A total of 372 clinical shifts (Huoshenshan Hospital, Wuhan, Hubei, China) were monitored from February 9, 2020 to April 11, 2020, during which 62 COVID-19 patients were treated. Huoshenshan Hospital is an emergency hospital, built between 23 January and 2 February 2020, in response to the COVID-19 pandemic.
The study was approved by the ethics committee of First Affiliated Hospital of PLA Air Force Military Medical University. All participants provided written informed consent.
Shifts were divided into a control group (186 shifts) and an observation group (186 shifts). The 186 shifts before the rectification were set as the control group; during this shift, a routine nursing mode was adopted. In the observation group, the wearing comfort of protective equipment was improved to reduce the frequency of changing the protective equipment. Also, the transfer of articles in the contaminated area was standardized.
The monitoring process included: 1) changing protective equipment during worktime; 2) communication between inside and outside the contaminated area; 3) time needed to restock the bedside consumables .
Wearing protective equipment
The following improvements were made: ① the hand sanitizer, laundry fluid, iodophor, or mist spray were evenly applied to goggles, leaving the liquid to dry. It was ensured that the edge of the mask fits between the upper edge of the mask and the skin (from the lower part of the outer eyelid through the bridge of the nose to the lower part of the opposite eyelid). In addition, the positive pressure tightness test and the negative pressure tightness test  were performed. During the process, if the airflow passed through the upper edge of the mask, the mask needed to be adjusted. If there was a visible gap, the mask could be worn after the application of facial decompression paste. The fixation position of the frenulum can be slightly close to the top of the head, so there is a certain pressure between the upper edge of the mask and the skin, and fit as closely as possible. ②Goggles, shoe cover, and other ties were adjusted according to personal conditions and properly tightened. If the goggles are too tight, headache and vomiting may occur; if the shoe cover is too tight, numbness of lower limbs may occur. ③After wearing the mask, it was necessary to check whether the fixation was firm so as to prevent the frenulum from slipping forward from the head, affecting the sealing effect, or sliding backward, thus making the frenulum press on the upper part of both ears, aggravating already uncomfortable experience and even causing skin ulceration. When wearing the goggles, they can easily slide down, especially after engaging in the activities, so it was ensured that the lower edge of the inner mask was close to the nasal wing, which affects the breathing. Therefore, the position of the goggles close to the nasal bridge should not be too low. ④
A delivery system for contaminated areas
The following improvements were made: ①the items were fixed, classified, and clearly marked. It was established that a network communication platform, such as WeChat working group would be useful. Publish the item placement diagram on the WeChat working group so that all medical staff can grasp it.After use, they should return to their original position according to the requirements and hand over strictly. For each shift, the designated person in charge shall count all the items consumed and supplemented for each shift and send them to the working group at least 30 minutes before the shift handover. The next shift checked the information before entering the contaminated area, and the required items were brought into the contaminated area through the warehouse of the clean area. ③The reserve base was adjusted according to the consumption reported by each shift every week, the warehouse was timely notified of insufficient surplus items and substitutes were requested. ④Before entering the work area, the basic information of the patients were shared in advance via computer in the cleaning area, and the doctors and nurses jointly pre-judged the required items. ⑤The address book of each ward was created, keeping the communication smooth, and making emergency deployment under special circumstances. Meanwhile, this reduced the communication time between inside and outside the contaminated area and reduced the waiting time of goods delivery.
Establishing a new system for the use of consumables
The following improvements were made: ①The configuration of the treatment vehicle was standardized. Every three beds were equipped with a treatment vehicle, and the management was fixed. The type and quantity of consumables stored in the treatment vehicle were standardized, and previous staff members supplemented replacement consumption. According to the workflow and reasonable treatment of patients, the successor estimated the number of consumables needed on duty, to reduce the time of repeated replenishment of consumables and the time needed to enter and leave the treatment room. ②Modular first-aid supplies kit group was set up including emergency airway management and peripheral venous catheterization, etc. For example, oxygen mask, high flow oxygen nasal catheter, endotracheal intubation, guidewire, disposable laryngoscope, noninvasive ventilator mask, disposable ventilator humidification tank, ventilator pipe, etc. were prepared in the emergency airway treatment box group, and the consumables for each group were prepared in 3 sets. ③ Spare bed management. After patients were transferred out, when the beds were temporarily empty, the person on duty prepared a base number of conventional consumables for new patients, including oxygen inhalation devices, electrode piece, ventilator pipeline, etc. ④Strengthening information communication. When it was determined after a consultation that the transferred or newly admitted patients from the ward were confirmed by the consulting doctor and the department of critical care medicine, the basic information of the patients and the special materials to be prepared were also communicated at the same time, and the nurses made preparations in advance.
SPSS 22.0 software was used for statistical analysis, measurement data were expressed as mean±standard deviation, and a t-test was performed. Count data were tested by the χ2 test. A P<0.05 was considered statistically significant.