COVID-19: Difficulties and Countermeasures in the Prevention and Control of Neuro ICU Infection and Medical Quality Control in China
By Yingying Su
From February to March 2020, the epidemic of COVID-19 peaked in China. The situations for neuro ICU were as follows: In addition to some medical staff sent to the designated hospital or ward of COVID-19 to combat the epidemic, most of them were still on duty at their local neuro ICU, routinely guarding against the outbreak of COVID-19, taking responsibility of quality and safety in the diagnosis and treatment of severe neurological diseases.
Therefore, the neuro ICU faced many challenges:
- It was imperative to prevent COVID-19 infection and transmission in the neuro ICU.
- With the consideration of pneumonia complications prevalent in the neuro ICU, the differential diagnosis between pneumonia complications and novel coronavirus pneumonia (NCP) became the top priority.
- A shortage of protective items lead to panic and anxiety for the medical staff.
- The high risk of cross-infection of COVID-19 in hospitals led to tremendous psychological stress.
On March 16, 2020, in the neuro ICU isolation room of The First People's Hospital of Yunnan Province, Zhu Huimin and other doctors (under secondary protection) carried out tracheal intubation under visual laryngoscope in the patient with severe anti-NMDAR encephalitis and respiratory failure, but not excluding COVID-19.
However, in the face of this unprepared public health emergency, more than 100 neuro ICUs in the Chinese mainland had launched emergency plans, adjusted the focus of work, formulated response plans and processes, and made contributions to maintaining the basic medical order and medical quality.
On March 1, 2020, Dr. Jie Cao (Neuro ICU, the First Clinical Hospital of Norman Bethune Health Science Center of Jilin University) treated critical COVID-19 patients combined with acute renal injury and cardiac insufficiency with continuous renal replacement therapy (CRRT) in Wuhan (the special ward of Tongji Hospital, Tongji Medical College, Huazhong University of Science ＆ Technology).
For this reason, the Neurocritical Care Committee of the China Neurologist Association (NCC/CAN) and Neurocritical Care Committee of the Chinese Society of Neurology (NCC/CSN) planned and completed the “Investigation of Infection Prevention and Medical Quality Control of Neuro ICU during COVID–19 Epidemic.” The investigation data was from five of the most representative provinces and cities (distributed in the East, West, South, North and middle of China). Based on the survey, the “Difficulties and Countermeasures of Neuro ICU Infection Prevention and Medical Quality Control During the COVID-19 Epidemic” was written.
The investigation showed that compared with the same period in 2019, there were fewer neuro ICU patients admitted during the epidemic period, especially those from outside cities; the length of stay was prolonged; the proportion of severe stroke patients was increased; the incidence of pneumonia complications was higher; the rate of lung CT scan reached 100%; however, the detection rate of SARS-COV-2 nucleic acid and antibody (IgM & IgG) was limited; the application rate of airway atomization and closed sputum aspiration increased, but the invasive operation rate of endotracheal intubation, tracheotomy, mechanical ventilation and fiberoptic bronchoscopy decreased. Although patients with Apache II > 15 scores accounted for a relatively high proportion, but the death toll has not increased. Stroke or traumatic brain injury (TBI) were still the first place of death and that the cause of death was still cerebral hernia or central respiratory and circulatory failure. Although there were suspected COVID-19 cases strayed into the neuro ICU (isolation room) in the early stage of the epidemic, the medical staff implemented standardized protection (level 2-3 protection), and no one was infected after 14 days of isolation observation (at least 2 times of negative COVID-19 nucleic acid test).
"Difficulties and Countermeasures of Neuro ICU Infection Prevention and Medical Quality Control During the COVID-19 Epidemic" was written based on the investigation report. It focused on all difficulties and countermeasures encountered in the neuro ICU during the epidemic:
- The neuro ICU epidemic prevention and control
- Critical neurological diseases diagnosis
- Critical neurological diseases treatment
- Diagnosis and treatment of critical neurological diseases complications
- Diagnosis and treatment of critical neurological diseases with COVID-19
- Further whereabouts or receiving units when the patients were transferred out of the neuro ICU
- Mental health of medical staff
We hope that our efforts and experience could offer help for neuro ICU colleagues during the global COVID-19 epidemic.