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Objective To analyze the current situation of healthcare-associated infection (HCAI) management of fever clinics among different levels of medical institutions in Wuhan, and to provide a scientific basis for improving hospital infection management. Methods In January 2023, a network questionnaire survey was conducted on medical institutions with fever clinics in Wuhan. Results A total of 72 medical institutions were investigated, of which 58.33% had CT, and 48.61% had fever clinics for children. The total qualified rate of HCAI management was 78.28%. The qualified rates of four primary indicators, including hospital management, diagnosis and treatment environment protection, training and education, and implementation of infection control measures, were 82.27%, 71.49%, 75.93%, and 81.31%, respectively. There were statistical differences among different levels of medical institutions (all P<0.01). Among the 13 secondary indicators, the qualified rates of 7 indicators were more than 80%, with the highest being medical item management (93.06%), medical waste disposal (89.72%), and personnel management (83.33%), and the lowest being facilities and equipment (66.32%), and patients and accompanying personnel education (66.67%). Among the 65 tertiary indicators, 30 had a pass rate great than 80%. Conclusion Wuhan actively promotes the construction of fever clinics in medical institutions, and the overall situation of HCAI management is good. However, there are still some problems to varying degrees, especially in the layout procedures, hand hygiene, and staff training of fever clinics in secondary and lower medical institutions, which should be further strengthened.
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As a front-line department for the prevention and control of respiratory infectious diseases, the construction and management of fever clinics have also been adjusted with the changes of the epidemic situation in different periods. In this context, the scope of diagnosis and treatment of fever clinics should be expanded again, not limited to the detection and screening of infectious diseases, but should focus on early treatment and prevention of severe diseases. Management measures should also be further optimized with the expansion of patient types. Face of this situation, we need to actively explore the integration of epidemic prevention and control into the normalized diagnosis and treatment environment, and at the same time maintain the ability to respond to the outbreak of the epidemic. As a hospital of traditional Chinese medicine, it is also important to play and develop the characteristics of traditional Chinese medicine in the construction of fever clinic.
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OBJECTIVE@#To simulate the different prevalence of corona virus disease 2019 (COVID-19) in Beijing as the spreading and the outbreak city and analyze the response capacity of its medical resources of fever clinics, and to provide a scientific basis for optimizing the spatial layout in Beijing under severe epidemics.@*METHODS@#The study obtained epidemiological indicators for COVID-19, factors about medical resources and population movement as parameters for the SEIR model and utilized the model to predict the maximum number of infections on a single day at different control levels in Beijing, simulated as an epidemic spreading city and an epidemic outbreak city respectively. The modified two-step floating catchment area method under ArcGIS 10.6 environment was used to analyze spatial accessibility to fever clinics services for the patients in Beijing.@*RESULTS@#According to the results of the SEIR model, the highest number of infections in a single day in Beijing simulated as an epidemic spreading city at low, medium and high levels of prevention and control were 8 514, 183, and 68 cases, the highest number of infections in a single day in Beijing simulated as an outbreak city was 22 803, 10 868 and 3 725 cases, respectively. The following result showed that Beijing was simulated as an epidemic spreading city: among the 585 communities in Beijing, under the low level of prevention and control, there were 17 communities (2.91%) with excellent accessibility to fever clinics, and that of 41 communities (7.01%) with fever clinics was good. Spatial accessibility of fever clinics in 56 communities (9.57%) was ranked average, and 62 communities' (10.60%) accessibility was fair and 409 communities (69.91%) had poor accessibility; at the medium level of prevention and control, only the west region of Fangshan District and Mentougou District, the north region of Yanqing District, Huairou District and Miyun District had poor accessibility; under the high level of prevention and control, 559 communities' (95.56%) had excellent accessibility. The accessibility in 24 communities (4.10%) was good and in 2 communities (0.34%) was average. In brief, the existing fever clinics could meet the common demand. Beijing was simulated as an outbreak city: under the low level of prevention and control, only 1 community (0.17%) had excellent accessibility to fever clinics, and 5 communities (0.86%) had good accessibility. The accessibility of fever clinics in 10 communities (1.71%) was average and in 12 communities (2.05%) was fair. The accessibility of fever clinics in 557 communities (95.21%), nearly all areas of Beijing, was poor; under the middle and high level of prevention and control, the accessibility of ecological conservation areas was also relatively poor.@*CONCLUSION@#The distribution of fever clinic resources in Beijing is uneven. When Beijing is simulated as an epidemic spreading city: under the high level of prevention and control, the number of fever clinics can be appropriately reduced to avoid cross-infection; at the medium level of prevention and control, the fever clinics can basically meet the needs of patients with fever in Beijing, but the accessibility of fever clinics in ecological conservation areas is insufficient, and priority should be given to the construction of fever clinics in public hospitals above the second level in the ecological conservation areas. When the level of prevention and control is low, the accessibility of fever clinics in ecological conservation areas is poor. Priority should be given to the construction of fever clinics in ecological conservation areas, and temporary fever sentinels can be established to relieve the pressure of fever clinics. When Beijing is simulated as an outbreak city and has low prevention and control, due to a large number of infections, it is necessary to upgrade the prevention and control level to reduce the flow of people to curb the development of the epidemic.
Subject(s)
Humans , Beijing , COVID-19 , Catchment Area, Health , China/epidemiology , Cities , SARS-CoV-2ABSTRACT
Objective To observe the visits of fever clinic during the epidemic of coronavirus disease 2019 (COVID-19) and the epidemic characteristics of COVID-19, so as to analyze the disease development trend. Methods The clinical data of fever outpatients (including COVID-19 patients) in Gongli Hospital affiliated to Naval Medical University (Second Military Medical University) from Jan. 15, 2020 to Feb. 29, 2020 were collected for epidemiological descriptive analysis. Results Among the 2 193 patients visiting our hospital between Jan. 15, 2020 and Feb. 29, 2020, 97.08% had respiratory system infection, followed by digestive system infection and urinary system infection. Eighty-one suspected cases and 10 confirmed cases of COVID-19 were identified. Among the suspected cases, there were 38 males (46.91%) and 43 females (53.09%). Among the confirmed cases, four were males and six were females. The onset age of the suspected cases ranged from 20 to 69 years old (83.95%), and all the 10 confirmed patients were ≥50 years old. The suspected patients were mainly employees (31 cases, 38.27%) and retirees (14 cases, 17.28%). Among the 10 confirmed patients, eight cases were retirees. Of the suspected cases, 15 (18.52%) had lived in Hubei province and 52 (64.20%) had an epidemiological history. Of the confirmed cases, seven had lived in Hubei province and all had an epidemiological histories. The onset cycles of suspected and confirmed cases were mainly from Jan. 21, 2020 to Feb. 10, 2020. The main clinical symptoms of the suspected cases were fever (66 cases, 81.48%) and cough (50 cases, 61.73%). The blood routine showed normal white blood cell (65 cases, 80.25%), normal lymphocyte (49 cases, 60.49%) and decreased lymphocyte (24 cases, 29.63%). Chest CT showed COVID-19 characteristics in 13 cases (16.05%). Among the 10 confirmed patients, the main clinical manifestations were also fever (nine cases) and cough (eight cases). The blood routine showed normal white blood cells (10 cases), normal lymphocytes (six cases) and decreased lymphocytes (four cases). Chest CT showed COVID-19 characteristics in seven cases. Conclusion COVID-19 is more common in middle-aged and elderly retirees, with significant epidemiological and family clustering characteristics.
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Objective To discuss the image features of different types of pneumonia. Methods The method and flow for CR chest radiography at fever clinics were described. Results The method and flow for CR chest radiography at fever clinics were improved. Conclusion Method improvement is very significant.