MMWR Morb Mortal Wkly Rep. 2020 Apr 17;69(15):472-476. doi: 10.15585/mmwr.mm6915e5.
On February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California (1). The patient was initially evaluated at hospital A on February 15; at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient's transfer to hospital B, a real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2; three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19; HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.
2020 年 2 月 26 日，在美国加利福尼亚州索拉诺县，首例社区获得性 2019 年冠状病毒病（COVID-19）病例得到确认（1）。患者最初于 2 月 15 日在医院 A 进行评估；当时，由于患者否认有旅行史或与有症状者接触，因此并未怀疑 COVID-19。在 4 天的住院期间，患者接受了标准预防措施，并进行了多次气溶胶生成程序（AGP），包括雾化治疗、双水平气道正压通气（BiPAP）、气管插管和支气管镜检查。患者转至医院 B 几天后，实时逆转录-聚合酶链反应（real-time RT-PCR）检测 SARS-CoV-2 呈阳性。在接触过患者的 121 名医院 A 医护人员（HCP）中，有 43 名（35.5%）在接触后 14 天内出现症状，并接受了 SARS-CoV-2 检测；其中 3 人的检测结果呈阳性，这是美国首批已知的 SARS-CoV-2 可能在医护人员中发生职业传播的病例。在医疗机构中，人们对 SARS-CoV-2 传播的具体危险因素知之甚少。为了更好地描述和比较发生 COVID-19 的 HCP 和未发生 COVID-19 的 HCP 的暴露情况，对接受 SARS-CoV-2 检测的 37 名医院 A HCP 进行了标准化访谈，其中包括 3 名检测结果呈阳性的 HCP。与未发生 COVID-19 的 HCP 相比，接受过雾化治疗的 HCP 进行体格检查和接触患者的情况更为常见；发生 COVID-19 的 HCP 与患者的接触时间也更长。由于没有使用基于传播的预防措施，因此没有 HCP 在接触指数患者时穿戴推荐用于 COVID-19 患者护理的个人防护设备（PPE）。医疗机构应强调早期识别和隔离可能患有 COVID-19 的患者，并使用推荐的 PPE，以尽量减少无保护、高风险的 HCP 暴露，保护医护人员。
