Management of COVID-19 Rehabilitation Nursing

COVID-19 confronted rehabilitation specialists with a new challenge. With the rapid development of rehabilitation medicine, rehabilitation nursing became a new and independent discipline with its unique theories, contents, and tasks closely related to but different from basic clinical nursing. Rehabilitation nursing emphasizes the rehabilitation of patients as the main focus, mobilizing patients’ subjective initiative in rehabilitation treatment, guiding them to participate actively, and attaching importance to the role of social and psychological factors. Through rehabilitation health education, rehabilitation psychological nursing, and rehabilitation extended nursing guidance, patients’ rehabilitation can be accelerated.

Establishment and Management of the Ward

Establishment of the Rehabilitation Isolation Ward

Rational and Scientific Layout

COVID-19 is mainly transmitted through the respiratory tract, droplets, and contact, and can be transmitted sustainably from person to person Therefore, according to patients’ admission and treatment requirements with respiratory infectious diseases, the disease areas are strictly divided. Following the principle of “three zones and two channels”, the three zones are contaminated zones, semicontaminated zones, and clean zones; the two channels are the staff channel and patient channel, and the staff and patients go in and out separately. In the meantime, set up a buffer between the two channels and the three zones with clear and well-marked boundaries between the districts. Establish two treatment areas in the ward to meet the needs of rehabilitation treatment.

Establishment of Nursing Staff

The infectious disease nature of COVID-19 and the national recommended protection plan calls for 36 beds and two treatment areas for a COVID-19 rehabilitation ward. Twenty nursing staff are deployed by the nursing department in the face of the sudden outbreak and intensive nursing work, including 12 former rehabilitation nurses and four rehabilitation specialist nurses.

Establishment of the Rehabilitation Isolation Ward

Management of Nursing Personnel

Divide the 20 nurses of the department into two responsible groups with three nurses and a leader in each group. The group leader should be a rehabilitation specialist nurse. Group A’s working hours are from 8:00 to 14:00, and from 14:00 to 20:00 for Group B. In addition to basic care, a COVID-19 rehabilitation and nursing plan should be customized and implemented under the leadership of the team leader. The head nurse makes nursing rounds twice a week and directs the nursing work of the responsible group. The rest are the shift group, and the clerical group and shift nurses work in pairs. By taking personal ability, specialty, and age into consideration, the nurses’ strength is relatively evenly matched. Each shift is 6 hours long.

Disinfection and Isolation Management in the Ward

All rehabilitation practitioners who contact patients for assessment and treatment of respiratory rehabilitation should strictly observe and implement Technical Guide for COVID-19 Prevention and Control in Medical Institutions (First Edition) and COVID-19 Guidelines for Common Use of Medical Protection (Trial) issued by the National Health Commission (NHC).

8.1.2.2.1 Air Disinfection

Air disinfection shall be carried out following the requirements of the Air Purification Management Standard in Hospitals.

Open the window of occupied rooms for ventilation twice a day for 30 minutes each time, or use an air sanitizer four times a day for 2 hours each time. Make general wards as isolation wards. Air conditioners can be used if the air conditioning system is set independently; otherwise, they should be shut down.

An ultraviolet lamp is irradiated once a day for more than one hour in an unoccupied room.

It is advisable to use 3% hydrogen peroxide or 5,000 mg/L peracetic acid or 500 mg/L chlorine dioxide for disinfection through an ultralow-capacity sprayer, 20-30 mL/m² for 2 hours. Close doors and windows during disinfection, and disinfect in strict accordance with the concentration use, dose usage, disinfection effect time, and operation method. After disinfection, rooms can be used only after full ventilation (at least 1 hour).

• 8.1.2.2.2 Disinfection of Articles and Ground
• 1) Strictly follow the Technical Specifications for Disinfection of Medical Institutions.
• 2) Ground and walls: When there are visible contaminants, remove them entirely before disinfection. When there is no visible contaminant, disinfect by wiping and spraying 1,000 mg/L chlorine-containing disinfectant or 500 mg/L chlorine dioxide disinfectant. For ground disinfection, it is first sprayed from outside to inside with a spray amount of 100-300 mL/m². After disinfecting the room, spray again from inside to outside. Disinfection time should be no less than 30 minutes.
• 3) Article surface: When there are visible containments on the surface of medical facilities and equipment, such as bed fences, bedside tables, furniture, door handles, household items, etc., completely clean them before disinfection. If there are no visible containments, spray, wipe or soak articles with 1,000 mg/L chlorine-containing disinfectant or 500 mg/L chlorine-containing disinfectant and wipe with clean water after 30 minutes.
• 4) Contaminants (patient’s blood, secretions, vomit, and excreta)

a. A small amount of contaminants can be carefully removed with disposable absorbent materials (such as gauze or dishcloths) by dipping 5,000-10,000 mg/L chlorine-containing disinfectant (or disinfectant wipes that can achieve a high

b. A large number of containments should be fully covered with disinfection powder or bleach-containing water-absorbing ingredients, or completely covered with disposable water-absorbing materials and then pour enough 5000-10000mg/L chlorine-containing disinfectant on the water-absorbing materials. Then carefully remove after more than 30 minutes.

c. Avoid contact with containments in the process of removal, and dispose of the cleaned containments as medical waste. The excreta, secretions, and patients’ vomitus should be collected in a special container and soaked and disinfected for 2 hours with 20,000 mg/L chlorine-containing disinfectant in the ratio of 1:2 for patient’s contaminants and disinfectant.

d. After the removal of contaminants, the surfaces of contaminated articles should be disinfected. Containers containing contaminants can be soaked in a disinfectant solution with 5,000 mg/L of active chlorine for 30 minutes and then wiped with clean water.

• 8.1.2.2.3 Disinfection of Reusable Instruments and Articles
• 1) Use disposable medical equipment, appliances, and articles as much as possible. The cleaning, disinfection, or sterilization of reusable medical equipment, instruments and articles should be handled following the Technical Specifications for Disinfection of Medical Institutions.
• 2) Common articles such as stethoscopes, infusion pumps, and blood pressure monitors should be thoroughly wiped and disinfected with 1,000 mg/L chlorine-containing disinfectant after each use. Thermometers should be soaked in 1,000 mg/L chlorine-containing disinfectant for 30 minutes and then cleaned and dried.
• 8.1.2.2.4 Medical Fabric Washing and Disinfection

Reusable medical fabrics should be disposed of following the Technical Specification for Washing and Disinfection of Medical Fabrics in Hospital (WS/ T508-2016).

• 1) Avoid aerosol generation during collection and incinerate medical waste.
• 2) If there are no visible contaminants, the medical fabric can be disinfected by circulating steam or boiling for 30 minutes if it needs to be reused; or soak in 500 mg/L chlorine-containing disinfectant for 30 minutes and then wash as usual; or use orange-red bags for air-tight packaging, and immediately transport to the washing center, and record the hand-over.
• 8.1.2.2.5 Treatment of Medical Waste

The disposal of medical waste shall comply with the requirements of the Regulations on Management of Medical Waste and Measures on Management of Medical Waste in Medical and Health Institutions, and shall follow the routine disposal process after the packaging of the double-layer yellow medical waste bags.

• 8.1.2.2.6 Precautions for Ultraviolet Air Disinfection
• 1) Air disinfection: Doors and windows should be closed, and rooms should be kept clean and dry when used. Start the time after the light is on for 5-7 minutes. The effective distance is no more than 2 meters.

The disinfection time is 60 minutes each time; open the window for ventilation after irradiation; stop the ultraviolet disinfection lamp’s exposure when there is a need to enter the room.

2) Disinfection of article surface: Spread or hang the items to expose them to direct radiation. Ultraviolet rays cannot penetrate objects.

The distance from the lamp to the contaminated surface should not exceed 1 meter. If the lamp’s ultraviolet radiation intensity meets the requirements, the exposure time should be no less than 60 minutes.

• 3) Personnel protection: Ultraviolet radiation causes unavoidable damage to human skin mucosa and has a stimulation effect on the deep respiratory tract and eyes. When using an ultraviolet disinfection lamp, be careful not to look directly at the ultraviolet light source. After the eyes are burned by ultraviolet ray, symptoms such as red eyes, fear of light, tears, pain will appear after 5-7 hours, and the pain will last for 24-72 hours.
• 4) Equipment management: The surface of the ultraviolet lamp should be clean during the use. Wipe it once a week with 75% alcohol cotton balls. If there is dust or oil on the surface of the lamp tube, wipe it at any time.
• 8.1.2.2.7 Precautions for Using Chlorine-Containing Disinfectants
• 1) Skin corrosion: Chlorine-containing disinfectants should not be sprayed directly on the face for disinfection. Long-term contact with chlorine-containing disinfectants will erode the skin. Its chemical properties are very active and toxic, so personnel must wear gloves when using chlorine-containing disinfectants and wash their hands afterward.
• 2) Stimulation of the nerve system and respiratory tract: Do not use chlorine-containing disinfectant in an acidic environment, as it will produce toxic chlorine, and then stimulate the nerve system and respiratory tract.
• 3) Chronic disease induction: chlorine is a strong irritant gas, causing sore eyes and tears, throat itching, and dyspnea. Long-term inhalation may cause chronic poisoning, rhinitis, chronic bronchitis, emphysema, and liver cirrhosis.
• 4) Instability after water dissolving: chlorine disinfectants dissolved in water can produce substances that can inhibit microbial activity and can also kill all kinds of microorganisms, including bacterial propagator, virus, fungus, mycobacterium tuberculosis, and the most resistant bacterial spores. However, it is susceptible to light, heat, and humidity and is unstable when dissolved in water, so it can be a health hazard if not used properly.

Protection Management of Medical Staff

All rehabilitation practitioners who are in contact with patients for rehabilitation treatment and care shall strictly comply with the requirements of the

Technical Guide for COVID-19 Prevention and Control in Medical Institutions (First Edition) and COVID-19 Guidelines for Common Use of Medical Protection (Trial) issued by the NHC. The Office of Hospital Infection Management organizes online and offline training guidance uniformly. The head nurse assesses wearing and taking off protective equipment for all staff in the department and is responsible for the supervision and inspection of disinfection, isolation, and use of protective equipment for each person in and out of the area, especially for the therapists, cleaning workers, and other staff, giving on-site correction for existing problems.

COVID-19 is highly contagious. Strengthening the protection awareness of medical personnel should be given top priority. The health registration of all on-duty staff shall be carried out by the department’s special staff at work. After work, nurses are required to take a hot bath, wash their hair and hands with running water after leaving the isolation area.

• 8.1.2.3.1 Protection Classification and Requirements
• 1) Low-risk areas: People with low probability of direct contact with patients, patients’ contaminants, contaminated articles, and environmental surface.

a. Requirements: Strictly take standard preventive measures; wear work clothes, disposable work caps, and disposable surgical masks; strictly observe hand hygiene during medical treatment and the removal of personal protective equipment.

2) High-risk areas: All medical personnel have direct or potential contact with patients, the patient’s contaminants, contaminated articles, and environmental surfaces.

a. Requirements: Strictly take standard preventive measures; wear work clothes, protective clothing, medical protective masks, gog-gles/face masks, disposable hats, and latex gloves, and shoe covers if necessary. When performing operations that may produce aerosols (such as endotracheal intubation and related operations, cardiopulmonary resuscitation, bronchoscopy, sputum aspiration, throat swab sampling) for patients with suspected or confirmed cases and when using high-speed equipment (such as drilling, sawing, centrifugal operation), medical personnel should take three-level protection, that is, add a comprehensive type of protective mask for secondary protection.

3) Order of putting on and taking off protective equipment (tertiary prevention):

a. Putting on: Wash hands, wear a medical protective mask (do a tightness test), wear a disposable round cap, wear goggles/face masks, wear gloves, wear protective clothing, wear a comprehensive protective mask or respirator, wear shoe covers, and wear a second layer of gloves.

b. Taking off: Remove the outer gloves, wash hands, remove the comprehensive protective mask or respirator, wash hands, remove the protective clothing and shoe covers, wash hands, remove the goggles/protective mask, wash hands, remove the disposable round cap, wash hands, remove the medical protective mask, wash hands, change personal clothes.

8.1.2.3.2 Hand Hygiene

The hand-washing method of medical personnel shall be strictly carried out following the “six-step washing method” stipulated in the Hand Hygiene Standards for Medical Personnel.

Quick-drying hand disinfectant is preferred when sanitizing hands, and other hand sanitizers can be used for allergic people. Chlorhexidine is ineffective in inactivating coronavirus, so it is not recommended. Hand disinfectants containing chlorine, alcohol, hydrogen peroxide, and other ingredients are recommended.

Wearing gloves should not replace hand hygiene. Hand hygiene should be carried out after removing gloves.