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急诊实施气泡式管理的实践和效果  

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

作　　者：杨雪 张燕红 程晔 陈扬 何丽明 王文超 陆国平 马健[2] YANG Xue;ZHANG Yanhong;CHENG Ye;CHEN Yang;HE Liming;WANG Wenchao;LU Guoping;MA Jian(Department of Critical Care Medicine,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Nosocomial Infection Prevention and Control,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院重症医学科,上海201102 [2]复旦大学附属儿科医院医院感染科,上海201102

出　　处：《中国循证儿科杂志》2022年第3期175-178,共4页Chinese Journal of Evidence Based Pediatrics

基　　金：国家重点研发计划项目:2021YFC2701800、2021YFC2701805;上海市市级科技重大专项资助课题:ZD2021CY001。

摘　　要：背景上海市2022年3至5月发生的新型冠状(新冠)病毒Omicron疫情(简称:本次疫情)使得复旦大学附属儿科医院(我院)重症医学科急诊救治和疫情防控非常具有挑战。目的探讨实施气泡式管理策略对急诊救治和疫情防控的效果。设计观察性研究。方法本次疫情期间我院为大气泡,急诊作为中气泡,设置缓冲、急救、诊室和留观4个小气泡。基于“四区二通道二预检”对急诊原来的布局和流程加以改造。四区:①清洁区为医务人员生活区、办公室、库房及个人防护设备(PPE)穿戴区,②潜在污染区包括个人防护用品第一脱卸间(一脱间)和第二脱卸间(二脱间),③污染区包括第二预检区、候诊区、急救小气泡、诊室小气泡、留观室小气泡,④高风险区为第一预检区和缓冲小气泡;二通道:清洁和污染通道;二次预检:预检初筛在急诊入口处,入急诊后根据五级分诊预检。急诊缓冲小气泡接诊健康码红码、无48 h内核酸检测阴性结果、预检初筛时医生判断为危重症的患儿;抢救室小气泡接诊有48 h内核酸检测阴性结果、第二次预检五级分诊Ⅰ级和Ⅱ级患儿;诊室小气泡接诊有48 h内核酸检测阴性结果或虽无48 h内核酸检测阴性结果但现场抗原检测阴性、第二次预检Ⅲ~Ⅴ级患儿;留观小气泡收治我院当天核酸检测结果阴性、需要留观的患儿。设立第二急诊作为急诊出现新冠阳性患儿需要临时封控时的备用急诊室。建立气泡破裂预案,当患儿核酸检测结果阳性但因报告延迟而进入急诊抢救室和诊室小气泡时,暴露场所先进行环境采样以评估环境污染程度,终末消毒后再次采样以评估环境安全性,核酸检测阴性再恢复使用。必要时启用第二急诊。主要结局指标医护、医辅人员职业暴露和医院感染。结果我院急诊共接诊患儿12114例,Ⅰ~Ⅴ级分别有15、310、8728、2564、497例。进行大抢救7次,�Background The Omicron pandemic in Shanghai from March to May 2022 is very challenging for the emergency department to attach equal importance to emergency rescue and pandemic prevention and control.Objective To explore the effect of bubble strategy on emergency rescue and pandemic prevention and control.Design Observational study.Methods During this pandemic period,the hospital is designed as a big bubble,and the emergency department is designed as a medium bubble.The buffer zone,resuscitation room,consulting room and observation room are designed as small bubbles.Based on"four zones,two channels and twice triage",the original layout and process of emergency department were modified.The four zones were as the following:a.the clean zone mainly included personnel living room and personal protective equipment(PPE)donning room;b.the potentially contaminated zone was set between the contaminated zone and clean zone,including PPE doffing room 1 and 2;c.the contaminated zone included the second triage area,waiting area,resuscitation room,consulting rooms and observation room;d.the high-risk contaminated zone included the first triage area and buffer zone.Two channels were clean and contamination channels.Twice triage referred to the initial screening at the entrance of the emergency department,and five-level triage after admission to the emergency department.The buffer zone was used for those who were diagnosed with critical illness but had a red health code and no negative nucleic acid test results within 48 hours.LevelⅠ/Ⅱpatients with negative nucleic acid test results within 48 hours were admitted to the resuscitation room.LevelⅢ-Ⅴpatients with negative nucleic acid test results within 48 hours or negative on-site antigen test results were arranged to the consulting room.Patients who had negative nucleic acid test results on the day of entering the hospital and requirements for observation are admitted to the observation room.The second emergency room was set up as a backup emergency room when the major emer

关 键 词：新型冠状病毒 医院感染 职业暴露 急诊 危重症 

分 类 号：R473.72[医药卫生—护理学]