Prevention and Control of Coronavirus Disease 2019 in Grade-III Class-A Hospitals Outside of Wuhan
The novel coronavirus disease 2019 (COVID-19) epidemic has posed a significant threat to global health, with medical staff facing high risks of occupational exposure during the early stages of the outbreak. The infection of healthcare workers not only diminishes the operational capacity of medical institutions but also facilitates the spread of the virus within hospitals. This underscores the critical importance of robust hospital management, prevention, and control systems in combating infectious diseases. The Chinese People’s Liberation Army Strategic Support Force Characteristic Medical Center (referred to as “the Center”), a Grade-III Class-A hospital located in a densely populated area, implemented a hierarchical and resilient management strategy to address the epidemic. This strategy was tailored to different stages of the outbreak, including the pre-epidemic period, the onset latency, and the full outbreak. This article provides a comprehensive overview of the Center’s approach, offering valuable insights for general hospitals in non-epidemic regions.
Pre-Epidemic Period
Emergency Response
In late December 2019, the Center became aware of cases of pneumonia with unknown causes through online sources. Recognizing the potential severity of the situation, the Center established a “public health emergency information group” to monitor developments, hold regular meetings, and assess the potential impact of the emerging threat. This proactive approach enabled the Center to stay ahead of the curve in preparing for a possible outbreak.
Flow of Human, Material, and Information Resources
To ensure readiness, the Center developed an emergency plan for epidemic outbreaks. This included upgrading the management of medical supplies and expanding procurement channels to secure adequate resources for prevention and control measures. By increasing the supply of essential materials, the Center aimed to mitigate potential shortages during a crisis.
Epidemic Prevention and Control
The Center prioritized training its staff on severe acute respiratory syndrome (SARS)-like diseases and laboratory safety management. Additionally, a preliminary “Emergency Response Plan (Reference Version)” was prepared to guide consultation and treatment processes. These measures laid the groundwork for an effective response to the impending epidemic.
Onset Latency
Emergency Response
By mid-January 2020, the Center had established a leading group for COVID-19 prevention and control, in accordance with the “Protocol for the Prevention and Control of Novel Coronavirus Pneumonia (Second Edition)” issued by the National Health Commission. This group organized offices and expert teams to formulate regulations on diagnosis, prevention, control, and reporting of COVID-19. Simultaneously, the Center began preparing a medical team to support the epidemic-stricken regions.
Flow of Staff, Material, and Information Resources
To manage the evolving situation, the Center implemented flexible duty shifts for medical staff and established procurement management teams to enhance the acquisition of prevention and control supplies. The Center stockpiled twice the usual amount of supplies and set up a reporting system for patients with fever to identify high-risk individuals promptly.
Epidemic Prevention and Control
The Center adhered to the “Technical Specifications for Disinfection in Medical Institutions” to ensure standardized disinfection and quarantine management. Regular coordination meetings on COVID-19 prevention and control were held, and a Welink system was employed to facilitate remote group consultations, reducing face-to-face interactions among staff. Additionally, the Center revised its prevention measures and provided medical staff with Chinese herbal decoctions to bolster their immunity against the virus.
Full Outbreak
Emergency Response
In late January 2020, following regulations from the Beijing Municipal Health Commission, the Center identified suspected and confirmed COVID-19 patients based on clinical standards. A specific route was designated for patient transport, and guidelines were established for the diagnosis and treatment of ordinary patients, patients with fever, and inpatients.
Flow of Staff, Material, and Information Resources
To manage routine medical needs, the Center required outpatients to make appointments in advance and implemented strict controls over hospitalization and the flow of people. The Center increased the prescription duration for patients with chronic diseases from one month to three months and introduced online consultations to reduce non-emergency visits. Despite these measures, the percentage of emergency cases remained consistent with the previous year, indicating that essential medical services were not disrupted.
The Center also ramped up the procurement of protective supplies, increasing the purchase amount to five times the regular level. When inventory fell below a three-day supply, the Center initiated the disinfection and reuse of some protective materials. To prevent misinformation and panic, the leading group designated a special department to ensure the accurate and timely release of information. In high-risk departments, clinical work was rotated among staff to prevent overwork.
Epidemic Prevention and Control
The Center reorganized inpatient areas and designated two additional isolation wards for potential outbreaks. Special processes were developed to manage and treat COVID-19 infections in pregnant women and children with fever. These measures ensured that the Center was prepared to handle complex cases during the outbreak.
Summary of Experience
Establishment of a Resilient Management System in Public Hospitals
The World Health Organization’s Scientific and Technical Advisory Group for Infectious Hazards recommends building resilient health systems to respond effectively to emergencies. The Center’s experience highlights the importance of a hierarchical management system tailored to local realities. This system should include a prioritized emergency response scheme, adequate emergency supplies, rational distribution of medical resources, and robust infectious disease management.
Adequate Emergency Supplies
The Center’s early evaluation and preparation ensured a stable supply of protective materials during the COVID-19 epidemic. This experience underscores the need for hospitals to maintain sufficient stockpiles of essential supplies to avoid shortages during crises.
Rational Distribution of Medical Resources
The Center’s approach to managing medical resources ensured that patients in urgent need of care received timely treatment. High-risk departments, such as emergency, obstetrics, pediatrics, and hemodialysis, implemented standardized measures to protect medical staff while maintaining essential services.
Infectious Disease Management
Timely identification and standardized treatment of infectious diseases are fundamental to epidemic prevention and control. The Center’s training and examination programs for clinicians strengthened their capacity to respond to emergencies effectively.
Leveraging Technology for Dynamic Management
The Center utilized WeChat and other digital tools to enhance the dynamic management of epidemic-related information. Online consultations, web offices, and WeChat workgroups reduced occupational exposure and improved communication efficiency. These measures played a crucial role in the Center’s successful management of the epidemic.
Comprehensive and Elaborate Prevention and Control System
A comprehensive prevention and control system, with the full participation of all staff, is essential for effective epidemic management. Medical institutions must establish resilient and hierarchical systems to implement targeted measures for epidemic prevention and control.
The Center’s experience during the COVID-19 epidemic provides valuable lessons for hospitals in non-epidemic regions. By adopting a hierarchical and resilient management strategy, ensuring adequate emergency supplies, and leveraging technology, hospitals can enhance their capacity to respond to infectious disease outbreaks effectively.
doi.org/10.1097/CM9.0000000000000912
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