National Health Commission: In the event of an epidemic in a districted city, nucleic acid testing within the designated area should be completed within 24 hours

On the 22nd, the National Health Commission website released the "Implementation Guidelines for Regional Novel Coronavirus Nucleic Acid Testing Organizations (Third Edition)", which clarified that "after the outbreak of the new coronavirus pneumonia epidemic, the districted city where it is located, including urban residents Megacities with a population of more than 10 million should complete regional nucleic acid testing tasks within 24 hours." The full text is as follows: Implementation Guidelines for Regional Novel Coronavirus Nucleic Acid Testing Organizations (Third Edition) In order to further guide various regions to prevent and control the new coronavirus epidemic, ensure that regional nucleic acid testing tasks are completed within the specified time with high quality and quantity, and achieve "early detection, early detection, and early detection". "Isolation, early diagnosis, and early treatment", combined with previous practice, we revised the "Implementation Guidelines for the All-Staff New Coronavirus Nucleic Acid Testing Organization (Second Edition)" and formed the "Regional New Coronavirus Nucleic Acid Testing Organization Implementation Guidelines (Third Edition)" version)". 1. Overall requirements: Based on accurate and rapid flow investigation and community control, scientifically determine the risk of epidemic spread, delineate the scope of regional nucleic acid testing, formulate specific work plans, strengthen organizational management, optimize the procurement, delivery, inspection and reporting processes, and further Improve the quality and efficiency of nucleic acid testing. After the outbreak of the new coronavirus pneumonia, the districted city where it is located, including megacities with a permanent urban population of more than 10 million, should complete the regional nucleic acid testing tasks within 24 hours. When necessary, protection can be provided through regional coordinated support; when necessary, national support can be applied for. 2. Organizational Management (1) Establish organizational mechanism. The districted city has established a nucleic acid testing working group under the local joint prevention and control mechanism. It is led by the Standing Committee of the Municipal Party Committee and organizes relevant departments such as health, public security, civil affairs, transportation, finance, industry and information technology, ecological environment, and party committee propaganda departments. Linkage, establish a flat working mechanism, and activate it urgently when an epidemic occurs. Districts and cities are used as units to coordinate regional nucleic acid testing work, grasp the overall situation of the jurisdiction, and avoid simply dividing work tasks and assigning them to counties. (2) Formulate a work plan. Districts and cities should formulate operable regional nucleic acid testing work plans under the local joint prevention and control mechanism, clarify the division of responsibilities and responsible persons of each relevant department, streamline the entire chain of work processes, combine emergency situations, and carry out early warning screening in a timely manner drill. (3) Establish a special work class. 1. Special class in data statistics. Mainly responsible for unified and centralized management of data information generated by regional nucleic acid testing, establishing a clear information flow process, and dedicated personnel to collect, compile statistics, and report. The nucleic acid testing working group dispatches liaisons to each testing institution responsible for regional nucleic acid testing tasks, establishes a contact supervision mechanism between the data statistics team and the testing institutions, monitors the testing progress of each institution in real time, and solves any problems encountered at any time problems, and urge the timely uploading of test results, etc. 2. Special classes for inspection and matching. Mainly responsible for formulating the testing and testing matching plan according to the nucleic acid testing work plan, and strengthening the dynamic command and adjustment of testing and testing matching. It is necessary to accurately grasp the nucleic acid testing capacity available for mobilization in the city and the population base of each street (township), community, and residential area. In the process of regional nucleic acid testing, the progress of collection, delivery, and inspection must be grasped in real time to avoid uneven busyness of testing institutions or samples. Backlog. 3. Special class for sample transfer. Mainly responsible for scientifically calculating transportation capacity needs, rationally deploying transportation forces, closely cooperating with the collection and testing matching team, dynamically adjusting sample transportation plans, and ensuring that each testing institution enters saturated working status as quickly as possible. The arrangement and deployment of transportation capacity should be optimized based on the number and distance of nucleic acid sampling points, the carrying capacity of the transfer vehicle, and the time required for transfer. 4. Special class for handling positive results. Mainly responsible for coordinating and managing the disposal of all positive nucleic acid test results in cities involved in the epidemic (including apheresis positives and mixed collection positives), and quickly coordinating the completion of information flow, apheresis review of mixed collection positives, and the transfer of apheresis positive personnel. The special class is composed of 120 transport, public security, disease control and emergency sampling teams. 5. Special class for material support. Mainly responsible for the estimation, reserve and supply guarantee of various materials required for regional nucleic acid testing, including testing materials, protective materials, transfer materials, disinfection materials and necessary living materials, etc., and establish an effective call mechanism to manage them nearby. .

Among them, the consumables required for sampling are reserved locally based on the local population, and are uniformly dispatched by cities and counties. 6. Special class for quality control. Mainly responsible for the quality control of regional nucleic acid testing, establishing a nucleic acid sampling supervision group and a nucleic acid testing supervision group to supervise the operation of sampling personnel, personal protection, laboratory testing quality control, and cross-infection prevention and control at sampling points and laboratories. By strengthening quality control, we will minimize false negatives or false positives and eliminate the issuance of false nucleic acid test reports. 7. Special class for medical waste disposal. Mainly responsible for the collection, temporary storage, transfer, disposal and other management of medical waste generated in each link of nucleic acid testing. According to the increase or decrease in the amount of medical waste generated, the frequency of clearing and transportation is adjusted in a timely manner and the centralized disposal of medical waste is carried out. 8. Special class for information security. Responsible for the operation and monitoring of the nucleic acid testing information system, handling information system failures in a timely manner, ensuring the safe operation of the system, and avoiding problems such as downtime or system crash; doing a good job in ensuring communication during the nucleic acid testing period. 9. Special class on comprehensive management. Mainly responsible for writing regional nucleic acid testing work plans, nucleic acid testing analysis reports, and comprehensive coordination and guarantee work for each special work team within the nucleic acid testing working group. Each locality can add or merge the above 9 special classes according to the actual situation and according to the organizational mobilization, sample collection, specimen testing, order maintenance, biosafety, supervision and inspection, news publicity, etc. required to carry out the work, but the responsibilities must be clear , implement it to everyone, and there will be no responsibility gap. 3. Work content (1) Find out the population base. Each district and city implements the "four party responsibilities" and establishes a work ledger. Through grid management and drag-net investigations, it is possible to find out the actual managed population of streets (townships), communities, and residential areas within the jurisdiction. (2) Calculate sampling and testing capabilities. All districts and cities, regardless of population size, match sampling and testing capabilities according to the goal of completing the city's nucleic acid testing within 24 hours. Among them, in principle, all sampling tasks should be completed within 6 hours; if there are indeed difficulties, they can be completed within 12 hours. Calculate the number of sampling personnel based on the standard of collecting 120 people per hour per sampling station (2 sampling personnel). The calculation formula is: Number of nucleic acid sampling personnel (unit: person) = Number of population ÷ 360; 10-in-1 mixed sampling detection technology is used , the detection capability calculation formula is: nucleic acid detection power (unit: tube/day) = population ÷ 10 × 2; if 20-in-1 mixed detection technology is used, the detection capability calculation formula is: nucleic acid detection power (unit: tube/day) day) = population ÷ 20 × 2. (3) Refine the sampling plan. 1. Sampling point setting. The first is to scientifically plan sampling points. Each districted city should scientifically plan the layout of sampling points based on population size, geographical transportation, distribution of nucleic acid testing institutions, etc. Calculated based on the daily sampling time of 6 hours, one sampling point can be set up for 2000-3000 people, and one sampling station can be set up for 600-800 people. Each sampling point requires 4-5 sampling stations (each locality can be based on communities, streets, towns, etc. , rural and suburban actual population numbers are set as a whole), and in principle sampling points are set up in residential areas. The second is to scientifically select sampling points. Sampling points should be selected in open, well-ventilated, relatively independent venues, such as gymnasiums, exhibition halls, school playgrounds and other venues with ventilated and independent spaces. It is encouraged to set up outdoor sampling points when natural conditions permit. The third is to scientifically arrange sampling points. The sampling point is divided into waiting areas, sampling areas, buffer areas, temporary isolation areas, and medical waste temporary storage areas to effectively disperse the density of people to be tested. Set up an area for putting on and taking off protective clothing, equipped with hand hygiene facilities, full-length mirrors or protective devices. Clear guidance signs must be set up at sampling points to ensure one-way flow of personnel, and the sampling procedures and precautions must be clarified. Green channels should be set up for independent sampling for the elderly over 60 years old, pregnant women, disabled people and other groups. Dedicated nucleic acid testing sampling points (sampling channels) for personnel with "yellow code" health codes should be set up to avoid cross-infection among personnel. The fourth is to quickly build sampling points. Sampling points are required to complete standardized construction and use within 2-4 hours. On the basis of fixed sampling points, a grid management model is adopted, focusing on community sampling, and is refined and improved by entering schools, enterprises, units, etc. The layout facilitates mass sampling and improves sampling efficiency. 2. Sampling tissue.

On the basis of grid management, the organization and mobilization of nucleic acid sampling should be strengthened, the departments and personnel responsible for organization and mobilization should be clarified, and the organization and mobilization work process should be standardized. Residential buildings, natural village groups, schools, government institutions, enterprises, companies, markets, hotels, etc. are used as the smallest units to ensure that there is no shortage of households or people. The nucleic acid sampling site has strengthened refined organizational management. While staff and volunteers maintain work order, it is encouraged to strictly implement the "1-meter line" spacing requirement through the use of physical means such as seats and metal grid lines. By making reservations, notifications and sampling at different times in advance, we can reduce the number of people gathering in a short period of time and strive to ensure that the queue time does not exceed 20 minutes to avoid cross-infection. 3. Sampling method. Determine the sampling method based on the control measures taken by the target population. Centralized isolation points and other key groups are subject to separate collection and single inspection; people in closed and controlled areas are subject to separate collection and single inspection or one household per management; 10-in-1 mixed collection can be implemented in control areas; 20-in-1 mixed collection can be implemented in prevention areas and other areas . If the subject of apheresis and single-inspection testing does not detect positive in multiple rounds of testing, 10-in-1 mixed sampling may be implemented as appropriate. (4) Implement sampling capabilities. Prepare sampling medical personnel and information entry personnel in advance, and carry out relevant training. Based on a reasonable assessment of the workload, each sampling station should be equipped with 2 sampling personnel (must be medical staff, consider changing shifts) and 1 information entry personnel. Each sampling station collects samples from 120 people per hour. . Sampling medical personnel should be proficient in the collection methods of nasopharyngeal and oropharyngeal swabs, and undergo strict personal protection and infection control training. Information entry personnel should be proficient in the operating procedures of the nucleic acid testing information system and conduct relevant infection control training. (5) Sample preservation and transportation. Test samples should be stored at low temperature (2-8°C). One hour after starting regional nucleic acid sampling, the first batch of samples should be transferred to the testing institution so that the testing institution can start operation. Subsequent samples can be collected and transferred every half hour to 2 hours, ensuring that they are delivered to the laboratory within 3 hours of collection. Priority will be given to transferring samples from sealed and controlled areas, ensuring that they are transferred no more than every 2 hours; in remote villages, mountainous areas, and pastoral areas, the transfer time and frequency will be reasonably determined based on the specific circumstances. You can refer to the fact that the number of samples sent each time is about 10 of the testing agency's single-day testing capacity, so that testing can be carried out in an orderly manner. The special sample transfer class estimates the number of special vehicles, personnel and transfer boxes required for transfer based on actual needs, and makes a good reserve and deployment of vehicles, personnel, transfer boxes and other materials. At the same time, the status of vehicles responsible for regional nucleic acid testing transfer tasks must be registered with the health administrative department. During the transfer mission, the vehicle must not be used for other purposes, and biosafety protection during transfer must be taken. The transportation of non-inactivated samples must be approved by the health administrative department at or above the provincial level in accordance with the law. Public security, transportation and other departments shall do a good job in transportation support based on actual needs. Carry out personnel protection and item disinfection during the transfer of nucleic acid samples. Non-inactivated samples are packaged in accordance with the specifications of PI602 for Class A infectious substances of UN2814 in the World Health Organization's "Guidelines for the Transport of Infectious Substances", and inactivated samples are packaged with PI650 of Class B infectious substances of UN3373. Before the sample transfer box is closed, 75 alcohol or 0.2 chlorine-containing disinfectant must be used to disinfect the surface of the container. (6) Strengthen information support. 1. Establish a nucleic acid testing information system. Each province coordinates the construction of regional nucleic acid testing information systems divided into districts and cities. The information system should realize the rapid and accurate entry of relevant information, including subject information (name, certificate type, certificate number, residential address, contact number) and sampling information (sampling point name, district and county where the sample is located, sample number, sample collection location Date, time, collection site, type, quantity), and quickly feedback the information of the subjects suspected of positive samples. Realize fast, accurate and real-time monitoring of nucleic acid testing collection, delivery, inspection and reporting information, and achieve full-process management of nucleic acid testing work. The information system can support multi-role, multi-user, high-concurrency operation, and has the function of real-time summary statistics of collection, transmission and inspection of various information. Before going online, a stress test must be conducted in advance to ensure the stability of the information system in accordance with the standard of completing population sampling of 10 people with an actual managed population of 10 every 10 minutes. 2. Do a good job in matching procurement, delivery and inspection.

Before starting regional nucleic acid testing, matching of collection, delivery and inspection should be done in advance and dynamic scheduling should be carried out. First, based on the sampling capacity of the set sampling points and the actual detection capabilities of each testing institution, match the slicing and sample delivery in advance. The second is to deliver samples in batches and dynamically schedule according to the experimental rhythm of the nucleic acid testing institutions to achieve "no empty machines and no accumulation of samples" and make full use of the testing capabilities of each testing institution. 3. Feedback of nucleic acid results. All districts and cities must provide timely feedback on nucleic acid test results, ensure accurate information in all aspects of collection, delivery, and inspection, promptly provide the public with methods and channels for querying test results, and conduct stress testing of the query service system in advance to ensure that the public takes samples within 24 hours. The results can be found. (7) Ensure material supply. In accordance with the principle of "better to be prepared than to use it, to be unprepared if it is not available", before starting the regional nucleic acid testing work, it is necessary to do a good job in material support in advance. Ensure the sampling tubes required for testing (single tube, 10-in-1, 20-in-1, etc., it is recommended to use inactivated sampling tubes), throat swabs (nasopharynx, oropharynx), detection reagents, medical consumables, protective equipment, disinfection There is an adequate supply of supplies and other materials with good quality and suitable models and specifications. There is an adequate supply of office supplies, necessary daily necessities and other materials. The material reserves at the sampling points must fully consider special weather factors such as rain, snow, low temperature, high heat, typhoons, etc., and carry out list-based and ledger-style reserve management based on the layout of the sampling points. 4. Scientifically determine the testing strategy. The district-municipal joint prevention and control mechanism should study and judge the epidemic spread trend based on the traceability of the epidemic, the notification of close contacts, etc., and scientifically delineate the risk areas and regional nucleic acid testing scope as soon as possible and make dynamic adjustments. In principle, in the first three days after the outbreak, a round of regional nucleic acid testing will be carried out every day to understand the potential risks to society; then, based on comprehensive research and judgment such as the traceability of the epidemic, the scope of community closure and control, and the results of nucleic acid screening, the follow-up procedures will be determined. Scope and frequency of screening. If the social risks are not under control and the risk points are unclear, one round of regional nucleic acid testing will continue to be carried out every day. When social risks are under control and risk points are basically clear, key areas can be divided into relevant streets, communities, and communities based on the distribution of cases. Key areas will be inspected once a day, and non-key areas will be inspected every other day or every 3 days depending on the situation. One inspection per day, and the test results will be issued within the specified time as required. Gradually narrow the scope of nucleic acid screening, improve screening accuracy, and conduct scientific and precise screening. All localities can combine the relevant requirements for COVID-19 antigen testing to promote the monitoring model of "antigen screening, nucleic acid diagnosis", add antigen testing as a supplementary method to regional nucleic acid testing, study and refine the implementation plan, and organize implementation. 5. Standardize the disposal process of positive samples (1) Disposal process of positive apheresis test. When a single sample test result is positive, the testing agency should immediately report to the data statistics class of the nucleic acid testing working group, which will immediately notify the positive result disposal class, which will carry out the following five tasks: First, notify the 120 negative pressure ambulance Carry out the transfer of the positive infected person; second, notify the centralized isolation management facility to prepare to receive the positive infected person; third, notify the community (community) where the positive infected person is located to find and control the positive infected person; fourth, notify the public security agency to assist in the transfer of the positive infected person , and carry out the trajectory investigation of the positive infected person; fifth, notify the disease control department to carry out follow-up traceability, close contact investigation and community containment. The notifications from the above departments are in no particular order. (2) Process for handling positive mixed samples. Each city has established an emergency sampling team, which is on duty 24 hours a day and is ready to go at any time. When a mixed sample test is positive, the testing institution should immediately report it to the nucleic acid testing working group, which will also notify the emergency sampling team, the community (community) where the mixed sample is located, and the public security agency to immediately isolate the personnel involved in place and conduct a separate sampling review. Apheresis review of positive mixed samples requires double sampling and single examination of nasopharynx and oropharynx. Apheresis review samples adopt a first-inspection responsibility system and are sent to the original laboratory for testing. If the apheresis review result is positive, refer to the positive apheresis test disposal process. The handling of positive mixed collection tests should be completed within 6 hours (see the figure below for details). Figure Flow chart for handling positive mixed sampling tests 6. Strengthening the quality control of nucleic acid testing (1) Strengthening the quality control of sampling.

The Nucleic Acid Sampling Supervision Team used the form of divided responsibility to tour and guide each sampling point, standardize sampling operations, personal protection, cross-infection prevention and control and other related work, guide each sampling point to maintain on-site order, strengthen the preservation and management of collected samples, and ensure The sampling work is high quality and efficient. (2) Strengthen testing quality control. The nucleic acid testing supervision team has established a spot supervision mechanism and organized clinical testing experts to conduct point-to-point spot supervision of each testing institution. Laboratory performance verification, indoor quality control, and inter-room quality evaluation are carried out in accordance with the relevant requirements of the "Medical Institutions Novel Coronavirus Nucleic Acid Testing Work Manual (Trial Second Edition)" to ensure the quality of testing. Where 20-in-1 mixed testing is adopted for the first time, training and organization and implementation must be strengthened in accordance with the "Technical Specifications for 20-in-1 Mixed Testing of New Coronavirus Nucleic Acid". Strictly implement laboratory access and personnel access requirements, formulate standardized laboratory procedures, and strictly prevent laboratory contamination and cross-infection within the laboratory. 7. Standardize personnel and other related management (1) Standardize personnel and laboratory biosafety management. All localities should carry out laboratory registration as required and strengthen laboratory biosafety management in accordance with the "Biosafety Law", "Pathogen Laboratory Biosafety Management Regulations", "Novel Coronavirus Laboratory Biosafety Guidelines (Second Edition)" and other regulations. Prevent biosecurity incidents from occurring. Strengthen infection control training for medical staff and other non-medical staff, and training on the application of regional nucleic acid testing information systems. The protection requirements for sampling personnel and laboratory testing personnel are implemented in accordance with the "Medical Institutions Novel Coronavirus Nucleic Acid Testing Work Manual (Trial Second Edition)". The local area must do a good job in overall planning and coordination, strengthen care for those involved in nucleic acid sampling and testing, and do a good job in logistical support. (2) Strengthen medical waste treatment. All localities should standardize the management of medical waste, do a good job in the collection, packaging, harmless treatment, temporary storage, handover and transfer of medical waste, use double-layer packaging bags to contain medical waste, seal effectively, ensure tight sealing, and ensure that medical waste packaging is safe. Damaged, no leaks. Special teams for medical waste disposal should promptly coordinate with medical waste disposal units with corresponding qualifications to dispose of medical waste at transfer sampling points and nucleic acid testing institutions. Medical waste generated at nucleic acid sampling sites must be cleared and transported on the same day; medical waste generated by nucleic acid testing institutions must be cleared and transported on the same day when temporary storage conditions permit, and the temporary storage time shall not exceed 2 days. Nucleic acid testing institutions should make an appointment with the collection and transportation unit for clearing and transportation based on the temporary storage location and medical waste storage conditions. Cleaning and transportation should avoid strong winds and thunderstorms. Collection and transportation units should optimize the dispatch of transportation vehicles, reasonably arrange collection and transportation routes, and ensure the removal and transportation of medical waste.