医护人员感染严重急性呼吸综合征冠状病毒2的感染预防与控制风险因素：一项全球多中心病例对照研究
Infection prevention and control risk factors for SARS-CoV-2 infection in health workers: a global, multi-centre, case-control study.
作者信息
Cassini A, Mo Y, Simniceanu A, Gon G, Cowling B J, Allegranzi B
机构信息
Infection Prevention and Control Hub and Task Force, Integrated Health Services, UHC/Life Course, World Health Organization, Geneva, Switzerland; Office of the Cantonal Doctor, Geneva, Switzerland.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore, Singapore; Department of Medicine, National University of Singapore, Singapore.
出版信息
J Hosp Infect. 2025 Jan;155:40-50. doi: 10.1016/j.jhin.2024.04.031. Epub 2024 Sep 20.
BACKGROUND
Health workers were at higher risk for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the coronavirus disease 2019 (COVID-19) pandemic due to occupational risk factors. This study aimed to characterize these risk factors as part of the World Health Organization (WHO) Unity Studies initiative.
METHODS
This global, multi-centre, nested, case-control study was conducted in 121 healthcare facilities in 21 countries. Cases were health workers who tested positive for SARS-CoV-2 infection with documented occupational exposure to COVID-19 patients in the 14 days pre-enrolment. Controls were enrolled from the same facilities with similar exposure but negative serology. Case and control status was confirmed with serological testing at baseline and after 3-4 weeks. Demographic and infection risk factor data were collected using structured questionnaires.
FINDINGS
Between June 2020 and December 2021, data were obtained for 1213 cases and 1844 controls. Risk of SARS-CoV-2 infection was associated with non-adherence to personal protective equipment (PPE) guidelines [adjusted odds ratio (aOR) 1.67, 95% confidence interval (CI) 1.32-2.12] and not performing hand hygiene consistently after patient contact (aOR 2.52, 95% CI 1.72-3.68). Direct close contact with COVID-19 patients was also associated with increased risk of SARS-CoV-2 infection, particularly during prolonged contact (>15 min). Items associated with lower risk of SARS-CoV-2 infection were use of a respirator during aerosol-generating procedures; and use of gloves, and a gown or coverall during contact with contaminated materials/surfaces. No difference was observed between health workers using respirators vs surgical masks for routine care.
CONCLUSION
Appropriate implementation of infection prevention and control measures and use of PPE remain a priority to protect health workers from SARS-CoV-2 infection.
背景
在2019冠状病毒病（COVID-19）大流行期间，由于职业风险因素，卫生工作者感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的风险更高。本研究旨在将这些风险因素作为世界卫生组织（WHO）统一研究倡议的一部分进行特征描述。
方法
这项全球多中心嵌套病例对照研究在21个国家的121个医疗机构中进行。病例为在入组前14天内有记录的职业性接触COVID-19患者且SARS-CoV-2感染检测呈阳性的卫生工作者。对照从相同机构中具有相似接触史但血清学检测呈阴性的人员中选取。在基线和3 - 4周后通过血清学检测确认病例和对照状态。使用结构化问卷收集人口统计学和感染风险因素数据。
结果
在2020年6月至2021年12月期间，获取了1213例病例和1844例对照的数据。SARS-CoV-2感染风险与未遵守个人防护装备（PPE）指南[调整后的比值比（aOR）1.67，95%置信区间（CI）1.32 - 2.12]以及在接触患者后未始终进行手部卫生处理（aOR 2.52，95% CI 1.72 - 3.68）有关。与COVID-19患者的直接密切接触也与SARS-CoV-2感染风险增加有关，尤其是在长时间接触（>15分钟）期间。与SARS-CoV-2感染风险较低相关的因素包括在产生气溶胶的操作过程中使用呼吸器；以及在接触污染材料/表面时使用手套和长袍或工作服。在日常护理中使用呼吸器与使用外科口罩的卫生工作者之间未观察到差异。
结论
适当实施感染预防和控制措施以及使用个人防护装备仍然是保护卫生工作者免受SARS-CoV-2感染的优先事项。
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