上海市2022年3至5月新型冠状病毒疫情防控中复旦大学附属儿科医院新生儿人群实施气泡式管理的实践和效果

The practice and effect of implementing bubble management for newborns at Children's Hospital of Fudan University during the pandemic of Omicron variant of COVID-19 from March to May 2022 in Shanghai

背景上海市2022年3至5月新型冠状(新冠)病毒疫情(简称:本次疫情)中复旦大学附属儿科医院(我院)作为新生儿的定点收治医院,面对本次疫情的复杂性,对新生儿特殊人群,协调好疫情防控和医疗救治面临挑战。目的在我院气泡管理总体策略中实施和完善新生儿中气泡的管理策略。设计观察性研究。方法新生儿中气泡的院内管理中包括4个小气泡。(1)上海市公共卫生中心新冠病房(红色)小气泡,收治核酸或抗原阳性的新生儿,按照我院新冠病房管理原则进行管理。(2)隔离病房(橙色)小气泡,设置于我院内单独楼,收治高危流行病史新生儿,进入橙色小泡的新生儿均需完成7 d医学隔离和观察,其中的负压和非负压房间设置各自独立的物品放置点,工作人员分别为二级和一级防护(+4),物品和标本的运送由摆渡人完成;(3)过渡病房(黄色)小气泡,收治低危流行病史新生儿,每间隔24 h行核酸检测,连续3 d核酸阴性则结束医学观察,其中单间和多人间设置各自独立的物品放置点,工作人员分别为二级和一级防护(+4),物品和标本的运送由摆渡人完成;(4)清洁病房(绿色)小气泡,我院常规住院新生儿的诊疗区域,接收橙色和黄色小气泡确定无新冠感染风险的新生儿。新生儿转运统一由上海市120急救车及不同气泡转运团队护送转入,红色小泡的出泡按照我院新冠病房管理原则进行;橙色小泡出泡需同时满足:①新生儿完成7 d医学观察,②出院后所住家庭的楼栋无新冠阳性感染者,③居家照护者及同住人均为健康码绿码,或已解除隔离,④接新生儿出院家属为健康绿码及48 h内核酸阴性;黄色小泡出泡需满足:完成72 h医学观察。住院期间,医务人员通过微信与新生儿家长沟通,随时解决父母的疑惑、焦虑和困难。主要结局指标医护医辅人员职业暴露和医院感染。结果本次疫情期间我院共收治新生儿677例,其中158例(130例来自红色小泡,其他医疗机构转运21例,橙色小泡转运团队外出转运7例)进入橙色小泡,其中早产儿10例(6.4%);519例新生儿(375例来自社区,黄色小泡转运团队外出转运144例)进入黄色小泡,其中早产儿173例(33.3%),需机械通气呼吸支持82例(15.8%),无创通气45例(8.7%),完成72 h医学观察后全部进入绿色小泡,其中NICU 137例,普通病房382例,平均住院时间为13.5 d。1例新生儿在橙色小泡诊断为复杂性先天性心脏病,在完成7 d医学观察后转入心脏ICU(CCU)。2例在橙色小泡期间核酸检测阳性(为生后与新冠阳性母亲有接触史)转入红色小泡。324名医护医辅人员参与红色、橙色、黄色和绿色小泡工作,均未发生职业暴露,未发生新冠病毒医院感染。结论本次疫情下实施新生儿气泡管理可行,防控职业暴露和医院感染效果好。

Background Children's Hospital of Fudan University was the designated hospital for newborns in the SARS-CoV-2 omicron variant wave in Shanghai from March to May 2022.Facing the complexity of the current pandemic,it was a challenge for special populations such as newborns to coordinate pandemic control and medical treatment.Objective To implement and improve the bubble strategy for newborns on the basis of the overall strategy in the hospital.Design Observational study.Methods Four small bubbles were developed in the bubble management of newborns in the hospital.The COVID-19 ward in Shanghai Public Health Clinical Center,as a small red bubble,was used to admit the infants with nucleic acid or antigen positive results,in accordance with the protocol set by Children's Hospital of Fudan University.The isolation ward,as a small orange bubble,was set in a separate building in the hospital including negative pressure rooms.Infants with high-risk epidemic history were admitted.All infants in the small orange bubble were required to complete a 7-day medical observation and perform nucleic acid test every day.The negative pressure rooms and the non-negative pressure rooms had their own independent places for storing materials.The staff were protected by grade II and grade I(+4)standard protective equipment respectively.The transportation of stuff and specimens was carried out by special"ferrymen".The transition ward with single rooms and multi-person rooms,as a small yellow bubble,was set to admit low-risk epidemic history infants.Nucleic acid testing was performed every 24 hours and medical observation would be ended if nucleic acid was negative for 3 consecutive days.The single rooms and the multi-person rooms had their own independent places for storing materials.The staff were protected by grade II and grade I(+4)standard protective equipment respectively.The transportation of stuff and specimens was carried out by special"ferrymen".The clean wards,as the small green bubbles,were the areas for routine hospitalized infants as usual.They admitted defined risk-free infants from orange and yellow bubbles.The transport of infants was uniformly taken by 120 emergency vehicles of the whole city.The infants were transported to the bubble by the transport team of the corresponding bubble.Infants came out of the the small red bubble according to the protocol of COVID-19 ward in the other article of the whole hospital in this issue.Infants came out of small orange bubble according to the following protocols:a.The 7-days medical observation was completed;b.There was no COVID-19 patients in the building of the family where the infants lived after being discharged;c.The health code of the home caregivers and the co-residents was green,or the isolation had been removed;d.The health code of the family members who took the infants out of the hospital was green,and the nucleic acid within 48 hours was negative.Infants could come out of small yellow bubble after 72h medical observation.During the hospitalization of the infants,the medical staff conveyed humanistic care to the parents of the newborn through WeChat to relieve the doubts,anxieties and difficulties of parents at any time.Main outcome measures No occupational exposure and nosocomial infections among medical staff.Results A total of 677 infants were admitted,of which 158(130 from Shanghai Public Health Clinical Center,21 from other medical institutions,and 7 transported by small orange bubble team)were admitted into the small orange bubble for management.There were 10(6.4%)premature infants out of them.The remaining 519 infants(375 from the community,144 transported by the small yellow bubble team)admitted into the yellow bubble for management.There were 173(33.3%)preterm infants,82(15.8%)infants with intubation,45(8.7%)with non-invasive ventilation,all of whom entered the small green bubbles after medical observation,including 137 in the NICU and 382 in the general ward.The average length of stay was 13.5 days.One infant was diagnosed as complex congenital heart disease in the small orange bubble and transported to CCU after medical observation.Two infants with positive nucleic acid test in the small orange bubble who had contact history with COVID-19 mothers after birth were and transported to the red bubble for management.There were 324 medical staff participating in the work of the small red,orange,yellow and green bubbles,and no occupational exposure or hospital infection occurred.Conclusion It is feasible to implement newborn bubble management in this pandemic wave,and the effect of preventing and controlling occupational exposure and hospital infection is good.