淺析CDC新冠指南在普通門診的應用

by ZHF

新冠疫情在美國已經不可避免，目前有80例本土感染，死亡人數達9位（數字每天在變）。疫情在社區蔓延開的時候，門診醫生們往往處在抗疫的第一線。然而很多普通門診都沒有負壓隔離病房。在這種情況下，怎樣才能更好地保護醫護人員，又能正確處理具有急性呼吸道症狀和發熱的病人呢？
首先，根據CDC指南正確地評估和分診具有急性呼吸道症狀的病人，降低醫護人員感染病毒的機會。需要做好一個分診的流程圖，讓前台接待員在病人電話或者是電腦預約的時候可以使用。詢問所有預約病人的症狀，如果有發熱、咳嗽、呼吸困難這些急性呼吸道感染症狀，同時又有去疫區的旅行史或者跟確診的新冠病人密切接觸史，那麽根據CDC的指南，他們是符合疑似新冠病人(PUI)的標準（見下表）。這時，需要立即給當地的衛生防疫部門或者是醫院係統的傳染病專家打電話，而他們會接手病人下一步的測試。病人暫時不要到診所來，這樣就減少了病毒感染整個診所和醫護人員的機會，從而進一步降低了醫源性密集性傳染社區的風險。
Contact your local or state health department
Healthcare providers should immediately notify their localexternal icon or stateexternal icon health department in the event of a PUI for COVID-19.

Criteria to Guide Evaluation of PUI for COVID-19

As availability of diagnostic testing for COVID-19 increases, clinicians will be able to access laboratory tests for diagnosing COVID-19 through clinical laboratories performing tests authorized by FDA under an Emergency Use Authorization (EUA). Clinicians will also be able to access laboratory testing through public health laboratories in their jurisdictions.This expands testing to a wider group of symptomatic patients. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.Epidemiologic factors that may help guide decisions on whether to test include: any persons, including healthcare workers2, who have had close contact3 with a laboratory-confirmed4 COVID-19 patient within 14 days of symptom onset, or a history of travel from affected geographic areas5 (see below) within 14 days of symptom onset.

International Areas with Sustained (Ongoing) Transmission

Last updated February 28, 2020

• China (Level 3 Travel Health Notice)
• Iran (Level 3 Travel Health Notice)
• Italy (Level 3 Travel Health Notice)
• Japan (Level 2 Travel Health Notice)
• South Korea (Level 3 Travel Health Notice)
•  

其次，根據CD C的感染防控指南
infection prevention and control (IPC)，製定修改符合自己診所的感染防控規章製度。因為有的病人不通過預約會直接到診所來，另外根據CD C的指南，還有一類病人就是有急性呼吸道症狀，但是沒有旅行史或接觸史，如果能夠排除其他原因引起的症狀，也符合上麵所說的疑似新冠病人標準。這一部分病人就必須到診所裏來，才能排除其他原因。而這個過程就存在著汙染整個診所的可能性。在此之前，製定好整個診所的感染防控規章製度，培訓好診所的所有員工就至關重要。這包括1. 照顧病人時的標準防護、接觸防護、空氣飛沫和眼睛的防護。2. 看病人之前和之後，接觸到有可能汙染物質之後，穿上個人防護用具之前和脫掉防護用具之後正確的洗手程序。3. 學習和訓練如何正確地穿脫個人防護用具，以降低自身汙染的可能性。4. 在可能產生氣霧的操作過程中，正確使用個人防護用具和遵循正確的操作規範。
第三就是注意環境的清潔與消毒。常規的消毒和清潔診所對新冠病毒的防控也是合適的，包括產生氣霧操作過程中病人所在的區域。正確處理衣物，食品用具，醫源性廢物。
最後， 還要知道何時聯係當地衛生防疫部門和職業健康機構。當醫護人員在沒有防護狀態下接觸到疑似或確診的新冠病人，應該立即向職業健康部門匯報。如果醫護人員出現了疑似新冠症狀，如發燒，咳嗽，呼吸困難等，留在家裏不要上班，並馬上聯係職業健康部門。
reference: 
https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html