key: cord-0838576-aakpbbvl
authors: Du, Na; OuYang, Yingjie; chen, Yong
title: The experience of prevention measures taken by the psychiatric hospital during the emergence of asymptomatic patients with COVID-19
date: 2020-05-30
journal: Psychiatry Res
DOI: 10.1016/j.psychres.2020.113109
sha: ce00f4a7e77ea3e630e7618d8210acca7d32b021
doc_id: 838576
cord_uid: aakpbbvl

nan

The outbreak of the COVID-19 pandemic has lasted for five months. On April 8, 2020, Wuhan, China lifted the lockdown. A large number of people stranded in Wuhan due to the lockdown gradually returned to their hometowns. Despite China's staged success in preventing and containing the epidemic, the emergence of asymptomatic infections has kept the government vigilant.

While faced with such a severe pandemic, all countries should learn the experiences in containment from each other and adapt to their circumstances. Especially for medical institutions, how to implement effective epidemic containment measures in the first place becomes the most important thing to prevent the spread of the epidemic. Due to the high infectivity of the COVID-19, without proper countermeasures, any input of infected patients would contaminate the entire ward. Therefore, most psychiatric hospitals in China like Wuhan Mental Health Center (WMHC) adopted the closed management mode of inpatients (visit prohibited) during this time. Despite this, unfortunately, on February 8, China News Weekly reported that nosocomial infection had occurred in WMHC [1] . Thus, how to do an excellent job in epidemic prevention in psychiatric hospitals became a big challenge.

Chengdu, Sichuan Province, as a major city for exporting labor to Wuhan, was facing a great risk of infection imports. The Fourth People's Hospital of Chengdu, also known as Chengdu Mental Health Center, is a psychiatric specialty hospital that can accommodate 1,400 patients. After the outbreak, our hospital quickly adopted a series of countermeasures, including the establishment of fever clinics to screen patients for suspected COVID-19 infections, prohibiting family visits in closed inpatient wards, and extending the closed management mode to all departments. It is worth mentioning that the hospital temporarily established a transitional ward to treat patients who met the mandatory admission criteria during the outbreak. These patients needed to be quarantined for 14 days until they were confirmed to be excluded from the infection of COVID-19 and then transferred to other general wards. Other specific measures have been reported in detail in a relevant journal and will not be elaborated here [2] .

Although China's domestic situation was under control, a nosocomial infection in Harbin occurred half a month ago once again sounded the alarm of epidemic prevention. During the hospitalization of a patient with respiratory symptoms in Harbin, more than 20 people were directly and indirectly infected with COVID-19. Through the continuous tracing of the confirmed cases, as of April 21, 2020, the chain of transmission has caused 75 people to be infected with COVID-19, of which 52 were confirmed patients and 23 were asymptomatic infections [3] . According to the current understanding of the symptoms of the COVID-19, most patients have fever symptoms [4] , but there are also a large number of asymptomatic infections, which makes the most basic and most commonly used screening method, that is the body temperature test be no longer effective. Referring to the nosocomial infection incident in Harbin, our hospital has updated a new screening procedure for all newly admitted patients to prevent the import of infections. The procedure is as follows: 1. All newly admitted patients must undergo nucleic acid testing, and the specific screening process is as follows:

A. Patients with fever, epidemiological history, or respiratory symptoms within 14 days must enter the fever clinic to complete blood routine examination, CRP, chest CT, and nucleic acid sampling. If the blood routine and chest CT results are not abnormal, and the suspected infection of COVID-19 is excluded, the patient can be admitted to the hospital and isolated in a single room. During isolation, samples shall be taken as soon as possible for the nucleic acid test. Only when the test result is negative can the patient be transferred to the general ward. Otherwise, if the patient's chest CT and blood routine suggest viral infection, the patient must wait for the nucleic acid test result in the fever clinic. Only when the nucleic acid result is negative can the patient be admitted to the hospital.

B. Patients with no fever, epidemiological history, or respiratory symptoms within 14 days need to complete the blood routine examination, CRP, and chest CT in the outpatient or emergency department. If there is no abnormality, the patient can be admitted to the hospital and isolated in a single room for the nucleic acid test. The patient could not be transferred to the standard ward until the test result shows negative. If the chest CT examination indicates signs of infection, the doctor should refer the patient to the fever clinic and do the nucleic acid test. Only when the nucleic acid result is negative can the patient be admitted to the hospital. 2. Patients in the hospital who have fever or respiratory symptoms must undergo nucleic acid testing. 3. Each newly admitted patient needs to enter the isolation ward from the designated channel to avoid contact with other inpatients. The attending physician needs to collect the epidemiological history in the isolation ward alone with first-class protection. 4. Once there is a suspected COVID-19 infected patient or a confirmed case in the ward, that ward needs to be closed. All personnel who have contact with the patient must not leave the ward, even after work. Other staff who have not contacted the patient shall not enter that ward until the patient can be excluded from infection, and staff can then pass the ward. 5. Before entering the inpatient ward, all nursing stuff are required to undergo the nucleic acid test, provide health certificates, and obtain a nursing card issued by the hospital. In principle, all nurses cannot be replaced during hospitalization. If the patient needs to change nurses or the nurse needs to leave the inpatient ward, the nucleic acid test should be conducted again before re-entering.

Since our hospital constantly adjusted the countermeasures according to the epidemic situation and implemented dynamic management and evaluation, since the outbreak, the number of COVID-19 infections diagnosed in our hospital is 0, and there were no other related nosocomial infections occurred. Therefore, we would like to share our experience of the epidemic prevention and control implemented in our hospital and the management experience during the epidemic, hoping to provide a reference for other hospitals to overcome the difficult situation.

The risk and prevention of novel coronavirus pneumonia infections among inpatients in psychiatric hospitals

COVID-19 Prevention and control strategies for psychiatric hospitals

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

We sincerely thank all the healthcare workers in our hospital for their assistance in this study.

On behalf of all authors, the corresponding author states that there is no conflict of interest.