Original Media

Since December 2019, a number of patients with pneumonia infected with novel coronavirus (2019-nCoV) have been found in Wuhan, Hubei Province, China [1,2]. With the spread of the epidemic, confirmed cases have been found in all provinces and abroad. As of January 30, 2020, the number of confirmed cases has reached 7828, exceeding the number of confirmed cases during the SARS period in 2003.
The National Health Commission quickly issued an announcement to include the disease in the "the People's Republic of China Infectious Disease Prevention and Control Law" as stipulated in Class B infectious diseases, and required the prevention and control measures of Class A infectious diseases [3]. At the same time, the Chinese government responded quickly and launched a first-level response policy for major public health emergencies in all provinces, municipalities, and autonomous regions across the country, and implemented the most stringent prevention and control measures.
At present, the whole country is making concerted efforts, and the prevention and control work is being carried out effectively and orderly. In accordance with the spirit of the State Council's instructions, all localities and departments are firmly confident, working together in the same boat, scientific prevention and control, and precise implementation of policies to resolutely win the battle of epidemic prevention and control.
As we all know, cardiovascular disease is the leading cause of adult death in China, accounting for 44% of the total death in China. Winter and spring alternate seasons, the same period of high incidence of cardiovascular disease. As a cardiovascular doctor, shouldering the mission, in the context of the new coronavirus sense control, is fighting day and night in the front line of protecting people's health.
In the face of this epidemic, many cardiovascular doctors, like soldiers, have embarked on this battlefield without gunpowder smoke, and their hearts and bodies have never been under pressure. Between the tests of life and death, everyone has the courage to "give up my duty" and work selflessly on the front line of virus prevention and control and disease treatment.
In order to do a good job in the protection of patients and all first-line cardiovascular doctors in outpatient clinics, chest pain centers, wards, catheter rooms and cardiac rehabilitation centers, and to better cooperate with hospitals in fever outpatient clinics and disease treatment, this paper formulates the protection strategy of cardiovascular doctors under the background of novel coronavirus infection control according to the work characteristics of cardiovascular doctors [4,5], which can be used for reference by hospitals at all levels in the country.
This strategy will be updated as national, provincial, municipal, and hospital regulations change.

General principles

1. For ordinary patients with cardiovascular non-emergency, avoid hospitalization as far as possible and be admitted to hospital after epidemic control.

2. For patients with pneumonia who are clearly diagnosed with novel coronavirus infection, such as acute myocardial infarction and other cardiovascular diseases, in principle, they should be isolated on the spot, and the hospital should organize cardiovascular experts to consult and formulate treatment plans. The diagnosis and treatment process and protective measures shall be implemented according to the prevention and control process formulated by the hospital.

3. For pneumonia patients suspected of novel coronavirus infection with acute cardiovascular disease, if the disease occurs outside the hospital, they should be transferred to a designated hospital designated by the local health and Health Commission for treatment. If you have seen a doctor in the hospital, you should isolate it in time, assign a special person to handle it, start the consultation with experts in the hospital, and report to the superior health and health committee.
If intervention/surgical treatment is really needed, the operation should be performed in the designated special catheter room/operating room, and after the operation, the patient should be transferred to the designated intensive care unit with negative pressure isolation for single isolation. And in accordance with the provisions of the state as soon as possible to start the pathogenic detection process, such as the exclusion of new coronavirus infection of pneumonia, according to the routine treatment. If confirmed, transfer to a hospital designated by the local Health Commission for further treatment should be considered.

4. For patients with fever combined with acute cardiovascular disease, hospital expert consultation should be initiated and routine treatment should be carried out after exclusion. If suspected, it should be handled according to general principle 3.

5. For pneumonia patients with suspected/confirmed novel coronavirus infection who need interventional/surgical treatment, the signature of the informed consent form for the operation shall, in principle, be signed by the family members who have no history of close contact with the patient. Family members of patients with a history of close contact can communicate by telephone and record as evidence under isolation, and those without family members can report to the medical department for filing according to the conventional process.
 

Prevention and control management of 1. cardiovascular clinic

1. Cardiovascular doctors should do their own protection, wear white coats, hats and medical surgical masks, and strictly implement hand hygiene.
2. In the process of outpatient and emergency diagnosis and treatment, medical staff should strengthen the monitoring of patients' body temperature. In case of fever patients with respiratory symptoms, medical surgical masks should be issued and patients should be guided to the fever clinic. Pneumonia patients who are highly suspected of new coronavirus infection after relevant examinations shall immediately start reporting step by step according to national regulations.
Patients delivered by 120 ambulance:
120 fever patients have a clear epidemiological history (Wuhan returning to Shanghai, contact with Wuhan returning to Shanghai, and receiving confirmed patients). According to the patient's vital signs, the 120 is directly sent to the fever clinic or the hospital to set up a special intensive care unit for single-room isolation. Such as patients with cardiovascular disease, by the cardiovascular physician in the full protection of the case of consultation, see the fourth part: consultation management of patients with fever.
4. Emergency and critically ill patients coming to our hospital through other channels:
1) Fever patients: It is recommended to see a doctor in the fever clinic. If necessary, please consult a cardiovascular physician. For details, please refer to Part IV: Consultation Management of Fever Patients.
2) non fever patients: emergency treatment according to conventional, if in the course of treatment, found that patients suspected fever, the organization of hospital expert group expert consultation.

Prevention and control management of 2. cardiology ward

1. Strict implementation of staff personal protection
All staff must wear surgical masks correctly in the hospital and must implement hand hygiene before and after contact with patients in the ward.
2. Implement the daily reporting system for patients with fever in the ward
Before 9: 00 a.m. every day, the ward doctors and nurses will report the situation of fever patients in each ward to the medical department, which will report to the superior health administrative department after summarizing. The specific contents of the report are:
1) Number of fever patients in the ward;
2) Number of patients with pulmonary infection;
3) From 8: 00 the previous day to 8: 00 today, the number of new fever patients; Causes of fever patients; The number and specific conditions of fever but unclear diagnosis; The number of deaths and critical cases among fever patients in the ward.
3. Implement strict access control system
It is suggested that the ward should start the entrance guard system. For all personnel entering the ward, the nursing department should be responsible for measuring the body temperature at the entrance of the ward. For those with elevated body temperature, they should be refused to enter the ward, and disposable medical masks should be issued and they should be advised to go directly to the fever clinic for treatment. For key areas (cardiovascular intensive care unit), the nursing department is responsible for the implementation of the visit registration system.
4. Implement rigorous patient management
1) Strengthen health education for hospitalized patients and their families, such as hospital education and warm tips posted at the gate of the ward. Admitted patients are advised to fill in the Letter of Commitment for Ward Patients in General Medical Wards during Special Periods.
2) Hospitalized patients are strictly forbidden to leave the hospital without permission, and no doctor is allowed to leave the patient for any reason.
3) Once the inpatient has fever, the patient shall be isolated in a single room immediately, and the medical staff shall take personal protection as required, and conduct an in-hospital expert consultation immediately.
4) Establish ward visiting system. It is recommended to visit regularly and by fixed persons, and to measure the temperature of patients, accompanying and visiting personnel. In principle, the escort is limited to one person.
5. Strengthen the screening of newly admitted patients
1) For patients with elective admission, when issuing a hospitalization permit and notifying the patient one day in advance, they must ask about the travel within 14 days, the history of close contact and the presence of fever, cough and other discomfort. Once you have the above symptoms and experience, it is forbidden to notify the admission.
2) For patients with emergency admission indications, they must also ask about their travel within 14 days, history of close contact, and discomfort such as fever and cough. Once you have the above symptoms and experiences, report the hospital feeling in time. Those who exclude the above conditions can be admitted to the hospital, but it is recommended to be treated separately from the original stable or critically ill patients, strengthen education, and closely monitor until the full 14 days.
3) Coordinate resources, concentrate on the protection of fever clinics, and in principle, do not admit elective inpatients. Follow-up according to the epidemic control, material allocation in place gradually open.
6. Ward management
1) Reduce the density of personnel in the ward. It is recommended not to use extra beds in the ward to prevent the occurrence and spread of epidemic in the ward.
2) Strengthen the ventilation, disinfection, medical waste management, etc., in accordance with the relevant requirements of national regulations.

Prevention and control management of 3. chest pain center

1. In order to ensure that patients with chest pain, their families, and medical staff avoid being cross-infected during treatment, it is recommended that the cardiovascular department and the hospital where they are located form an emergency working group, which is led by the medical department, cardiovascular treatment experts, infection (respiratory) experts, and emergency experts. composition.
2. The treatment clinic for patients with chest pain is fixed to ensure that the diagnosis and treatment process (electrocardiogram, myocardial enzyme, etc.) of the chest pain clinic does not have any cross with patients with fever. Emergency medical personnel need to wear medical surgical masks, latex examination gloves, hats correctly. For patients, routinely check body temperature and remind patients and family members to wear masks. It is suggested that chest pain clinic should be equipped with ECG machine and myocardial marker POCT to reduce the patient's walking. Chest pain clinics should be regularly disinfected.
3. For patients with chest pain (especially STEMI) who are confirmed to need treatment, they should be transferred strictly according to the fixed transfer route, avoiding the diagnosis and treatment route of fever patients and suspected/confirmed patients. The relevant staff shall do a good job in standard protection, and the equipment, instruments and articles used by patients shall be disinfected in time according to the provisions of the state.
4. Most patients with chest pain are emergency patients, and the diagnosis of new coronavirus infection is not clear. In order to reduce the risk of infection caused by emergency surgery, elective surgery is advocated. Emergency thrombolysis is recommended for STEMI patients within the time window (primary hospitals do not recommend 24-hour reexamination of coronary angiography for patients with successful thrombolysis, which can exclude novel coronavirus infection and then transfer to hospital for treatment).
5. Patients with suspected novel coronavirus infection pneumonia will not undergo elective surgery in principle. If the patients who need emergency surgery are considered after the preliminary condition assessment and treatment, they should be managed according to the fifth part "prevention and control management of patients who need emergency interventional therapy.

Consultation management of patients with 4. fever

1. First, the fever clinic doctor issued a medical mask to the patient and initially assessed the patient's vital signs.

2. If it is considered that cardiovascular Junior College disease is the primary contradiction of the patient, and no active intervention will endanger life, the fever clinic will directly contact the cardiovascular doctor for emergency consultation.

3. Cardiovascular Junior College doctors should enter fever clinic for consultation after protection according to national requirements before consultation.

4. If emergency surgery/interventional therapy is considered, immediately notify the hospital's sense department and medical department and start relevant prevention and control plans (see Part V for details).

5. If after consultation, it is considered that active surgery/intervention and other treatments are not needed for the time being, the fever clinic doctor will handle it.

6. If the patient is excluded from the novel coronavirus infection pneumonia, he Junior College transferred to the emergency department or ward for treatment.
 

Prevention and control management of 5. patients who need emergency interventional therapy

1. Identify reception and transfer routes

This type of patient is directly accompanied by the doctor of the chest pain center and goes to the designated snack catheter room through a dedicated passageway and a dedicated elevator. Enter the designated isolation room from the patient access. Preoperative preparation by the cardiac catheterization room nurse according to the doctor's advice to complete, the staff as required to do a good job of personal protection.
2. Signing process of surgical conversation
It is recommended to complete the pre-operative conversation signature as required in General 5. Intraoperative and postoperative family members are not allowed to enter the cardiac catheterization room.
3. Special material allocation
One-piece protective clothing goggles; infrared thermometer; N95 mask; shoe cover; sterile instrument cover, air purifier, disposable bed sheet, etc.
4. Intraoperative prevention and control system
1) Minimize the personnel involved in the operation, and strictly carry out personal disinfection and protection according to the national requirements before the operation.
2) One nurse for indoor and one nurse for outdoor. Indoor personnel shall not leave the operation room during the operation, and outdoor personnel shall not enter the infection operation room without special circumstances.
3) Outdoor personnel can enter the operating room only after wearing protective equipment at the entrance of the operating room.
4) The disposable consumables needed during the operation shall be taken and used in this room as far as possible, so as to reduce the number of times of opening the door, and the outdoor nurse shall make operation records.
5) Secondary pollution is strictly prohibited, and the pollution of the ground is minimized. When there is dirty liquid and dirty blood on the ground and surface, wipe it dry with 2000mg/L effective chlorine-containing disinfection solution in time.
6) All medical waste shall be discarded in double-layer medical waste bags.
5. New special disinfection and isolation system
1) Isolate the room properly ventilated, twice a day ultraviolet air disinfection. The air purifier is continuously on.
2) Move all items temporarily unused or possibly unused in the machine room to the outside to avoid pollution. Prepare all the items needed for the operation and put them into the machine room.
3) DSA surgical bed with double-layer disposable sheets. The patient transfer vehicle is placed in the machine room (this vehicle is only for the patient) and disinfected after use.
4) All personnel in contact with special patients must wear the three-level protection standard: disposable hat, hand washing clothing, disposable surgical clothing, lead clothing, integrated protective clothing, goggles, N95 mask, long-tube shoe cover, gloves, etc.
5) All instruments in the machine room shall be covered with sterile instrument covers to avoid contamination of patients' blood and body fluids.
6) No. 2 room outside the hanging "infection surgery, irrelevant personnel are not allowed to enter" warning signs.
7) Disposable surgical kits and disposable surgical instruments, accessories and consumables are used in emergency operations. After use, it is directly discarded in the medical waste barrel.
8) Special patients before surgery to assess breathing and oxygen saturation, if necessary, oxygen, and wear a mask.
9) During the operation, all surgical personnel must stay in the machine room and are not allowed to enter or leave the control room at will.
10) During the operation, the operation is gentle to prevent the patient's blood and body fluid from splashing and causing pollution.
11) At the end of the operation, the personnel leaving the computer room must first change their gloves, then take off their protective clothing and foot covers and discard them in the medical waste bucket. After taking off their gloves, they must disinfect their hands with hand disinfectant according to the seven-step hand washing method, then take off their masks and goggles. After leaving the computer room, they must wash their hands underwater.
12) The goggles and headgear shall be disinfected with paper towel and then wiped with clear water gauze.
13) The lead coat used during the operation shall be disinfected with disinfection paper towel, then wiped with clear water gauze block, and hung on the lead hanger to dry.
14) After the operation, all the personnel involved in the operation will leave the cardiac catheterization room in the shower and change clothes.
6. Terminal disinfection after computer room operation
1) Cleaners must wear isolation gown, disposable hat, N95 mask and disposable gloves for disinfection and cleaning.
2) Follow the principle of disinfection-cleaning-re-disinfection.
3) All equipment, instruments and articles used or contacted by patients are infectious by default.
4) Wipe all instruments with 1000ml/L effective chlorine disinfection solution.
5) The ground, wall and surface of the object, where there is blood or secretion contamination, use 2000mg/L effective chlorine disinfection solution to sprinkle and soak for 30 minutes before wiping. The rest of the ground and walls (1.5 meters below) with 2000mg/L effective chlorine disinfection solution to wipe.
6) The suction drainage liquid is put into 2000mg/L effective chlorine disinfection solution, soaked for 60 minutes, and then poured into the sewer of the sewage washing room. The disposable drainage bottle is directly discarded in the medical waste barrel.
7) The medical waste double-layer bag is sealed and transported in a closed manner, and the special logo of "novel coronavirus pneumonia" is indicated.
8) The used cleaning tools shall be soaked in 2000mg/L effective chlorine-containing disinfection solution for 30 minutes in the sewage washing room, then cleaned, squeezed and hung separately to dry. The cleaning tools used in the isolated machine room shall be provided independently and shall not be mixed or put in a mixed way.
9) The special elevator for isolation of patients shall be disinfected by wet disinfection with 2000mg/L effective chlorine, and the air shall be disinfected by hydrogen peroxide spray.
7. Improve reporting and registration
The admission of such patients must be immediately reported to the department director and head nurse, and then reported step by step. The surgeon shall fill in the Infectious Disease Report Form in time. The "Operation Registration Book" must be marked with the words "novel coronavirus infection pneumonia" in the remarks column with a red pen.
8. Strengthen monitoring and communication
The emergency working group shall hold a working discussion meeting every 2 weeks, and hold an emergency meeting at any time in case of new tasks, new requirements and emergencies or emergencies. All members of the team are required to participate, express their opinions, speak freely, make suggestions on the work, give feedback and improve the process. The head nurse shall ensure adequate and reasonable management of materials.
 

6. epilogue

Respect and bless life, save the dying and heal the wounded, be willing to give, love boundless. In the face of this unprecedented major epidemic, in the critical period of national epidemic prevention and control, the national cardiovascular doctors should face the major challenges given to us by this era, Do not forget your initiative mind, keep in mind the mission, unite as one, and win the battle of national public health.
I hope this article can become a ray of sunshine in the cold winter shrouded by this virus. While fighting against viruses and diseases, protect your body and mind and contribute to the brilliant victory of national epidemic control!