SARS前后医院感染的流行病学调查

目的：了解医院感染发病率及其临床流行病学特征，找出控制医院感染的有效措施。方法：对SARS前后13829例住院患者进行医院感染的流行病学调查。结果：医院感染发病率SARS后（3．25％）较SARS前（5．59％）降低（u=6．69，P〈0．01），下呼吸道感染构成比：SARS后（27．31％）较SARS前（38．46％）降低（u=2．83，P〈0．01），真菌感染检出率：SARS后（20．41％）较SARS前（8．5％）升高（u=2．48，P〈0．05），病原菌SARS前后均以G^-杆菌为主，下呼吸道感染是SARS前后主要的感染部位，感染科室SARS前后不同。结论：SARS的发生未使该院医院感染率增高，对医院感染控制重视程度的提高，做好主动预防，采取有效措施，是降低医院感染发病率的关键。[     

我市医务人员严重急性呼吸综合征医院感染流行原因调查与对策

目的 调查某市医务人员感染严重急性呼吸综合征(severe acute respiratory syndrome，SARS)的途径及危险因素。方法 对直接参加过抢救和间接接触SARS患而被感染的医务人员采取统一填表、座谈、走访、电话采访等方式进行调查。结果 调查三所医院感染SARS的医务人员共88人，占全市发病医务人员总人数的87．13％。导致医务人员易感的原因是：对疾病缺乏认识，防范意识不强；管理网络不健全；患隐瞒流行病史；隔离环境及防护用品达不到要求等。结论 重视医院感染管理及对医务人员的医院感染知识培训，强化消毒隔离和自我保护意识，是控制医院感染流行及保护医务人员的有力措施。     

Asymptomatic SARS coronavirus infection among healthcare workers, Singapore

We conducted a study among healthcare workers (HCWs) exposed to patients with severe acute respiratory syndrome (SARS) before infection control measures were instituted. Of all exposed HCWs, 7.5% had asymptomatic SARS-positive cases. Asymptomatic SARS was associated with lower SARS antibody titers and higher use of masks when compared to pneumonic SARS.     

SARS病区医院感染控制与管理

目的 探讨和总结SARS流行期间，医院感染控制与管理的方法和经验。方法 建立规范隔离病区、制定严格消毒隔离制度和规范消毒方法、采取严格患者管理、有效切断传播途径、加强医护人员防护等综合控制医院感染措施。结果 避免了SARS在医院内的传播，有效预防了医护人员与患者间的交叉感染。结论 加强医院感染控制与管理，针对SARS传播特点，制定科学的消毒隔离制度及医护人员防护措施，对控制SARS医院感染具有重要的作用。     

SARS病区住院患者医院感染分析

目的了解SARS住院患者医院感染发生状况,分析可能的原因,为防止SARS医院感染提供借鉴. 方法对2003年SARS流行期间SARS专病病房收治的 213例患者,住院期间医院感染情况进行调查分析. 结果 213例SARS患者发生医院感染31人次,共46例次;本组医院感染发生率为14. 55%;明显高于我院常年医院感染率(P<0.01);调查病例中抗菌药物使用率达94.00 %;激素使用率69.10%.病原菌培养阳性13例,占本组医院感染41.94%,共查到致病菌株76株, 真菌、凝固酶阴性葡萄球菌等条件致病菌、耐药菌占有较高的比例. 结论 SARS流行期间患者合理用药,对防止医院感染特别是条件致病菌引起的二重感染有着重要意义.     

Severe acute respiratory syndrome (SARS) and healthcare workers

The recent outbreak of severe acute respiratory synt drome (SARS) was spread by international air travel, a direct result of globalization. The disease is caused by a novel coronavirus, transmitted from human to human by droplets or by direct contact. Healthcare workers (HCWs) were at high risk and accounted for a fifth of all cases globally. Risk factors for infection in HCWs included lack of awareness and preparedness when the disease first struck, poor institutional infection control measures, lack of training in infection control procedures, poor compliance with the use of personal protection equipment (PPE), exposure to high-risk procedures such as intubation and nebulization, and exposure to unsuspected SARS patients. Measures to prevent nosocomial infection included establishing isolation wards for triage, SARS patients, and step-down; training and monitoring hospital staff in infection-control procedures; active and passive screening of HCWs; enforcement of droplet and contact precautions; and compliance with the use of PPE.     

如何预防医务人员COVID-19感染：来自中国武汉的经验

 在新型冠状病毒肺炎（COVID-19）大流行的背景下,全球已有数以千计的医务人员感染新型冠状病毒（SARS-CoV-2）,并有人因此失去生命。在疫情早期,中国发生了医务人员感染。由于对SARS-CoV-2的特点认识有限,湖北有3,000多名医务人员在疫情暴发初期感染了SARS-CoV-2。由于当地医院医务人员工作超负荷,超过4.2万名医务人员（包括军队医务人员）,从全国各地被派往湖北。在疫情最严重的时期,中国有十分之一的重症监护医生在武汉工作。在中国抗击COVID-19的过程中,虽然在疫情早期发生了一定数量的医务人员感染SARS-CoV-2,但通过及时采取预防措施,包括快速诊断,及时对患者进行隔离,强调医务人员的安全,加强医务人员基本防护知识培训和统一管理等有效防护措施,国家援鄂医疗队42,632名队员最终未报告感染,并且当地医院医务人员感染病例显著减少,说明医务人员院内感染COVID-19是完全可以预防的。本文旨在阐述中国武汉疫情期间,如何通过采取有效措施预防医务人员感染SARS-CoV-2。     

Infection control for SARS in a tertiary paediatric centre in Hong Kong

Severe acute respiratory syndrome (SARS) is an emerging infectious disease. After the appearance of an index patient in Hong Kong in February 2003, SARS outbreaks occurred rapidly in hospitals and spread to the community. The aim of this retrospective study is to evaluate the effectiveness of a triage policy and risk-stratified infection control measures in preventing nosocomial SARS infection among paediatric healthcare workers (HCWs) at the Prince of Wales Hospital, a general hospital to which children with SARS are referred in Hong Kong. The acute paediatric wards were stratified into three areas: (1) ultra high-risk area, (2) high-risk area and (3) moderate-risk area according to different risk levels of nosocomial SARS transmission. The implementation of different levels of infection control precautions was guided by this risk stratification strategy. Between 13 March and 23 June, 38 patients with probable and suspected SARS, 90 patients with non-SARS pneumonia, and 510 patients without pneumonia were admitted into our unit. All probable SARS cases were isolated in negative-pressure rooms. Twenty-six HCWs worked in the ultra high-risk area caring for SARS patients and 88 HCWs managed non-SARS patients in other ward areas. None of the HCWs developed clinical features suggestive of SARS. In addition, there was no nosocomial spread of SARS-associated coronavirus to other patients or visitors during this period. In conclusion, stringent infection control precautions, appropriate triage and prompt isolation of potential SARS patients may have contributed to a lack of nosocomial spread and HCW acquisition of SARS in our unit.     

Use of quarantine to prevent transmission of severe acute respiratory syndrome--Taiwan, 2003

On July 5, 2003, Taiwan was removed from the World Health Organization (WHO) list of severe acute respiratory syndrome (SARS)-affected countries. As of July 9, a total of 671 probable cases of SARS had been reported in Taiwan. On February 21, the first identified SARS patient in Taiwan returned from travel to Guangdong Province, mainland China, by way of Hong Kong. Initial efforts to control SARS appeared to be effective; these efforts included isolation of suspect and probable SARS patients, use of personal protective equipment (PPE) for health-care workers (HCWs) and visitors, and quarantine of contacts of known SARS patients. However, beginning in mid-April, unrecognized cases of SARS led to a large nosocomial cluster and subsequent SARS-associated coronavirus transmission to other health-care facilities and community settings. In response to the growing epidemic, additional measures were taken to limit nosocomial and community transmission of SARS, including more widespread use of quarantine. By the end of the epidemic, 131,132 persons had been placed in quarantine, including 50,319 close contacts of SARS patients and 80,813 travelers from WHO-designated SARS-affected areas. This report describes the quarantine measures used in Taiwan and discusses the need for further evaluation of quarantine and other control measures used to prevent SARS.     

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。     

Impact of severe acute respiratory syndrome care on the general health status of healthcare workers in taiwan.

BACKGROUND: The impact of the outbreak of severe acute respiratory syndrome (SARS) was enormous, but few studies have focused on the infectious and general health status of healthcare workers (HCWs) who treated patients with SARS. DESIGN: We prospectively evaluated the general health status of HCWs during the SARS epidemic.The Medical Outcome Study Short-Form 36 Survey was given to all HCWs immediately after caring for patients with SARS and 4 weeks after self-quarantine and off-duty shifts. Tests for detection of SARS coronavirus antibody were performed for HCWs at these 2 time points and for control subjects during the SARS epidemic. SETTING: Tertiary care referral center in Taipei, Taiwan. SUBJECTS: Ninety SARS-care task force members (SARS HCWs) and 82 control subjects. RESULTS: All serum specimens tested negative for SARS antibody. Survey scores for SARS HCWs immediately after care were significantly lower than those for the control group (P<.05 by the t test) in 6 categories. Vitality, social functioning, and mental health immediately after care and vitality and mental health after self-quarantine and off-duty shifts were among the worst subscales. The social functioning, role emotional, and role physical subscales significantly improved after self-quarantine and off-duty shifts (P<.05, by paired t test). The length of contact time (mean number of contact-hours per day) with patients with SARS was associated with some subscales (role emotional, role physical, and mental health) to a mild extent. The total number of contact-hours with symptomatic patients with SARS was a borderline predictor (adjusted R2=0.069; P=.038) of mental health score. CONCLUSIONS: The impact of the SARS outbreak on SARS HCWs was significant in many dimensions of general health. The vitality and mental health status of SARS HCWs 1 month after self-quarantine and off-duty shifts remained inferior to those of the control group.     

控制SARS医院感染的护理管理

目的总结本院控制SARS医院感染护理管理经验. 方法对本院2003年开设的3个SARS隔离病区在控制SARS医院感染护理管理中采用的各种措施进行分析. 结果我院在收治SARS患者的过程中,实现医护人员和患者零感染、患者零死亡、治愈率100%的目标,有效控制了SARS的医院感染. 结论我院制定应急处理方案是有效应对本次疫情的保证;护理人力资源管理是控制SARS医院感染工作中的重点与难点.     

SARS患者血清免疫球蛋白、补体含量的变化及结果分析

目的测定传染性非典型肺炎(SARS)患者血清中免疫球蛋白IgA、IgG、IgM与补体C3、C4含量的变化,探讨SARS病毒感染和机体体液免疫状态的关系.方法采用免疫比浊法检测42例SARS患者血清中IgA、IgG、IgM与补体C3、C4含量.结果SARS患者血清中IgA、IgG及C3较正常对照组及无感染组均明显降低,其差别具有显著性(P＜0.05).恢复期IgA、IgM、C3含量增高,其他指标降低,IgA指标治疗前后有显著性差异(P＜0.05).结论感染SARS病毒后机体免疫力低下,SARS发病后可能导致体液免疫抑制;两者存在一定的关系,但病毒感染如何抑制免疫功能尚有待进一步研究.     

Which preventive measures might protect health care workers from SARS?

Background  

Despite the use of a series of preventive measures, a high incidence of severe acute respiratory syndrome (SARS) was observed among health care workers (HCWs) during the SARS epidemic. This study aimed to determine which preventive measures may have been effective in protecting HCWs from infection, and which were not effective.     

SARS流行时期医务人员防护及效果评价

目的了解广东省有急性传染性非典型肺炎(SARS)接触史的医务人员在防治SARS时期的个人防护状况,评价防护措施对预防SARS感染的效果. 方法对广东省9所诊治SARS的医院中所有有SARS接触史的工作人员进行调查. 结果1 645名调查对象中有 152例感染SARS,其中有79.61%的确诊时间在2003年2月,随时间推移而确诊病例数迅速减少;同时,所有调查对象在第1次接触SARS时对各项防护工具的使用率随时间推移而增加,趋势检验均有统计学意义;第1次接触SARS时使用各项防护工具的医务人员感染SARS的频率均低于没有使用者;9所医院医务人员对防护工具使用率和感染率也呈负相关关系,相关系数为-0.7386,P值为0.023. 结论对与SARS患者接触的医务人员,采取积极有效的防护措施能大大降低感染的风险,从而保护其身体健康.     

不同消毒剂对SARS定点收治医院空气消毒效果的观察和比较

目的对SARS定点收治医院病区进行消毒前后的空气采样,检测不同消毒剂对空气中微生物的现场杀灭效果,降低医院交叉感染. 方法自然沉降法,利用重力作用使空气中的微生物粒子自然沉降在营养琼脂培养基上. 结果含氯消毒剂消毒效果优于过氧化氢优于银离子消毒剂,含氯消毒剂对空气中自然菌的各次消亡率达>95.95%. 结论对疫区消毒是防治疫情扩散、切断各种传播途径、预防交叉感染的有效措施之一;要因时、因地、因人、因物合理选择消毒剂及方法,有效控制和降低医院交叉感染的发生具有十分重要的意义.     

北京市朝阳区“非典”康复患者心理健康状况调查

目的研究"非典"康复患者的心理健康状况及其影响因素.方法运用症状自评量表(SCL-90)对辖区可随访到的55名"非典"出院患者进行调查,分析患者SCL-90量表各因子得分情况和性别、住院时间长短及是否知晓传染源对SCL-90量表各因子分的影响.结果"非典"康复患者的SCL-90因子得分接近正常."非典"康复患者中女性在精神病性因子和强迫因子方面的得分显著高于男性(P＜0.05),其余各因子分男女间差异无统计学意义.住院时间长短不同的患者SCL-90各因子分差异无显著性.是否知晓传染源对患者SCL-90各因子分无显著性影响.结论经过近1年的康复后,"非典"患者的心理健康状况趋近正常.性别可能是影响患者康复后心理健康状况的因素之一.     

SARS期间医院感染控制的三级预防

目的 探讨SARS流行期间以预防为主的防治措施。方法 防治SARS医院内交叉感染强调预防为主的三级预防策略，提出了防护、隔离、消毒三级预防的具体措施、方案及目标。结果 通过对发热患者监测、危险因素确定、干预措施和控制方案制定等，确保了医院感染控制工作在应对SARS事件第一时间内全面展开。结论 SARS的防治和监测必须坚持不懈，医院感染控制必须落实三级预防措施。     

SARS患者继发细菌感染的检测及其耐药性

目的了解SARS患者继发细菌感染及其耐药性,为临床治疗控制医院感染提供参照与依据. 方法临床标本经分离培养,用ATB微生物鉴定系统鉴定;真菌的鉴定, 采用CHROMagar 念珠菌属显色培养基和生化反应试验法进行;用Kirby-Bauer纸片扩散法,根据NCCLS制定的标准进行药敏试验. 结果 76例SARS患者13例发生了继发感染;感染发生率为17.1%,引起继发感染的致病菌检出有13株,其中G-杆菌4株(30.77%),G 球菌5株(38.46%),真菌4株(30.77%);主要的致病菌为表皮葡萄球菌、粪肠球菌、鲍氏不动杆菌、液化沙雷菌、白色念珠菌等,对绝大多数抗生素耐药. 结论 SARS患者容易发生各种医院感染,特别是内源性感染,应予足够的重视;治疗时根据培养、耐药性试验结果,及时调整抗菌药物至关重要.