and LI Ning2
(1)
Radiology Department, Capital Medical University Beijing You’an Hospital, Beijing, China, People’s Republic
(2)
Capital Medical University Beijing You’an Hospital, Beijing, China, People’s Republic
Abstract
Since SARS epidemic beginning in Sep. 2002 in China, many hospitals established fever clinics to separate fever patients from common patients to control the spreading of infectious diseases. Such a measure played an indispensable role in curbing the spread of SARS.
16.1 Nursing Care Management in Fever Clinics
Since SARS epidemic beginning in Sep. 2002 in China, many hospitals established fever clinics to separate fever patients from common patients to control the spreading of infectious diseases. Such a measure played an indispensable role in curbing the spread of SARS.
16.1.1 Fever Clinics/Emergency Room
The medical institutions should be required to set up fever clinics and a system of pre-examination for triage should be established for patients to get appropriate treatments in fever clinics. The following measures should be taken in fever clinics:
1.
To set up an independent area for fever clinic with eye attracting signboard and with both entrance and exit independent of general out-patients’.
2.
The waiting area of the fever clinic should be well ventilated and spacious enough for waiting patients.
3.
A spare consulting room should be prepared.
4.
A toilet should be independently prepared.
5.
Registration department, consulting rooms and pharmacies should be independent of those in general clinics.
6.
Patients with fever and acute respiratory symptoms should wear surgical face masks, cover nose and mouth with a tissue when coughing or sneezing and dispose of the tissue to medical wastes containers.
7.
Standard preventive measures and preventive measures against droplet transmission should be applied when medical staffs closely contact (with a distance of less than 1 m) with patients with fever and acute respiratory symptoms. Patients should wear surgical face masks.
8.
Isolated observation rooms should be set up, which should be in an independent area with eye attracting signboard. A suspected patient should be quarantined in a single room equipped with bathroom. Patients should wear a surgical face masks and can move around only in the observation room.
16.1.2 Nursing Care Responsibilities in Fever Clinics/Emergency Rooms
1.
The consultation in fever clinic should be performed in an enclosed area with certain procedures. Based on the patients’ conditions, the patients should be timely and accurately triaged. The direct contacts between fever patients and other patients should be avoided. Protective face masks should be distributed to patients and the consulting time should be as short as possible.
2.
Protective quarantine between fever patients should be well performed. The patients with definitive diagnosis, suspected diagnosis and patients for medical observations should be strictly distinguished for placement to avoid cross infections. Meanwhile, the patients conditions should be closely observed and recorded in detail. Any abnormalities should be timely reported to physicians and necessary assistance in management should be performed.
3.
After the consultation, the nurse should record in detail the patients’ final diagnosis and the recommendations and therapies for future inquiries.
4.
For patients with confirmative or suspected diagnosis, their personal data including residence address, work unit address, telephone number of the patients should be reported to the local CDC and they should be quickly transferred to the designated hospital or designated inpatients area. The family members of patients with confirmative or suspected diagnosis should be quarantined according to the national law on the prevention treatment of infectious diseases.
16.2 Nursing Care in Inpatient Areas
16.2.1 Requirements for Working Staffs (Class II Protection)
Principle: Limit the number of working staffs who make contacts to patients.
These working staffs should not be assigned to attend other patients. The number of other hospital staffs who have access to these patients, such as cleaners and laboratory workers, should also be restricted.
The body temperatures of the working staffs who have direct contact with patients should be measured and recorded twice daily by themselves. Any occurrence of fever should be reported to the hospital administration. Once these working staffs who have direct contacts with patients are found to have a body temperature of above 38 °C, they should receive treatment immediately.
The working staffs who feel ill should not be appointed to directly attend patients because their exposure to Influenza A (H1N1) virus may cause them more susceptible to Influenza A (H1N1) or may have increased chances of severe diseases.
1.
Medical protective masks must be worn when one enters the quarantined observation room and specialized inpatients areas. And the medical protective masks should be changed every 4 h or when sense of wetness is felt. In addition, other protective measures including work clothing, special clothing for quarantine, gloves, shoes cover and working cap should be worn.
2.
After attendance to the patient, the working staffs should wash and sterilize their hands as soon as possible. For hands sterilization, 0.3–0.5 % iodophor disinfectant solution can be applied. Alternatively, instant hand disinfectant (acetate chlorhexidine alcohol solution, benzalkonium bromide in alcohol solution or 75 % alcohol) can be applied to rub hands for 1–3 min.
3.
Treatment, nursing care and daily activities of patients should be limited within the wards.
4.
Operations of treatment or nursing care within a short distance to patients should be performed with protective glasses worn.
16.2.2 Management Requirements for Patients
Patients who are classified as medically observed patients or with a history of close contact with definitive diagnosed patients should be medically observed for 7 days. The confirmatively diagnosed and suspected patients should be separately managed.
For the suspected patients, a single room should be prepared for one patient to be medically observed. Several suspected patients sharing one room is prohibited.
For the confirmatively diagnosed patients, the patients should be admitted to the designated hospital. Several patients can share one room. Such patients should be quarantined within designated wards with >1 cm interval between ward beds. Physical barriers (such as curtains and screens) should be preferably used to separate ward beds.
16.2.3 Management Requirements for Circumstances of Inpatients Areas
The quarantine wards should have eye-attracting signboard and the visits should be limited. Specific ways should be dedicated respectively for working staffs and patients.
1.
The wards should be well-ventilated in an independent area with an eyes attracting signboard.
The ward should be reasonably layout, with a clean area, a semi-contaminated area and a contaminated area, with no overlapping to each other. A buffer zone should be divided out respectively in the three areas with an isolating barrier.
2.
Offices for medical staffs should be well-ventilated and isolated from wards without crossed area, preferably with a certain distance.
3.
Visitors and working staffs entering into the wards must be protected with class II protection, measures including wearing cotton masks of more than 12 layers, caps, gloves, quarantining clothes, shoes covers.
4.
A staff member should be designated to inspect the protective measures adopted by visitors and working staffs.
5.
Hospitalized patients are required to wear a mask, strictly quarantined and managed. Their leaving the ward is prohibited.
6.
A visiting regulatory system should be strictly implemented. No companions and no visitors are permitted. For critically and severely ill patients, the visitors should be protected with class II protective measures, including wearing cotton masks of more than 12 layers, caps, gloves, clothes covers and shoes covers.
16.2.4 Management Requirements for Environments and Medical Materials
According to the guidelines for infection regulation in hospitals,
1.
Enough expertise in disinfection and quarantine, such as disinfection of patients’ excrements and secretions, disinfection of air and medical history notebooks, disinfection of contaminated places and medical materials and terminal management of medical materials (equipments, medical history notebooks, wards, clothes, bed sheets) after discharge or death.
2.
Improved wards conditions, with restricted visitors flow and strictly regulated cleaning procedures to prevent cross-infection.
3.
Improved wards equipments, with favorable reservations of beds, equipments, facilities, pharmaceuticals, vehicles and other protective equipments.
16.3 Basic Protective Measures
16.3.1 Personal Protection of Medical Staffs
16.3.1.1 Class I Protection
1.
It is appropriate for medical staffs working in fever clinics/emergency departments.
2.
In working clothes, gloves and caps.
3.
After attendance to the patients, the medical staffs should immediately wash and sterilize their hands. For sterilizing hands, 0.3–0.5 % iodophor disinfectant solution can be used or instant hand disinfectants (acetate chlorhexidine alcohol solution, benzalkonium bromide in alcohol solution, 75 % alcohol) can be used to rub hands for 1–3 min.
16.3.1.2 Class II Protection
1.
It is appropriate for medical staffs who have access to the quarantined observation rooms and specialized inpatients areas, who collect specimens from bodies of the patients, who manage the patients’ secretions, excrements, personal belongings and corpses and those medical staffs and drivers with responsibilities of transferring patients.
2.
Medical protective face masks must be worn by anyone who has access to the observation rooms and specialized inpatients wards. The face mask should be changed every 4 h or when sense of wetness is felt. In addition, working clothes, clothes covers, gloves and caps should be worn.
3.
After attendance to the patients, the medical staffs should immediately wash and sterilize their hands. For sterilizing hands, 0.3–0.5 % iodophor disinfectant solution can be used or instant hand disinfectants (acetate chlorhexidine alcohol solution, benzalkonium bromide in alcohol solution, 75 % alcohol) can be used to rub hands for 1–3 min.
4.
A pair of protective glasses should be worn during operations in a short distance from the patients.
5.
The respiratory tract and mucous membrane should be given focused protection.
16.3.1.3 Class III Protection
1.
It is appropriate for the medical staffs performing sputum suction, tracheotomy and endotracheal intubation for patients.
2.
In addition to class II protection, the medical staffs should also wear a comprehensive respiratory protector.
16.3.2 Requirements and Methods for Hand-Cleaning and Hand-Disinfection
16.3.2.1 Requirements for Hand-Washing
1.
Before and after attendance to the suspicious, suspected and confirmative cases of Influenza A (H1N1).
2.
After contacts to blood, body fluids, excrements, secretions and contaminated materials.
3.
Before wearing protective wares for access to quarantined inpatients wards and after taking off protective wares leaving quarantined inpatients wards.
4.
For the same patient, before the shift from contaminated operations to clean operations.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
