在重症监护病房中减少医护人员季节性流感传播：泰国的一项为期 4 年的干预研究。
Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: a 4-year intervention study in Thailand.
机构信息
Division of Infectious Diseases and Infection Control Unit, Thammasat University Hospital, Pratumthani, Thailand.
出版信息
Infect Control Hosp Epidemiol. 2010 Oct;31(10):996-1003. doi: 10.1086/656565.
OBJECTIVE
To evaluate the feasibility and effectiveness of an influenza control bundle to minimize healthcare-associated seasonal influenza transmission among healthcare workers (HCWs) in an intensive care unit (ICU) equipped with central air conditioning.
METHODS
A quasi-experimental study was conducted in a 500-bed tertiary care center in Thailand from July 1, 2005, through June 30,2009. The medical ICU (MICU) implemented an influenza control bundle including healthcare worker (HCW) education, influenza screening of adult community-acquired pneumonia patients, antiviral treatment of patients and ill HCWs who tested positive for influenza, promotion of influenza vaccination among HCWs, and reinforcement of standard infection control policies. The surgical ICU (SICU) and coronary care unit (CCU) received no intervention.
RESULTS
The numbers of influenza infections among HCWs during the pre- and postintervention periods were 18 cases in 5,294 HCW days and 0 cases in 5,336 HCW-days in the MICU (3.4 vs 0 cases per 1,000 HCW-days; P ! .001), 19 cases in 4,318 HCW-days and 20 cases in 4,348 HCW-days in the SICU (4.4 vs 4.6 cases per 1,000 HCW-days; Pp.80), and 18 cases in 5,000 HCW-days and 18 cases in 5,143 HCW-days in the CCU (3.6 vs 3.5 cases per 1,000 HCW-days; Pp.92), respectively. Outbreak-related influenza occurred in 7 MICUHCWs, 6 SICU HCWs, and 4 CCU HCWs before intervention and 0 MICU HCWs, 9 SICU HCWs, and 8 CCU HCWs after intervention.Before and after intervention, 25 (71%) and 35 (100%) of 35 MICU HCWs were vaccinated, respectively (P ! .001); HCW vaccination coverage did not change significantly in the SICU (21 [70%] of 30 vs 24 [80%] of 30; Pp.89) and CCU (19 [68%] of 28 vs 21 [75%]of 28; Pp.83). The estimated costs of US $6,471 per unit for postintervention outbreak investigations exceeded the intervention costs of US $4,969.
CONCLUSION
A sustained influenza intervention bundle was associated with clinical and economic benefits to a Thai hospital.
目的
评估流感防控综合措施在配备集中空调的重症监护病房（ICU）中降低医护人员（HCWs）发生季节性流感医院感染的可行性和效果。
方法
这是 2005 年 7 月 1 日至 2009 年 6 月 30 日在泰国一个拥有 500 张床位的三级保健中心进行的一项准实验研究。该中心的内科 ICU（MICU）实施了流感防控综合措施，包括医护人员（HCW）教育、对成人社区获得性肺炎患者进行流感筛查、对流感检测阳性的患者和患病 HCWs 进行抗病毒治疗、促进医护人员接种流感疫苗以及强化标准感染控制政策。外科 ICU（SICU）和冠心病监护病房（CCU）未实施任何干预措施。
结果
在干预前和干预期间，医护人员流感感染的例数分别为：MICU 为 5294 个医护人员日中的 18 例和 5336 个医护人员日中的 0 例（每 1000 个医护人员日 3.4 例和 0 例；P ！.001），SICU 为 4318 个医护人员日中的 19 例和 4348 个医护人员日中的 20 例（每 1000 个医护人员日 4.4 例和 4.6 例；Pp.80），CCU 为 5000 个医护人员日中的 18 例和 5143 个医护人员日中的 18 例（每 1000 个医护人员日 3.6 例和 3.5 例；Pp.92）。干预前有 7 例 MICU 医护人员、6 例 SICU 医护人员和 4 例 CCU 医护人员发生与暴发相关的流感，干预后无 MICU 医护人员、9 例 SICU 医护人员和 8 例 CCU 医护人员发生与暴发相关的流感。在干预前和干预后，分别有 25（71%）和 35（100%）例 MICU 医护人员接种了疫苗（P ！.001）；SICU（21 [70%]例和 30 [80%]例；Pp.89）和 CCU（19 [68%]例和 28 [75%]例；Pp.83）的医护人员疫苗接种覆盖率没有显著变化。干预后，单位的暴发调查费用估计为 6471 美元，超过了干预费用 4969 美元。
结论
泰国医院持续实施流感防控综合措施可带来临床和经济效益。
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