4 DISCUSSION
Limiting points of entry to control the source of infection,
epidemiological investigation are important parts in the infection
control. The incubation period for COVID-19 is thought to extend to 14
days, with a median time of 4-5 days from exposure to symptoms
onset.11Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of
Coronavirus Disease 2019 in China. The New England journal of
medicine. 2020.,22Li Q, Guan X, Wu P, et
al. Early Transmission Dynamics in Wuhan, China, of Novel
Coronavirus-Infected Pneumonia. The New England journal of medicine.
2020. 97.5% of persons with COVID-19 develop symptoms of SARS-CoV-2
infection within 11.5 days.33Lauer SA, Grantz KH, Bi Q, et al.
The Incubation Period of Coronavirus Disease 2019 (COVID-19) From
Publicly Reported Confirmed Cases: Estimation and Application. Annals
of internal medicine. 2020. Therefore, screening everyone entering
our ward for COVID-19 symptoms at the admission office and the
re-screening at the entrance of our ward, including checking the travel
track of all patients and workers, then monitoring daily temperature
within 14 days every day44Chinese Society of Cardiology. Chinese
Clinical Guidance For COVID-19 Pneumonia Diagnosis and Treatment.
China: Chinese Society of Cardiology; 2020 [cited 2020 Apr. 16].
Available
from:http://kjfy.meetingchina.org/msite/news/show/cn/3337.html.
became the key points of ward management.
The role of the families in improving ill patients’ conditions is
important. A flexible visiting policy can have a positive effect of the
patients condition and eventually their families and help them cope with
physiological and emotional disruption.55Khaleghparast S,
Joolaee S, Ghanbari B, Maleki M, Peyrovi H, Bahrani N. A Review of
Visiting Policies in Intensive Care Units. Glob J Health Sci.
2015;8(6):267–276. In China, if a patient is hospitalized, an
escort family will take care of him during his stay and his other family
members, relatives, friends and colleagues will continue to visit him,
visiting and patients’ accompany management become parts of ward
management. As a result, visitors would be the potential source of
infection, especially those from high-risk areas during the COVID-19
epidemic. Therefore, we re-established and constantly updated policies
for visiting and accompany to restrict visitors and control exogenous
sources of infection. However, the rapidly evolving COVID-19 pandemic,
the restriction of visitors and their own diseases lead to the negative
psychological state of patients in different
degrees.66MA Kai-xuan,ZHANG
Yi-de,HOU Tian-ya,WU Ming-lan,CAI Wen-peng,WEN Tong, Investigation of
physical and mental health in isolated people during the outbreak of
novel coronavirus pneumonia[J].Chinese Journal of Clinical
Medicine,2020,27(1):36-40. So, humane care, fixed escort and
essential visitation were allowed in our ward. The use of alternative
mechanisms for patient and visitor interactions such as video-call
applications on cell phones or tablets, call and message have received
good results.
Hand is the main transmission route
of respiratory infectious diseases, especially the healthcare
professionals’ hands being the most common transmission route.77Graveto
JMGN, Rebola R, Fernandes E, Costa PS. Hand hygiene: nurses’ adherence
after training. Rev Bras Enferm. 2018;71(3):1189-93. Hand hygiene as
a key infection prevention and control intervention is widely accepted
as the cornerstone for preventing healthcare-associated infections. The
ability of hand hygiene, including hand washing or the use of
alcohol-based hand sanitizers to prevent the transmission of pathogens
in healthcare settings is related to reductions in the number of viable
pathogens that transiently contaminate the hands.88Pidot SJ, Gao
W, Buultjens AH, et al. Increasing tolerance of hospital Enterococcus
faecium to handwash alcohols. Sci Transl Med. 2018;10(452):eaar6115.
Therefore, more attention should be paid to hand hygiene of heathcare
personnel in our hospital by offering alcohol-based ABHR with 75%
ethanol which can inactivate viruses that are genetically related to,
and with similar physical properties as, the 2019-nCoV at the entrance
of inpatient building, ward and rooms.99National Health
Committee of the People’s Republic of China. Specification of hand
hygiene for healthcare workers: WS/T 313-2019 [S/OL]. (2019-11-26)
[2020-04-07].
http://www.nhc.gov.cn/wjw/s9496/202002/dbd143c44abd4de8b59a235feef7d75e/files/6a3e2bf3d82b4ee8a718dbfc3cde8338.pdf
Minimizing chance for exposures to occupational infections is a
fundamental method of protecting healthcare personnel, and personal
protective equipment(PPE) is an effective control. In times of
shortages, specifically facemasks, N95 respirators and gowns at the
begining of COVID-19 outbreak, we made strict system and PPE usage
standard so as to protect healthcare personnel and avoid the waste of
PPE. Appropriate PPE and alternatives were provided depends on their job
duties. Nurses and physicians would wear facemasks for part of the day
when not engaged in direct patient care activities, only switching to
higher level respirator when PPE is required and reusable PPE must be
properly cleaned, decontaminated, and maintained after and between uses.
Supervision is the most cost-effective and effective means to ensure
that policies and measures are effectively implemented. Timely and
periodical record of the implementation of the air and surface
disinfection is a convenient way.
As the COVID-19 pandemic progresses, staffing shortages occurred due to
the medical staff support for the prevention and control of the COVID-19
epidemic in hubei province. Strategies to mitigate staffing shortages
are available, including training and education, material and emotional
support to assist HCP with anxiety and stress, flexible shift according
to the workload and difficulty of the work.