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Promulgation Date: 2020-3-13 Title: Notice on Reinforcing the Prevention of Nosocomial Infections During the Epidemic by General office of the National Health Commission Document Number:国卫办医函〔2020〕226号 Expiration date: Promulgating Entities:General Office of the National Health Commission Source of text: http://www.nhc.gov.cn/yzygj/s7659/202003/0c85996bb762437581e98317365fa01c.shtml
To supplement the orderly delivery of medical services, the following outlines the requirements to reinforce the prevention of nosocomial infections and reduce cross-infection.
I. Combine management by region and level, strengthening regional deployments and guiding implementation
Health administrations of various levels should pay attention to the prevention and control of hospital-acquired infections. Treat the prevention and control of hospital-acquired infections as a top priority and the basis and premise of routine medical operations. Reinforce internal cooperation and planning based on the spread of COVID-19 and regional risk levels. Follow the directives on infection control and prevention with care. Reinforce the active management of infection prevention and control in regional medical institutions, such that problems can be discovered and corrected without delay. Avoid both insufficient and excessive infection management. Medical establishments with many problems should set up a rectification ledger and resolve the issues within the time limit.
II. Strictly implement standardized prevention, employ appropriate protective measures
Medical institutions should strictly implement standard preventive strategies. Personnel who enter the hospital should correctly choose and wear masks. Practice good hand hygiene. Medical institutions should practice good ventilation strategies and implement zoning directives. Separate the areas into clean, potentially contaminated and contaminated zones. Separate the staff passageway from the patient passageway. Medical workers should follow the "Guideline on Personal Protection Strategies for Medical Workers during the COVID-19 Epidemic (Provisional)" and practice proper use of protective equipment. Starting with standard preventive measures, use additional protection based on the risk level of medical practices. When exposure to the patients' blood, bodily fluids, and secretions is likely, or when conducting aerosol-generating procedures, wear PPE such as goggles/face shields, isolation gowns, and medical respirators.
III. Strengthen emergency triage, implementing the requirements of the 'four earlies'.
Medical institutions should implement the directives in "Management Measures for the Triage of Patients with Infectious Diseases in Medical Institutions" and "Management Measure for Virtual Health Care", and carry out patient triage and risk management with care. Using online consultation, inquire, with emphasis, whether respiratory symptoms such as fever and cough are present, as well as epidemiological history, to make a preliminary triage decision. Stagger patient appointment booking and reduce on-site registration. Set up standard triage points at outpatient and emergency departments to screen the patients' temperature. Patients with a fever should be moved to fever clinics. Doctors at fever clinics should ask the patient about travel and residence history in high-risk countries and regions, check for symptoms related to COVID-19, and order imaging and laboratory tests for suspected cases. Strive for early detection, early reporting, early quarantine and early treatment. A buffer zone can be set up in the emergency department for the isolation and treatment of patients would require emergency treatment and are suspected cases of COVID-19.
IV. Strengthen the management of patients at intake and in residential care
Based on regional risk levels, medical institutions should strictly implement the local measures regarding the management of the four types of people (confirmed cases, suspected cases, patients with fever, close contacts of patients), and develop a triage workflow for incoming patients. For admitted patients with epidemiological histories or at risk of COVID-19 infection, use imaging, etiological and serological tests for differential diagnosis. Medical institutions in medium or high-risk regions are encouraged to set up transition wards if circumstances allow, and treat newly admitted patients in isolation. After COVID-19 has been ruled out, patients can be transferred to regular wards for further treatment in order to reduce the risks of cross-infection. Reinforce the management of caregivers and visitors of admitted patients. Set up management plans for caregivers and visitors based on the local epidemic situation.
V. Do a good job of nosocomial monitoring and health monitoring
Medical institutions should actively monitor the situation for infection prevention. Focus the surveillance efforts on key populations such as patients in the ER, and patients receiving hemodialysis or chemotherapy. Surveillance should cover all of the invasive procedures such as surgeries and endoscopy. Through active surveillance, quickly discover sporadic infections, cluster infections and suspected cases of COVID-19, and take corresponding infection control and investigation measures. Medical institutions should set up medical surveillance programs that require daily reporting of health conditions for all medical workers, other staff members (housekeeping, delivery, security, care workers and so on), patients and their caretakers. Promptly identify people with fever or respiratory symptoms and take corresponding measures.
VI. Refine medical service processes for key populations
Medical institutions of various levels should focus on the patient population with special needs, such as pregnant women, patients undergoing emergency surgery, patients with acute cardiovascular diseases, hemodialysis patients and cancer patients, and develop targetted treatment plans and emergency plans based on local conditions. When COVID-19 can not be ruled out in ER patients, the patients should be treated as suspected cases to ensure the safety of patients and medical workers. In outpatient care of patients with chronic illnesses, the length of prescription may be extended depending on the conditions. Additionally, virtual follow-up appointments should be encouraged. Medical institutions are also encouraged to conduct consultations and advisement online, and to ensure the supply of medications.
VII. Do a good job of routine infection prevention and control
Health administrations of various levels should make the prevention and control of infection one of the criteria for evaluating medical institutions. Routine supervision and management should be strengthened. Medical institutions should carefully implement the "Basic System for the Control and Prevention of Nosocomial Infections (Provisional)" (国卫办医函〔2019〕480号), strengthen the allocation of full-time and part-time infection control staff, increase funding for infection control, and carry out the responsibilities of each level of infection control organizations. Strictly carry out training for all infection prevention and control personnel. Staff who have not passed training certification are not allowed to work. Ensure that the priority departments have building layout and workflow that meet the requirements of relevant technical standards and specifications, and are equipped with the necessary equipment and facilities for the hygiene of medical workers, such as convenient showers. Integrate the standard infection prevention concept into routine work, carry out disinfection, quarantine, prevention of occupational exposure, medical waste management, and so on to reduce the risk of nosocomial infection.
General Office of the National Health Commission
March 13, 2020