Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America.
Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America.
PLoS One. 2020 Dec 10;15(12):e0238409. doi: 10.1371/journal.pone.0238409. eCollection 2020.
Universal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public hospital serving a diverse, largely immigrant and low-income patient population and an epicenter of the global pandemic.
We conducted a retrospective cross-sectional study. All pregnant women admitted to the L&D Unit of Elmhurst Hospital from March 29, 2020 to April 22, 2020 were included for analysis. The primary outcomes of the study were: (1) SARS-CoV-2 positivity among universally screened pregnant women, stratified by demographic characteristics, maternal comorbidities, and delivery outcomes; and (2) Symptomatic or asymptomatic presentation at the time of testing among SARS-CoV-2 positive women. A total of 126 obstetric patients were screened for SARS-CoV-2 between March 29 and April 22. Of these, 37% were positive. Of the women who tested positive, 72% were asymptomatic at the time of testing. Patients who tested positive for SARS-CoV-2 were more likely to be of Hispanic ethnicity (unadjusted difference 24.4 percentage points, CI 7.9, 41.0) and report their primary language as Spanish (unadjusted difference 32.9 percentage points, CI 15.8, 49.9) than patients who tested negative.
In this retrospective cross-sectional study of data from a universal SARS-Cov-2 screening program implemented in the L&D unit of a safety-net hospital in Queens, New York, we found over one-third of pregnant women testing positive, the majority of those asymptomatic. The rationale for universal screening at the L&D Unit at Elmhurst Hospital was to ensure safety of patients and staff during an acute surge in SARS-Cov-2 infections through appropriate identification and isolation of pregnant women with positive test results. Women were roomed by their SARS-CoV-2 status given increasing space limitations. In addition, postpartum counseling was tailored to infection status. We quickly established discharge counseling and follow-up protocols tailored to their specific social needs. The experience at Elmhurst Hospital is instructive for other L&D units serving vulnerable populations and for pandemic preparedness.
在分娩（L&D）病房进行 SARS-CoV-2 感染的普遍筛查是管理患者和卫生工作者安全的关键策略，尤其是在高危高发病率社区。我们描述了纽约皇后区埃尔姆赫斯特医院 L&D 病房 SARS-CoV-2 普遍筛查计划的结果，该医院是一家拥有 545 张床位的公立医院，服务于多样化的、主要是移民和低收入患者群体，也是全球大流行的中心。
我们进行了一项回顾性横断面研究。所有于 2020 年 3 月 29 日至 4 月 22 日期间入住埃尔姆赫斯特医院 L&D 病房的孕妇均纳入分析。该研究的主要结果是：（1）根据人口统计学特征、产妇合并症和分娩结果，对普遍筛查的孕妇进行 SARS-CoV-2 阳性率分层；（2）SARS-CoV-2 阳性妇女在检测时的症状或无症状表现。在 3 月 29 日至 4 月 22 日期间，共对 126 名产科患者进行了 SARS-CoV-2 筛查。其中，37%呈阳性。在检测呈阳性的女性中，72%在检测时无症状。检测呈 SARS-CoV-2 阳性的患者更有可能是西班牙裔（未调整差异 24.4 个百分点，CI 7.9，41.0），并且报告其主要语言为西班牙语（未调整差异 32.9 个百分点，CI 15.8，49.9），而检测呈阴性的患者则较少。
在这项对纽约皇后区一家安全网医院 L&D 病房实施的 SARS-CoV-2 普遍筛查计划数据的回顾性横断面研究中，我们发现超过三分之一的孕妇检测呈阳性，其中大多数为无症状。埃尔姆赫斯特医院 L&D 病房进行普遍筛查的基本原理是通过适当识别和隔离检测结果阳性的孕妇，确保在 SARS-CoV-2 感染急剧增加期间患者和工作人员的安全。根据 SARS-CoV-2 检测结果为患者安排病房。此外，对产后护理进行了针对性调整以适应感染状况。我们迅速制定了符合其特定社会需求的出院咨询和随访方案。埃尔姆赫斯特医院的经验为服务于弱势群体的其他 L&D 病房和大流行防范提供了借鉴。
