广东省13家医院医护人员严重急性呼吸综合征医院内感染情况

目的　分析收治严重急性呼吸综合征 (SARS)患者重点医院医护人员发生SARS院内感染的因素 ,评价干预措施。方法　通过对 13家重点医院收治SARS患者的数量及病情、医护人员SARS的发病率、医院性质、病区 (科室 )环境及隔离措施调查 ,分析医护人员发生SARS院内感染的原因。结果　 13家医院共收治SARS患者 84 1例 ,参加诊治工作的 2 36 5名医护人员中 2 85人发病。综合性医院、收治危重患者较多的医院、医护人员个人防护不到位的医院医护人员发病率较高 (93/2 85 ,32 .6 3% ) ;独立病房收治SARS患者的医院、具有感染科或隔离病区 (包括临时开设的隔离病区 )的医院医护人员发病率较低。结论　收治SARS患者的病情、医院性质、病区 (科室 )环境、个人防护状况是医护人员感染SARS的危险因素     

Cluster of severe acute respiratory syndrome cases among protected health-care workers--Toronto,Canada, April 2003

Infections among health-care workers (HCWs) have been a common feature of severe acute respiratory syndrome (SARS) since its emergence. The majority of these infections have occurred in locations where infection-control precautions either had not been instituted or had been instituted but were not followed. Recommended infection-control precautions include the use of negative-pressure isolation rooms where available; N95 or higher level of respiratory protection; gloves, gowns, and eye protection; and careful hand hygiene. This report summarizes a cluster of SARS cases among HCWs in a hospital that occurred despite apparent compliance with recommended infection-control precautions.     

Factors associated with metabolic syndrome among Korean office workers

To assess the prevalence of metabolic syndrome (MetS) and identify risk factors associated with MetS among Korean office workers, this cross-sectional study was conducted with 776 office workers. The prevalence of MetS was 13.5%; elevated waist circumference (27.5%), elevated fasting glucose (23.1%), elevated triglycerides (22.2%), low high-density lipoprotein cholesterol (HDL-C) (13.4%), and elevated BP (9.4%). Having any medical health problems (OR = 3.98, 95% CI: 2.01–7.85), more knowledge of MetS (OR = 1.26, 95% CI: 1.02–1.56), higher BMI (OR = 1.42, 95% CI: 1.30–1.57), current smoking (OR = 3.78, 95% CI: 1.04–13.73), and physical inactivity (OR = 3.22, 95% CI: 1.21–8.58) were significantly associated with increased likelihood of MetS. Addressing the influence of these factors on MetS could lead to the development of workplace-based intervention strategies to encourage lifestyle changes and prevent the risk of MetS among Korean office workers.     

Factors affecting perceived risk of contracting severe acute respiratory syndrome among academic physicians.

SARS disproportionately affects healthcare providers. A physician survey was administered within three hospitals providing care to SARS patients. Knowing a colleague who contracted SARS and previous occupational exposure to infectious agents were significantly predictive of greater perceived risk, whereas perceived effectiveness of precautions and provision of direct care were not.     

Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among healthcare workers

The traffic control bundle consists of procedures designed to help prevent epidemic nosocomial infection. We retrospectively studied the serial infection control measures to determine factors most effective in preventing nosocomial infections of healthcare workers (HCWs) during the 2003 Taiwanese severe acute respiratory syndrome (SARS) epidemic. Fever screening stations, triage of fever patients, separating SARS patients from other patients, separation of entrances and passageways between patients and HCWs, and increasing hand-washing facilities all demonstrated a protective effect for HCWs (univariate analysis; P<0.05). By multiple logistic regression: (i) checkpoint alcohol dispensers for glove-on hand rubbing between zones of risk, and (ii) fever screening at the fever screen station outside the emergency department, were the significant methods effectively minimising nosocomial SARS infection of HCWs (P<0.05). The traffic control bundle should be implemented in future epidemics as a tool to achieve strict infection control measures.     

41例医务人员严重急性呼吸综合征的临床特点分析

目的　探讨严重急性呼吸综合征 (SARS)的临床特点。方法　对我院 2 0 0 3年 3月中旬至 4月中旬收治的 4 1例医务人员SARS患者的临床资料进行回顾性分析。结果　患者年龄 2 3～ 5 5岁 ,平均 32岁。男 8例 ,女 33例 ;医生 13例 ,护理人员 2 8例。传播途径为近距离接触传播 ,过度劳累是发病诱因。以发热为首发症状者 30例 (73% ) ,乏力伴周身酸痛 10例 (2 4 % ) ,1例在体检时发现双下肺部炎症而整个病程无临床症状。 4 1例中危重型病例 2例 (5 % ) ,重型病例 4例 (10 % ) ,普通型35例 (85 % )。外周血白细胞计数 (× 10 9/L)在病程第 1周最低 ,为 4 4± 1 5 ,与第 2～ 4周的白细胞计数 (7 1± 5 2 ,11 0± 5 2 ,10 5± 4 5 )比较差异有显著性。血小板计数 (× 10 9/L)第 1周最低 ,为14 3± 37,与第 2～ 4周的血小板计数 (16 8± 85 ,2 5 4± 90 ,2 6 2± 10 9)比较差异有显著性。肝功能异常者 2 7例 (6 6 % ) ,以丙氨酸转氨酶升高为主 ,发生于病程第 3～ 4周者 19例 (70 % )。病程第 1天CT发现肺部病变者 30例 (73% ) ,累及双肺 15例 (37% )。应用糖皮质激素者 36例 ,31例 (86 % )用量为 80～ 2 4 0mg/d。使用人工通气者 2 7例 ,有创机械通气者 1例。死亡 2例 ,病死率为 5 %。结论　 1/ 3的医务人员SA     

Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore

AIMS: To describe the psychological impact of severe acute respiratory syndrome (SARS) on health care workers in a regional general hospital 2 months post-outbreak. METHOD: Doctors and nurses were encouraged to participate. The survey consisted of self-report measures: demographics, the General Health Questionnaire (GHQ) 28 and Impact of Events Scale (IES). A questionnaire enquiring about changes in life's priorities due to SARS and circumstances that helped with coping was used. Participation was strictly voluntary and responses anonymous. RESULTS: In total 177 out of 661 (27%) participants [40 out of 113 (35%) doctors and 137 out of 544 (25%) nurses] had a GHQ 28 score >or=5. Doctors [P = 0.026, odds ratio (OR) = 1.6 and 95% confidence interval (CI) = 1.1-2.5] and single health care workers were at higher risk (P = 0.048, OR = 1.4 and 95% CI = 1.02-2.0) compared to nurses and those who were married. Approximately 20% of the participants had IES scores >or=30, indicating the presence of post-traumatic stress disorder (PTSD). Four areas were classified as more important using factor analysis: health and relationship with the family, relationship with friends/colleagues, work and spiritual. The areas for coping strategies were clear directives/precautionary measures, ability to give feedback to/obtain support from management, support from supervisors/colleagues, support from the family, ability to talk to someone and religious convictions. Support from supervisors/colleagues was a significant negative predictor for psychiatric symptoms and PTSD. Work and clear communication of directives/precautionary measures also helped reduce psychiatric symptoms. CONCLUSIONS: Many health care workers were emotionally affected and traumatized during the SARS outbreak. Hence, it is important for health care institutions to provide psychosocial support and intervention for their health care workers.     

Singapore’s response to the severe acute respiratory syndrome outbreak: what do Singapore physicians think?

Objective  

To gauge Singapore physicians’ perceptions of the national response to the severe acute respiratory syndrome (SARS) outbreak using a questionnaire survey.     

Severe acute respiratory syndrome: lessons from Singapore

An outbreak of severe acute respiratory syndrome (SARS) occurred in Singapore in March 2003. To illustrate the problems in diagnosing and containing SARS in the hospital, we describe a case series and highlight changes in triage and infection control practices that resulted. By implementing these changes, we have stopped the nosocomial transmission of the virus.An outbreak of severe acute respiratory syndrome (SARS) was first recognized in Singapore on March 12, 2003. The index patient was hospitalized at Tan Tock Seng Hospital, which has since become the country’s designated SARS hospital. The patient infected 20 other people (including patients and healthcare workers), who subsequently became the sources for secondary spread of the infection (1). As of June 12, 2003, a total of 206 cases and 31 deaths attributed to SARS had been reported in Singapore.We describe the important lessons learned during the triage and containment of SARS at the National University Hospital, Singapore. Both involved expanding isolation criteria to include all patients with undifferentiated fever (even in the absence of respiratory symptoms or chest x-ray changes), improving contact-tracing methods, enforcing the use of fit-tested personal protective equipment in all patient-care areas, avoiding aerosol-generating procedures, and carefully monitoring all healthcare workers for fever or respiratory symptoms. We also highlight the impact of these measures on preventing the entry and nosocomial spread of infection.     

Vaccination policies for health-care workers in acute health-care facilities in Europe

The aim of this study was to evaluate existing policies regarding recommended and mandatory occupational vaccinations for health-care workers (HCWs) in Europe. A standardized questionnaire was sent to experts in Infection Control or Occupational Health in all 27 European Union Member States, as well as Norway, Russia, and Switzerland. All 30 countries have established policies about HCW vaccination against vaccine-preventable diseases. However significant gaps and considerable country-to-country variation were found, in terms of number of recommended vaccines and target subgroups of HCWs and health-care settings. Vaccination against hepatitis B and annual vaccination against seasonal influenza are almost universally recommended for HCWs in Europe (29 countries each, including eight countries where vaccination against hepatitis B is mandatory or required for employment). Policies regarding HCW vaccination also exist against mumps (12 countries), measles or rubella (15 countries), varicella (17 countries), diphtheria-tetanus (14 countries), pertussis (9 countries), poliomyelitis (11 countries), hepatitis A (11 countries), tuberculosis (BCG vaccine) (9 countries), and against meningococcus group C or meningococci groups A, C, W135, Y (tetravalent vaccine) (in 4 countries each). Re-evaluation of occupational vaccine policies for HCWs in Europe on a consensus basis is imperative in order to promote HCW and patient safety.     

Factors influencing the wearing of facemasks to prevent the severe acute respiratory syndrome among adult Chinese in Hong Kong

BACKGROUND: The global outbreak of the severe acute respiratory syndrome (SARS) in 2003 has been an international public health threat. Quick diagnostic tests and specific treatments for SARS are not yet available; thus, prevention is of paramount importance to contain its global spread. This study aimed to determine factors associating with individuals' practice of the target SARS preventive behavior (facemask wearing). METHODS: A total of 1329 adult Chinese residing in Hong Kong were surveyed. The survey instrument included demographic data, measures on the five components of the Health Belief Model, and the practice of the target SARS preventive behavior. Logistic regression analyses were conducted to determine rates and predictors of facemask wearing. RESULTS: Overall, 61.2% of the respondents reported consistent use of facemasks to prevent SARS. Women, the 50-59 age group, and married respondents were more likely to wear facemasks. Three of the five components of the Health Belief Model, namely, perceived susceptibility, cues to action, and perceived benefits, were significant predictors of facemask-wearing even after considering effects of demographic characteristics. CONCLUSIONS: The Health Belief Model is useful in identifying determinants of facemask wearing. Findings have significant implications in enhancing the effectiveness of SARS prevention programs.     

医护人员预防SARS医院内感染的个人防护措施效果评价

目的 评价医务人员预防SARS医院内感染个人防护措施的效果,验证SARS的传播途径。方法 在广东省10家收治SARS患者的主要医院进行了成组设计的病例对照研究,对象为常规参加SARS诊治工作且直接抢救重患者的医护人员,共257人,其中病例组77例,对照组180人。采用统一调查表了解调查对象接触SARS患者程度、个人防护情况、卫生习惯、预防服药等方面情况。单因素分析采用X2检验、多因素分析利用非条件logistic回归分析。并用趋势X2检验分析个人防护措施的剂量反应关系和联合使用效果。结果 单因素分析结果显示,一直戴12层及以上口罩、穿隔离衣、用鞋套、戴手套、必要时戴眼罩、消毒洗手、漱口液漱口、用滴鼻滴眼液保护鼻眼黏膜、及时洗澡换衣、“不在病区吃饭/饮水/抽烟”、服oseltamivir phosphate等均有保护作用(P<0.05)。非条件logistic多因素回归分析有显著意义的有戴口罩(OR=0.78,95％CI:0.60～0.99)、戴眼罩(OR=0.20,95％CI:0.10～0.41)和穿鞋套(OR=0.58,95％CI:0.39～0.86)。并且趋势分析显示口罩及口罩类型、穿隔离衣、用鞋套、戴手套、必要时戴眼罩、漱口液漱口、用滴鼻滴眼液保护鼻眼黏膜和及时洗澡换衣等措施存在剂量效应关系。无防护参与SARS患者抢救的医护人员的罹患率高达61.5％(16/26),保护率随防     

Factors associated with critical-care healthcare workers' adherence to recommended barrier precautions during the Toronto severe acute respiratory syndrome outbreak.

OBJECTIVE: To assess factors associated with adherence to recommended barrier precautions among healthcare workers (HCWs) providing care to critically ill patients with severe acute respiratory syndrome (SARS). SETTING: Fifteen acute care hospitals in Ontario, Canada. DESIGN: Retrospective cohort study. PATIENTS: All patients with SARS who required intubation during the Toronto SARS outbreak in 2003. PARTICIPANTS: HCWs who provided care to or entered the room of a SARS patient during the period from 24 hours before intubation until 4 hours after intubation. METHODS: Standardized interviews were conducted with eligible HCWs to assess their interactions with the SARS patient, their use of barrier precautions, their practices for removing personal protective equipment, and the infection control training they received. RESULTS: Of 879 eligible HCWs, 795 (90%) participated. In multivariate analysis, the following predictors of consistent adherence to recommended barrier precautions were identified: recognition of the patient as a SARS case (odds ratio [OR], 2.5 [95% confidence interval {CI}, 1.5-4.5); recent infection control training (OR for interactive training, 2.7 [95% CI, 1.7-4.4]; OR for passive training, 1.7 [95% CI, 1.0-3.0]), and working in a SARS unit (OR, 4.0 [95% CI, 1.8-8.9]) or intensive care unit (OR, 4.3 [95% CI, 2.0-9.0]). Two factors were associated with significantly lower rates of consistent adherence: the provision of care for patients with higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (OR for score APACHE II of 20 or greater, 0.4 [95% CI, 0.28-0.68]) and work on shifts that required more frequent room entry (OR for 6 or more entries per shift, 0.5 [95% CI, 0.32-0.86]). CONCLUSIONS: There were significant deficits in knowledge about self-protection that were partially corrected by education programs during the SARS outbreak. HCWs' adherence to self-protection guidelines was most closely associated with whether they provided care to patients who had received a definite diagnosis of SARS.     

Human metapneumovirus detection in patients with severe acute respiratory syndrome

We used a combination approach of conventional virus isolation and molecular techniques to detect human metapneumovirus (HMPV) in patients with severe acute respiratory syndrome (SARS). Of the 48 study patients, 25 (52.1%) were infected with HMPV; 6 of these 25 patients were also infected with coronavirus, and another 5 patients (10.4%) were infected with coronavirus alone. Using this combination approach, we found that human laryngeal carcinoma (HEp-2) cells were superior to rhesus monkey kidney (LLC-MK2) cells commonly used in previous studies for isolation of HMPV. These widely available HEp-2 cells should be included in conjunction with a molecular method for cell culture followup to detect HMPV, particularly in patients with SARS.     

SARS流行期间医务人员个人防护状况调查

目的　了解医务人员在传染性非典型肺炎流行期间的个人防护状况和防护效果。方法　采用整群抽样方法抽取广东省 9家医院 ,用问卷调查方式对其中接触过传染性非典型肺炎病人的 16 4 5名医务人员进行调查。结果　戴 <12层口罩的医务人员的感染率高于戴≥ 12层者 (χ2 =14 32 8,P <0 0 1) ;使用衣帽一体隔离服比使用衣帽分体的隔离服的医务人员的感染率低 (χ2 =13 5 4 6 ,P <0 0 1) ;穿 1层隔离服的医务人员的感染率明显高于穿 1层以上者 (χ2 =2 0 6 5 9,P <0 0 1) ;戴眼罩的医务人员的感染率明显低于未戴眼罩者 (χ2 =6 6 92 4 ,P <0 0 1) ;戴手套的感染率明显低于未戴手套者 (χ2 =30 814 ,P <0 0 1) ;使用非接触式洗手装置的医务人员的感染率低于使用接触式洗手装置者 (χ2 =19 2 83,P <0 0 1)。结论　建议医务人员采取严格的个人防护措施。     

Predicting super spreading events during the 2003 severe acute respiratory syndrome epidemics in Hong Kong and Singapore

One of the intriguing characteristics of the 2003 severe acute respiratory syndrome (SARS) epidemics was the occurrence of super spreading events (SSEs). Here, the authors report the results of identifying the occurrence of SSEs in the Hong Kong and Singapore epidemics using mathematical and statistical analysis. Their predicted occurrence of SSEs agreed well with the reported occurrence of all seven super spreaders in the two cities. Additional unidentified SSEs were also found to exist. It was found that 71.1% and 74.8% of the infections were attributable to SSEs in Hong Kong and Singapore, respectively. There also seemed to be "synchronized" occurrences of infection peaks in both the community and the hospitals in Hong Kong. The results strongly suggested that the infection did not depend on the total number of symptomatic cases, with only a very small proportion of symptomatic individuals being shown to be infectious (i.e., able to infect other individuals). The authors found that the daily infection rate did not correlate with the daily total number of symptomatic cases but with the daily number of symptomatic cases who were not admitted to a hospital within 4 days of the onset of symptoms.     

Using an integrated infection control strategy during outbreak control to minimize nosocomial infection of severe acute respiratory syndrome among healthcare workers

Healthcare workers (HCWs) are at risk of acquiring severe acute respiratory syndrome (SARS) while caring for SARS patients. Personal protective equipment and negative pressure isolation rooms (NPIRs) have not been completely successful in protecting HCWs. We introduced an innovative, integrated infection control strategy involving triaging patients using barriers, zones of risk, and extensive installation of alcohol dispensers for glove-on hand rubbing. This integrated infection control approach was implemented at a SARS designated hospital ('study hospital') where NPIRs were not available. The number of HCWs who contracted SARS in the study hospital was compared with the number of HCWs who contracted SARS in 86 Taiwan hospitals that did not use the integrated infection control strategy. Two HCWs contracted SARS in the study hospital (0.03 cases/bed) compared with 93 HCWs in the other hospitals (0.13 cases/bed) during the same three-week period. Our strategy appeared to be effective in reducing the incidence of HCWs contracting SARS. The advantages included rapid implementation without NPIRs, flexibility to transfer patients, and re-inforcement for HCWs to comply with infection control procedures, especially handwashing. The efficacy and low cost are major advantages, especially in countries with large populations at risk and fewer economic resources.