Infection Control In Emergency Department Research Articles

小児におけるCOVID–19の特徴と救急診療上の注意点(Characteristics and considerations in the medical treatment for COVID–19 in children)

要旨 小児における新型コロナウイルス（SARS–CoV–2）による感染症（COVID–19）は，軽症患者が圧倒的に多く，重症化する割合や，死亡の割合は非常に小さい。重症化した小児では，喘息を含む慢性肺疾患，心血管系疾患，免疫抑制状態の患者が多く，基礎疾患をもつ小児では特に注意を要すると考えられている。最近，小児COVID–19の確定または疑い患者において，肺炎像がないにもかかわらず，長引く発熱，腹痛，心機能低下などを伴い，強い炎症反応を呈する症例が報告されているが，SARS–CoV–2感染との関連はまだ不明な点が多い。小児の特徴として不顕性感染が多く，家族内や地域，医療機関において感染源となることが懸念されている。救急医療の現場では不顕性感染の可能性を考慮した感染予防策が必要である。一方，感染予防対策としての外出制限や休校措置は，健康な小児に対し，予想を超える精神的・身体的な影響を及ぼしている可能性がある。身体症状を訴えて受診するなかに精神的なサポートを必要とする小児や，社会的に孤立し救急外来への受診が唯一の社会的接点になっている小児がいる可能性を考慮して，必要に応じソーシャルワーカーなど多職種と連携して対応することが重要である。

Checklist for infection control in the emergency department

救急外来部門では，新興感染症も含め，様々なヒト‐ヒト感染症と遭遇する危険性があり，その感染対策は十分かつ適切に行われるべきである。しかし，救急外来部門での感染対策について十分なエビデンスに基づいて作成されたガイドラインなどはこれまで世界的にも作成されておらず，各施設で独自の対応策を検討・実施している。日本救急医学会は「救急外来部門における感染対策検討委員会」を設置し，日本感染症学会，日本環境感染学会，日本臨床救急医学会，日本臨床微生物学会とともに5学会連携の救急外来部門における感染対策について検討する合同ワーキンググループを組織した。この合同ワーキンググループにおいて，救急外来における感染対策およびそれに関連する事項について総合的かつ多面的に検討を行い，「救急外来部門における感染対策チェックリスト」を公開するに至った。本チェックリストは，救急専従医が少数あるいは配置されていない小規模な救急外来部門であっても，このチェックリストに従い準備をすれば大きな間違いをせずに感染対策が行えることを目的に作成された。この中には，感染対策の管理体制，教育・検診・予防接種体制，感染が疑われる患者への対応，ハード面の感染リスク管理などが含まれており，さらにチェックすべき時期やその間隔については，それぞれカテゴリーとして明示している。本チェックリストが，救急外来部門における感染対策の充実に資することを期待したい。

Checklist for infection control in the emergency department.

The risk of encountering human-to-human infections, including emerging infectious diseases, should be adequately and appropriately addressed in the emergency department. However, guidelines based on sufficient evidence on infection control in the emergency department have not been developed anywhere in the world. Each facility examines and implements its own countermeasures. The Japanese Association for Acute Medicine has established the "Committee for Infection Control in the Emergency Department" in cooperation with the Japanese Association for Infectious Diseases, Japanese Society for Infection Prevention and Control, Japanese Society for Emergency Medicine, and Japanese Society for Clinical Microbiology. A joint working group has been established to consider appropriate measures. This group undertook a comprehensive and multifaceted review of infection control measures for emergency outpatients and related matters, and released a checklist for infection control in emergency departments. This checklist has been prepared such that even small emergency departments with few or no emergency physicians can control infection by following the checklist, without committing any major errors. The checklist includes a control system for infection control, education, screening, and vaccination, prompt response to suspected infections, and management of the risk of infection in facilities. In addition, the timing of the check and interval at which the check is carried out are specified as categories. We hope that this checklist will contribute to improving infection control in the emergency department.

CHARACTERISTICS and considerations in the medical treatment of COVID-19 in children.

It is rare for children to be in serious condition or die from coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) except for those with underlying diseases such as chronic lung disease (including asthma), cardiovascular disease, and immunosuppressive disease. Recently, patients with hyperinflammatory shock have been identified among children who are confirmed to have or are suspected of having SARS-CoV-2 infection. The presenting signs and symptoms are characterized by prolonged fever, abdominal pain, and cardiac involvement without any signs of pneumonia on chest computed tomography. However, it is uncertain at this time whether SARS-CoV-2 infection affects this syndrome. Compared with adults, quite a few children are asymptomatic even when infected with SARS-CoV-2, which could make these children serious sources of infection at home or in medical institutions. Considering these characteristics, it is important to take appropriate precautions during medical examinations and perform infection control in emergency departments to save the lives of both the children and adult patients. Most healthy children are suffering from huge stress due to restrictions against going outside and school closures as social means to control infection. It is possible that children are socially isolated when they come to the emergency department, and they might require mental or social support even if they are only complaining about their physical condition. Health-care providers are required to examine the children's circumstances carefully and cooperate with workers in other professions appropriately.

A survey on infection control in emergency departments in Japan.

AimInfection control in the emergency department is important for hospital risk management; however, few clinical guidelines have been established. This study aimed to determine whether hospitals in Japan have infection control manuals, and investigate the contents of manuals, consulting systems, and isolation facilities for emergency departments.MethodsA total of 517 hospitals certified as educational institutions for board‐certified acute care physicians in Japan were requested between March and May 2015 to provide a written evaluation of the infection control in the emergency department.ResultsA total of 51 of 303 (16.8%) hospitals had no manuals regarding infection control in the emergency department. Among 250 hospitals having emergency department manuals, 115 (46.0%) did not include contents regarding disinfection and sterilization for imaging examination rooms, and only 44 (17.6%) had criteria for contacting the emergency medical service when patients are suspected of, or diagnosed with, communicable diseases. Of the 303 hospitals, 277 (91.4%) prepared specific manuals for the 2009 pandemic influenza. Of the 303 hospitals, 80 (26.4%) did not prepare manuals for the Ebola virus disease outbreak in West Africa in 2014. Furthermore, 92 (30.4%) of the 303 hospitals did not have any negative‐pressure isolation rooms.ConclusionsPractices and guidelines necessary for infection control in the emergency department were not sufficiently covered in the hospitals studied. Education, information sharing, and a checklist for preparing manuals are needed to establish better infection control systems in emergency departments.

응급실에서의 감염관리 표준지침의 반영에 관한 연구 -응급실에서의 감염관리 표준지침과 응급의료에 관한 법률의 반영 비교를 중심으로-

응급실은 병원으로 입원하는 주요 경로로서, 감염환자의 1차적 내원의 가능성이 높은 곳이다. 국내에서 질병관리본부 가 2009년에 제정한 “응급실에서의 감염관리 표준지침”이 응급실 감염환자 관리 방안과 표준시설기준을 규정하고 있으나 각 병원 응급실의 감염환자 시설은 병원마다 차이가 있고 지침에 따른 일관된 감염환자 관리시설을 갖추었다고 보기 어렵다. 본 연구는 응급실에서의 감염관리 표준지침의 실효성을 알아보기 위해 법적 강제성을 갖는 “응급의료에 관한 법률”과 비교 하여, 첫째 지침이 법률 시설기준에 반영된 여부를 분석하였고, 둘째 2009년 전후에 신축 또는 개축한 응급실들을 분석대상 으로 하여 각 시설기준 항목들의 반영여부를 파악하였다. 그 결과 지침과 법률 시설기준의 상호연관성은 없었다. 분석대상 응급실들의 시설은 법적기준을 모두 충족한 반면 지침의 감염관리시설은 선별적으로 적용되어 있었고, 설치 항목들이 건축 년도에 관계없이 분석대상 응급실에 대부분 적용되어 “응급실에서의 감염관리 표준지침”의 제정과는 무관한 것으로 나타났 다. 본 연구 결과는 향후 응급실의 감염관리시설의 법적기준 체계 보완에 참고자료로 활용 될 수 있을 것이다.