Ying Zhao, Ya Guo
The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, China
As a novel pandemic outbreak in the whole world, coronavirus disease 2019 (COVID-19) has spread rapidly and infected more than 2 million people until 19th April[]. However, in Wuhan, the epicenter of COVID-19 in China, both the number of infected patients and the risk of infection have decreased to low or middle level according to national center of disease control. Meanwhile, the temporary and legendary contagious hospital, named Huoshenshan hospital, were finally closed on 15th, April after finishing the mission of treating more than 3000 patients and achieving the goal of zero infection in healthcare workers (HCW). Compared to the high infected rates of HCW in Wuhan during early stages of the pandemic, the zero infection of HCW is not only a hard-won result, but also the efforts of infection control teams. Herein, we summarize several measures and share the experience, which we hope might help other hospitals to enact effective plan of infection control to prevent COVID-19.
First of all, both facilities and protective equipment played key role in infection control. The hospital was strictly designed and built according to the standard of contagious hospital, namely three zones including contaminated area as red zone, buffered area as yellow zone, and clean area as green zone, while two independent corridors for patients and HCW separately. To prevent virus leaking among areas, pressure of wards are negative whereas the working section for HCW are positive. As World Health Organization suggested, HCW should use personal protective equipment (PPE) rationally for COVID-19[]. Due to nationwide production and supply to Wuhan, PPE are relatively sufficient to use in our hospital. Specifically, during work in contaminated area, HCWs were required to wear respirator, protective suits plus surgical gowns, eye protector, face shield and three pairs of gloves for personal protection, while HCW only wore surgical masks in green zone and in daily life. As one expert of infection control said, ample PPE equipped in this hospital might give HCW an opportunity to reflect and even fear some experienced procedures rather than being infected actually.
Besides aforementioned hardware, the software of infection control is also worth mentioning. First of all, the standardized protocols of wearing and taking off PPE were formulated by infection control experts, thereafter all HCWs were required to receive training of PPE wearing and taken exams concerning to theory and practice of infection control, before they stepped into the red zone.
Secondly, regulations and plans of infection control, which are related to nearly all kinds of healthcare work including waste disposal and exposure management, were formulated and implemented. Notably, important requirements and measures are made in flash or video for HCW to learn and practice in daily work. Last but not the least, digital video monitor systems worked in 24 hours by seven days, especially for key steps related to infection risks, such as actions of taking off PPE in dressing room. The specially-assigned person supervised all the departments through central screens and rectified the mistaken actions by voice in real time. Then daily report of infection control was published the next day via network to summarize the work of previous day and point out the incorrect or inaccurate activities to rectify. All these aforementioned measures helped infection control worked well.
Huoshenshan hospital was finally sealed on April 15th, 2020. In sum, a total of 3059 COVID-19 patients admitted in this hospital, of which 2961 patients were discharged and recovered well. No infection occurred in HCW until now, though14 days of observational isolation continued. We hope our measures and experience in Huoshenshan hospital might assist infection prevention and control in other medical facilities.
Figure 1. PPE and digital video monitor system in Huoshenshan Hospital. A. Isolation gown, B. Particulate Respirator, C. Eye protector, D. Face Shield, E&F. HCW took off PPE recorded by video monitor. PPE, personal protective equipment; HCW, healthcare workers.
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