To:
- Directors of hospitals
affiliated to the Ministry of Health;
- Departments of Health;
- Health units of central authorities.
Implementing Decision No. 237/QD-BYT dated
31/01/2020 by the Minister of Health on promulgation of plan for response to
the novel coronavirus pneumonia (nCoV) epidemic at various levels; following
Official Dispatch No. 362/BYT-KCB dated 28/1/2020 by the Ministry of Health, to
ensure that healthcare establishments are prepared to receive, manage and treat
patients as appropriate to each situation and prevent patient deaths, the
Ministry of Health requests directors of hospitals affiliated to the Ministry
of Health; Directors of Departments of Health and health units of central
authorities to seriously direct healthcare establishments to prepare for
response, receipt, diagnosis, treatment and management of confirmed and
suspected nCoV-2019 cases. To be specific:
- Seriously organize emergency
aid, admission and treatment in health units.
- Organize quarantine,
treatment and management of nCoV-2019 cases, and ensure the safety of
healthcare workers, patients’ families and communities according to
regulations. Isolated treatment areas shall be divided into three units: an
area for suspected cases, an area for confirmed cases and an area where
patients stay before discharge.
- Be prepared to classify
patients immediately when they register for medical examination at healthcare
establishments: classify and provide separate examination rooms for patients
with symptoms of acute respiratory tract infection (cough, fever, etc.); pay
attention to those living in or coming from China within the past 14 days.
- Healthcare establishments
having inpatient beds (hospitals at district level and equivalent and higher)
shall receive, treat, manage, monitor and isolate suspected nCoV-2019 cases.
- All hospitals must have a
plan for patient transport upon referral order. When a patient's condition
worsens beyond the hospital’s technical capacity, refer the patient to the
appropriate level of care (according to Appendix 1).
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- Collect and send samples
from suspected cases to local Institutes of Hygiene and Epidemiology and
Pasteur Institutes for confirmatory testing as follows:
+ Healthcare establishments shall collect,
transport and preserve samples from suspected nCoV-2019 cases in accordance
with guidelines for nCoV-2019 monitoring and prevention from the Ministry of
Health.
+ Sample receiving units:
(1) Laboratories of National Institute of Hygiene
and Epidemiology shall receive samples from Northern provinces.
(2) Laboratories of Ho Chi Minh City Pasteur
Institute shall receive samples from Southern and Central Highlands provinces.
(3) Laboratories of Central Highlands Institute of
Hygiene and Epidemiology shall receive samples from Central Highlands
provinces.
(4) Laboratories of Nha Trang Pasteur Institute
shall receive samples from Central provinces.
(5) Other laboratories permitted to receive samples
by the Ministry of Health.
+ Sample testing units:
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(2) Laboratories of Ho Chi Minh City Pasteur
Institute shall test samples from Southern and Central Highlands provinces.
(3) Laboratories of Central Highlands Institute of
Hygiene and Epidemiology shall test samples from Central Highlands provinces.
(4) Laboratories of Nha Trang Pasteur Institute
shall test samples from Central provinces.
(5) Depending on the nCoV-2019 situation and
testing capacity of units, the Ministry of Health will consider allowing
hospitals affiliated to the Ministry of Health and provincial hospitals and
CDCs to perform confirmatory tests where necessary.
- Strictly control infection
and prevent cross-contamination in healthcare establishments according to
guidelines in Official Dispatch No. 96/KCB-DD&KSNK dated 24/01/2020 by
Medical Services Administration on nCoV-2019 prevention and control in
hospitals. Take all protective measures for health officials directly
participating in patient examination, treatment and care to prevent
transmission to health officials.
- nCoV-2019 rapid response
teams of central and tertiary hospitals (according to Decision No. 225/QD-BYT
dated 30/1/2020 by the Minister of Health) shall be ready to support hospitals
of lower levels of care when mobilized by the Ministry of Health.
- Always prepare plans and
resources to admit more patients and respond promptly when the disease starts
spreading.
- Establish and properly
maintain a Tele-Medicine system to carry out online briefings, medical
consultations and professional exchanges between hospitals in the network.
- Continue to raise the
awareness of patients and their families about personal protective measures
(face masks, regular hand washing, etc.) and of health officials about
procedures for infection control and personal protection in healthcare
establishments.
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P.P. THE
MINISTER
THE DEPUTY MINISTER
DEPUTY HEAD OF NATIONAL STEERING COMMITTEE FOR nCoV-2019 PREVENTION AND
CONTROL
Nguyen Truong Son
APPENDIX 1
GUIDELINES ON CLASSIFICATION OF TREATMENT BASED ON
OUTBREAK LEVELS
1. Classification
of treatment for outbreak level 2:
(1) All healthcare establishments (at district
level and equivalent and higher) shall prepare a separate area for patient
management and treatment. Suspected cases shall be received, monitored and
completely isolated in isolated treatment areas. When a patient's condition
worsens beyond the hospital’s technical capacity, refer the patient to the
appropriate level of care.
(2) Provincial hospitals shall:
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- Suspected cases shall be
received, monitored and completely isolated in isolated treatment areas. When a
patient's condition worsens beyond the hospital’s technical capacity, refer the
patient to the appropriate tertiary hospital; or report to the Ministry of
Health, which will mobilize the nCoV-2019 rapid response team for assistance.
(3) Tertiary hospitals:
- In the North:
+ National Hospital for Tropical Diseases (Kim
Chung branch, 500 beds) shall receive patients from Ha Tinh province
northwards.
+ If all backup beds of National Hospital for
Tropical Diseases are occupied, patients shall be transferred to Bach Mai
Hospital and National Children’s Hospital. For the time being, these hospitals
shall prepare facilities for isolated treatment units with 30-60 beds.
- In the Central:
+ Hue Central Hospital shall receive patients from
Central and Central Highlands provinces (from Quang Binh province to Phu Yen
province).
+ If all backup beds of Hue Central Hospital are
occupied, patients shall be transferred to Da Nang General Hospital. Hue
Central Hospital (branch 2) shall prepare an isolated treatment unit with 30-60
beds (for adults and children) ready to accept patients.
- In the South:
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+ If all backup beds of Ho Chi Minh City Hospital
for Tropical Diseases are occupied, patients shall be transferred to Cho Ray
Hospital (tropical disease department with 30-60 beds), Children Hospital No. 2
(30-60 beds) and Ho Chi Minh City Children Hospital (Department of Infectious
Disease D: 30-60 beds).
Note: Where necessary, healthcare establishments
may transfer severe cases to hospitals besides those abovementioned and shall
concurrently report to the Ministry of Health and National Steering Committee
for nCoV-2019 Prevention and Control .
2) Classification of treatment
for outbreak level 3:
(1) All healthcare establishments (at
district level and equivalent and higher) shall prepare a separate area for
patient management and treatment. Suspected cases shall be received, monitored
and completely isolated in isolated treatment areas. When a patient's condition
worsens beyond the hospital’s technical capacity, refer the patient to the
appropriate level of care.
(2) Provincial hospitals shall:
- Prepare an isolated
treatment area for at least 20 nCoV-2019 patients in the infectious disease
department of the provincial general hospital or provincial tropical disease
hospital/ tuberculosis and lung disease hospital.
- Suspected cases shall be
received, monitored and completely isolated in isolated treatment areas. When a
patient's condition worsens beyond the hospital’s technical capacity, refer the
patient to the appropriate tertiary hospital; or report to the Ministry of
Health, which will mobilize the nCoV-2019 rapid response team for assistance.
- Receive, admit, treat,
manage, monitor and completely isolate nCoV-2019 cases in provinces (in the infectious
disease department, provincial general hospital or provincial tropical disease
hospital/ tuberculosis and lung disease hospital); and only refer patients
whose condition worsens beyond the hospital’s technical capacity to the
tertiary hospital.
(3) Tertiary hospitals:
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+ National Hospital for Tropical Diseases (700
beds), Central Lung Hospital (50 beds), Bach Mai Hospital and National
Children’s Hospital shall prepare additional treatment units to receive
patients and support lower levels of care (20-50 beds).
+ Hospitals in Hanoi such as Bac Thang Long
Hospital, Duc Giang Hospital, Saint Paul Hospital, Dong Da Hospital, Thanh Nhan
Hospital and Ha Dong Hospital shall receive patients and support treatment.
Patients with milder clinical symptoms or having passed the critical stage and
awaiting discharge will be transferred from National Hospital for Tropical
Diseases, Bach Mai Hospital and National Children’s Hospital to the
abovementioned hospitals.
+ E Hospital, Thai Nguyen National Hospital, Uong
Bi Vietnam - Sweden Hospital, Hai Phong Vietnam - Czech Hospital, Thai Binh
General Hospital and Thanh Hoa General Hospital shall receive nearby patients
(each hospital shall have 20-50 isolated and fully equipped beds and a backup
isolated area with 20-50 beds in case of large local outbreak).
In the Central:
- The isolated area in the
infectious disease department of Hue Central Hospital shall be expanded to
receive 50 patients (both adults and children).
- General hospitals of Da
Nang, Binh Dinh, Khanh Hoa and Dac Lac shall receive and treat nCoV-2019
patients. Each hospital shall prepare 30 isolated and fully equipped beds and
30 backup isolated beds in the infectious disease department.
In the South:
+ Ho Chi Minh City Hospital for Tropical Diseases:
50 beds
+ Cho Ray Hospital: 30-60 beds
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+ Children’s Hospital No. 2: 30 beds
+ City Children’s Hospital: 30 beds
+ Can Tho Central General Hospital: 20-50 beds
+ Kien Giang General Hospital: 30 beds
- + Internal isolated
treatment facilities shall be established in schools, factories, office
buildings, military units, etc. having confirmed cases.
- Mobilize human and material
resources (equipment, medications, materials, etc.) for treatment units.
Provide technical and workforce assistance for localities with complicated
situation.
3) Classification of treatment
for outbreak level 4:
- Maintain continue operation
of hospitals at central, provincial and district levels to ensure provision of
essential medical services, including services for vulnerable groups such as
children, pregnant women, the elderly and persons with chronic diseases.
- Increase number of health
units receiving patients, classify patients at each level of care, avoid
referring patients to higher levels of care to prevent overload.
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- Expand morgues to receive
deceased patients. Launch plans for funerals in the event of high number of
deaths.
- In unaffected
localities
(1) Provincial central general hospitals:
Each hospital shall prepare an isolated treatment
area in the infectious disease department and may mobilize additional personnel
and equipment from the intensive care unit and pediatrics department. Each
hospital shall prepare at least 20 isolated beds for admission and treatment
(depending on its capacity).
(2) Provincial general hospitals:
Each hospital shall prepare an isolated treatment
area in the infectious disease department and may mobilize additional personnel
and equipment from the intensive care unit and pediatrics department. Each
hospital shall prepare at least 20 isolated beds for admission and treatment
(depending on its capacity).
(3) Provincial hospitals for tropical diseases
and hospitals for tuberculosis and lung diseases:
Each hospital shall prepare an isolated treatment
area in the intensive care unit. Each hospital shall prepare at least 20
isolated beds for admission and treatment (depending on its capacity).
(4) District-level hospitals:
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When a patient's condition worsens beyond a
district-level hospital’s capacity, refer the patient to a tertiary hospital
after notifying the tertiary hospital in advance to prevent overload.
(5) Hospitals of central authorities:
The following hospitals of central authorities
shall join the treatment network upon a large outbreak:
- 19/8 Hospital, 30/4 Hospital
and 199 Hospital (Ministry of Public Security)
- Agriculture Hospital I
(Ministry of Agriculture and Rural Development)
- National Transport Hospital
and regional transport hospitals
- Hospital of Post and
Telecommunications I
- Construction Hospital, etc.
Each hospital shall prepare at least 10 isolated
beds (depending on its capacity). These hospitals shall join the fight against
nCoV-2019 when a large outbreak happens in their localities and receive
equipment, medications and materials from the national reserve.
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Detect and send suspected cases to hospitals for
treatment and notify local centers for disease control and prevention to take
measures against nCoV-2019. Give instructions on measures to prevent the
disease from spreading to family members and other people, use of face masks
and respiratory hygiene to patients.
APPENDIX 2
nCoV-2019 INFORMATION AND REPORTING SYSTEM
1. Reporting hospitals:
All hospitals where suspected nCoV-2019 cases are
monitored, isolated, tested, supervised and treated must submit reports.
2. Regular data collecting period:
• According to shifts, from 7:30 AM of the
reporting day to 7:30 AM of the following day.
3. Regulations on reporting time:
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• The following cases shall be reported on within 2
hours:
• When patients are admitted, discharged or
deceased
• When test results are available
• When a patient’s condition worsens or improves
4. Regulations on reporting period:
• The system shall not replace the infectious
disease reporting system.
• Guiding documents from the Ministry of Health
shall be followed throughout the period where the Ministry of Health declares a
state of emergency.
5. Account:
• Website for online epidemic reporting: cdc.kcb.vn
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• Support email: mailto:[email protected]
• Support phone number: posted on online software
6. Report
form
6.1 Form of general report on examination and
treatment of confirmed or suspected nCoV-2019 cases
For healthcare establishments where suspected
nCoV-2019 cases are monitored, isolated, supervised and treated
Is there any development related to nCoV-2019 in
the hospital?
[default] [ ] No [ ] Yes
If yes, report using the following form:
Item
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Cumulative sum
1. Number of suspected
nCoV-2019 cases visiting for examination [1 ]
Number of cases visiting for examination having
epidemiologic factors related to nCoV-2019 [2]
2. Number of suspected cases
admitted
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3. Total number of patients
receiving treatment in isolation
3.1- Number of severe cases (noninvasive
ventilation)
3.2- Number of severe cases (mechanical
ventilation, emergency, ICU)
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4.1 - Recovered and improved
4.2 - Referred to higher level or care or
specialized department
4.3 - Referred to lower level of care
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4.3 - Deceased
4.4 - Severe and ask to return home
4.5 - Escaped
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5. Number of cases whose samples
have been collected (5.1 + 5.2 + 5.3)
- Genetic sequencing
- Realtime PCR
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5.1 Number of cases having positive result
- Genetic sequencing (+)
- Realtime PCR (+)
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- Other tests
5.2. Number of cases having negative result
- Genetic sequencing (-)
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- Realtime PCR (-)
- Other tests
5.3 Number of cases pending test result
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• Description of progression, treatment and result
or detailed description of patient condition etc.
• Other recommendation (if any)
Attached documents (multi-files):
• More detailed report or summary of medical
record etc.
8. Contact (daily)
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7.2 Full name of reporter
Phone number
Email
7.3 Name of leader of nCoV-2019 prevention
operations
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Email
Report number
Report recipient
Receiving emails (separated by “ ; “)
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[2] Having clinical symptoms and epidemiological
factors (having returned from infected areas, having contact with confirmed
cases, etc.)
6.2. Detail on suspected nCoV-2019 cases being
monitored, isolated, supervised and treated
1. Patient number
2. Full name
3. Age/ Date of birth
4. Sex
5. Place of residence
6. Telephone number
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8. Reason for admission
9. Epidemiological factors: within
14 days prior to the onset of symptoms, did you
a. Live in or travel to or from an infected
locality?
[ ]
Yes
[ ]
No
[ ] Don’t know
If yes, specify the address:
b. Have direct contact with or give care to a
confirmed or suspected nCoV-2019 case?
[ ]
Yes
[ ]
No
[ ] Don’t know
c. Live or work with a confirmed or suspected
nCoV-2019 case?
[ ]
Yes
[ ]
No
[ ] Don’t know
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[ ]
Yes
[ ]
No
[ ] Don’t know
e. Return from Wuhan City/ China?
[ ]
Yes
[ ]
No
[ ] Don’t know
f. Have a family member who returned from Wuhan
City/ China?
[ ] Yes
[ ]
No
[ ] Don’t know
10. Confirmatory test results
1. Have not collected sample [
] 2. Have collected
sample [ ]
No.
Type of sample
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Laboratory
Date of result
announcement
Method
Result
If (-), write
“good result”
Edit
1. Throat swab
2. Nasal swab
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4. Tracheal swab
5. Inhaled body in airway
6. Alveolar wash
7. Blood
8. Feces
9. Other
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- Realtime PCR (-)
- Negative
- Positive
- Suspected
11. Primary diagnosis (ICD-10)
[ICD-10 list]
12. Comorbidity diagnosis
(ICD-10) [ICD-10 list] (multiple comorbidities)
13. Complication diagnosis
(ICD-10) [ICD-10 list] (multiple complications)
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No.
Time of change
Development
Description (in
case of severe condition or death)
Hour - Date
Stable
• Improved
• Severe, complication: oxygen therapy
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• Severe, complication: invasive ventilation
• Severe, complication
• Death
• Severe, ask to return home
• Other development
15. Treatment: [Paragraph]
16. Condition upon discharge
• Stable
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• Severe and referred
• Discharged
• Deceased
17. Note/ Detailed
description:
• More detailed description
18. Attached documents
(summarized medical record, clinical case report, etc.)
9. Responsibility
8.1. Hospital
- Assign a standing official
to report
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- Take responsibility for data
quality
8.2. Department of Health
• Expedite inspection
• Aggregate data of the whole province and data
from hospitals of Ministries and central authorities in its province
• Take measures against nCoV-2019 according to
collected data
8.3. Ministry of Health
• Develop report consolidation tools and guidelines
• Supervise compliance
• Supervise data quality
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10. Features
• Log in
• Authorize
• Add new / Delete and change data
• Confirm submission of hospital-level reports,
confirm submission of department-level reports
• View and print daily, weekly and monthly reports
• Review data via Email
• Review data via SMS
• Provide map according to patient’s current
address
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• Expand to include other infectious diseases
11. Guidelines for clinical coding
• WHO temporary assigns the ICD-10 code of U07.1 to
“2019-nCoV acute respiratory disease”.
• The disease is named nCoV-2019 for the time
being. WHO will announce the official name of the disease after virus
isolation.
• The U07 code group has been renamed to
"Emergency care".