on the Eve of the Day of medical worker Moscow doctors received specialized main prize of the country — “the Calling”. Statuette “Golden hand doctor hold the crystal human life” handed over 21 to the employee the capital’s hospitals. They were awarded in the nomination “For the creation of a new direction in medicine,” noting the organization of work during a pandemic emergency and the conversion of hospitals for the treatment of coronavirus.
Moscow became the first city in Russia, which on a large scale are faced with a new infection. The entire health infrastructure had to rebuild as quickly as possible. The hospital promptly redeveloped. This was developed for a specific standard: the Department put the equipment to work with COVID-19, has installed an oxygen plant, deployed additional intensive care beds, provided the opportunity to conduct a CT-scan.
throughout Moscow launched for patients with coronavirus. They were received in the offices of more than 70 Federal, city and private hospitals. One of the first of these patients, a new medical complex in Kommunarka, which was closed just two days. Record quickly — within a month — built infectious diseases hospital in the Voronovo.
About how the doctors had to rebuild their lives and work, we talked to the winners of the award “Calling”. They are personally involved in the refurbishment of hospitals, have worked and continue to work in COVID centers.
When the hospital decided to convert to the infectious diseases hospital, the first thing we need to re-organize the space to comply with sanitary norms and to divide the streams of people. In hospitals were promptly established decontamination stations and gateways, shared the building with “dirty” and “clean” areas, open areas of decontamination and waste disposal, to deliver food and clean Laundry unfolded the treatment area sanitary transport, all staff were trained.
To properly and clearly organize the work, to the place went the team of experts. One of them was the infectious diseases doctor infectious hospital № 1 Maria Serova. Experts studied the floor plans of the buildings, gathered information about hospital equipment and made a detailed plan for the conversion.
“the Scheme of organization of sanitary systems in the institutions that were originally not designed for this purpose, is extremely difficult. Somewhere organized them on the street, because companies are designed so that in the building it is impossible,” — says Maria Serova.
Experts have examined intensive-care units, evaluated the technical condition of the system the supply of oxygen, the possibility of flow separation medical staff and patients. “All this needs to be done to the medical organizationI that is not designed for work with infectious patients, could provide medical assistance to such patients and this was provided epidemiological safety of the personnel”, says Maria Serova.
According to her, actively to restructure Moscow hospitals began in early March. The experts then had to travel to hospitals day and night — the holiday time practically didn’t remain.
In General, Maria Serova reacted to the pandemic COVID-19 safely. “Infectious diseases once a new virus scare,” says the doctor. She is certain that the coronavirus is not yet fully disappeared, and it is important to try to reduce the risk of infection.
Maria Serova reminded what we can’t forget everyone: how often to wash hands, use masks and sanitizer not to touch your face with your hands, to respect the social distance and to avoid large gatherings of people.
What the doctors had to adjust to new working conditions, said the Deputy chief doctor of the surgical care clinical hospital named after V. V. Vinogradov, Andrey Mylnikov. The redesigned office was opened there in mid-April. To separate the flow of patients and staff was a system of gateways.
“the hospital Staff comes into the gateway, changes clothes, puts on a protective suit and goes to the closed “Krasnow area. Outside there is a shower and a special room for removal and decontamination suits and remedies. In the end washed and cleaned experts back to “cestou zone” — says the doctor.
Before you can be in “red” zone, everyone needs to wear surgical pyjamas, airtight protective suit, feet — boots, hands, double gloves, head — cap, mask and glasses. “It’s heavy suits like the knights in the tournament. To work them very hard, especially in hot weather,” says the surgeon.
In the same outfit he had to work in hospitals Dagestan, where Moscow doctors went to help colleagues. “The temperature was over 30 degrees, and ventilation in the buildings is off, because it is impossible to make out the air from viruses. For a few hours two or three pounds definitely lose,” — says Andrei Mylnikov. In protective suits doctors work for 6-12 hours depending on the schedule.
it was Difficult because COVID-19 — not studied infection. Treatments had to develop what is called in the field, constantly being in touch with doctors from other countries. According to Andrei Mylnikov, at first were taken as a basis experience of colleagues from Italy, Spain and China, which first collided with the epidemic. Then the Russian doctors began to develop their recommendations for treatment, they are still correct given the new data.
Heavythan just Moscow physicians had in late April — early may, when the increasing incidence was at its peak. According to Andrei Mylnikov, the tension grew due to the fact that every doctor had to conduct a lot more patients than usual. Now, after 2.5 months, I managed to work out all the treatment algorithms and to switch completely to the new conditions.
Brigade of the Moscow hospitals sent to the most “hot” points in the regions. Since the end of may, they help doctors in hospitals of Dagestan, North Ossetia, Ingushetia, Pskov, Vladimir, Chita, Kamchatka and Yamal-Nenets Autonomous district.
the New pandemic in almost all countries has caused a sharp increase in the number of seriously ill patients. Of the patients were on intensive care beds, and that Moscow medicine was ready, says anesthesiologist medical complex in Kommunarka Andrey Bykov. Here patients with coronavirus infection has started taking in March.
According to him, it was difficult to adjust it to work in a high risk of infection in the PPE. Your standard working day Andrey Bykov describes: “You come to the hospital entrance on the handle arm, get mask, go to the locker room, dressed in his usual scrubs to get into “Krasnow area. Then you all the rules must wear a special protective suit, respirator, glasses, fully pack yourself and go to work.”
the Fact that all of these remedies for a long time can not be removed is a challenge for many physicians. If at first they laughed at the new conditions, soon the humour was gone. “Have you seen pictures where people have on a body there are traces of PPE? Imagine you wear it four consecutive months in the same place. In overalls and two pairs of gloves terribly hot. It would be like to go to the bath” — describes his feelings Andrey Bykov.
even such measures cannot absolutely guarantee that someone from the staff will not be infected. “The risk of infection is always there. You’re in the rain can’t stay dry outside, you’re still going to get wet anyway — hands, feet, face. But although I have four months to work, I have so far, all PCR tests negative,” says resuscitator. But his colleagues still ill with the coronavirus. Infectious disease Maria Serova was at the hospital with a diagnosis of COVID-19, and the surgeon Andrei Mylnikov had no symptoms, that showed the analysis on antibodies.
Another test for the doctors was the separation of families — many had to isolate themselves from spouses, children, and elderly parents. “We didn’t know what we face. All were isolated at this time, it was difficult to be away from their relatives and near��their people,” — says Andrey Bykov.
In search of the most effective treatments COVID-19 doctors of Kommunarka cooperate with leading experts from different countries. According to Andrey Bykov, when the infection was just beginning, the doctors proposed to use the achievements, remaining after the SARS epidemic. Disease appearance was similar, but in the first days of the Moscow doctors have noticed a paradox: for new disease does not fit the pattern described earlier. It is made to create own recommendations.
According to him, communication with foreign colleagues and joint protocols for the management of patients has allowed to reduce mortality to a minimum.
the doctors in Moscow, said Andrei Bykov, not afraid of the second wave of the pandemic in the capital, once managed to organize the work of the hospitals. In addition, doctors now know better how to treat the infection, — have the appropriate practices and protocols, and most importantly — a great experience.
Today, the standards of work of the Moscow COVID hospitals are implementing in the regions of Russia. 17 multidisciplinary teams of doctors sent to the regions to assist in the reshaping of hospitals, in the development of new algorithms, streaming and routing of patients.
the Reduction of incidence allows you to gradually return to a Moscow hospital by the usual mode of operation. In the reserve remain temporary medical centers based on 17 hospitals including the Institute of emergency care named after N. In. Sklifosovsky, city clinical hospital № 15 named after O. M. Filatov, medical complex in Kommunarka and other.
Through this city easier to return the hospital to provide the planned assistance. Planned patients already taking hospital of a name of D. D. Pletnev, named after E. O. Mukhin, named VP Demikhova, named M. E. of Zhadkevich, I. V. davydovskiy, clinical hospital No. 31, the hospital on Shabolovka and hospitals for war veterans No. 1, 2 and 3. In the near future this work will begin in hospitals no 17, 51, 29 N.Uh. Bauman named after S. I. Spasokukotskogo, № 1 named after N. And. Pirogov and in the tuberculosis hospital named after A. E. Rabukhin.
In hospitals, dismantle the equipment, to carry out sanitary processing, testing all personnel for the presence of coronavirus infection. Then employees will be research on COVID-19 on a weekly basis. For all hospitals, who will return to the usual mode, set a temporary standard of performance: the distance between beds in the wards increasing, space is additionally ventilated, and the air inside is disinfected.
also Changed the rules of admission and hospitalization. Patients take through a separate entrance, the interval between visits is at least 15 minutes. It is necessary to spend disinfection.
in addition to t��go, patients are tested for coronavirus and planned treatment start only after obtaining negative results. At this time people are placed in separate chambers in compliance with all requirements of sanitary-epidemiological security.