新型冠状病毒肺炎患者床旁血液净化治疗的感染防控

doi:10.19723/j.issn.1671-167X.2020.03.003

摘要/Abstract

摘要：

目的探讨新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者隔离病区床旁血液净化治疗的感染防控策略,评价感染防控的效果。方法通过回顾性分析2020年2月8日至2020年3月31日期间在武汉华中科技大学同济医学院附属同济医院中法新城院区COVID-19隔离病区床旁血液净化治疗患者的临床特征、感染情况和转归,总结所采取的感染防控措施,分析医护人员和患者COVID-19交叉感染情况以及患者之间血源性病原体交叉感染的情况,评估各项感染防控措施在控制交叉感染发生和传播中的作用。结果研究期间该隔离病区累计收治101例COVID-19患者,其中10例(占9.90%)开展床旁血液净化治疗,采取的血液净化治疗方式均为连续性血液透析滤过(continuous venovenous hemodiafiltration, CVVHDF), 累计床旁血液净化治疗79例次。采取的感染防控管理措施包括病区隔离分区、患者行为隔离和患者安置、操作人员个人防护和手卫生,透析废液、空气、物体表面、医疗器械和医用织物等环境物品管理。无1例医护人员感染COVID-19,所有医护人员两次咽拭子COVID-19病毒核酸检测(两次采样间隔>1 d)均为阴性;开展床旁血液净化治疗的患者中2例COVID-19疑似病例在住院期间多次咽拭子病毒核酸检测及血清COVID-19病毒抗体IgG、IgM均阴性,胸部CT无病毒性肺炎表现;患者未发生血源性病原体的院内交叉传播。结论在COVID-19隔离病区开展床旁血液净化治疗,通过采取有效的感染防控管理,能够有效控制院内交叉感染的发生和传播,可以为呼吸道传染病隔离病区患者诊治和感染防控提供一定的经验。

关键词: 新型冠状病毒肺炎, 隔离病区, 床旁血液净化治疗, 感染防控

Abstract:

Objective: To explore the infection prevention and control strategy of bedside blood purification treatment in corona virus disease 2019 (COVID-19) isolation ward, and to evaluate the effect of infection prevention and control management measures. Methods: We summarized and analyzed the clinical features, infection status, outcome and infection prevention and control measures of bedside blood purification treatment patients in COVID-19 isolation ward from February 8, 2020 to March 31, 2020, analyzed the COVID-19 cross-infection between the patients and medical staffs, and the blood-borne pathogens cross-infection situation between the patients, and analyzed the effect of bundle prevention and control measures in controlling the occurrence and spread of cross-infection. Results: A total of 101 COVID-19 patients were hospitalized in this COVID-19 isolation ward, of whom 10 patients (9.90%) received bedside blood purification treatment and the blood purification treatment method was continuous hemodialysis filtration (CVVHDF), and the 10 patients received 79 times of blood purification treatment in total. The prevention and control management measures adopted included divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room air purification, object surfaces, medical devices and medical fabrics dis-infection management. There were no occurrence and spread of COVID-19 in the medical healthcare workers and blood-borne pathogens cross-infection in the patients. And all the twice throat swabs (two sampling interval > 1 day) of the medical staffs in COVID-19 virus nucleic acid test were negative. The 2 suspected COVID-19 patients’ throat swab virus nucleic acid test and the COVID-19 IgG, IgM were always both negative, the chest CT showed no viral pneumonia. Conclusion: Bedside blood purification treatment in the COVID-19 isolation ward, the occurrence and spread of healthcare associated infection can be effectively controlled through effective infection prevention and control management, including divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room’s air purification, object surfaces, medical devices and medical fabrics disinfection, which can provide experience for diagnosis, treatment and prevention and control of patients in the respiratory infectious disease ward.

Key words: COVID-19, Isolation ward, Bedside blood purification treatment, Infection prevention and control

中图分类号:

R563.1

陈美恋,高燕,郭维,左力,王天兵. 新型冠状病毒肺炎患者床旁血液净化治疗的感染防控[J]. 北京大学学报（医学版）, 2020, 52(3): 414-419.

Mei-lian CHEN,Yan GAO,Wei GUO,Li ZUO,Tian-bing WANG. Infection prevention and control of bedside blood purification treatment in patients with COVID-19[J]. Journal of Peking University (Health Sciences), 2020, 52(3): 414-419.

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参考文献 18

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Number	Age/years	Gender	Underlying disease	COVID-19	Clinical classification	Dialysis modalities	Dialysis times
1	58	Female	Hypertension, chronic renal failure	Confirmed	Severe	CVVHDF	7
2	79	Male	Hypertension, chronic renal failure	Confirmed	Severe	CVVHDF	5
3	47	Male	Hypertension, chronic renal failure, coronary heart disease	Confirmed	Severe	CVVHDF	9
4	67	Male	Hypertension, chronic renal failure, coronary heart disease	Confirmed	Severe	CVVHDF	5
5	81	Male	Hypertension, chronic renal failure, coronary heart disease, diabetes	Confirmed	Severe	CVVHDF	12
6	68	Male	Hypertension, chronic renal failure, coronary heart disease, diabetes	Confirmed	Severe	CVVHDF	10
7	79	Female	Hypertension, chronic renal failure, coronary heart disease, COPD	Confirmed	Severe	CVVHDF	11
8	64	Male	Hypertension, chronic renal failure	Confirmed	Severe	CVVHDF	6
9	66	Female	Hypertension, chronic renal failure	Suspected	Severe	CVVHDF	9
10	40	Female	Hypertension, chronic renal failure, coronary heart disease, diabetes, COPD	suspected	Severe	CVVHDF	5

Number	Lengh of stay/d	COVID-19 RNA		Chest CT		Blood-borne pathogens		Outcome
Number	Lengh of stay/d	Admission	Discharge	Admission	Discharge	Admission	Discharge	Outcome
1	16	Positive	Negative	Viral pneumonia	Normal	Chronic hepatitis B	Chronic hepatitis B	Cured, transferred to the blood purification center for routine treatment
2	12	Positive	Negative	Viral pneumonia	Normal	Without	Without	Cured, transferred to the blood purification center for routine treatment
3	19	Positive	Negative	Viral pneumonia	Normal	Without	Without	Cured, transferred to the blood purification center for routine treatment
4	12	Positive	Negative	Viral pneumonia	Normal	Without	Without	Cured, transferred to the blood purification center for routine treatment
5	26	Positive	Negative	Viral pneumonia	Normal	Without	Without	Cured, transferred to the blood purification center for routine treatment
6	21	Positive	Negative	Viral pneumonia	Normal	Without	Without	Cured, transferred to the blood purification center for routine treatment
7	23	Positive	Negative	Viral pneumonia	Normal	Without	Without	Cured, transferred to the blood purification center for routine treatment
8	14	Positive	Negative	Viral pneumonia	Normal	Without	Without	Cured, transferred to the blood purification center for routine treatment
9	20	Negative	Negative	Pleural effusion	Normal	Without	Without	Exclude, transfer to blood purification center for routine treatment
10	12	Negative	Negative	Pleural effusion	Normal	Without	Without	Exclude, transfer to blood purification center for routine treatment