Liu Jien-Wei, Lu Sheng-Nan, Chen Shun-Sheng, Yang Kuender D, Lin Meng-Chih, Wu Chao-Chien, Bloland Peter B, Park Sarah Y, Wong William, Tsao Kuo-Chien, Lin Tzou-Yien, Chen Chao-Long
Committee of Infection Control and Division of Infectious Diseases, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
Infect Control Hosp Epidemiol. 2006 May;27(5):466-72. doi: 10.1086/504501. Epub 2006 Apr 26.
We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community.
We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures.
A 2,300-bed medical center in Kaohsiung, Taiwan.
A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later.
Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.
在严重急性呼吸综合征（SARS）医院内暴发初期开展流行病学调查，以阐明SARS传播动态、SARS暴发规模及该暴发给社区带来的影响。
确定所有医院获得性SARS的潜在病例，将其与最可能的感染源建立联系，并描述医院的防控措施。
台湾高雄一家拥有2300张床位的医疗中心。
共确定55例SARS病例，227名医院工作人员被隔离。首例患者及相邻患者被隔离。一个胸科医师团队查阅病历和胸部X光片，并监测病房内患者SARS的病情发展。部分患者存在基础肺部疾病和免疫功能低下，这使得SARS诊断困难。部分SARS病例在患者死亡后才得以确诊。只有在医护人员护理未被识别出SARS的患者时才会被感染，护理人员在SARS传播给家庭成员方面发挥了重要作用。随着医院内SARS病例数增加，医院关闭了受影响的病房，并加快在其他腾空楼层建造负压病房以进行患者分组，1周后医院发现了最后1例病例。
及时识别SARS极其重要。然而，鉴于SARS检测的局限性、可能的疫情联系缺失以及住院患者非特异性临床表现，建立SARS感染可能性低、中、高的人群队列非常重要。迅速关闭受影响病房可将对医院运营的影响降至最低。建立专门用于适当治疗SARS患者的医院可能会将该病在未来疫情中的影响降至最低。
