All relevant units:

In order to further promote the implementation of the Five Year Action Plan, standardize and strengthen the capacity building of the wound repair department and other relevant departments, improve the diagnosis and treatment capacity and standardization level of wound repair, strengthen the promotion of the professional technology of chronic wound repair, and give full play to the important role of continuing education in the training of professional talents. Our center has organized an expert committee to formulate the standards for the implementation of the One Million Five Year Action Plan (Version 2022) for the capacity building of wound repair discipline, which are now printed and distributed to you. All units are requested to earnestly implement them in light of actual conditions.

Contact: Guo Changshong

Tel.: 010-83,041,862

Appendix: Capacity Building of Wound Repair Discipline -- Executive Standard of the Million Five Year Action Plan (Version 2022)

Center for Capacity Building and Continuing Education of the National Health Commission

October 11, 2022

enclosure

Capacity Building of Wound Repair Discipline -- Executive Standard of the Million Five Year Action Plan (Version 2022)

General

In order to implement the spirit of the Notice on Strengthening the Management of Diagnosis and Treatment of Chronic Wound (Ulcer) on the Body Surface (GBYH [2019] No. 865) and promote the construction of the wound repair department with high quality, refer to the spirit of the "Thousand County Project" County Hospital Comprehensive Capacity Improvement Work Plan (54989934) (GBYH [2021] No. 538), This document is formulated in accordance with the requirements of the Notice on Carrying out the Capacity Building of Wound Repair Discipline -- One Million Five Year Action Plan (hereinafter referred to as "one million") issued by the Center for Capacity Building and Continuing Education of the National Health Commission and the relevant documents of the national hospital level review.

Ten million refers to 100 provincial and municipal (prefecture level) hospitals (tertiary hospitals, including comprehensive hospitals of western medicine, integrated hospitals of traditional Chinese and western medicine, traditional Chinese medicine hospitals, national hospitals, and public and private hospitals) 1000 county level hospitals, wound repair departments (wards) (secondary to tertiary hospitals, including comprehensive western medicine hospitals, integrated traditional Chinese and western medicine hospitals, traditional Chinese medicine hospitals, public and private hospitals) and 10000 wound treatment workstations for primary care (The first class hospitals, community health service centers, community health service stations assessed by the state, medical institutions of western medicine, traditional Chinese medicine, and integrated traditional and western medicine that have not been assessed but have a similar scale, and public and private hospitals are all acceptable).

Chapter I Hardware Facilities Configuration Requirements of Wound Repair D

epartment

1、 Outpatient setting of wound repair department

（1） General settings

1. Independent outpatient consulting room and treatment room; The regional setting shall be clearly marked; The pollution area, clean area and sterile area are reasonably divided with clear functions, and relevant areas meet the requirements for infection prevention and control.

2. The consulting room and treatment room are reasonably arranged, equipped with a diagnosis and treatment bed, film reading device, wound washing pool, oxygen supply equipment, suction device, disinfection facilities, basic rescue equipment and facilities and barrier free facilities.

3. All kinds of external drugs, consumables and instruments shall be placed at fixed points, kept by category and clearly marked; Rescue instruments and medicines are in standby state; All rules and regulations, operation procedures such as dressing change and first aid, as well as emergency plans, publicity and education materials, hospital infection monitoring registration and other records shall be placed at designated locations.

（2） Junior college setting

1. The treatment room shall be set up independently with clear signs. The medical waste collection point shall be set up nearby the wound treatment area for classified collection, meeting the requirements of infection prevention and control.

2. The qualified department consulting room can be equipped with infrared ray, red ray, blue ray therapeutic apparatus, ultrasonic debridement apparatus, etc.

2、 Ward setting of wound repair department

（1） General Settings

1. An independent treatment room is set up in the ward, and clear signs are set up. The indoor pollution area, clean area and sterile area are reasonably divided, with clear functions. The internal structure and layout of the ward are reasonable, the relevant facilities are complete, and the patient shower room needs to be set up in the ward; The ward area is relatively isolated from the office area and functional area.

2. The number of open beds in secondary hospitals is ≥ 10. (Level III hospital: the number of open beds is ≥ 20, and the number of beds at the beginning of the department construction is not less than 10). The building area and net use area of each bed meet the national hospital level standards. There is enough room in the ward beside the bed for dressing changes and various simple and innovative operations.

3. The ward shall reasonably arrange oxygen supply equipment, suction apparatus, compressed air, vital sign monitoring equipment, disinfection facilities, basic rescue equipment and facilities and barrier free facilities.

4. All kinds of external drugs, consumables and instruments in the ward shall be placed at fixed points, kept by category and clearly marked; Rescue instruments and medicines are in standby state; All rules and regulations, operation procedures, emergency plans, publicity and education materials, hospital infection monitoring registration and other records shall be placed at fixed points.

（2） Junior college setting

If possible, it can be equipped with limb Doppler blood flow meter, nerve vibration threshold detector, transcutaneous partial pressure of oxygen, infrared thermograph, plantar pressure detector, infrared therapeutic instrument, red blue light therapeutic instrument, ultrasonic debridement instrument, limb vein thrombosis prevention and treatment instrument and other equipment related to the diagnosis and treatment of wound diseases.

3、 Operation room setting of wound repair department

1. If conditions permit, independent operating rooms should be set up. If there is no independent operating room, the operating room should be relatively fixed. The operating room should be set up to meet the requirements of hospitals at corresponding levels. The layout should be reasonable, the zoning should be clear, the identification should be clear, and the functional process should be reasonable.

2. The operating table, operating lamp, oxygen supply equipment, aspirator, compressed air, vital sign monitoring equipment, disinfection facilities, basic rescue equipment and facilities, and barrier free facilities are fixedly arranged in the independent operating room; Surgical instruments, electrocoagulators, electric knives, medicines, equipment and consumables shall be placed at fixed points, kept by category and clearly marked. Various rules and regulations, operation procedures, emergency plans, publicity and education materials, hospital infection monitoring registration and other records shall be placed at fixed points.

4、 Hospital support conditions

1. The hospital where the wound repair department (ward) is established has an independent laboratory, microbiology room, imaging department, ultrasound department and pathology department to support the examination of wound related diseases (tertiary hospital). In this regard, the difference between the tertiary hospitals lies in the difference in the equipment and facilities that can carry out wound repair diagnosis and treatment technology projects and levels.

2. Considering the regional differences of the primary hospitals, the community medical institutions of the first-class hospitals can improve the corresponding specialized basic configuration according to the needs of wound diagnosis and treatment, in addition to the corresponding functional configuration according to the standards of the national health administrative department.

Chapter II Requirements for Disciplinary Staffing

According to the requirements of 2019 (No. 865) document issued by the General Office of the National Health Commission and refined by the expert committee, the requirements are as follows:

Third class hospital:

It is able to set up an independent wound repair department with 8 doctors, one of whom has the qualification for professional and technical posts above deputy high in wound repair related specialties. Hospitals undertaking teaching and scientific research tasks should appropriately increase their staff. For each additional 5 beds, at least one doctor with intermediate professional and technical qualifications in wound repair related disciplines shall be added. The department director shall have the professional and technical qualification above deputy senior level, have been engaged in wound repair related surgery for 10 years or more, and have been trained and qualified by the wound repair training institution designated by the provincial health administrative department. Four specialized nurses for wound treatment shall be allocated, and at least one specialized nurse shall be added for each additional five beds.

Second class hospital:

The relatively independent wound repair ward (room) shall be equipped with at least 4 full time doctors, of which one doctor shall have the professional and technical post qualification above the intermediate level in the wound repair related profession. For each additional five beds, at least one doctor shall be added, and the department director shall have the professional and technical post qualification above the intermediate level and be engaged in the specialty for at least five years. Allocate 2-4 specialized nurses for wound treatment, and at least one specialized nurse will be added for each additional 5 beds.

First class hospital:

It is required to set up a special wound clinic or treatment room in the outpatient department, with one doctor engaged in wound repair diagnosis and treatment, and 1-2 specialized nurses for wound treatment.

Chapter III Standardized Behavior of Wound Repair Diagnosis and Treatment

Whether the diagnosis and treatment behavior is standardized is the core of the operation of the discipline. However, wound repair is a new discipline, and the global basic medical education provides detailed explanation of various chronic wound diagnosis and treatment knowledge. To this end, the Center for Capacity Building and Continuing Education of the National Health Commission organized an expert committee to conduct in-depth research and discussion, and decided to use the Chinese Thinking and Principles for the Diagnosis and Treatment of Chronic Difficult Healing Joint Wounds (see: Chinese Journal of Burns 2018,34 (12): 868-873.) as the reference for standardizing the diagnosis and treatment of wound repair. Whether each unit implements standardized wound repair diagnosis and treatment behavior, experts from the quality control group of the expert committee will evaluate whether it meets the requirements of standardized diagnosis and treatment in the background in a double blind way according to the cases uploaded by the participants in the class to the APP in clinical practice.

Chapter IV Special Skills of the Wound Repair Department and Guidance on the Configuration of Related Instruments, Devices, Drugs, Dressings and Other Medical Supplies

The Trauma Repair Department has relevant professional skills and the configuration of various medical equipment and supplies, which is another important element in the discipline capacity building. Having reasonable or optimized relevant professional skills and the configuration of various medical equipment and supplies is the premise to ensure medical quality. To this end, we put forward guidance on the configuration of various medical equipment and supplies in hospitals of different levels.

1、 Wound repair departments of 100 provincial and municipal (prefecture level) hospitals

（1） Specialized diagnosis and related examination techniques

1. Limb blood supply evaluation technology: vascular ultrasound Doppler detection, ankle brachial index detection, etc

2. Limb nerve function evaluation technology: sensory nerve vibration threshold detection, etc.

3. Imaging examination techniques related to the wound, including X-ray, CT, CTA, CTV, MR, MRA, MRV, DSA and sinography.

4. Clinical examination, microbiological examination and pathological examination techniques related to the wound.

5. Foot pressure evaluation technology.

（2） Specialized treatment technology

1. Be able to independently carry out all mature wound non-surgical treatment methods: including various wound debridement and dressing change, physical therapy (such as ultrasound, infrared ray, red blue light therapy, etc.), biological therapy (such as platelet enriched plasma technology, etc.), chemical therapy, etc.

2. Be able to independently carry out all kinds of primary, secondary and tertiary wound repair operations related to wound repair, such as various debridement and expansion operations, autologous skin transplantation (including autologous split skin transplantation and full-thickness skin transplantation), autologous skin transplantation, skin harvesting, skin flap transplantation (random skin flap, axial skin flap, island skin flap), negative pressure sealing treatment, amputation (finger, toe), vascular surgery techniques, etc. If conditions permit, we can carry out three or four level operations such as endoscopic therapy, free flap plasty, greater omentum transplantation, etc.

3. Have certain rehabilitation concept, knowledge and simple rehabilitation treatment ability (including psychological rehabilitation).

（3） Specialized instrument and equipment configuration

1. Wound related inspection instruments

Basic configuration:

(1) Limb blood supply evaluation: Doppler blood flow meter, transcutaneous oxygen partial pressure meter

(2) Limb nerve function evaluation: sensory nerve vibration threshold detector, small nerve fiber inspection kit

(3) Wound temperature detection: skin thermometer

(4) Foot pressure evaluation: static/dynamic foot pressure detector

Optimize configuration:

(1) Foot pressure assessment: 3D foot scanner

(2) Various surgical related consumables and instruments

Basic configuration:

(1) Various surgical instruments for debridement and expansion

(2) Skin grafting instrument

(3) Flap, free flap, vascular surgery and microsurgery instruments

(4) Consumables of minimally invasive surgery related instruments

(5) Consumables related to negative pressure treatment

(6) Orthopedic surgical instruments

(7) Vascular interventional surgical instruments

Leading configuration:

(1) Consumables related to stem cell transplantation with indications for wound repair

(2) Consumables related to fat transplantation with indications for wound repair

(3) Non surgical instruments and equipment

Basic configuration:

(1) Routine instruments for non operative wound treatment

(2) Instrument and equipment for ultrasonic debridement

(3) Instruments and equipment for phototherapy, oxygen therapy and pressure therapy

(4) Instruments, equipment and consumables related to biological cell therapy technology (such as platelet enrichment plasma equipment consumables)

(5) Lower extremity pressure pump

Optimize configuration:

(1) Endoscopic equipment related to the treatment of sinus or fistula

(2) Laser therapy instrument and equipment for wound or skin and soft tissue diseases

(3) Hydrodynamic debridement instrument and equipment

(4) Large rehabilitation treatment instruments and equipment related to wound repair and functional recovery

Leading configuration:

(1) Stem cell therapy instrument and equipment

(2) Fat transplantation related instruments and equipment

（4） Preparation of department specific drug dressing

1. External medicine for wound specialist

(1) External antibacterial agents: such as sulfadiazine silver (zinc), compound polymyxin, mupirocin, and fusidic acid

(2) Disinfectants for external use: iodine containing preparations, hydrogen peroxide, hypochlorite, chlorhexidine, lysozyme, oxteridine, benzalkonium bromide, ethanol, etc

2. Common wound dressings

(1) Traditional dressing: gauze, vaseline gauze, cotton pad, bandage, etc

(2) New functional dressings: dressings with different functions, including various film dressings, foam dressings, hydrogels, hydrocolloid dressings, dressings containing alginate (alginate cellulose), carboxymethyl cellulose, chitosan, polyethylene, hydrophilic polyurethane polymers and other ingredients, and various elastic (self-adhesive) bandages or functional special materials

(3) Antibacterial functional dressing: silver containing antibacterial dressing (including liquid, gel and other dosage forms)

(4) External use of biological agents and dressings: external use of growth factor drugs, collagenase, bacterial cellulose, acellular xenogeneic or xenogeneic dermal matrix, tissue engineering materials, etc.

(5) Silicone dressing

2、 1000 county-level hospitals wound repair departments (wards)

（1） Specialized diagnosis and related examination techniques

Basic configuration:

1. Limb blood supply evaluation technology: vascular ultrasound Doppler detection, ankle brachial index detection, etc

2. Limb nerve function evaluation technology: sensory nerve vibration threshold detection, etc

3. Imaging examination techniques related to the wound, including X-ray, CT, CTA, CTV, MR, MRA, MRV

4. Clinical examination, microbiological examination and pathological examination techniques related to wound

Optimize configuration:

1. Imaging examination technology related to wound: DSA

2. plantar pressure evaluation technology

（2） Specialized treatment technology

1. Be able to independently carry out all mature wound non-surgical treatment methods: including various wound debridement and dressing change, physical therapy (such as ultrasound, infrared ray, red blue light therapy, etc.), biological therapy (such as platelet enriched plasma technology, etc.), chemical therapy, etc.

2. Be able to independently carry out Class I, II and III wound repair operations related to wound repair, such as various debridement and expansion operations, autologous skin transplantation (including autologous fault skin transplantation and full-thickness skin transplantation), autologous skin transplantation, skin removal, various random skin flap plasty, axial or island skin flap plasty (required to be a Class III hospital), vacuum sealing treatment, amputation (fingers and toes), etc.

3. Have certain rehabilitation concept, knowledge and simple rehabilitation treatment ability (including heart