School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
Program for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Infect Control Hosp Epidemiol. 2020 Oct;41(10):1196-1206. doi: 10.1017/ice.2020.237. Epub 2020 May 15.
In the current absence of a vaccine for COVID-19, public health responses aim to break the chain of infection by focusing on the mode of transmission. We reviewed the current evidence on the transmission dynamics and on pathogenic and clinical features of COVID-19 to critically identify any gaps in the current infection prevention and control (IPC) guidelines.
In this study, we reviewed global COVID-19 IPC guidelines by organizations such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC). Guidelines from 2 high-income countries (Australia and United Kingdom) and from 1 middle-income country (China) were also reviewed. We searched publications in English on 'PubMed' and Google Scholar. We extracted information related to COVID-19 transmission dynamics, clinical presentations, and exposures that may facilitate transmission. We then compared these findings with the recommended IPC measures.
Nosocomial transmission of SARS-CoV-2 in healthcare settings occurs through droplets, aerosols, and the oral-fecal or fecal-droplet route. However, the IPC guidelines fail to cover all transmission modes, and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol-generating procedures. However, recommendations regarding the type of face mask varied, and the CDC recommends cloth masks when surgical masks are unavailable.
IPC strategies should consider all the possible routes of transmission and should target all patient care activities involving risk of person-to-person transmission. This review may assist international health agencies in updating their guidelines.
在当前缺乏针对 COVID-19 的疫苗的情况下，公共卫生应对措施旨在通过关注传播模式来打破感染链。我们回顾了 COVID-19 的传播动力学以及发病和临床特征的现有证据，以批判性地确定当前感染预防和控制 (IPC) 指南中的任何空白。
在这项研究中，我们审查了世界卫生组织 (WHO)、美国疾病控制与预防中心 (CDC) 和欧洲疾病预防与控制中心 (ECDC) 等组织的全球 COVID-19 IPC 指南。还审查了来自 2 个高收入国家（澳大利亚和英国）和 1 个中等收入国家（中国）的指南。我们在英文的“PubMed”和 Google Scholar 上搜索了出版物。我们提取了与 COVID-19 传播动力学、临床表现和可能促进传播的暴露相关的信息。然后，我们将这些发现与推荐的 IPC 措施进行了比较。
在医疗保健环境中，SARS-CoV-2 通过飞沫、气溶胶以及口腔-粪便或粪便飞沫途径发生医院内传播。然而，IPC 指南未能涵盖所有传播模式，并且建议也相互冲突。大多数指南建议医护人员在常规护理期间佩戴外科口罩，在产生气溶胶的操作中佩戴 N95 呼吸器。然而，关于口罩类型的建议有所不同，CDC 建议在无法使用外科口罩时使用布口罩。
IPC 策略应考虑所有可能的传播途径，并应针对所有涉及人际传播风险的患者护理活动。本综述可能有助于国际卫生机构更新其指南。
