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A Brand New World for SARS Infection Control

A Brand New World for SARS 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 致上最虔誠的敬意. 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 !!. D-day + 17 (92/04/27) Dunkirk Normandy. New concept !. 醫護第一 , 病人次之 和平 vs 非和平 株

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A Brand New World for SARS Infection Control

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  1. A Brand New World for SARS Infection Control 顏慕庸 李建賢 Task Force of SARS Control Committee in Sung Shan Hospital, DOH

  2. 僅向葉金川局長及和平勇士致上最虔誠的敬意

  3. 不分種族黨派政治全面防疫 否則這將是場慘烈的戰爭

  4. It’s WAR !! D-day + 17 (92/04/27) Dunkirk Normandy

  5. 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

  6. New concept ! • 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

  7. 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 !! ?????

  8. 零 的迷失

  9. PCR test • Specificity 97% 3% pseudo-negative • 0.0003% • Universal precaution

  10. 1 Mistake ? 1 down, 10 isolate Exhausted for the rest 2 mistakes - - - - - -

  11. Shut down & Quarantine of the hospital Next step Only to approach 100 % SARS as a ghost shadow , 可敬的對手 mistake is acceptable

  12. Casual 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

  13. New concept ! • 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

  14. Epidemiology of a common cold • lessons from flu. • lessons from AIDS & Polio

  15. Epidemiology of a common cold • lessons from nosocomial infection • lessons from HK outbreak

  16. 二零零二年十 一月

  17. 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

  18. 和平 vs 非和平 Triage and Dispatch • 和平 ( outbreak ) • Virulence, infectivity • Treat the case cautiously • PPE • 非和平 (endemic nosocomial infection) • Treated it as previous rules • Case identification ?

  19. Case identification 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.

  20. When & where for next super virus ? Find it and control it, Yet prepared for the casualties of war

  21. surveillance • Definition: keep rolling for all aspect • In the front, there is no SOP • Case definition for the community outbreak: • Clustering of the acute respiratory symptoms • Home medication and observation for the fever / cough cases. • 單一窗口 • in community/hospital/ city/county/nation • Site of surveillance • ER, GP/OPD, entrance of buildings

  22. New concept ! • 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

  23. Case 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 urgently as battle has evolving form hospital into community ( super virus )

  24. New concept ! • 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

  25. 拋妻別子, 不敢回家 ReflexofCohort SOP : decom/decay

  26. 動線管制 ( Cohort ) • 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 %

  27. 動線管制, 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

  28. 動線管制, 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

  29. 松德SARS病房平面圖(一樓) 電梯 樓 梯 警 衛 女更衣 男 更 衣 餐廳 病患出入口

  30. 松德醫院二樓 Air curtain 樓梯 電梯 Air curtain CLEAN STATION

  31. Hand 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.

  32. SOP 居家除污 DECOM & DECAY

  33. 急診SARS檢傷分類 檢傷站 疑SARS病患 非疑SARS病患 flu 高度懷疑 (接觸史,發燒,呼吸症狀,急性聚集現象) 急診 fever diarrhea 緩衝區 Clear zone 污染路線 觀察區(respiratory, contact isolation 居家治療隔離

  34. 隔離觀察區 診療區 急診SARS檢傷分類 候診區 檢傷站 急診室入口

  35. New concept ! • 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

  36. 快速移行 for SOP • Home/asymptomatic • symptomatic flu • suspect case (fever) • probable case • ARDS • Intubation • mortality Fast moving process Intra / inter hospitals

  37. 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

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