European Centre for Disease Prevention and Control, Stockholm, Sweden.
Norwegian Institute of Public Health, Oslo, Norway.
Euro Surveill. 2023 Aug;28(32). doi: 10.2807/1560-7917.ES.2023.28.32.2200718.
The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.
COVID-19 大流行凸显了基于传播的预防措施的一些潜在局限性。飞沫传播和空气传播之间的区别，这一直是指导感染控制措施的基本概念，已受到质疑，导致针对 COVID-19 的基于传播的预防措施的专家建议存在相当大的差异。此外，接触预防措施的要素（如使用手套和长袍）的应用基于低质量和不确定的证据，并且可能产生意外后果，例如增加与医疗保健相关的感染发生率和多药耐药生物体的传播。这些观察结果表明需要高质量的研究来解决知识空白，并需要重新审视有关各种传播方式和与传播相关的术语定义的理论背景。此外，我们应该研究这些定义对以下基于传播的预防措施的组成部分的影响：（i）呼吸保护，（ii）使用手套和长袍预防呼吸道病毒感染，（iii）产生气溶胶的程序，以及（iv）在医疗保健环境中普遍使用口罩作为控制措施，特别是在季节性流行期间。这样的审查将确保基于传播的预防措施是一致的，并基于现有证据进行合理的决策，这将有助于决策制定、指南制定和培训，以及在实践中的应用。
