新冠肺炎定点医院医疗收治工作模式初探：以上海市某三甲医院为例

基于上海市某三甲医院的定点医院运行经历，总结该院“全诊疗周期”医疗收治协同工作模式的经验及不足，进而探索和分析新冠肺炎定点医院医疗收治工作模式。认为做好定点医院期间医疗收治工作，一是要建立应急状态下的医疗收治管理体系与工作机制；二是要根据患者结构特征及院区区域布局，及时调整医疗收治管理方法；三是要进一步强化重症患者医疗救治资源储备。建立科学有效的新冠肺炎定点医院医疗收治工作模式，有助于切实提高患者收治效果。     

新冠肺炎疫情期间PICC护理门诊应急管理防控策略

介绍PICC护理门诊在防控新冠肺炎期间的应急护理管理措施，通过全面落实预约诊疗服务、护理人力资源重新分配、加强门诊人员防护、严格候诊区管理、加大PICC、输液港维护室消毒隔离力度等措施，保证PICC护理门诊正常运作，避免就诊患者聚集，保障新冠疫情期间护理人员及来院患者的各项防护标准的有效落实。     

新冠肺炎护理防控中定点收治医院的防控体会

目的:对新冠肺炎护理防控中定点收治医院的防控措施进行总结。方法:通过文献资料及经验总结等方法对新冠肺炎护理防控中定点收治医院的防控措施进行探究。结果及结论:笔者所总结的防控措施包括健全组织,明确职责、制定院内疫情防控工作流程、全员培训、优化配置人力资源,组建应急诊疗区域、加强感染防控及健康监测、加强督导落实、确诊病人单独设立院区管理、区分患者及医护人员通道等。     

三级综合医院呼吸科病房应对新冠肺炎疫情的护理管理策略△

介绍三级综合性医院呼吸科病房在新型冠状病毒肺炎（COVID-19,NCP）疫情期间的护理管理策略,科室通过紧急实施分区收治管理、制订严格的病人收治标准、动态培训新冠肺炎相关知识、实施护理人力资源储备管理、强化责任制护理模式、做好工勤人员培训管理、提升护理人员身心健康以及加强防护用品管理等措施,成功收治患者443例次,无一例病人或医护及工勤人员发生院内感染。     

德阳市人民医院

3月7日18时03分,随着最后一名治愈患者走出医院大门,德阳18名新冠肺炎确诊患者全部治愈出院,实现了新冠肺炎在院治疗患者数为"0",确诊患者死亡数为"0",参与救治的医护人员感染数为"0",德阳市新冠肺炎医疗救治工作取得了阶段性成效。1月中旬,德阳市人民医院全面进入应急防控战备状态,全力应对新型冠状病毒感染的肺炎疫情,并被确定为德阳市新冠肺炎市级定点收治医院,负责收治全市确诊病例。     

支援新冠肺炎患者定点收治医院的实践与思考

文章总结了同济大学附属第十人民医院支援新冠肺炎患者定点收治医院的救治工作经验。即根据所支援的病区新冠肺炎患者状况，合理分配医师、护士、药师三方人力资源，明确各自岗位责任，在分工合作基础上，不断优化工作流程，并始终贯彻院感理念。文章认为对新冠肺炎重症患者治疗是支援救治工作的重点与难点，需同时采取多学科协作和心理干预方式，而持续强化重症医学学科的发展是今后应对重大公共卫生事件的重要策略。     

新冠肺炎护理应急管理双循环体系的构建与实施

以护理应急管理组织架构为基础，构建护理应急管理双循环体系，内循环为人员、物资、场地、制度，外循环为评估、计划、实施、评价、处置。以内循环四项元素为核心，按照外循环施行应急管理流程，推进“两库四级”护理人力分级储备和调度；设立新冠肺炎救治中心，形成患者分类收治；建立防护物资分级管理，优化物资配发和使用流程；落实重点病区和关键环节管理，形成科学有效、动态调整的管理网格。经实践，高效完成防控任务，所有医务人员零感染。基于双循环的护理应急管理体系，可全方位保障人力精准调度，物资精准供应，患者分类收治，保证关键环节质量，指导突发公共卫生事件下护理工作的高效安全开展。     

新冠肺炎疑似病例集中收治医院的改建与管理

目的：探索新冠疫情下,对作为某三级甲等综合医院临时分院,收治新冠肺炎疑似病例的乡镇卫生院的改建与管理。方法：由指定某三级甲等综合医院派出的医疗、护理及院感组成的管理团队对其进行直接管理,通过改造布局流程、规范运行模式、健全制度建设、合理人员配置、严格质量控制,有效落实新冠肺炎的防控措施,防止疫情扩散。结果：新冠肺炎疑似病例集中收治医院共收治新冠疑似患者91例,其中住院患者71例,留观患者20例,6例核酸检测阳性患者安全转运至定点收治医院治疗,所有患者（包含转出的6名）均康复出院居家隔离观察。结论：规范改建后的新冠肺炎疑似病例集中收治医院,成功收治甄别了近百名疑似患者,有效地落实疫情防控措施,提高了突发公共卫生事件的应对能力;同时还培养了一批专业管理及医护人员。     

新型冠状病毒肺炎定点医院应急管理实践与思考

新冠肺炎已被列为国家乙类传染病,并按照甲类传染病要求进行管理。中山大学附属第三医院作为省级新冠肺炎定点收治医院,在医院党委的坚强领导下,医院科学研判,精准施策,制定了一系列行之有效的应急预案和政策措施。通过优化布局、科学调配人力资源和强化后勤保障等一系列应急管理实践,科学有效地做好了院内疫情防控和病患筛查救治等工作。     

新型冠状病毒肺炎定点收治医院应急病房临时党支部建设与探索

目的:探讨传染病医院新型冠状病毒肺炎应急病房临时党支部机制建设。方法:根据《中国共产党支部工作条例(试行)》,规范设置党支部和党小组、推选党支部书记和支委成员,依据《条例》开展支部工作。结果:构建抗击新型冠状病毒肺炎疫情应急病房临时党支部管理模式。结论:收治新冠肺炎的关键时期,定点医院抗击新型冠状病毒肺炎应急病房临时党支部勇于承担管理责任,起到政治核心和管理核心的作用,切实维护人民群众身体健康和生命安全。     

新型冠状病毒感染流行期间大型综合性医院感染防控策略

目的探讨医院新型冠状病毒感染(COVID-19)疫情防控与诊疗救治并行时,如何制定COVID-19医院感染防控策略,为大型综合性医院制定疫情防控策略提供科学依据。方法医院以"管理传染源,切断传播途径,保护易感人群"为原则,分别从"管人"、"管物"、"管流程"方面提出建立应急防控组织体系、发挥疾病预防控制科的专业作用、加强门急诊的管理、加强住院患者的防控管理、管理各级各类人员、制订诊疗防控流程、环境的清洁消毒、人员培训教育、加强后勤物资保障等防控策略与具体措施。结果所有来院患者均得到科学合理接诊,医务人员身体和心理状态稳定,医护人员和住院患者均未出现COVID-19。结论研究医院的COVID-19防控策略可为疫情流行期间综合性医院院内感染防控提供参考。     

新冠肺炎危重症患者收治医院护理人力资源应急管理策略

面对新型冠状病毒肺炎疫情,积极与各医疗队进行沟通协调,护理部积极统筹部署,采取系列应急管理策略:梯队调配、建立规章制度、严格岗前培训、提供心理支持和后勤保障等,从而科学合理地进行人力资源管理,对新型冠状病毒肺炎防治工作顺利进行起到积极作用。     

大型综合医院新型冠状病毒肺炎流行期间门急诊与住院患者的管理实践

目的探讨在新型冠状病毒肺炎(COVID-19)流行期间门急诊与住院患者的管理,旨在有效阻断新型冠状病毒在医院内的传播流行。方法从传染病管理三要素"控制传染源、切断传播途径、保护易感人群"入手,分别对预检分诊、发热门诊及病区住院患者从发热筛查、接诊管理、人员防护、住院管理、应急处置、陪护管理、环境消毒等方面做出具体指导。结果门急诊患者与住院患者经过有效的筛查及合理的接诊、医务人员经过科学的防护、陪护人员经过有效的控制,新型冠状病毒感染流行期间未出现医护人员及住院患者的院内感染事件。结论某大型综合医院的门急诊与住院患者管理策略可为其他综合性医院制定疫情防控策略提供科学参考依据。     

新冠肺炎疫情期间急诊隔离病房改建与管理探讨

新冠肺炎疫情期间,因地制宜地将急诊留观病区改建为急诊重症疑似患者隔离病房,配置相应的物资和人员。通过对临时组建的隔离病房工作人员进行针对性培训,合理配置医务人员,实行弹性排班制度,对防护物资进行量出为入管理,严格执行医院感染防控措施,在疫情防控状态下,既做好了疫情防控工作,防止疫情蔓延,又使得重症疑似患者得到及时救治,也保证了急诊抢救室和普通病区工作的顺利开展。     

品质管理在迅速整建制接管新型冠状病毒肺炎病区中的应用

目的探索品质管理工具在迅速整建制接管新型冠状病毒肺炎病区中的应用,为突发公共卫生事件的应对提供参考。方法运用对策型鱼骨图,结合新型冠状病毒肺炎传染性强的特点,从护理人员管理(人)、物资设备管理(物)、制度流程管理(法)、病区改造管理(环),外加院感工作管理这五个方面来制定具体实施计划。同时引入Plan(计划)、Do(执行)、Check(检查)和Act(处理)的PDCA管理理念,在检查/处理阶段用查检表和甘特图进行检查跟踪,以确保整建制接管后病区能快速运作。结果医疗队到达武汉24 h内完成了病区的改造并开始收治新冠老年患者。24 h内将80名来自不同医院的护理人员摸底并进行了合理排班。驰援一个月以来,共收治患者61人,其中危重症患者17人(27.9%),80岁以上老年患者10人(16.4%)。与其他医疗队安全转运交接57人。护理质量控制检查合格率为100%。医疗队员零感染。结论对策型鱼骨图、调查表、甘特图这些品管方法以及PDCA管理理念在迅速整建制接管新型冠状病毒肺炎病区的实践中及质量持续改进中发挥了重要作用,提高了战时护理管理的效率,为完善突发公共生事件时的护理管理提供参考。     

Does Universal Testing for COVID-19 Work for Everyone?

The Coronavirus disease 2019 (COVID-19) pandemic has been especially devastating among nursing home residents, with both the health circumstances of individual residents as well as communal living settings contributing to increased morbidity and mortality. Preventing the spread of COVID-19 infection requires a multipronged approach that includes early identification of infected residents and health care personnel, compliance with infection prevention and control measures, cohorting infected residents, and furlough of infected staff. Strategies to address COVID-19 infections among nursing home residents vary based on the availability for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests, the incorporation of tests into broader surveillance efforts, and using results to help mitigate the spread of COVID-19 by identifying asymptomatic and presymptomatic infections. We review the tests available to diagnose COVID-19 infections, the implications of universal testing for nursing home staff and residents, interpretation of test results, issues around repeat testing, and incorporation of test results as part of a long-term response to the COVID-19 pandemic. We propose a structured approach for facility-wide testing of residents and staff and provide alternatives if testing capacity is limited, emphasizing contact tracing. Nursing homes with strong screening protocols for residents and staff, that engage in contact tracing for new cases, and that continue to remain vigilant about infection prevent and control practices, may better serve their residents and staff by thoughtful use of symptom- and risk-based testing strategies.     

The Winter Respiratory Viral Season During the COVID-19 Pandemic

The winter respiratory virus season always poses challenges for long-term care settings; this winter, severe acute respiratory syndrome coronavirus 2 will compound the usual viral infection challenges. This special article discusses unique considerations that Coronavirus Disease 2019 (COVID-19) brings to the health and well-being of residents and staff in nursing homes and other long-term care settings this winter. Specific topics include preventing the spread of respiratory viruses, promoting immunization, and the diagnosis and treatment of suspected respiratory infection. Policy-relevant issues are discussed, including whether to mandate influenza immunization for staff, the availability and use of personal protective equipment, supporting staff if they become ill, and the distribution of a COVID-19 vaccine when it becomes available. Research is applicable in all of these areas, including regarding the use of emerging electronic decision support tools. If there is a positive side to this year's winter respiratory virus season, it is that staff, residents, family members, and clinicians will be especially vigilant about potential infection.     

Absence of COVID-19 Disease Among Chronically Ventilated Nursing Home Patients

ObjectiveTo describe the experience of COVID-19 disease among chronically ventilated and nonventilated nursing home patients living in 3 separate nursing homes.DesignObservational study of death, respiratory illness and COVID-19 polymerase chain reaction (PCR) results among residents and staff during nursing home outbreaks in 2020.Setting and Participants93 chronically ventilated nursing home patients and 1151 nonventilated patients living among 3 separate nursing homes on Long Island, New York, as of March 15, 2020. Illness, PCR results, and antibody studies among staff are also reported.MeasurementsData were collected on death rate among chronically ventilated and nonventilated patients between March 15 and May 15, 2020, compared to the same time in 2019; prevalence of PCR positivity among ventilated and nonventilated patients in 2020; reported illness, PCR positivity, and antibody among staff.ResultsTotal numbers of deaths among chronically ventilated nursing home patients during this time frame were similar to the analogous period 1 year earlier (9 of 93 in 2020 vs 8 of 100 in 2019, P = .8), whereas deaths among nonventilated patients were greatly increased (214 of 1151 in 2020 vs 55 of 1189 in 2019, P < .001). No ventilated patient deaths were clinically judged to be COVID-19 related. No clusters of COVID-19 illness could be demonstrated among ventilated patients. Surveillance PCR testing of ventilator patients failed to reveal COVID-19 positivity (none of 84 ventilator patients vs 81 of 971 nonventilator patients, P < .002). Illness and evidence of COVID-19 infection was demonstrated among staff working both in nonventilator and in ventilator units.Conclusions and ImplicationsCOVID-19 infection resulted in illness and death among nonventilated nursing home residents as well as among staff. This was not observed among chronically ventilated patients. The mechanics of chronic ventilation appears to protect chronically ventilated patients from COVID-19 disease.     

Characteristics of Nursing Homes by COVID-19 Cases Among Staff: March to August 2020

ObjectiveTo measure the association between nursing home (NH) characteristics and Coronavirus Disease 2019 (COVID-19) prevalence among NH staff.DesignRetrospective cross-sectional study.Setting and ParticipantsCenters for Disease Control and Prevention COVID-19 database for US NHs between March and August 2020, linked to NH facility characteristics (LTCFocus database) and local COVID-19 prevalence (USA Facts).MethodsWe estimated the associations between NH characteristics, local infection rates, and other regional characteristics and COVID-19 cases among NH staff (nursing staff, clinical staff, aides, and other facility personnel) measured per 100 beds, controlling for the hospital referral regions in which NHs were located to account for local infection control practices and other unobserved characteristics.ResultsOf the 11,858 NHs in our sample, 78.6% reported at least 1 staff case of COVID-19. After accounting for local COVID-19 prevalence, NHs in the highest quartile of confirmed resident cases (413.5 to 920.0 cases per 1000 residents) reported 18.9 more staff cases per 100 beds compared with NHs that had no resident cases. Large NHs (150 or more beds) reported 2.6 fewer staff cases per 100 beds compared with small NHs (<50 beds) and for-profit NHs reported 0.8 fewer staff cases per 100 beds compared with nonprofit NHs. Higher occupancy and more direct-care hours per day were associated with more staff cases (0.4 more cases per 100 beds for a 10% increase in occupancy, and 0.7 more cases per 100 beds for an increase in direct-care staffing of 1 hour per resident day, respectively). Estimates associated with resident demographics, payer mix, or regional socioeconomic characteristics were not statistically significant.Conclusions and ImplicationsThese findings highlight the urgent need to support facilities with emergency resources such as back-up staff and protocols to reduce resident density within the facility, which may help stem outbreaks.     

2015—2018年某地上岗前职业健康检查职业禁忌证检出情况分析

采用描述性流行病研究方法，对2015—2018年某地上岗前职业禁忌证的构成和职业病危害因素分布进行统计学分析。结果显示，噪声、苯及苯系物作业和各类特殊工种的上岗前职业禁忌证检出率较高；双耳高频平均听阈N40dBHL而被列为噪声作业上岗前职业禁忌证者占56.98%。提示《职业健康监护技术规范》(GBZ188—2014)仍需完善，以最大限度地保证劳动者的职业健康。