Ho Hanley J, Zhang Zoe Xiaozhu, Huang Zhilian, Aung Aung Hein, Lim Wei-Yen, Chow Angela
Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
J Med Internet Res. 2020 May 26;22(5):e19437. doi: 10.2196/19437.
In early 2020, coronavirus disease (COVID-19) emerged and spread by community and nosocomial transmission. Effective contact tracing of potentially exposed health care workers is crucial for the prevention and control of infectious disease outbreaks in the health care setting.
This study aimed to evaluate the comparative effectiveness of contact tracing during the COVID-19 pandemic through the real-time locating system (RTLS) and review of the electronic medical record (EMR) at the designated hospital for COVID-19 response in Singapore.
Over a 2-day study period, all admitted patients with COVID-19, their ward locations, and the health care workers rostered to each ward were identified to determine the total number of potential contacts between patients with COVID-19 and health care workers. The numbers of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR-based and RTLS-based contact tracing methods was further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by health care workers.
Of 796 potential staff-patient contacts (between 17 patients and 162 staff members), 104 (13.1%) were identified by both the RTLS and EMR, 54 (6.8%) by the RTLS alone, and 99 (12.4%) by the EMR alone; 539 (67.7%) were not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and a specificity of 77.9%, while the RTLS had a sensitivity of 72.2% and a specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either the RTLS or the EMR (sensitivity 77.8%, specificity 73.4%).
RTLS-based contact tracing showed higher sensitivity and specificity than EMR review. Integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing of RTLS tags remain necessary.
2020年初，冠状病毒病（COVID-19）出现并通过社区传播和医院内传播扩散。对可能接触过的医护人员进行有效的接触者追踪对于预防和控制医疗机构内的传染病爆发至关重要。
本研究旨在通过实时定位系统（RTLS）和对新加坡指定COVID-19应对医院的电子病历（EMR）进行审查，评估COVID-19大流行期间接触者追踪的相对有效性。
在为期2天的研究期间，确定所有COVID-19住院患者、他们的病房位置以及分配到每个病房的医护人员，以确定COVID-19患者与医护人员之间潜在接触的总数。评估通过电子病历审查、基于实时定位系统的接触者追踪以及两种方法相结合确定的医护人员与患者接触的数量。通过将基于电子病历和基于实时定位系统的接触者追踪方法的敏感性和特异性与医护人员自我报告的医护人员与患者接触情况进行比较，进一步验证这两种方法的使用。
在796次潜在的医护人员与患者接触（17名患者和162名医护人员之间）中，104次（13.1%）通过实时定位系统和电子病历均被识别，54次（6.8%）仅通过实时定位系统被识别，99次（12.4%）仅通过电子病历被识别；539次（67.7%）通过两种方法均未被识别。与自我报告的接触相比，电子病历审查的敏感性为47.2%，特异性为77.9%，而实时定位系统的敏感性为72.2%，特异性为87.7%。通过纳入实时定位系统或电子病历识别的所有接触获得了最高敏感性（敏感性77.8%，特异性73.4%）。
基于实时定位系统的接触者追踪显示出比电子病历审查更高的敏感性和特异性。两种方法的整合为快速接触者追踪提供了最佳性能，尽管仍需要对实时定位系统进行技术调整并提高用户佩戴实时定位系统标签的依从性。
