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Measurement of body temperature to prevent pandemic COVID-19 in hospitals in Taiwan: repeated measurement is necessary

  • S-H. Hsiao
    Affiliations
    Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • T-C. Chen
    Correspondence
    Corresponding author. Address: Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68, Chunghwa 3rd Road, Kaohsiung City, Taiwan. Tel.: +886 7 291 1101; fax: +886 7 213 8400.
    Affiliations
    Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • H-C. Chien
    Affiliations
    Department of Nursing, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • C-J. Yang
    Affiliations
    Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Y-H. Chen
    Affiliations
    Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Institute of Graduate Medicine, Centre of Sepsis, Centre of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan

    Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan
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Published:April 09, 2020DOI:https://doi.org/10.1016/j.jhin.2020.04.004
      Sir,
      On 3rd April 2020, 990,338 people had confirmed SARS-CoV-2 infection and 51,215 people had died of coronavirus disease 2019 (COVID-19) globally. COVID-19 has become a critical public health challenge worldwide [
      • Lee P.I.
      • Hsueh P.R.
      Emerging threats from zoonotic coronaviruses-from SARS and MERS to 2019-nCoV.
      ,
      • Wang W.
      • Tang J.
      • Wei F.
      Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China.
      ,
      • Khan S.
      • Ali A.
      • Siddique R.
      • Nabi G.
      Novel coronavirus is putting the whole world on alert.
      ]. Although Taiwan is very close to China, the number of confirmed cases of COVID-19 is much lower in Taiwan compared with other neighbouring countries [
      • Wang C.J.
      • Ng C.Y.
      • Brook R.H.
      Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing.
      ,
      • Yang C.J.
      • Chen T.C.
      • Chen Y.H.
      The preventive strategies of community hospital in the battle of fighting pandemic COVID-19 in Taiwan.
      ]. The Taiwanese Government has been aggressive and proactive to prevent COVID-19 transmission, and almost all hospitals have taken many effective strategies to prevent hospital infection. These include use of personal protective equipment, education, information sharing, performance of drills, closure of as many entrances to hospital buildings as possible, establishment of outdoor quarantine stations to check body temperature, and completion of a TOCC history (travel, occupation, contact and cluster) sheet for every visitor before hospital entry.
      Kaohsiung Municipal Ta-Tung Hospital (KMTTH) is a 428-bed community hospital in Kaohsiung, Taiwan. Currently, the policy at KMTTH is to assess all persons in an outdoor quarantine station to avoid importation of infection.
      Together with TOCC history and presence of respiratory symptoms, fever is a key warning sign of COVID-19. Therefore, almost all Taiwanese hospitals have established temperature monitoring at outdoor quarantine stations using techniques such as infra-red temperature detectors and forehead thermometers. Febrile patients are prohibited from hospital entry and are sent to the Emergency Department for assessment. However, these thermometers can give normal values, or even hypothermia, in visitors who are actually febrile due to the influence of environmental factors, such as outdoor temperature, wind and rainfall. Erenberk et al. reported that accurate determination of fever in cold environmental conditions requires at least 10 min for children to become acclimatized after coming in from the cold [
      • Erenberk U.
      • Torun E.
      • Ozkaya E.
      • Uzuner S.
      • Demir A.D.
      • Dundaroz R.
      Skin temperature measurement using an infrared thermometer on patients who have been exposed to cold.
      ]. Another problem is that some patients may take antipyretics to avoid being blocked at outdoor quarantine stations.
      The risks of visitors with COVID-19 entering hospitals and staying in crowded waiting areas are very real. A large outbreak of Middle East respiratory syndrome coronavirus infection following a single patient exposure in Seoul provides a miserable, but important, lesson [
      • Cho S.Y.
      • Kang J.M.
      • Ha Y.E.
      • Park G.E.
      • Lee J.Y.
      • Ko J.H.
      • et al.
      MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study.
      ].
      In response, at KMTTH, all patients have their temperature checked again in the waiting area and inside the clinics. In March 2020, 40,887 patients attended KMTTH for medical services. Only five patients were found to have fever (>38oC) at the outdoor quarantine station. However, a further 37 patients were identified with fever when a second temperature recording was made inside. As such, it is recommended that medical institutions with outpatient services should take patients' body temperature for a second time after they have acclimatized to being indoors. This simple intervention could play an important role in hospital infection prevention and control.

      Acknowledgements

      The authors wish to thank all hospital staff for their efforts.

      Conflict of interest statement

      None declared.

      Funding sources

      None.

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