养老院中的 SARS-CoV-2 环境污染。
Environmental contamination with SARS-CoV-2 in nursing homes.
机构信息
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
出版信息
J Am Geriatr Soc. 2022 Jan;70(1):29-39. doi: 10.1111/jgs.17531. Epub 2021 Nov 5.
BACKGROUND
SARS-CoV-2 outbreaks in nursing homes (NHs) have been devastating and have led to the creation of coronavirus disease 2019 (COVID-19) units within NHs to care for affected patients. Frequency and persistence of SARS-CoV-2 environmental contamination in these units have not been studied.
METHODS
A prospective cohort study was conducted between October 2020 and January 2021 in four Michigan NHs. Swabs from high-touch surfaces in COVID-19-infected patient rooms were obtained at enrollment and follow-up. Demographic and clinical data were collected from clinical records. Primary outcome of interest was the probability of SARS-CoV-2 RNA detection from specific environmental surfaces in COVID-19 patient rooms. We used multivariable logistic regression to assess patient risk factors for SARS-CoV-2 contamination. Pairwise Phi coefficients were calculated to measure correlation of site-specific environmental detection upon enrollment and during follow-up.
RESULTS
One hundred and four patients with COVID-19 were enrolled (61.5% >80 years; 67.3% female; 89.4% non-Hispanic White; 51% short stay) and followed up for 241 visits. The study population had significant disabilities in activities of daily living (ADL; 81.7% dependent in four or more ADLs) and comorbidities, including dementia (55.8%), diabetes (40.4%), and heart failure (32.7%). Over the 3-month study period, 2087 swab specimens were collected (1896 COVID-19 patient rooms, 191 common areas). SARS-CoV-2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Nearly 90% (93/104) of patients had SARS-CoV-2 contamination in their room at least once. Environmental contamination upon enrollment correlated with contamination of the same site during follow-up. Functional independence increased the odds of proximate contamination.
CONCLUSIONS
Environmental detection of viral RNA from surfaces in the rooms of COVID-19 patients is nearly universal and persistent; more investigation is needed to determine the implications of this for infectiousness. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment.
背景
养老院（NH）中的 SARS-CoV-2 爆发是毁灭性的，这导致在 NH 内建立了专门用于照顾受感染患者的 2019 年冠状病毒病（COVID-19）病房。这些病房中 SARS-CoV-2 环境污染的频率和持续时间尚未得到研究。
方法
2020 年 10 月至 2021 年 1 月期间，在密歇根州的四家 NH 中进行了一项前瞻性队列研究。在 COVID-19 感染患者的病房中，从高接触表面获得拭子，在入组和随访时进行。从临床记录中收集人口统计学和临床数据。主要研究结果是从 COVID-19 患者病房的特定环境表面检测到 SARS-CoV-2 RNA 的概率。我们使用多变量逻辑回归来评估患者感染 SARS-CoV-2 的风险因素。计算配对 Phi 系数以衡量入组时和随访期间特定地点的环境检测的相关性。
结果
共纳入 104 例 COVID-19 患者（61.5% >80 岁；67.3%女性；89.4%非西班牙裔白人；51%短期入住），随访 241 次。研究人群的日常生活活动（ADL）存在严重残疾（81.7%在四项或更多 ADL 中依赖）和合并症，包括痴呆症（55.8%）、糖尿病（40.4%）和心力衰竭（32.7%）。在 3 个月的研究期间，共采集了 2087 个拭子样本（1896 个 COVID-19 患者病房，191 个公共区域）。患者病房表面的 SARS-CoV-2 阳性率为 28.4%（538/1896 个拭子），公共区域表面的阳性率为 3.7%（7/191 个拭子）。近 90%（93/104）的患者至少有一次房间内 SARS-CoV-2 污染。入组时的环境污染与随访期间同一部位的污染相关。功能独立性增加了近距离污染的几率。
结论
从 COVID-19 患者病房表面检测到病毒 RNA 几乎是普遍存在且持续的；需要进一步研究以确定这对传染性的影响。独立性较高的患者比完全依赖的患者更有可能污染其周围环境。
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