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How to prevent and control the use of ventilators in patients with new coronary pneumonia?


Release time:

2020-04-17

Ventilator use in patients with new coronary pneumonia is essential, so how should infection prevention and control of ventilator use be done?

The notice of the general office of the national health and health Commission and the office of the state administration of traditional Chinese medicine on the issuance of the new coronavirus pneumonia diagnosis and treatment plan (trial version 7) (the national health office medical letter (2020) No. 84) states: there is the possibility of aerosol transmission under the condition of long-term exposure to high concentration aerosols in a relatively closed environment, and the spread of pathogen-carrying droplets or aerosols is easy to occur during the use of the ventilator, which virtually increases the possibility of infection.

Etiological characteristics of 1. COVID-19 virus

The virus is sensitive to ultraviolet rays and heat, 56 ℃ for 30 minutes, ether, 75%(v/v) ethanol (alcohol-containing hand disinfectant> 60%(v/v), compound products can be based on product instructions.), chlorine disinfectant (bleaching powder ≥ 20%, sodium dichloroisocyanurate ≥ 55%,84 disinfectant according to product instructions, commonly 2% ~ 5%), peracetic acid (peracetic acid (calculated by C2H4O3) mass fraction 15% ~ 21%) and chloroform and other lipid solvents can effectively inactivate the virus, chlorhexidine cannot effectively inactivate the virus and should be avoided.

2. Ventilator Equipment and Infection Prevention and Control

For confirmed or suspected patients, in order to avoid problems such as incomplete cleaning and disinfection, it is recommended to use disposable medical products, such as disposable pipelines; The water collection cup uses an in-line device with a one-way valve. Disposable filters can be installed. Both inhalation and exhalation ends should be installed. Passive humidification (heat and moisture exchanger with bacteria filtration function) is recommended for invasive ventilators (including transfer ventilators); or use active humidification (heating humidifier with double heating guide wire); You can consider using a humidification tank with closed automatic water continuation function, or you can use a self-made semi-automatic humidification tank water filling device. When using a non-invasive ventilator, use a disposable exhalation valve as much as possible, instead of using a mask integrated valve and a platform valve, and a filter can be added between the mask and the exhalation valve. Note that when using the exhalation valve during non-invasive ventilation, the leakage hole should not be opposite to the operator to avoid increasing the risk of aerosol transmission.

Prevention and control of infection in the use of 3. ventilator

The external surface of the ventilator should be cleaned routinely, and 75% alcohol with good compatibility or disinfection wet wipes that meet the requirements can be used to wipe and disinfect. Regarding the question of pipeline replacement, it is not recommended to replace the ventilator pipeline regularly. When there is pollution and mechanical failure, it should be replaced in time. Attention should be paid to the disposal of condensate in use to avoid accidental splashing of condensate to pollute nursing staff or pour back into the airway of patients. It is recommended to suspend ventilation according to the requirements of the ventilator instructions before operation, and then directly disconnect the ventilator near the outlet end of the ventilator before operation. As the condensate contains high concentration of pathogenic bacteria, it should be removed regularly. As for the suction device, the closed suction device can be used as the first choice, and the second choice, others such as the establishment of a cleaning and disinfection system and the adoption of hand hygiene can also promote the prevention and control of ventilator infections.

Terminal disposal after 4. ventilator use

Immediately after use, thoroughly clean and disinfect the outer surface of the ventilator, which can be wiped with disinfectant wipes or alcohol. It is recommended to use disposable pipelines and accessories, and dispose of them according to infectious waste after use. The reusable pipelines shall be handed over to the disinfection supply center for cleaning, disinfection and sterilization, such as soaking and disinfection (loop) with chlorine-containing disinfectant and pressure steam sterilization. The ventilator gas path is a one-way open gas path, without the need for internal pipeline disinfection. Routine replacement of ventilator host and air compressor air filter. Sensors can generally be soaked disinfection or high temperature and high pressure disinfection, exhalation valve and other cleaning and disinfection methods refer to the instructions. Specific disinfection and monitoring requirements can also refer to the health industry standard WS392-2012 "clinical application of ventilator" and WS/T655-2019 "ventilator safety management.

References:

1. Notice of the General Office of the National Health Commission and the Office of the State Administration of Traditional Chinese Medicine on Issuing the Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial 7th Edition) No. 84 (2020)

2. Notice of the General Office of the National Health Commission on Issuing Guidelines for the Use of Disinfectants; Supervision Letter of the National Health Office [2020] No. 147

3. Expert consensus on management of ventilator use in patients with novel coronavirus pneumonia, Chinese Journal of Respiratory and Critical Care, February 2020, Volume 19, Issue 2

4. Guidelines for Diagnosis and Treatment of Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Chinese Adults (2018 Edition) Chinese Journal of Tuberculosis and Respiratory, April 2018, Volume 41, Issue 4

5. "Clinical Application of Ventilator" WS392-2012 Ministry of Health 6. "Ventilator Safety Management" WS/T655-2019 National Health Commission

 

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