| The emerging and fulminating infectious diseases not only seriously threatens the life and health of human beings,but also often takes away the lives of health care workers(HCWs)because of insufficient understanding of the way of infection and the chain of infection.In addition to biological prevention and control,physical prevention and control measures for emerging and fulminating infectious diseases are also important prerequisites and prevention and control measures.Among them,the scientific and reasonable design of the treatment center is an important prevention and control foundation for the effective isolation of the infectious source of the fulminating infectious disease,which can avoid the cross infection in the Ebola treatment center(ETC)and the rapid spread of the epidemic situation;Personal protective equipment(PPE)is a necessary item in the period of unknown and high risk infectious disease.It is not only the necessary requirement of strict isolation,but also the last line of defense to protect medical staff.However,at present,there is insufficient research on physical isolation and protection against emerging and fulminating infectious diseases at home and abroad.At the same time,quite a number of hospital administrators and clinical medical staff have limited understanding of the importance and practical significance of architectural design in the prevention and control of emerging and fulminating infectious diseases,and have not paid enough attention to the correct use of personal protective equipment,it has led to poor protection in response to emerging and fulminating infectious diseases,and has become one of the important causes of infection and even loss of life among several medical staff.This study aims to improve the ability of physical comprehensive prevention and control by comparative analysis of the architectural design and practice of the treatment center for emerging and fulminating infectious diseases,as well as the experimental study on the links and parts which easily contaminated in the PPE that putting on and taking off by medical personnel in order to improve the ability of physical comprehensive prevention and control to improve and optimize the architectural design of the treatment center,to enhance the correct use of personal protective equipment,to provide valuable reference.Objectives of the research:By comparing and analyzing the architectural design and practical effects of the two ETC already established in Liberia,the advantages and disadvantages are clearly defined.In order to improve the ability of prevention and control of emerging and fulminating infectious diseases,to reduce the risk of infection,and to better protect the safety of patients and medical personnel,the links and parts of PPE which are easily contaminated in the process of piercing and detaching are found out,which provide scientific basis for improving the ability of prevention and control of emerging and fulminating infectious diseases in the future.Methods:1.Use comparison of two types of Ebola treatment Center Architectural Design in LiberiaComparative analysis was used to compare and analyze the advantages and disadvantages of the ETC built in Liberia between China and WHO in terms of building materials,layout process and supporting facilities.2.Experimental study on the links and parts of personal protective equipment for emerging and fulminating infectious diseases2.1 Research subjects: recruitment of clinical front-line medical staff who volunteered to participate in the study;2.2 Research implementation process:(1)To recruit medical personnel to carry on the WHO and China CDC to recommend two kinds of putting on and taking off PPE procedures training;(2)Eight batches of simulated contaminated PPE piercing operations were carried out;(3)The contaminated links and sites in the process of penetrating PPE were recorded by the method of visual observation and recording with fluorescent labeling.2.3 The experimental data were entered and analyzed using Microsoft Excel 2016,SPSS23.0,and the difference between the two detachment methods was compared by paired t-test and non-parametric rank sum test.Results:1.Use comparison and questionnaire survey of two types of Ebola treatment Center Architectural Design in Liberia1.1 Building materials: the main material of ETC established by WHO is special canvas,while the ETC established in our country is made of color steel movable board.Compared with cloth material,the price of the two materials is relatively cheap,convenient transportation,construction time is less,and the color steel movable board house is sturdy,the sealing is better;in the ventilation effect,the tent ETC is better than the board room structure material;1.2 Layout and flow direction: the ETC process established by WHO did not strictly divide the area and flow direction.Medical personnel and articles shuttled in the intermediate disinfection area,which easily caused cross-infection;the construction of ETC in our country is based on the classical principle of "three zones,two bands and two lines",strictly classifies the trend of logistics and flow of people,and ensures the effect of physical isolation;1.3 Supporting facilities: WHO's tent ETC is made up of waterproof and moisture-proof plastic as ground isolator and stretcher bed as bed unit.The infrastructure is relatively simple,which is not convenient for the development of treatment and nursing work,and the comfort degree of patients is also poor.The ground in the China ETC is made of solid and smooth cement,with anti-skid color glue on it,and the three areas of red,yellow and green are strikingly marked,easy to identify and clean and disinfect;the treatment center is equipped with multi-function hospital bed unit,doctor-patient call intercom system,communication system,television monitoring system,visitation intercom system,air conditioning and other supporting facilities to facilitate the rescue and nursing work;each ward has independent living facilities such as shower and bathroom,which greatly improves the living comfort of patients.2.Experimental study on the easily polluted links and parts of the HCWs when putting on and taking off the PPE for emerging and fulminating infectious diseases2.1 The parts that are easy to make mistakes in the process of wearing PPE: the incidence of pollution from high to low is,the clothing touches the ground when wearing protective clothing(20.00%),the N95 mask is not checked for air tightness,the wrong method(13.33%),and the air tightness is not checked before wearing gloves(4.44%),protective clothing zipper is not closed(4.44%);2.2 The parts that are easy to make mistakes during the process of detaching PPE: the pollution incidence rate is from high to low.When the clothes are off the protective clothes,the clothes touch the ground or the inner surface is polluted(20.00%).When the N95 mask is removed,the method is wrong(14.44%),and the hand touches the pollution goggles mirror(12.22%).Incomplete washing steps,insufficient time and frequency(11.11%);2.3 According to China's CDC process,the parts that are easily contaminated during PPE removal: the frequency of easily contaminated parts is from high to low,left hand and wrist(7 times),left calf(7 times),front chest center,left and right chest(6 times each)and left abdomen(5 times);2.4 Decontaminating parts of the PPE process in accordance with the WHO process: the frequency of easily contaminated parts is from high to low,right hand and wrist(13 times),left hand and wrist(12 times),middle of the abdomen(10 times),left chest(9 times),and left abdomen(6 Times);2.5 There was no statistical difference between the two kinds of PPE piercing and removal(P > 0.05).Conclusions:1.The China ETC is superior to the tent ETC set up by WHO in the aspects of firmness,process rationality,use function,supporting facilities,patient comfort and so on,but it is inferior to the tent ETC in ventilation effect,construction period and cost.2.In the process of wearing and removing PPE,the improper use of protective clothing and N95 mask were the two most common links,followed by gloves and hand hygiene;3.In the recommendation process of removing PPE according to WHO and China CDC,the most frequently polluted parts were mainly in the hands and chest and abdomen;in addition,the selection of different protective equipment can also lead to inconsistent contamination sites.For example,the choice of rain boots than the choice of shoe cover caused by leg pollution frequency is lower;4.Under the guidance of the two processes recommended by China CDC and WHO,there was no significant difference in the frequency of pollution after removing PPE.It is speculated that the PPE recommendation process issued by WHO and China CDC is effective for personal protection against fulminating infectious diseases. |
PDF Full Text Request