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.