a brand new world for sars infection control

A Brand New World for A Brand New World for SARS Infection ControlSARS Infection Control

顏慕庸李建賢

Task Force of SARS Control Committee in Sung Shan Hospital, DOH

僅向葉金川局長及和平勇士僅向葉金川局長及和平勇士

致上最虔誠的敬意致上最虔誠的敬意

不分種族黨派政治全面防疫不分種族黨派政治全面防疫

否則這將是場慘烈的戰爭

It’s WAR !!It’s WAR !!

D-day + 17 (92/04/27)

Dunkirk

Normandy

New concept !New concept !

醫護第一 , 病人次之和平 vs 非和平株 SARS vs non-SARS 動線管制 , 快速移行壓迷失 , 生化規格 Universal precaution


醫護第一 , 病人次之和平 , 非和平 SARS vs non-SARS 動線管制 , 快速移行壓迷失 , 生化規格 Universal precaution

醫護第一病人次之醫護第一病人次之 6 sigma mistake control

95.0-97.0 % 3-5 % N.I.C 99.0-99.9 % 0.1-1.0 % ( 負壓 , PPE) 99.9997 % 0.0003 % NEW !!

100 % 0 !! ?????

零的迷失零的迷失

PCR testPCR test

Specificity 97%

3% pseudo-negative

0.0003%

Universal precaution

1 Mistake ?1 Mistake ?

1 down, 10 isolate

Exhausted for the rest

2 mistakes

- - - - - -

Shut down & Quarantine Shut down & Quarantine of the hospitalof the hospital

Next step

Only to approach 100 %

SARS as a ghost shadow ,

可敬的對手 mistake is acceptable

Casual mistake is acceptableCasual mistake is acceptable

When this is all over And if we are still alive Than we can take off our mask And to get to know each other better

Muh-Yong Yen桃榮 , 仁濟


醫護第一病人次之和平 vs 非和平株

• Triage & Dispatch : ER/ID

SARS vs non-SARS 動線管制快速移行 Universal precaution

Epidemiology of a common coldEpidemiology of a common cold

lessons from flu. lessons from AIDS & Polio

Epidemiology of a common coldEpidemiology of a common cold

lessons from nosocomial infection lessons from HK outbreak

二零零二年十

一

月

Super virus ? !Super virus ? !

香港 -- 曹婦 -- 和平廣東 -- 台商 -- 台灣

劉姓醫師 in Honk Kong 勤姓台商 in Taiwan

• Both probably not the 1st case of the region

和平和平 vs vs 非和平非和平 Triage and DispatTriage and Dispatchch

和平 ( outbreak )Virulence, infectivityTreat the case cautiously PPE

非和平 (endemic nosocomial infection)Treated it as previous rules

Case identification ?

Case identification Case identification for super virus ? for super virus ?

the 1 st index case could always be sacrificed

Be prepared for the case surveillance (through 1st index case ) and fighting for incoming outbreak.

When & where for next When & where for next super virus ?super virus ?

Find it and control it,

Yet prepared for the casualties of war

surveillancesurveillance

Definition: keep rolling for all aspectIn the front, there is no SOP 　

Case definition for the community outbreak:Clustering of the acute respiratory symptomsHome medication and observation for the fever / co

ugh cases. 單一窗口

• in community/hospital/ city/county/nation Site of surveillance

• ER, GP/OPD, entrance of buildings


醫護第一 , 病人次之和平 vs 非和平 SARS vs non-SARS 動線管制 , 快速移行負壓迷失 , 生化規格 Universal precaution

Case Definition / case findingCase Definition / case finding

SARS vs non- SARS 和平 case mix & cohort ER case mix & cohort

Probable case / suspect case / etc need to real-time change case definition u

rgently as battle has evolving form hospital into community ( super virus )

拋妻別子拋妻別子 , , 不敢回家不敢回家

Reflex of Cohort

SOP : decom/decay

動線管制動線管制 ( ( CohortCohort ) ) mistake De-bug

20 –30 % natural course 3-5 % regulation, education 0.1-1.0 % SOP, PPE 0.0003 % 動線管制

To approaching 0 %

動線管制動線管制 , , 快速移行快速移行

biochemical/nuke warfare

clear zone inter-zone contamination

Same principle in all layer Level 1 Level 2 Level 3

Enter with PPE, leaving with Decontamination

Tree Tree Tree Tree Tree TreeTreeTree

第六病房（）緩衝區

（

）

第九病房隔離區

醫療大樓

民眾停車場

健康路

６ 1病房樓通道

紅色線標示區塊為管制區

樓層通道管制標示

通道管制說明國軍松山醫院成立隔離病房院區管制平面示意圖

６醫療大樓至病房二樓通道

醫療指揮中心

９－ 2 4病房樓逃生通道安全門

６９病房至病房二樓通道

病患運送入口

９－ 1 4病房樓逃生通道安全門

防疫病患停車場

戶外區第一管制線

憲兵管制衛哨

憲兵管制衛哨

工作人員進出管制線

救護車輛運送動線

動線管制動線管制 , , 快速移行快速移行

biochemical/nuke warfare ( no flush/spray )

clear zone inter-zone contamination

Same principle in all layer Level 1 Level 2 Level 3

終端管制 : clear – contam. : mask / hand washing

松德松德 SARSSARS 病房平面圖病房平面圖 (( 一樓一樓 ))

病患出入口

電梯樓梯

女更衣

餐廳男更衣

警衛

電梯

CLEAN STATION

Aircurtain

Aircurtain

松德醫院二樓

樓梯

Hand washingHand washing 75 % alcohol, steridal: can’t leave my eyes offo it

Sandwich hand washing

Wash hand: protect environment ( p’t unit )

Procedure, including lunch

Wash hand: protect personnel.

SOP SOP 居家除污居家除污

DECOM & DECAY

急診急診 SARSSARS 檢傷分類檢傷分類檢傷站

非疑 SARS 病患

急診

Clear zone

疑 SARS 病患

flu fever diarrhea 高度懷疑( 接觸史 , 發燒 , 呼吸症狀 ,急性聚集現象 )

污染路線緩衝區

居家治療隔離觀察區 (respiratory, contact isolation

急診 SARS 檢傷分類

急診室入口

檢傷站

候診區

診療區

隔離觀察區

快速移行快速移行 for SOPfor SOPHome/asymptomaticsymptomatic flu suspect case (fever) probable caseARDSIntubationmortality

Fast moving process

Intra / inter hospitals

單一窗口單一窗口手機 ( 移動指揮部 )組訓 , 人流 , 物流專家越來越多 , 公婆只有一個

CDC, NHI, VGH ---- 松指部

Flexibility for SOPFlexibility for SOP

full supply intermediate shortage

machine guns pistols bayonet N 95 no compromise face shield 投影片隔離衣雨衣

全國醫學中心趕建負壓病房全國醫學中心趕建負壓病房

負壓病房

SOP

PPE

動線管制

Respiratory contact

Universal PrecautionsUniversal Precautions

Respiratory UP ( community, Taxi, etc.)

Contact UP Case finding (surveillance ) UP: GP, ER

行政體系行政體系

人力 , 物資 , 指揮 , 媒體 .

和平志工發燒和平志工發燒人員组訓新兵受訓 , 即赴戰場

If you can’t fight itIf you can’t fight it

You’ll just have to live with it

Thanks for your attentionsThanks for your attentions

THE END !!

a brand new world for sars infection control

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