Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
King's College London, UK.
Anaesthesia. 2020 Nov;75(11):1437-1447. doi: 10.1111/anae.15170. Epub 2020 Jul 9.
Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.
参与产生气溶胶的程序(如气管插管)的医护人员可能面临更高的感染 COVID-19 的风险。然而,这种风险的程度尚不清楚。我们进行了一项前瞻性的国际多中心队列研究,招募参与疑似或确诊 COVID-19 患者气管插管的医护人员。通过自我报告收集气管插管事件、个人防护设备使用以及随后提供者健康状况的信息。主要终点是在气管插管后发生实验室确诊的 COVID-19 诊断或出现新症状需要自我隔离或住院的发生率。Cox 回归分析检查了主要终点与医护人员特征、程序相关因素和个人防护设备使用之间的关联。在 2020 年 3 月 23 日至 6 月 2 日期间,来自 17 个国家 503 家医院的 1718 名医护人员报告了 5148 次气管插管事件。在中位数(IQR [范围])为 32 天(18-48 [0-116])的随访中,主要终点的总体发生率为 10.7%。首次气管插管后 7、14 和 21 天的累积发生率分别为 3.6%、6.1%和 8.5%。主要终点的风险因国家而异,女性较高,但与其他因素无关。大约每 10 名参与疑似或确诊 COVID-19 患者气管插管的医护人员中,就有 1 人随后报告 COVID-19 结果。这对机构提供基本医疗服务的人力资源能力有影响,对 COVID-19 的传播也有更广泛的社会影响。
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