms, and strictly implement them.

2. Set up reasonable isolation areas to meet the needs for on-site isolation and treatment of suspected and confirmed patients.

3. Medical personnel should strictly implement prevention measures; ensure personal protection and diagnosis and treatment environments are correctly managed. When implementing diagnosis and treatment measures, such as emergency endotracheal intubation, for which the occupational exposure to infection risk is relatively high, (medical personnel) should adopt prevention measures according to the requirements for treating patients with confirmed diagnoses.

4. Diagnosis and treatment areas shall be well ventilated and regularly cleaned and disinfected.

5. Employ effective measures is setting up waiting areas and so forth, to avoid concentrating groups of people.

(3) General wards (rooms).

1. Emergency isolation rooms should be put in place and used for the isolation and emergency treatment of suspected or diagnosed patients; the related work systems and processes should be established, and sufficient disinfectant and protective articles should be prepared for responding to acute respiratory tract infections.

2.病区（房）内发现疑似或确诊患者，启动相关应急预案和工作流程，按规范要求实施及时有效隔离、救治和转诊。

3.疑似或确诊患者宜专人诊疗与护理，限制无关医务人员的出入，原则上不探视；有条件的可以安置在负压病房。

4.不具备救治条件的非定点医院，应当及时转到有隔离和救治能力的定点医院。 等候转诊期间对患者采取有效的隔离和救治措施。

5.患者转出后按《医疗机构消毒技术规范》对其接触环境进行终末处理。

(4) Wards (rooms) for patient with pneumonia suspected or diagnosed as being infected with the novel corona virus.

1.建筑布局和工作流程应当符合《医院隔离技术规范》等有关要求，并配备符合要求、数量合适的医务人员防护用品。 设置负压病区（房）的医疗机构应当按相关要求实施规范管理。

2.对疑似或确诊患者应当及时采取隔离措施，疑似患者和确诊患者应当分开安置；疑似患者进行单间隔离，经病原学确诊的患者可以同室安置。

3.在实施标准预防的基础上，采取接触隔离、飞沫隔离和空气隔离等措施。 具体措施包括：

（1）进出隔离病房，应当严格执行《医院隔离技术规范》《医务人员穿脱防护用品的流程》，正确实施手卫生及穿脱防护用品。

（2）应当制定医务人员穿脱防护用品的流程；制作流程图和配置穿衣镜。 配备熟练感染防控技术的人员督导医务人员防护用品的穿脱，防止污染。

（3）用于诊疗疑似或确诊患者的听诊器、体温计、血压计等医疗器具及护理物品应当专人专用。 若条件有限，不能保障医疗器具专人专用时，每次使用后应当进行规范的清洁和消毒。

4.重症患者应当收治在重症监护病房或者具备监护和抢救条件的病室，收治重症患者的监护病房或者具备监护和抢救条件的病室不得收治其他患者。

5.严格探视制度，原则上不设陪护。 若患者病情危重等特殊情况必须探视的，探视者必须严格按照规定做好个人防护。

6.按照《医院空气净化管理规范》规定，进行空气净化。

III. Protection of Medical Personnel

（一）医疗机构和医务人员应当强化标准预防措施的落实，做好诊区、病区（房）的通风管理，严格落实《医务人员手卫生规范》要求，佩戴医用外科口罩/医用防护口罩，必要时戴乳胶手套。

（二）采取飞沫隔离、接触隔离和空气隔离防护措施，根据不同情形，做到以下防护。

1.接触患者的血液、体液、分泌物、排泄物、呕吐物及污染物品时：戴清洁手套，脱手套后洗手。

2.可能受到患者血液、体液、分泌物等喷溅时：戴医用防护口罩、护目镜、穿防渗隔离衣。

3.为疑似患者或确诊患者实施可能产生气溶胶的操作（如气管插管、无创通气、气管切开，心肺复苏，插管前手动通气和支气管镜检查等）时：（1）采取空气隔离措施；（2）佩戴医用防护口罩，并进行密闭性能检测；（3）眼部防护（如护目镜或面罩）；（4）穿防体液渗入的长袖隔离衣，戴手套；（5）操作应当在通风良好的房间内进行；（6）房间中人数限制在患者所需护理和支持的最低数量。

（三）医务人员使用的防护用品应当符合国家有关标准。

（四）医用外科口罩、医用防护口罩、护目镜、隔离衣等防护用品被患者血液、体液、分泌物等污染时应当及时更换。

（五）正确使用防护用品，戴手套前应当洗手，脱去手套或隔离服后应当立即流动水洗手。

(6) Strictly implement measures for preventing injuries from sharps.

（七）每位患者用后的医疗器械、器具应当按照《医疗机构消毒技术规范》要求进行清洁与消毒。

IV. Strengthening Patient Management.

（一）对疑似或确诊患者及时进行隔离，并按照指定规范路线由专人引导进入隔离区。

（二）患者进入病区前更换患者服，个人物品及换下的衣服集中消毒处理后，存放于指定地点由医疗机构统一保管。

（三）指导患者正确选择、佩戴口罩，正确实施咳嗽礼仪和手卫生。

（四）加强对患者探视或陪护人员的管理。

（五）对被隔离的患者，原则上其活动限制在隔离病房内，减少患者的移动和转换病房，若确需离开隔离病房或隔离区域时，应当采取相应措施如佩戴医用外科口罩，防止患者对其他患者和环境造成污染。

（六）疑似或确诊患者出院、转院时，应当更换干净衣服后方可离开，按《医疗机构消毒技术规范》对其接触环境进行终末消毒。

（七）疑似或确诊患者死亡的，对尸体应当及时进行处理。 处理方法为：用3000mg/L的含氯消毒剂或0.5%过氧乙酸棉球或纱布填塞患者口、鼻、耳、肛门等所有开放通道；用双层布单包裹尸体，装入双层尸体袋中，由专用车辆直接送至指定地点火化。 患者住院期间使用的个人物品经消毒后方可随患者或家属带回家。

Attachment: Procedures for Medical Personnel Wearing and Removing Protective Gear

I. Procedures for Medical Personnel Putting on Protective Gear to Enter Quarantine Zones

（一）医务人员通过员工专用通道进入清洁区，认真洗手后依次戴医用防护口罩、一次性帽子或布帽、换工作鞋袜，有条件的可以更换刷手衣裤。

（二）在进入潜在污染区前穿工作服，手部皮肤有破损或疑似有损伤者戴手套进入潜在污染区。

（三）在进入污染区前，脱工作服换穿防护服或者隔离衣，加戴一次性帽子和一次性医用外科口罩（共穿戴两层帽子、口罩）、防护眼镜、手套、鞋套。

II. Procedures for Medical Personnel Removing Protective Gear on Leaving Quarantine Zones

（一）医务人员离开污染区前，应当先消毒双手，依次脱摘防护眼镜、外层一次性医用外科口罩和外层一次性帽子、防护服或者隔离衣、鞋套、手套等物品，分置于专用容器中，再次消毒手，进入潜在污染区，换穿工作服。

（二）离开潜在污染区进入清洁区前，先洗手与手消毒，脱工作服，洗手和手消毒。

（三）离开清洁区前，洗手与手消毒，摘去里层一次性帽子或布帽、里层医用防护口罩，沐浴更衣，并进行口腔、鼻腔及外耳道的清洁。

（四）每次接触患者后立即进行手的清洗和消毒。

（五）一次性医用外科口罩、医用防护口罩、防护服或者隔离衣等防护用品被患者血液、体液、分泌物等污染时应当立即更换。

（六）下班前应当进行个人卫生处置，并注意呼吸道与黏膜的防护。