Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others?

被引:124
作者
Yu, Ignatius T.
Xie, Zhan Hong
Tsoi, Kelvin K.
Chiu, Yuk Lan
Lok, Siu Wai
Tang, Xiao Ping
Hui, David S.
Lee, Nelson
Li, Yi Min
Huang, Zhi Tong
Liu, Tao
Wong, Tze Wai
Zhong, Nan Shan
Sung, Joseph J.
机构
[1] Chinese Univ Hong Kong, Ctr Emerging Infect Dis, Hong Kong, Peoples R China
[2] Chinese Univ Hong Kong, Dept Family & Community Med, Hong Kong, Peoples R China
[3] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Peoples R China
[4] Zhongshan Univ, Guangzhou Inst Resp Dis, Guangzhou Med Coll, Guangzhou, Peoples R China
[5] Zhongshan Univ, Guangzhou Peoples Hosp 8, Guangzhou, Peoples R China
[6] Zhongshan Univ, Affiliated Hosp 2, Guangzhou, Peoples R China
[7] Guangdong Prov Hosp Tradit Chinese Med, Guangzhou, Peoples R China
关键词
D O I
10.1086/512819
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. Most documented "superspreading events" of severe acute respiratory syndrome (SARS) occurred in hospitals, but the underlying causes remain unclear. We systematically analyzed the risk factors for nosocomial outbreaks of SARS among hospital wards in Guangzhou and Hong Kong, China. Methods. A case-control study was conducted. Case wards were hospital wards in which superspreading events of SARS occurred, and control wards were wards in which patients with SARS were admitted, but no subsequent nosocomial outbreaks occurred. Information on environmental and administrative factors was obtained through visits to the wards and interviews with ward managers or nursing officers. Relevant information about host factors was abstracted from the medical records. Logistic regression analyses were used to identify the major risk factors for superspreading events. Results. Eighty-six wards in 21 hospitals in Guangzhou and 38 wards in 5 hospitals in Hong Kong were included in the study. Six risk factors were significant in the final multiple-logistic regression model: minimum distance between beds of <= 1 m (odds ratio [OR], 6.94; 95% confidence interval [CI], 1.68-28.75), availability of washing or changing facilities for staff (OR, 0.12; 95% CI, 0.02-0.97), whether resuscitation was ever performed in the ward (OR, 3.81; 95% CI, 1.04-13.87), whether staff members worked while experiencing symptoms (OR, 10.55; 95% CI, 2.28-48.87), whether any host patients (index patient or the first patient with SARS admitted to a ward) required oxygen therapy (OR, 4.30; 95% CI, 1.00-18.43), and whether any host patients required bi-level positive airway pressure ventilation (OR, 11.82; 95% CI, 1.97-70.80). Conclusions. Our results revealed that factors that were associated with the ward environment and administration were important in nosocomial outbreaks of SARS. The lessons learned from this study remain very important and highly relevant to the daily operation of hospital wards if we are to prevent nosocomial outbreaks of other respiratory infections in the future.
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收藏
页码:1017 / 1025
页数:9
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