【摘要】 背景新型冠状(新冠)病毒奥密克戎变异株的传染力极强，使得上海市2022年3至5月新冠病毒奥密克戎疫情(简称：本次疫情)在防控之初就兼具复杂性、动态性和不确定性多重特质，使得医院的防控更具挑战。目的 探讨实施气泡式管理策略对防控新冠病毒医院感染和职业暴露的效果。设计观察性研究。方法 将本次疫情复旦大学附属儿科医院(我院)院内接诊-门诊-急诊-住院-出院设计为一个大气泡，大气泡中6个疫情防控医疗关键部门设计为中气泡，中气泡的9个要隘部门设计为小气泡。(1)新冠门急诊中气泡接诊健康码红码患儿，五级分诊Ⅰ和Ⅱ级导入抢救室小气泡，Ⅲ～Ⅴ级导入阳性小气泡、既往感染小气泡、密切接触者(密接)小气泡，放射检查室小气泡内接诊新冠门急诊和新冠病房需进行X线/CT检查的患儿；(2)发热门急诊中气泡接诊绿码/黄码伴发热的患儿；(3)急诊中气泡接诊绿码/黄码不伴发热的患儿，根据患儿有无48 h内核酸检测阴性报告分流至缓冲区和急诊区，配备第二急诊室备用；(4)新冠病房中气泡接收新冠门急诊需要收治住院的患儿，重型/危重型收入新冠ICU小气泡，轻型/普通型收入新冠普通病房小气泡；(5)过渡病房中气泡接收除危重症和新生儿外的新入院患儿；(6)新生儿隔离病房中气泡接收医疗机构通过120救护车转运到我院院区的新生儿，收入新生儿隔离病房负压病室小气泡，连续3 d核酸检测，阳性即转入新冠病房，均阴性则转至非负压病室小气泡。不同风险等级的气泡间人员、物品不流动，工作人员从低一级风险进入高一级风险需上报医务科。设立气泡破泡预案。根据工作人员不同岗位制定规范的培训内容及考核要求，通过语音视频监控系统和现场督查进行检查。主要结局指标职业暴露和新冠病毒医院感染。结果 我院累计收治新冠阳性患儿432例，其中轻型341例(78.9%),普通型88例(20.4%),危重型3例。3例危重型患儿均行有创机械通气，1例行连续肾脏替代治疗和体外膜肺氧合。无死亡病例。伴基础疾病29例。陆续有109名医务人员进入新冠门急诊和新冠病房工作，其中医生46人、护士49人、医技人员9人、医辅人员5人。未发生职业暴露，未发生新冠病毒医院感染。门急诊接诊253 571人次，在医院入口筛查，拦截红码189人次，红码患儿均顺利导入新冠门急诊，未进入普通门急诊区域。急诊接诊12 114人次，经核酸检测筛查出6例新冠阳性患儿，其中3例进入急诊区小气泡，引起急诊中气泡3次封闭消杀，启用第二急诊。发热门急诊接诊8 328人次，核酸检测阳性50例，转入新冠门急诊；新冠门急诊接诊763人次，五级分诊Ⅰ级和Ⅱ级共4例，3例为新冠肺炎危重型；收治新生儿690例，其中低危流行病史516例，高危流行病史174例；过渡病房收治693例，其中急诊入院223例，择期入院470例。所有进入隔离病区工作的医务人员均参加基础理论培训，高风险气泡专项培训29次，培训291人次，理论培训和操作培训均考核合格，视频监控和现场督查304人次。结论 本次疫情期间在我院实施气泡式管理取得了新冠病毒医院感染和职业暴露双零效果。更多还原

【Abstract】 Background As Omicron variant is extremely infectious, the pandemic of Omicron variant in Shanghai from March to May this year is complex, dynamic and uncertain, therefore it is more challenging for hospitals. Objective To summarize the experience of bubble management of preventing and controlling nosocomial infection and occupational exposure of COVID-19. Design Observational study. Methods In this pandemic, our hospital is designed as a big bubble. Six key medical departments are designed as medium bubbles, including the outpatient of COVID-19, fever clinic, emergency department, special ward of COVID-19, neonatal isolation ward and transition ward. Several important departments of medium bubbles are designed as small bubbles. Those with a red code, positive results of coronavirus nucleic acid or antigen tests, or infection history of COVID-19, and the close contacts of COVID-19 were admitted to the outpatient of COVID-19. According to the condition and epidemic history, they were arranged to different functional small bubbles. Those fever patients with a green code or a yellow code were admitted to fever clinic. Those with emergent conditions but without fever were admitted to the emergency department which was further divided into two small bubbles named as the buffer area and general area. The back-up was also available. Patients with a positive PCR result were admitted to the special ward of COVID-19 while those with severe critical illness were in the ICU, and the other with mild or common type were in the general ward. All newly admitted children except critical illness and neonates were in the transition ward. Neonates with negative primary screening nucleic acid from pregnant women with COVID-19 were admitted to neonatal isolation ward while all neonates were arranged in the small bubble of negative pressure area first. After daily nucleic acid tests for 3 days, those with negative resulst were transferred to non-negative pressure area and the other with positive results were transferred to special ward of COVID-19. The flow of personnel and meterial with different risk rate was not allowed. The staff with the lower risk moving to the higher level risk should be reported to the department of medical affairs. Meanwhile the plan of the bubble burst is ready. Standard training contents and assessment requirements were formulated according to different posts of staff, and checked through voice and video monitoring system and on-site supervision. Main outcome measures Nosocomial infection and occupational exposure of COVID-19. Results A total of 432 patients with COVID-19 were admitted to our hospital, including 341 patients with mild type(78.9%), 88 patients with common type(20.4%), and 3 patients with critical illness. Each critical illness had invasive mechanical ventilation while one patient had additional CRRT and ECMO.None of them died from COVID-19. Twenty-nine patients had underlying disease and 109 staff successively worked in outpatient and inpatient of COVID-19 including 46 doctors, 49 nurses, 9 medical technicians and 5 auxiliary medical personnel, none of which had nosocomial infection and occupational exposure of COVID-19. A total of 189 persons with a red code were intercepted at the entrance of the hospital. All patients with red codes were guided to the outpatient of COVID-19, therefore, none of them was permitted into the general outpatient and emergency department. The total number of outpatient and emergency patients was 253 571, 12 114 of which was admitted to emergency. Six emergency patients were positive of primary nucleic acid test. Three patients with COVID-19 entered the general area of emergency, resulting in the closed disinfection and sterilization for 3 times, activating the back-up emergency area. A total of 8 328 patients were admitted to fever clinic, 50 of which were transferred to the outpatient of COVID-19 after positive nucleic acid test. The total number of outpatient of COVID-19 was 763. According to grade V triage, 3 of 4 cases of grade I/II were critical illness. In total, 690 neonates were admitted to our hospital including 516 cases of low-risk epidemic history and 174 cases of high-risk epidemic history, 2 cases of which were positive of nucleic acid test. Six hundred and ninety-three patients were admitted to the transition ward including 223 emergency cases and 470 selective cases, 1 of which was positive of nucleic acid test. All staff working in the isolation ward participated in theoretical training and special training on high-risk bubbles was carried out for 29 times for 291 people. Both theoretical training and operation training were qualified.Video monitoring and on-site supervision were performed for 304 people. Conclusion There was neither nosocomial infection nor cupational exposure of COVID-19 in this bubble management.更多还原