Urgent recommendation and practice of prevention and control of novel coronavirus disease 2019 (COVID-19) in intensive care units in West China Hospital of Sichuan University during the epidemics_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Lingying ¹ , HE Lin ² , DENG Lijing ¹ , AN Qi ³ , ZHANG Jinmei ¹ , ZHANG Fengming ¹ , CHEN Lijun ¹ , LUO Yulan ¹ , FENG Mei ¹ , LUO Bingru ¹ ,  TANG Menglin ⁴

1. Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Inteligence Library Center, Chinese Cochrane Center and MAGIC-China Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
3. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
4. Department of Critical Care Medicine/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

TANG Menglin, Email: 1329317046@qq.com

Keywords：

Clinical practice; novlel coronavirus disease 2019 (COVID-19); public health emergency; intensive care unit; recommendation

DOI：

10.7507/1007-4848.202002066

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Objective To provide recommendations for the management of intensive care unit patients without novel coronavirus disease 2019 (COVID-19).Methods We set up a focus group urgently and identified five key clinical issues through discussion. Total 23 databases or websites including PubMed, National Guideline Clearing-House, Chinese Center for Disease Control and Prevention and so on were searched from construction of the library until February 28, 2020. After group discussion and collecting information, we used GRADE system to classify the evidence and give recommendations. Then we apply the recommendations to manage pediatric intensive care unit in the department of critical care medicine in our hospital. Results We searched 13 321 articles and finally identified 21 liteteratures. We discussed twice, and five recommendations were proposed: (1) Patients should wear medical surgical masks; (2) Family members are not allowed to visit the ward and video visitation are used; (3) It doesn’t need to increase the frequency of environmental disinfection; (4) We should provide proper health education about the disease to non-medical staff (workers, cleaners); (5) Medical staff do not need wear protective clothing. We used these recommendations in intensive care unit management for 35 days and there was no novel coronavirus infection in patients, medical staff or non-medical staff. Conclusion The use of evidence-based medicine for emergency recommendation is helpful for the scientific and efficient management of wards, and is also suitable for the management of general intensive care units in emergent public health events.

Citation： WANG Lingying, HE Lin, DENG Lijing, AN Qi, ZHANG Jinmei, ZHANG Fengming, CHEN Lijun, LUO Yulan, FENG Mei, LUO Bingru, TANG Menglin. Urgent recommendation and practice of prevention and control of novel coronavirus disease 2019 (COVID-19) in intensive care units in West China Hospital of Sichuan University during the epidemics. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(4): 388-394. doi: 10.7507/1007-4848.202002066 Copy

1.	Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med, 2020, 382(8): 727-733.
2.	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
3.	牛学英. 心内科重症监护室患者心理特点及护理分析. 继续医学教育, 2019, 33(5): 107-109.
4.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ (online), 2008, 336(7650): 924-926.
5.	中国疾病预防控制中心. 新型冠状病毒感染的肺炎—公众预防指南: 口罩使用临时指南. [2020-01-29]. URL: http://www.chinacdc.cn/jkzt/crb/zl/szkb_11803/jszl_2275/202001/t20200129_211523.html.
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8.	Milton DK, Fabian MP, Cowling BJ, et al. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathogens, 2013, 9(3): e1003205.
9.	Radonovich LJ Jr, Simberkoff MS, Bessesen MT, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: A randomized clinical trial. JAMA, 2019, 322(9): 824-833.
10.	国家卫生健康委员会疾病预防控制局. 关于印发不同人群预防新型冠状病毒感染口罩选择与使用技术指引的通知. [2020-02-04]. URL: http://www.nhc.gov.cn/jkj/s7916/202002/485e5bd019924087a5614c4f1db135a2.shtml.
11.	卫生部办公厅. 关于印发《重症医学科建设与管理指南 (试行)》的通知. [2009-02-26]. URL: http://www.nhc.gov.cn/yzygj/s3577/200902/349983b6ac9844a7a4b2f1ebc75e45fc.shtml.
12.	国家卫生健康委员会妇幼健康司. 关于做好儿童和孕产妇新型冠状病毒感染的肺炎疫情防控工作的通知. [2020-02-02]. URL: http://www.nhc.gov.cn/fys/s7902/202002/de2d62a5711c41ef9b2c4b6f4d1f2136.shtml.
13.	Markwell H, Godkin D. Visitor restrictions during a public health emergency: ethical issues and guidelines for policy development. Ministry of Health and Long Term Care, 2004.
14.	Currie K, Curran E, Strachan E, et al. Temporary suspension of visiting during norovirus outbreaks in NHS Boards and the independent care home sector in Scotland: a cross-sectional survey of practice. J Hosp Infect, 2016, 92(3): 253-258.
15.	尹红, 汪爱民. 探讨预防严重急性呼吸综合征输入与传播的探视制度. 上海护理, 2004, 4(2): 49-50.
16.	Akbari R, Karimi Moonaghi H, Mazloum SR, et al. Implementation of a flexible visiting policy in intensive care unit: A randomized clinical trial. Nurs Crit Care, 2020.
17.	吴雨晨, 姜变通, 丁楠楠, 等. 不同探视制度对 ICU 患者 ICU 获得性感染及相关因素影响的 Meta 分析. 中国感染控制杂志, 2020, 19(1): 20-29.
18.	刘远金, 黄玉敏, 文艺, 等. 视频与传统健康教育相结合模式在限制式探视 ICU 患者家属中的应用. 齐鲁护理杂志, 2018, 24(11): 71-74.
19.	李舍予, 黄文治, 廖雪莲, 等. 新型冠状病毒感染医院内防控的华西紧急推荐. 中国循证医学杂志, 2020, 20(2): 125-133.
20.	Hess AS, Shardell M, Johnson JK, et al. A randomized controlled trial of enhanced cleaning to reduce contamination of healthcare worker gowns and gloves with multidrug-resistant bacteria. Infect Control Hosp Epidemiol, 2013, 34(5): 487-493.
21.	张晶, 周晶, 田洋洋, 等. 神经外科监护病房高频接触物体表面消毒频次的研究. 中国感染控制杂志, 2019, 18(4): 331-334.
22.	董锋. 护工培训需求的调查分析与对策. 深圳中西医结合杂志, 2014, 24(1): 155-156.
23.	Gupta P, Tang X, Rettiganti M, et al. Association of house staff training with mortality in children with critical illness. Acta Paediatrica, 2015, 105(2): e60-e66.
24.	丁汉梅, 吴红, 邓晖, 等. 烧伤 ICU 的护工强化管理. 护理学杂志, 2011, 26(6): 79-80.
25.	国家卫生健康委员会疾病预防控制局. 新型冠状病毒感染不同风险人群防护指南. [2020-01-30]. URL: http://www.nhc.gov.cn/jkj/s7916/202001/a3a261dabfcf4c3fa365d4eb07ddab34.shtml.

1. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med, 2020, 382(8): 727-733.
2. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
3. 牛学英. 心内科重症监护室患者心理特点及护理分析. 继续医学教育, 2019, 33(5): 107-109.
4. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ (online), 2008, 336(7650): 924-926.
5. 中国疾病预防控制中心. 新型冠状病毒感染的肺炎—公众预防指南: 口罩使用临时指南. [2020-01-29]. URL: http://www.chinacdc.cn/jkzt/crb/zl/szkb_11803/jszl_2275/202001/t20200129_211523.html.
6. 国家卫生健康委员会. 关于印发新型冠状病毒肺炎诊疗方案 (试行第六版) 的通知. [2020-02-18]. URL: http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
7. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Interim guidance for the use of masks to control seasonal influenza virus transmission. [2019-03-05]. URL: https://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm.
8. Milton DK, Fabian MP, Cowling BJ, et al. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathogens, 2013, 9(3): e1003205.
9. Radonovich LJ Jr, Simberkoff MS, Bessesen MT, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: A randomized clinical trial. JAMA, 2019, 322(9): 824-833.
10. 国家卫生健康委员会疾病预防控制局. 关于印发不同人群预防新型冠状病毒感染口罩选择与使用技术指引的通知. [2020-02-04]. URL: http://www.nhc.gov.cn/jkj/s7916/202002/485e5bd019924087a5614c4f1db135a2.shtml.
11. 卫生部办公厅. 关于印发《重症医学科建设与管理指南 (试行)》的通知. [2009-02-26]. URL: http://www.nhc.gov.cn/yzygj/s3577/200902/349983b6ac9844a7a4b2f1ebc75e45fc.shtml.
12. 国家卫生健康委员会妇幼健康司. 关于做好儿童和孕产妇新型冠状病毒感染的肺炎疫情防控工作的通知. [2020-02-02]. URL: http://www.nhc.gov.cn/fys/s7902/202002/de2d62a5711c41ef9b2c4b6f4d1f2136.shtml.
13. Markwell H, Godkin D. Visitor restrictions during a public health emergency: ethical issues and guidelines for policy development. Ministry of Health and Long Term Care, 2004.
14. Currie K, Curran E, Strachan E, et al. Temporary suspension of visiting during norovirus outbreaks in NHS Boards and the independent care home sector in Scotland: a cross-sectional survey of practice. J Hosp Infect, 2016, 92(3): 253-258.
15. 尹红, 汪爱民. 探讨预防严重急性呼吸综合征输入与传播的探视制度. 上海护理, 2004, 4(2): 49-50.
16. Akbari R, Karimi Moonaghi H, Mazloum SR, et al. Implementation of a flexible visiting policy in intensive care unit: A randomized clinical trial. Nurs Crit Care, 2020.
17. 吴雨晨, 姜变通, 丁楠楠, 等. 不同探视制度对 ICU 患者 ICU 获得性感染及相关因素影响的 Meta 分析. 中国感染控制杂志, 2020, 19(1): 20-29.
18. 刘远金, 黄玉敏, 文艺, 等. 视频与传统健康教育相结合模式在限制式探视 ICU 患者家属中的应用. 齐鲁护理杂志, 2018, 24(11): 71-74.
19. 李舍予, 黄文治, 廖雪莲, 等. 新型冠状病毒感染医院内防控的华西紧急推荐. 中国循证医学杂志, 2020, 20(2): 125-133.
20. Hess AS, Shardell M, Johnson JK, et al. A randomized controlled trial of enhanced cleaning to reduce contamination of healthcare worker gowns and gloves with multidrug-resistant bacteria. Infect Control Hosp Epidemiol, 2013, 34(5): 487-493.
21. 张晶, 周晶, 田洋洋, 等. 神经外科监护病房高频接触物体表面消毒频次的研究. 中国感染控制杂志, 2019, 18(4): 331-334.
22. 董锋. 护工培训需求的调查分析与对策. 深圳中西医结合杂志, 2014, 24(1): 155-156.
23. Gupta P, Tang X, Rettiganti M, et al. Association of house staff training with mortality in children with critical illness. Acta Paediatrica, 2015, 105(2): e60-e66.
24. 丁汉梅, 吴红, 邓晖, 等. 烧伤 ICU 的护工强化管理. 护理学杂志, 2011, 26(6): 79-80.
25. 国家卫生健康委员会疾病预防控制局. 新型冠状病毒感染不同风险人群防护指南. [2020-01-30]. URL: http://www.nhc.gov.cn/jkj/s7916/202001/a3a261dabfcf4c3fa365d4eb07ddab34.shtml.

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Urgent recommendation and practice of prevention and control of novel coronavirus disease 2019 (COVID-19) in intensive care units in West China Hospital of Sichuan University during the epidemics

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