SARS医院感染的流行病学和预防控制措施研究

目的 探讨严重急性呼吸综合征(SARS)医院感染的流行病学特点和预防控制措施。方法选择某综合性医院3～4月份收治和医院感染的SARS病例，进行个案调查和发病所在科室的流行病学侦查。结果 (1)流行病学特点：时间分布在3月中旬和下旬有两个发病高峰，地理分布：发病病例主要集中住院大楼西单元的5个楼层的4、5号病房，人群分布：住院患者多年龄较大且合并较严重的基础病，而受染的医护人员以工作在一线的中青年为主；(2)输人性病例是导致医院感染的第一代传染源，医院内继发传染的住院者和医护人员是进一步扩散蔓延的第2批传染源；(3)研究发现近距离空气传播和密切接触传播为本次SARS医院感染的主要传播途径，同时还提示：存在气溶胶经病房排风系统垂直长距离传播的可能性；(4)控制隔离传染源、加强病区通风换气和定时消毒、关闭空调新风系统、医护人员加强防护等各项措施采取后，医院感染得到有效控制。结论 医院感染是SARS流行初期的主要形式，该院医护人员的受染方式前期以医院内传染为主，后期以门急诊窗口岗位受染较为突出，通过采取针对性预防控制措施，SARS医院感染是可控可防的。

Study on the Epidemiology and Nosocomial Infection Control Measures of SARS

OBJECTIVE To study the epidemiological characteristics and nosocomial infection control measures of SARS. METHODS Definite SARS patients (inpatients and medical stuffs) were selected from a general hospital in March and April. Individual and environment survey were carried out by a standardized questionnaire of China CDC. Contact history with SARS patient, place and route of infection, method of protection were included in the survey. RESULTS (1)Epidemiological characteristics: There were two peaks of incidence (Mar 13th -16th and Mar 24th). Distributions: places were confined to Ward 4, 5, 6 on the 7, 8, 12, 13 and 14th floors in west unit of the inpatient building. Among the SARS cases, the inpatients were older and most had severe original diseases, and the medical staffs were younger juniors. (2)Source of transmission Index patients were the first generation source of transmission and the secondary attacked inpatients and medical staffs were the second generation. The latent infected persons who had close contact with SARS patients were also possible latent sources of transmission. (3)Route of transmission The major transmission routes were near space droplet infection and close contact infection. There was also a clue to the probability of aerosol or droplet nuclei infection through air condition and ventilation system. (4)Many measures such as control and isolation of the source of transmission, enforcing ventilation and disinfection of the ward area, stopping fresh air system, strengthen prevention of medical staffs were carried out and the hospital infection was under control eventually. CONCLUSIONS Hospital infection was the main epidemic form of SARS in the early stage. Hospital infection of SARS can be prevented and controlled by a series of the efficient measures.