改善医院室内空气中二氧化碳浓度的监测器：一项随机交叉试验。
Monitors to improve indoor air carbon dioxide concentrations in the hospital: A randomized crossover trial.
机构信息
Geriatrics Department, Imelda Hospital, Bonheiden, Belgium; Geriatrics Department, University Hospitals Leuven, Leuven, Belgium.
Department of Medical Microbiology, Imelda Hospital, Bonheiden, Belgium.
出版信息
Sci Total Environ. 2022 Feb 1;806(Pt 3):151349. doi: 10.1016/j.scitotenv.2021.151349. Epub 2021 Oct 30.
BACKGROUND
Ventilation has emerged as an important strategy to reduce indoor aerosol transmission of coronavirus disease 2019. Indoor air carbon dioxide (CO) concentrations are a surrogate measure of respiratory pathogen transmission risk.
OBJECTIVES
To determine whether CO monitors are necessary and effective to improve ventilation in hospitals.
METHODS
A randomized, placebo (sham)-controlled, crossover, open label trial. Between February and May 2021, we placed CO monitors in twelve double-bed patient rooms across two geriatric wards. Staff were instructed to open windows, increase the air exchange rate and reduce room crowding to maintain indoor air CO concentrations ≤800 parts per million (ppm).
RESULTS
CO levels increased during morning care and especially in rooms housing couples (rooming-in). The median (interquartile range, IQR) time/day with CO concentration > 800 ppm (primary outcome) was 110 min (IQR 47-207) at baseline, 82 min (IQR 12-226.5) during sham periods, 78 min (IQR 20-154) during intervention periods and 140 min (IQR 19.5-612.5) post-intervention. The intervention period only differed significantly from the post-intervention period (P = 0.02), mainly due to an imbalance in rooming-in. Significant but small differences were observed in secondary outcomes of time/day with CO concentrations > 1000 ppm and daily peak CO concentrations during the intervention vs. baseline and vs. the post-intervention period, but not vs. sham. Staff reported cold discomfort for patients as the main barrier towards increasing ventilation.
DISCUSSION
Indoor air CO concentrations in hospital rooms commonly peaked above recommended levels, especially during morning care and rooming-in. There are many possible barriers towards implementing CO monitors to improve ventilation in a real-world hospital setting. A paradigm shift in hospital infection control towards adequate ventilation is warranted.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04770597.
背景
通风已成为降低 2019 年冠状病毒病室内气溶胶传播的重要策略。室内空气二氧化碳（CO）浓度是呼吸病原体传播风险的替代测量指标。
目的
确定 CO 监测器是否有必要且有效，以改善医院的通风状况。
方法
一项随机、安慰剂（假）对照、交叉、开放标签试验。2021 年 2 月至 5 月期间，我们在两个老年病房的十二间双人病房中放置了 CO 监测器。工作人员被指示打开窗户、增加空气交换率和减少房间拥挤，以将室内空气 CO 浓度维持在≤800ppm。
结果
晨间护理期间，尤其是在夫妻同住的房间（rooming-in）中，CO 水平会升高。CO 浓度>800ppm 的时间/天中位数（四分位距，IQR）（主要结局）在基线时为 110 分钟（IQR 47-207），在假期间为 82 分钟（IQR 12-226.5），在干预期间为 78 分钟（IQR 20-154），干预后为 140 分钟（IQR 19.5-612.5）。干预期间与干预后期间的差异有统计学意义（P=0.02），主要是由于 rooming-in 不平衡所致。在干预期间与基线和干预后相比，CO 浓度>1000ppm 的时间/天和每日 CO 浓度峰值的次要结局有显著但较小的差异，但与假期间相比无差异。工作人员报告说，患者感到寒冷不适是增加通风的主要障碍。
讨论
医院病房内的室内空气 CO 浓度通常会超过推荐水平，尤其是在晨间护理和 rooming-in 期间。在现实医院环境中，实施 CO 监测器以改善通风存在许多可能的障碍。有必要对医院感染控制进行范式转变，以实现足够的通风。
试验注册
ClinicalTrials.gov 标识符：NCT04770597。
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