CPHMC was designated as a COVID-19 hospital in Chongqing on January 21, 2020, and diagnosed and treated its first confirmed COVID-19 patient on January 24, 2020. Up to March 15, 2020, 224 patients (14 critical, and 17 severe), have been admitted. All patients were admitted to three isolation buildings with six wards (including one negative pressure ward) and a total of 430 HCWs from 61 departments of CPHMC worked in these isolated areas.
The participation of TB BASICS project laid a solid foundation for us to manage this challenge. COVID-19 is a respiratory infectious disease like tuberculosis. Tuberculosis is mainly airborne, but COVID-19 is mainly spread by droplets and contact. Based on the current view point, both of them can be spread by aerosols. The management of COVID-19 response was enhanced by the lessons learned from TB BASICS. Scientific and rational COVID-19 response strategy was established and more than 20 standardized workflows were developed including access to the COVID-19 isolation area, patient transfer, disinfection of emergency vehicles, donning and doffing of PPE, among others, which covered administrative control, environmental control and personal protection equipment. Several IPC guidelines were compiled to guide the epidemic response and printed for easy access by facility staff.
After receiving the task of treating COVID-19 patients, the CPHMC, based on its experience learnt in TB BASCIS, offered personnel and financial support, established COVID-19 Emergency Team. All staff of the infection control department engaged in workflow development. The function of each room and pathway of HCWs were discussed thoroughly and the best way was determined to avoid cross contamination. Some physical barriers were built for protecting HCWs from infection. In addition, in order to make all staff familiar with new workflow, training and drills were carried out, and further revisions were made to improve feasibility. After several rounds of drills, an optimized pathway was agreed upon which guaranteed smooth workflow and reduced transmission risk for all HCWs.
Since January 20, 2020, more than 20 intensified IPC trainings and workflow rehearsals were conducted. Before participating in the treatment of patients with COVID-19, all HCWs must receive IPC training and pass the assessment before entering the isolation ward. These training courses were based in part on information learned from TB BASICS, covered IPC guidelines and best practices, and helped HCWs comply strictly with the requirements that aim to reduce the risk of COVID-19 transmission. Trainings on standard prevention measures based on transmission mode (6) were strengthened.
Using principles and techniques learned from TB BASICS, environmental measures in isolation area were improved. Before COVID-19 patients were moved into isolation wards, a transmission risk assessment was performed in each area. The air changes per hour (ACH) were measured to assess the ventilation with the goal of achieving 12 ACH in all isolation areas. For areas with poor ventilation (did not meet 12 ACH criteria), upper room GUV fixtures were installed to supplement poor ventilation. One hundred sets of upper-room GUV fixtures were purchased for replenishment, and a robotic disinfection machine and other disinfection facilities were acquired and used. HCWs were assigned to sterilize the isolation area every day at least twice. Work in isolation area being completed, infection control department has taken samples from the isolation area. And bacterial cultures of 200 samples were all negative.
In personal protection, N95 respirator fit-testing was provided. The respirators for all staff were selected based on fit testing results. Every staff who was assigned to the isolation area was given one-on-one training on respirator use to guarantee their correct use of the respirator without leakage. A total of 428 staff were given fit-testing to make sure that each staff wore his/her own respirator suitably (7). Moreover, the CPHMC provided surgical masks for all COVID-19 patients without charge.
After completing all work in the isolation area, all HCWs tested negative for COVID-19 using RT-PCR tests for SARS-CoV-2. In addition, after a 14-day quarantine, all HCWs had 2–3 follow up specimens and tested by RT-PCR for SARS-CoV-2, all of which were negative. However, a small investigation of PPE outer surfaces including 5 sets of randomly selected goggles and respirators using environmental sampling methods illustrated detection of SARS-CoV-2 on 1 of the five sampled sets. These results and the fact that none of our HCWs were infected with SARS-CoV-2 highlights the protective effectiveness and proper doffing of PPE among our HCWs.