Experiences in managing nosocomial infection prevention in the hematology department
Overview of general measures about nosocomial infection prevention in the hematology department
The hematological department of Zhongnan Hospital of Wuhan University constitutes an outpatient clinic and an inpatient department. The latter includes three units, namely, general, intensive care, and laminar air flow wards. Several measures have been implemented to prevent nosocomial infection in the hematology department, and an overview of these measures is shown in Fig. 1.
The inpatient department was reorganized in accordance with the request of nosocomial prevention and control strategies. Intensive care and laminar air flow wards were closed. Temporary isolation wards were planned with three zones and two aisles in case of a suspected or confirmed COVID-19 case . Furthermore, the rules of sanitation and standards of operational procedures were fully implemented in different dimensions, such as health personnel, patient and accompany management, local sanitation management including environment disinfection, medical facilities and equipment’s sterilization, and medical and non-medical waste disposal.
A workflow for the outpatient clinic management was also designed to exclude potential risk of these two kinds of patients carrying SARS-CoV-2, namely, infected patients without symptoms and patients in infectious incubation stage  (see Fig. 2). All patients were first received at the pre-check office, followed by temperature measurement and short investigation of COVID-19 epidemiology. Then, these patients were guided to fever clinic or specialist clinic for further consultation . Once the patients were excluded for COVID-19, they were allowed to consult with the hematology clinic. Temperature was checked, and careful epidemiological history was inquired again before evaluating hematological problems. For patients who did not require admission for having no or mild symptoms, prescription was provided with a suggestion to continue online follow-up. For patients who needed hospital admission for further treatment, COVID-19 screening tests including chest CT scan, blood routine test, virus PCR, and antibody test were prescribed immediately after admission. Patients with positive findings were transferred to temporary isolation wards attending for expert consultation, and then transferred to the infectious disease department or designated hospital. Only the patients with negative findings could continue specific treatment with close temperature monitoring.
Detailed measures implemented in the hematology department
Standard measures of hygiene for all staff and local environment were implemented according to the international suggestions and guidelines from the National Health Commission about nosocomial infection prevention and control [15,16,17,18]. Moreover, additional measures with intensification were carried out for the management of health personnel and patients.
Health personnel management
Personal health status report with temperature check
All staff provided daily report of their temperature and contact history with confirmed or suspected cases with COVID-19. The body temperature of staff on duty was checked before entering the ward.
Strict implementation of standard prevention and hand hygiene
Standard personal protection with surgical mask, cap, and gloves were applied in dealing with routine activities for all patients. Level 2 protection was implemented with additional isolation gown and protective mask once a patient presented fever and potential risk of COVID-19 exposure. Once the patients were diagnosed as suspected or confirmed with COVID-19, level 3 protection was implemented, especially during high-risk medical activities. Hand hygiene was strictly implemented all the time.
Standardized daily behaviors of medical staff
The maximum number of staff in the department was limited, and they were required to have enough rest for enhanced self-immunity. All the staff complied with the confinement of direct pathway between home and hospital to avoid unnecessary contact with persons with unknown conditions. All staff meetings were scheduled through Internet as E-meeting. The use of personal protection equipment should comply with hygienic regulations, and it should be replaced after use for each suspected patient. Eating and drinking were only allowed in the clean area. Furthermore, staff was allowed to rest in staggered time intervals. In case of unexpected meeting with each other, a distance of at least 1 m was observed. Hand hygiene was observed before examining patients and doing tests. After contact with patients, providing treatment, and touching any sample from patients, hand hygiene was strictly observed. All staff was required to wear a mask even during breaks.
Sustained training by taking theory courses and doing drill practice
First, training courses about COVID-19 knowledge, including clinical manifestation, diagnosis, and treatments; nosocomial infection prevention and control strategies, including personal and environmental hygiene maintenance; and wearing and removing personal protective equipment correctly, were provided to all the staff by online courses and video. An assessment quiz was conducted after training courses to make sure that all members know how to protect themselves. Second, an emergency drill was designed and practiced with small groups, as shown in Fig. 3. A particular case was examined, and the medical team dealt with this situation as an actual emergency. By doing this drill, potential problems about personal protection and the implementation of a chart about dealing with a local COVID-19 outbreak were examined, and improvements and adjustments were realized according to the results of drill. Finally, all the staff were well trained before this epidemic.
Patient and their family management
Training courses and brochures about COVID-19 and nosocomial infection prevention and control strategies were provided at the first day of admission. Local management rules were explained clearly with signature of confirmation. New patients admitted could have COVID-19 screening tests. No companions or visitors were permitted, except for extremely old and disabled patients with an absolute demand of assistance, and COVID-19 screening tests were required for companions before entering the department. Furthermore, once the patient developed fever or other suspected symptoms, COVID-19 screening tests were conducted again to make ensure that he or she was not infected or a potential infection source. Temperature was checked twice a day. The patients were asked to stay in their own wards with group meals delivered to their door to reduce unnecessary contact. Patients and their companions were asked to respect personal hygiene instructions, such as wearing masks, 1 m of distance in contact, eating or drinking in staggered time, hand hygiene, and taking showers frequently.