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对严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)奥密克戎变异株引发的大流行初期,美国领先的学术医院中针对 2019 年冠状病毒病(COVID-19)感染控制政策的调查。

Survey of coronavirus disease 2019 (COVID-19) infection control policies at leading US academic hospitals in the context of the initial pandemic surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant.

机构信息

Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts.

Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

出版信息

Infect Control Hosp Epidemiol. 2023 Apr;44(4):597-603. doi: 10.1017/ice.2022.155. Epub 2022 Jun 16.

DOI:10.1017/ice.2022.155
PMID:35705223
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9253430/
Abstract

OBJECTIVE

To assess coronavirus disease 2019 (COVID-19) infection policies at leading US medical centers in the context of the initial wave of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant.

DESIGN

Electronic survey study eliciting hospital policies on masking, personal protective equipment, cohorting, airborne-infection isolation rooms (AIIRs), portable HEPA filters, and patient and employee testing.

SETTING AND PARTICIPANTS

"Hospital epidemiologists from U.S. News top 20 hospitals and 10 hospitals in the CDC Prevention Epicenters program."  As it is currently written, it implies all 30 hospitals are from the CDC Prevention Epicenters program, but that only applies to 10 hospitals.  Alternatively, we could just say "Hospital epidemiologists from 30 leading US hospitals."

METHODS

Survey results were reported using descriptive statistics.

RESULTS

Of 30 hospital epidemiologists surveyed, 23 (77%) completed the survey between February 15 and March 3, 2022. Among the responding hospitals, 18 (78%) used medical masks for universal masking and 5 (22%) used N95 respirators. 16 hospitals (70%) required universal eye protection. 22 hospitals (96%) used N95s for routine COVID-19 care and 1 (4%) reserved N95s for aerosol-generating procedures. 2 responding hospitals (9%) utilized dedicated COVID-19 wards; 8 (35%) used mixed COVID-19 and non-COVID-19 units; and 13 (57%) used both dedicated and mixed units. 4 hospitals (17%) used AIIRs for all COVID-19 patients, 10 (43%) prioritized AIIRs for aerosol-generating procedures, 3 (13%) used alternate risk-stratification criteria (not based on aerosol-generating procedures), and 6 (26%) did not routinely use AIIRs. 9 hospitals (39%) did not use portable HEPA filters, but 14 (61%) used them for various indications, most commonly as substitutes for AIIRs when unavailable or for specific high-risk areas or situations. 21 hospitals (91%) tested asymptomatic patients on admission, but postadmission testing strategies and preferred specimen sites varied substantially. 5 hospitals (22%) required regular testing of unvaccinated employees and 1 hospital (4%) reported mandatory weekly testing even for vaccinated employees during the SARS-CoV-2 omicron surge.

CONCLUSIONS

COVID-19 infection control practices in leading hospitals vary substantially. Clearer public health guidance and transparency around hospital policies may facilitate more consistent national standards.

摘要

目的

在严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)奥密克戎变异株首轮疫情背景下,评估美国顶尖医疗中心的 2019 年冠状病毒病(COVID-19)感染防控政策。

设计

通过电子调查研究,征集医院在戴口罩、个人防护装备、群体隔离、空气传播感染隔离室(AIIR)、便携式高效空气颗粒过滤器以及患者和员工检测方面的政策。

地点和参与者

“美国新闻排名前 20 的医院和疾病预防控制中心预防流行中心计划中的 10 家医院的医院流行病学家。” 目前的表述方式暗示所有 30 家医院都来自疾病预防控制中心预防流行中心计划,但实际上仅适用于 10 家医院。或者,我们可以简单地说“来自 30 家美国顶尖医院的医院流行病学家。”

方法

使用描述性统计报告调查结果。

结果

在接受调查的 30 名医院流行病学家中,有 23 名(77%)于 2022 年 2 月 15 日至 3 月 3 日之间完成了调查。在所调查的医院中,18 家(78%)使用医用口罩进行普遍口罩佩戴,5 家(22%)使用 N95 呼吸器。16 家医院(70%)要求普遍使用眼部防护装置。22 家医院(96%)在常规 COVID-19 护理中使用 N95,1 家(4%)将 N95 保留用于产生气溶胶的程序。2 家(9%)医院使用专门的 COVID-19 病房;8 家(35%)使用混合 COVID-19 和非 COVID-19 病房;13 家(57%)同时使用专门和混合病房。4 家医院(17%)对所有 COVID-19 患者使用空气传播感染隔离室,10 家(43%)对产生气溶胶的程序优先使用空气传播感染隔离室,3 家(13%)使用替代风险分层标准(不基于产生气溶胶的程序),6 家(26%)不常规使用空气传播感染隔离室。9 家医院(39%)不使用便携式高效空气颗粒过滤器,但 14 家(61%)在各种情况下使用它们,最常用于在没有空气传播感染隔离室或特定高风险区域或情况下替代空气传播感染隔离室。21 家医院(91%)对入院无症状患者进行检测,但入院后检测策略和首选标本部位差异很大。5 家医院(22%)要求未接种疫苗的员工定期检测,1 家医院(4%)报告在 SARS-CoV-2 奥密克戎疫情期间,即使是接种疫苗的员工也必须每周进行强制检测。

结论

领先医院的 COVID-19 感染防控实践存在较大差异。更明确的公共卫生指导和医院政策透明度可能有助于制定更一致的国家标准。