综合性医院SARS感染的预防控制措施及效果评价

目的：探讨控制SARS医院感染的措施及评价。方法：选择某医院2003年3—4月医院感染的SARS病例，进行流行病学调查。结果：①共发生医院感染病例30例。②流行病学特点：在3月中旬和下旬有2个发病高峰，病例主要集中住院大楼西单元的5个楼层的4、5号病房，住院患者多年龄大且合并较重基础病，而受染医护人员以一线中青年为主。③输入性病例是导致医院感染的第一代传染源，医院内传染的住院者和医护人员是SARS进一步扩散的继发传染源。④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，并存在气溶胶经病房排风系统垂直长距离传播的可能性。结论：医院感染是SARS流行初期的主要形式。通过控制传染源，增设发热门诊及隔离病房，建立医学观察区，病区通风和消毒，严禁探视和加强人员防护等措施，医院内感染得到有效控制。

Study and evaluation on the measures of prevention and control in SARS hospital infection

Objective:To study and evaluate the measures of control in SARS hospital infection. Methods:Definite SARS patients (inpatients and medical staffs) were selected from a general hospital between March and June 2003. Individual and environment survey were carried out by a standardized questionnaire of China CDC. Results:There were 30 SARS cases of hospital infection. Epidemiological characteristics: There were two peaks of incidence (Mar 13th -16th and Mar 24th). Distributions by places were confined to Ward 4, 5, 6 on the 7,8,12,13 and 14 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. Source of transmission: Index patients were the first generation source of transmission and the secondary attacked inpatients and medical staffs were the second generation. Route of transmission: The major transmission routes were near space droplet infection and close contact infection. There was a probability of aerosol or droplet nuclei transmission through the ventilation system. Conclusions: Hospital infection was the main epidemic form of SARS in the early stage. Many measures such as control and isolation of the source of transmission, setup of the fever clinic and medical observation area, isolation and medical observation of suspected cases, enforcing ventilation and disinfection of the ward area, stopping fresh-air system, forbidding outside visiting, strengthen prevention of medical staffs were carried out and the SARS hospital infection could be prevented and controlled.