2006 年至 2018 年期间中国北京胸科医院的医院内结核传播。
Nosocomial tuberculosis transmission from 2006 to 2018 in Beijing Chest Hospital, China.
机构信息
Nosocomial Infections Control Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China.
Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China.
出版信息
Antimicrob Resist Infect Control. 2020 Oct 24;9(1):165. doi: 10.1186/s13756-020-00831-5.
INTRODUCTION
Strong evidence is lacking to support effectiveness of currently implemented tuberculosis infection prevention control (TB-IPC) measures for preventing nosocomial tuberculosis (TB) transmission. This 13-year analysis is the longest follow-up investigation to date to identify risk factors underlying nosocomial TB transmission.
METHODS
We monitored all staff of Beijing Chest Hospital each year from 2006 to 2018. Age, gender, duration, department, education, income, respirator, ultraviolet, and ventilation were chosen as variables. Univariate cox regression, correlation analysis, and multivariate cox regression were analyzed sequentially.
RESULTS
Using multivariable cox regression analysis, variables of income, ultraviolet germicidal irradiation (UVGI), natural ventilation and mechanical ventilation conferred significant protective effects, with odds ratios of 0.499, 0.058, 0.003, and 0.015, respectively (P < 0.05). Medical N95 respirator conferred an excellent protective effect, with an associated TB infection rate of 0%. Notably, inadequately maintained mechanical ventilation systems were less protective than natural ventilation systems.
CONCLUSION
UVGI, adequate ventilation, and use of medical N95 respirator may be risk factors of nosocomial TB transmission.
引言
目前实施的结核病感染预防控制（TB-IPC）措施在预防医院内结核病（TB）传播方面的有效性缺乏有力证据。这项长达 13 年的分析是迄今为止对医院内 TB 传播相关因素进行的最长时间的随访调查。
方法
我们每年监测北京胸科医院的所有员工，从 2006 年到 2018 年。选择年龄、性别、工龄、科室、教育程度、收入、呼吸防护器、紫外线、通风作为变量。依次进行单因素 Cox 回归、相关分析和多因素 Cox 回归分析。
结果
使用多因素 Cox 回归分析，收入、紫外线杀菌（UVGI）、自然通风和机械通风变量具有显著的保护作用，比值比分别为 0.499、0.058、0.003 和 0.015（P<0.05）。医用 N95 呼吸防护器具有极好的保护作用，相关结核感染率为 0%。值得注意的是，维护不当的机械通风系统的保护作用不如自然通风系统。
结论
UVGI、充分通风和使用医用 N95 呼吸防护器可能是医院内 TB 传播的危险因素。
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