Exposure to Influenza Virus Aerosols During Routine Patient Care

被引:177
作者
Bischoff, Werner E. [1 ]
Swett, Katrina [3 ]
Leng, Iris [3 ]
Peters, Timothy R. [2 ]
机构
[1] Wake Forest Sch Med, Infect Dis Sect, Dept Internal Med, Winston Salem, NC USA
[2] Wake Forest Sch Med, Dept Pediat, Winston Salem, NC USA
[3] Wake Forest Hlth Sci, Dept Biostat Sci, Div Publ Hlth, Winston Salem, NC USA
关键词
Influenza; aerosol; exposure; infection control; routine care; healthcare providers; A VIRUS; RESPIRATORY VIRUSES; AIRBORNE VIRUSES; TRANSMISSION;
D O I
10.1093/infdis/jis773
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Defining dispersal of influenza virus via aerosol is essential for the development of prevention measures. Methods. During the 2010-2011 influenza season, subjects with influenza-like illness were enrolled in an emergency department and throughout a tertiary care hospital, nasopharyngeal swab specimens were obtained, and symptom severity, treatment, and medical history were recorded. Quantitative impaction air samples were taken not <= 0.305 m (1 foot), 0.914 m (3 feet), and 1.829 m (6 feet) from the patient's head during routine care. Influenza virus was detected by rapid test and polymerase chain reaction. Results. Sixty-one of 94 subjects (65%) tested positive for influenza virus. Twenty-six patients (43%) released influenza virus into room air, with 5 (19%) emitting up to 32 times more virus than others. Emitters surpassed the airborne 50% human infectious dose of influenza virus at all sample locations. Healthcare professionals (HCPs) were exposed to mainly small influenza virus particles (diameter, <4.7 mu m), with concentrations decreasing with increasing distance from the patient's head (P < .05). Influenza virus release was associated with high viral loads in nasopharyngeal samples (shedding), coughing, and sneezing (P < .05). Patients who reported severe illness and major interference with daily life also emitted more influenza virus (P < .05). Conclusions. HCPs within 1.829 m of patients with influenza could be exposed to infectious doses of influenza virus, primarily in small-particle aerosols. This finding questions the current paradigm of localized droplet transmission during non-aerosol-generating procedures.
引用
收藏
页码:1037 / 1046
页数:10
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