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Objective:To analyze the causes of SARS-CoV-2 nosocomial infection among healthcare workers (HCWs) and explore the effective precaution strategies in Emergency Center.Methods:The data of SARS-CoV-2 infected HCWs from January 5 to March 2, 2020 were retrospectively analyzed and compared under different conditions in Emergency Center of Zhongnan Hospital of Wuhan University.Results:Totally 13 SARS-CoV-2 infected HCWs (12 confirmed cases and 1 suspected case) were included in this study. The overall infection rate was 17.8% (13/73). The infection rates in outpatient/rescue room, isolation observation room and isolationin patient ward were 11.8% (4/34), 20.0% (3/15), 25% (6/24), respectively. The infection rate of physician was 13.0% (3/23), and the infection rate of nurse was 20.0% (10/50). All the infected HCWs had the definite exposure with confirmed or suspected COVID-19 patients. One asymptomatic cases were identified by laboratory findings of SARS-CoV-2 infection screening. There was no new confirmed SARS-CoV-2 infected HCWs after February 5, 2020. All the infected HCWs were cured.Conclusions:Under the epidemic of COVID-19, HCWs of Emergency Center have a high risk of occupational exposure and infection, especially for staffs working in COVID-19 isolation units. Scientific prevention and control management can effectively reduce the risk of SARS-CoV-2 infections and ensure the occupational safety for HCWs in Emergency Center.
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Objective:To investigate thromboprophylaxis of patients with COVID-19.Methods:Clinical data of 31 patients with COVID-19 in Zhongnan Hospital of Wuhan University was analyzed retrospectively, including basic information, clinical characteristics, examination results, therapy and Padua scores. 5G remote ultrasound diagnosis system was used in the ultrasonography of lower limb vein, inferior vena cava and the heart. According to the patient′s status, the thromboprophylaxis was established, and the incidence of venous thromboembolism (VTE) was observed.Results:There were 20 cases of general types and 11cases of severe types. All patients underwent dynamic assessment and thromboprophylaxis. Basic prevention was applied in 28 cases and mechanical prevention was used in 3 cases. There was no VTE event in all patients during hospitalization.Conclusions:Prevention and monitoring of VTE is an important part of the treatment of patients with COVID-19, which can effectively reduce the incidence of lower extremity deep vein thrombosis and fatal pulmonary embolism in isolation ward.
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Objective To compare the change of management time for patients with acute cerebrovascular disease before and after re-accreditation of Grade Ⅲ Class A in a general hospital.Methods Electronic medical records of 490 patients diagnosed as acute cerebrovascular disease(215 cases of cerebral infarction,275 cases of cerebral hemorrhage) managed in Zhongnan Hospital of Wuhan University from June 2015 to July 2016 were collected,including 262 patients managed before re-accreditation (group A,June 2015 to December 2015) and 228 patients admitted after re-accreditation (group B,January 2016 to July 2016).In group A,there were 109 cases of cerebral infarction and 153 cases of cerebral hemorrhage(68 caused by trauma);in group B there were 106 cases of cerebral infarction and 122 cases of cerebral hemorrhage(54 caused by trauma).The time in emergency department (ED time),time waiting for admission (admission time) and the total management time (total time) were analyzed and compared between two groups.Results The ED time in group A and group B was 44.5 (30.0,71.5) and 39.0 (20.3,69.0) min (Z =-2.103,P =0.036) respectively;the admission time was 35.0 (25.8,50.0) and 39.0 (27.3,55.8) min(Z =-2.211,P=0.027);and total time was 85.0(62.8,120.0)and 82.5(61.0,119.0) min(Z =-0.356,P =0.722) in two groups respectively.For patients of cerebral infarction in group A and B the ED time was 49.0 (33.5,81.5) and 41.0 (29.8,74.3) min(Z =-1.872,P =0.061);the admission time was 37.0(27.0,52.0) and 36.0(25.0,52.3) min(Z =-0.516,P =0.606);and total timewas97.0(69.5,131.0)and 83.5(62.0,118.3) min(Z=-1.914,P=0.056).For patients of cerebral hemorrhage in group A and B,the ED time was 42.0 (28.0,64.0) and 35.0 (17.8,65.0) min (Z=-1.426,P =0.154);the admission time was 34.0(24.5,49.0)and 41.0(31.0,61.0) min (Z=-3.353,P =0.001);and total time was 79.0(58.0,108.0) and 82.0(60.0,120.8) min (Z =-1.052,P =0.293).Conclusions After re-accreditation of Grade Ⅲ Class A Hospital the total waiting time for patients of cerebral infarction is decreased significantly in emergency department,however,for patients of cerebral hemorrhage the waiting time for admission is longer.
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Objective To explore the role of rescue video logical slice and interactive analysis in the continuous improvement of quality of emergency care of multiple injury. Methods To establish a management team for the rescue video interactive analysis. From May, 2015 to April, 2016, every Wednesday from 8:00-11:00 am, the data of multi-injury patients registered in our management software of critical emergency cases were selected. A typical case study of the rescue video logical slices were processed through sorting the video cases in the video surveillance system installed in the emergency room. According to the characteristics of diagnosis and treatment of multiple injury, the evaluation indexes of nursing quality in emergency treatment of multiple injury were formulated and video data was analyzed interactively by using the failure mode analysis and root cause analysis. Based on the above analyzed results, the quality of emergency care of Multiple Injury was controlled and improved. Before and after performing the rescue video logic slices and interactive analysis management, the examined results of multiple injury first-aid nursing quality index, as well as the rate of patients satisfaction and nursing defects were compared. Results Before the implementation of the above method, the time of emergency treatment for multiple injury, the rate of patients with successful rescue, the rate of patient transport defect and the rate of missing items in the rescue unit were respectively as follows:(87.1±7.4)min, 90.77%(59/65), 30.77%(20/65), 12.31%(8/65),whereas after the implementation, the relevant data were (57.5 ± 5.2) min, 100.00%(68/68), 10.29%(7/68), 2.94%(2/68). The comparative difference before and after the implementation was statistically significant (t=26.84, χ2=2.15, 2.72, 1.72, all P < 0.05). Besides, the satisfaction with the various evaluations of patients′ family members was increased and the differences were statistically significant (χ2=15.45-23.21, P<0.05). Conclusions The introduction of rescue video slices and interactive analysis can effectively reduce the patient′s rescue time, improve the success rate of patients rescues, decrease the rate of patient transport defect and missing items in the rescue unit, effectively control the quality of links, improve the management efficiency, and thus realize the standardized management under normal working condition.
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Objective To investigate the effect of medical student involvement on the quality of actual cardiopulmonary resuscitation (CPR).Methods A digital video-recording system was used to record and analyze CPR procedures for adult patients from March 2011 to September 2012.Results Twenty-six student-involved and 40 non-student-involved cases were studied.The chest compression rate in the studentinvolved group was significantly higher than that in the non-student-involved group (P ＜ 0.01).The proportion of compressions atabove 110 cpm was higher in the student-involved group (P =0.021),whereas the proportion at 90 ～ 110 cpm was lower in the student-involved group (P =0.015).The ratio of hands-off time to total manual compression time was significantly lower in the student-involved group than in the non-student-involved group (P ＜ 0.05).In contrast,the student-involved group delivered a higher ventilation rate compared with the non-student-involved group (P ＜ 0.05).The observed time delay to first compression and first ventilation was very similar between the groups.There were no significant differences between groups in either return of spontaneous circulation or time from survival to discharge.Conclusions Student-involved resuscitation teams were able to perform good CPR,with higher compression rates and fewer interruptions.However,the supervision from medical staff is still needed to ensure appropriate chest compression and ventilation rate in student-involved actual CPR in the emergency department.
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Objective To investigate the anti-tumor effect of ultrasound-targeted microbubble destruction (UTMD) mediated herpes simplex virus thymedine kinase (HSV-TK) on mice ovarian cancer.Methods Forty female BALB/c-nu mice were randomly divided into four groups after the models of subcutaneous transplantation tumors were established:(A)HSV-TK + Microbubbles + Ultrasound (HSV-TK+ MBs + US);(B) HSV-TK+ Ultrasound (HSV-TK + US);(C) HSV-TK;(D) PBS.TheTK protein and mRNA expression were separately detected by western-blot and real time RT-PCR.TUNEL staining was used to detect the tumor cell apoptosis.The inhibition rates and survival time of the animals were compared among all groups.Results The HSV-TK gene transfection efficacy and tumor inhibitory effect of HSV-TK on mice transplantable tumor in group A (HSV-TK + MBs + US) were significantly improved compared with group B (HSV-TK + US),group C (HSV-TK) and group D (PBS) (P ＜0.05).However,group A has no significant difference (P ＞0.05) with other groups in improving the survival time of tumor-bearing mice.Conclusions Ultrasound-targeted microbubble destruction can effectively transfect HSV-TK gene into target tissues and play a significant inhibition effect on ovarian cancer in mice.However,this new method is not able to improve the survival time of mice for a short-term observation.