上海市2022年3至5月新型冠状病毒疫情防控中复旦大学附属儿科医院实施院区气泡式管理的实践和效果  

The practice and effect of bubble management of Children's Hospital of Fudan University during the pandemic of Omicron variant of COVID-19 in Shanghai from March to May in 2022

作　　者：柳龚堡[1] 顾莺 张晓波 王传清 曾玫[5] 沈国妹[6] 陆国平 曹云 张明智 王中林 马健[5] 葛艳玲 张澜 李志华 夏爱梅 翟晓文 周文浩 桂永浩 徐虹 黄国英 LIU Gongbao;GU Ying;ZHANG Xiaobo;WANG Chuanqing;ZENG Mei;SHEN Guomei;LU Guoping;CAO Yun;ZHANG Mingzhi;WANG Zhonglin;MA Jian;GE Yanling;ZHANG Lan;LI Zhihua;XIA Aimei;ZHAI Xiaowen;ZHOU Wenhao;GUI Yonghao;XU Hong;HUANG Guoying(Department of Medical Affairs,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Nursing,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Respiratory,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Infectious Disease,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Nosocomial Infection Control and Prevention,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Outpatient and Emergency Management,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Critical Care Medicine,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Neonatology,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Hematology and Oncology,Children's Hospital of Fudan University,Shanghai,201102,China;Key Laboratory Ministry of Health for Neonatal Diseases,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Nephrology,Children's Hospital of Fudan University,Shanghai,201102,China;Department of Cardiovascular Center,Children's Hospital of Fudan University,Shanghai,201102,China)

机构地区：[1]复旦大学附属儿科医院医务部,上海201102 [2]复旦大学附属儿科医院护理部,上海201102 [3]复旦大学附属儿科医院呼吸科,上海201102 [4]复旦大学附属儿科医院感染传染科,上海201102 [5]复旦大学附属儿科医院医院感染控制和防保办公室,上海201102 [6]复旦大学附属儿科医院门急诊管理办公室,上海201102 [7]复旦大学附属儿科医院重症医学科,上海201102 [8]复旦大学附属儿科医院新生儿科,上海201102 [9]复旦大学附属儿科医院血液科,上海201102 [10]复旦大学附属儿科医院卫生部新生儿疾病重点实验室,上海201102 [11]复旦大学附属儿科医院肾脏科,上海201102 [12]复旦大学附属儿科医院心血管中心,上海201102

出　　处：《中国循证儿科杂志》2022年第3期161-168,共8页Chinese Journal of Evidence Based Pediatrics

基　　金：国家重点研发计划项目:2021YFC2701800,2021YFC2701801;上海市加强公共卫生体系建设三年行动计划(2020-2022)-儿童传染病应急体系建设项目:GWV3.2。

摘　　要：背景新型冠状(新冠)病毒奥密克戎变异株的传染力极强,使得上海市2022年3至5月新冠病毒奥密克戎疫情(简称:本次疫情)在防控之初就兼具复杂性、动态性和不确定性多重特质,使得医院的防控更具挑战。目的探讨实施气泡式管理策略对防控新冠病毒医院感染和职业暴露的效果。设计观察性研究。方法将本次疫情复旦大学附属儿科医院(我院)院内接诊-门诊-急诊-住院-出院设计为一个大气泡,大气泡中6个疫情防控医疗关键部门设计为中气泡,中气泡的9个要隘部门设计为小气泡。①新冠门急诊中气泡接诊健康码红码患儿,五级分诊Ⅰ和Ⅱ级导入抢救室小气泡,Ⅲ~Ⅴ级导入阳性小气泡、既往感染小气泡、密切接触者(密接)小气泡,放射检查室小气泡内接诊新冠门急诊和新冠病房需进行X线/CT检查的患儿;②发热门急诊中气泡接诊绿码/黄码伴发热的患儿;③急诊中气泡接诊绿码/黄码不伴发热的患儿,根据患儿有无48 h内核酸检测阴性报告分流至缓冲区和急诊区,配备第二急诊室备用;④新冠病房中气泡接收新冠门急诊需要收治住院的患儿,重型/危重型收入新冠ICU小气泡,轻型/普通型收入新冠普通病房小气泡;⑤过渡病房中气泡接收除危重症和新生儿外的新入院患儿;⑥新生儿隔离病房中气泡接收医疗机构通过120救护车转运到我院院区的新生儿,收入新生儿隔离病房负压病室小气泡,连续3 d核酸检测,阳性即转入新冠病房,均阴性则转至非负压病室小气泡。不同风险等级的气泡间人员、物品不流动,工作人员从低一级风险进入高一级风险需上报医务科。设立气泡破泡预案。根据工作人员不同岗位制定规范的培训内容及考核要求,通过语音视频监控系统和现场督查进行检查。主要结局指标职业暴露和新冠病毒医院感染。结果我院累计收治新冠阳性患儿432例,其中轻型341例(7Background As Omicron variant is extremely infectious,the pandemic of Omicron variant in Shanghai from March to May this year is complex,dynamic and uncertain,therefore it is more challenging for hospitals.Objective To summarize the experience of bubble management of preventing and controlling nosocomial infection and occupational exposure of COVID-19.Design Observational study.Methods In this pandemic,our hospital is designed as a big bubble.Six key medical departments are designed as medium bubbles,including the outpatient of COVID-19,fever clinic,emergency department,special ward of COVID-19,neonatal isolation ward and transition ward.Several important departments of medium bubbles are designed as small bubbles.Those with a red code,positive results of coronavirus nucleic acid or antigen tests,or infection history of COVID-19,and the close contacts of COVID-19 were admitted to the outpatient of COVID-19.According to the condition and epidemic history,they were arranged to different functional small bubbles.Those fever patients with a green code or a yellow code were admitted to fever clinic.Those with emergent conditions but without fever were admitted to the emergency department which was further divided into two small bubbles named as the buffer area and general area.The back-up was also available.Patients with a positive PCR result were admitted to the special ward of COVID-19 while those with severe critical illness were in the ICU,and the other with mild or common type were in the general ward.All newly admitted children except critical illness and neonates were in the transition ward.Neonates with negative primary screening nucleic acid from pregnant women with COVID-19 were admitted to neonatal isolation ward while all neonates were arranged in the small bubble of negative pressure area first.After daily nucleic acid tests for 3 days,those with negative resulst were transferred to non-negative pressure area and the other with positive results were transferred to special ward of COVID-19.The flow of pers

关 键 词：新型冠状病毒 气泡式管理 医院感染 职业暴露 

分 类 号：R473.72[医药卫生—护理学]