To better prevent and control the possible rebound of SARS in the winter and spring seasons, Beijing municipal health bureau, the capital's healthcare watchdog, inspected 24 designated fever clinics recently and released the inspection results. Han Demin, vice director of the Beijing Municipal Health Bureau, pinpointed eight problems detected in the fever clinics.

1. Some fever clinics were dissolved without authorization. According to the orders from the Ministry of Health, fever clinics must be kept through the winter till next spring. Among the all 24 hospitals inspected, four hospitals have dissolved their designated fever clinics.

2. Hospitals have an unclear definition of a fever clinic (on tenure either as a short-time temporary measure or a fixed institute). Some hospital leaders paid insufficient attention and installed the fever clinics as an outdoor temporary institute, which will make it hard for patients to seek treatment.

3. Hospitals have unclear definitions of the function of fever clinics. The fever clinics have a mixed relationship with the traditional infectious disease clinics (such as the intestinal clinic, emergency clinic and respiratory clinic). Some hospitals set up a separate fever clinic and intestinal clinic, further straining human resources, material and capital. Some other hospitals did not separate the designated fever clinic from common emergency clinic and regarded the fever clinics as a substitute for a common emergency clinic.

4. The construction of fever clinics fails to meet medical demands from design plans to ventilation for wards. Some fever clinics set their ventilation windows directly facing the dining hall or put waste tubs on intake positions, which makes a possible fuse of an outbreak.

5. Thirty-five percent of medical workers in fever clinics over-protect themselves. Some hospitals build fever clinics into a quarantine ward. Medical workers put on isolation gown, protective glasses and gloves and live in a concentrated area. Han Demin said that over protection in fever clinics makes no sense except mounting up medical costs and exerting more pressure on medical workers.

6. No standard operation procedure has been prescribed for the fever clinics. The fever clinics have different standards to put on patients with symptoms under medical observation. The under going operation procedure is not reasonable in some situations and creates loopholes for cross contamination. Fever patients with respiratory disease symptoms receive transfusions within the same room with other fever patients or even other disease patients. Some clinics do not treat medical waste according to treatment standard.

7. According to the investigation, the SARS mobile reaction teams respond to the scene within 20 minutes and up to 2 hours after receiving a help calling. "The slow responding indicates that Beijing's emergency reaction system needs further improvement," said Han Demin.

8. Hospital leadership did not draft comprehensive anti-rebounding plans. Some hospital front-desk nurses were not familiar with standard treatment processes of fever patients. Some fever clinics did not assign personnel to pre-scan body temperatures.

Han Demin suggested that Beijing should establish a long-term effective procedure to prevent another outbreak of infectious disease. The setting-up of fever clinics, building layout, logistics and ventilation system standards should be established after thorough deliberation by experts. He also stressed sufficient and proper protection standards and operation process standards should be made for clinic medical workers.

(China.org.cn by Alex Xu July 28, 2003)