This is an Accepted Manuscript for Infection Control & Hospital Epidemiology as part of the

Cambridge Coronavirus Collection.

DOI: 10.1017/ice.2020.119

Article Type: Letter to the Editor

Title page
Title: Application and effects of fever screening system in the prevention of nosocomial
infection in the only designated hospital of coronavirus disease 2019 (COVID-19) in
Shenzhen, China

Short Title: Fever screening system in the prevention of COVID-19 in Shenzhen.

Authors: Ting Huang1,*, Yinsheng Guo2, Shaxi Li1, Yanqun Zheng1, Lin Lei1, Xianhu Zeng1,

Qiao Zhong3, Yingxia Liu1,*, Lei Liu1,*

1
Department of healthcare-associated infection management, The National Clinical Research
Center for Infectious Diseases/The Third People's Hospital of Shenzhen (Second Affiliated
Hospital of Southern University of Science and Technology), Shenzhen, 518112, PR China
2
Environment and Health Department, Shenzhen Center for Disease Control and Prevention,
Shenzhen, 518055, Guangdong, China
3
Department of healthcare-associated infection management, Shenzhen Maternity and Child
Healthcare Hospital, Southern Medical University, Shenzhen 518028, China

*Corresponding author. Tel.: +86 755 61222333-8986; fax: +86 755 61238928.

E-mail address: liulei3322@aliyun.com, yingxialiu@hotmail.com, hting622@hotmail.com.

Key words: COVID-19; Designated hospital; Fever screening system; Nosocomial infection;

Conflict of interest

The authors declare that there are no conflicts of interest.

Acknowledgments and financial statement

The authors would like to thank all the participants in our study. This study was
supported by grants from the Science and Technology Innovation Committee of Shenzhen
Municipality (202002073000001) and National Key Research and Development Program
2020YFC0841700.
Word count: 1142
 Application and effects of fever screening system in the prevention of nosocomial infection

in the only designated hospital of coronavirus disease 2019 (COVID-19) in Shenzhen, China

The novel coronavirus, newly named as “coronavirus disease 2019 (COVID-19)” by the

world health organization (WHO), was firstly identified by the Chinese scientists 1, 2. Infected

with this human-to-human transmission virus could cause severe respiratory diseases, such as

SARS and MERS. It was reported that COVID-19 could spread through droplets, aerosols,

3, 4
contact or digestive tract . Up to March 1st, more than 80, 000 cases have been confirmed

in China. Meanwhile, over 7200 cases have been diagnosed in the other 61 countries,

including Korea, Iran and the United States, etc 5.

As a megalopolis with a large floating population, the epidemic situation in Shenzhen

has developed rapidly6. Since January 11, the first case was confirmed in Shenzhen (also the

first case in Guangdong province)7. Up to March 1st, a total of 418 cases have been

confirmed in just 50 days time. Since the outbreak of this new type of coronavirus pneumonia,

the third people's hospital of Shenzhen has been identified as the only designated hospital for

all the COVID-19 patients in Shenzhen. As is shown in Figure 1, from January 11th to March

1st, the average number of the confirmed patients per day was 18.44 ± 16.18. The maximum

number of the admitted patients was 56 for one day. Among them, the average number of

severe patients and critically ill patients per day was 4.04 ± 5.10 and 0.84 ± 2.23. The

maximum number of severe patients and critically ill patients was 17 and 12, respectively, for

one day. In total, 31 infectious diseases areas, 508 wards and 1374 hospital beds were

applied.
 Facing up to this suddenly happened and threatening epidemic situation, the infection

prevention and control department of the third people's hospital of Shenzhen has done a lot of

work in the prevention of virus transmission, cross infection and medical staff infection8. The

initiated first fever screening system plays an important role in the prevention and control of

hospital infection.

1. Three levels of triages of fever patients

In order to avoid the cross infection of patients in the process of outpatient treatment, the

hospital department strictly controls the entrance and exit of outpatient area. Only the

entrance of outpatient hall and emergency hall are reserved at the entrance and exit. All

patients need to go through the "three passes". The first pass: the pre-examination and triage

pass. Doctors and nurses take temperature measurements and do triage work for each patient

in this pass. The epidemiological history and clinical symptoms of the patients have been

carefully inquired by the triage personnel. Each fever patient was issued surgical masks and

detailly registered for traceability. According to the specific content of the questionnaire, the

two-dimensional code is set as "red", "yellow" and "green". The red code is sent to the fever

clinic by a special person according to the designated route. The yellow code is sent to the

follow-up clinic after the discharge of COVID-19. The green code enters the outpatient hall.

The second pass: a special triage pass. The patient must show the two-dimensional code at

this special triage. The triage nurse takes the patient's temperature again and asks about the

epidemiological history orally. Third, in the consulting room, the doctor signs the

"notification of epidemiological history" of the patient after inquiring about the medical

history. The two sides have been signed and filed. In the second and third passes, the fever
patients found in the pre examination will be delivered to the fever clinic along the

designated route, accompanied with the staff of the pre-examination triage. The areas that the

patients pass through will be disinfected at the same time.

The flowchart for pre-inspection and three-stage triage system is shown in Fig 2. From

January 11 to March 1, 421 people went to fever clinic under the guidance of outpatient

pre-examination triage office. Among them, 12 cases were confirmed COVID-19. It is

precisely because of the strict three-level triages that the COVID-19 patients are prevented

from infecting other patients or medical staff in the public area of the clinic.

2. District management of fever clinics

The fever clinic is located in an independent area far away from the clinic hall. The

patient channel and the medical staff channel are independent and do not cross with each

other. In the fever clinic, there are consulting rooms, waiting area, charge office, pharmacy,

specimen collection office, X-ray examination area and resuscitation rooms. To our

knowledge, this is the first time to divide the fever clinic into different areas. The two fever

clinics are relatively independent and do not cross each other. As shown in Fig 3, the patients

will be screened by Healthy-QR code. The red Healthy-QR code indicates that the patient has

an epidemiological history, and the owner should go to fever clinic 1 for treatment. The green

Healthy-QR code indicates that the patient has no epidemiological history, and the owner

should go to fever clinic 2 for treatment.

As shown in table 1, a total of 2140 visits were received in fever clinics from January

24th to March 1st. Among them, 1,408 patients were admitted to the fever clinic 1, and all

patients were given the nucleic acid test (NAT). In addition, 56 patients were positive and the
positive rate of nucleic acid test was 3.98%.

Meanwhile, 732 patients were admitted to the fever clinic 2, and all patients were tested

for the NAT. Among them, 2 cases were positive, and the nucleic acid positive rate was

0.27%. The difference of positive rate of NAT between the two fever clinics was statistically

significant (Χ2 = 25.059, P<0.001). It can be seen that this method effectively avoids cross

infection of patients in the fever clinic.

The third people's hospital of Shenzhen has made great contributions to both the

treatment of patients and the prevention of the epidemic. Up to March 1st, a total of 418 cases

of COVID-19 were admitted to this hospital, and 163 cases had been discharged. Meanwhile,

none of the 1, 264 medical staff was infected. Moreover, there was no cross-infection among

the 1, 870 other patients hospitalized at the same period.

Reviewing the cross and medical staff infections emerged in other hospitals, the main

reasons for cross infection in hospital are as below. Firstly, the patients did not undergo

strictly screening and triage before the treatment. Secondly, the division of treatment zones

between suspected patients and ordinary patients were not clear. Last but not the least,

suspected patients were neglected and protections of medical staff were inadequate in the

early stage of epidemic.

In order to providing reference for more hospitals which are involved in the treatment of

patients infected with COVID-19, we summarized the fever screening system of the third

people's hospital of Shenzhen. It is believed that the moment of comprehensive victory over

the new crown pneumonia epidemic is not far away.

Reference

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 Table 1 Comparison of NAT results between two fever clinics
Number of
Number of
Total patients Positive
confirmed P value
Visits performing rate
patients
NAT
Fever Clinic 1
(with Epidemiological
1408 1408 56 3.98%
History)
＜0.001
Fever Clinic 2
(without
732 732 2 0.27%
Epidemiological
History)
Figure legends
Fig.1. The number of patient admission of the third people's hospital of Shenzhen during

the period of January 11th to March 1st.

 Fig.2. The flowchart for three-stage triages system and Healthy-QR codes. The blue

boxes represent the triage table or consulting room, and the red boxes represent the inspection

method.
 Fig.3. The flowcharts for fever clinics. The blue boxes represent the consulting room,

and the red boxes represent the patient classification.