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2019年冠状病毒病大流行对美利坚合众国部分州医疗机构中季铵化合物消毒剂使用情况的影响

Impact of the COVID-19 Pandemic on the Use of Quaternary Ammonium Compound Disinfectants in Healthcare Facilities Within Selected States in the United States of America.

作者信息

Moran Callie, Gaiko Kathrine, Landers Tillman, Paros Hannah L, Xu Chang, Fernandez Elizabeth, Burwell Brooke, Steve Tyler, Margob Sasha, Davis Marisela, Price Karen, Chew Madeleine E, Worrill Sara, Childress Brianna R, Safford Sara, Patel Janvi, Marino Jessica, Azmoodeh Ashley, McCann Theresa J, Hrubec Terry

机构信息

Epidemiology and Public Health, Edward Via College of Osteopathic Medicine - Virginia, Blacksburg, USA.

Epidemiology and Public Health, Edward Via College of Osteopathic Medicine - Auburn, Auburn, USA.

出版信息

Cureus. 2024 Dec 9;16(12):e75382. doi: 10.7759/cureus.75382. eCollection 2024 Dec.

Abstract

Introduction Quaternary ammonium compounds (QACs) are the active ingredient in the majority of disinfectants approved for use against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the coronavirus disease 2019 (COVID-19). Although widely used, they have been linked to infertility and birth defects in animals, and have been shown to increase proinflammatory cytokines, decrease mitochondrial function, and disrupt sterol biosynthetic pathways in a dose-dependent manner in humans. This study examined if there was an increased use of QAC-based disinfectants among healthcare settings in response to the COVID-19 pandemic and aims to bring to light the negative health outcomes that this rise in QAC exposure may pose.  Methods This hypothesis was explored using a telephone survey tool with both open-ended and closed-ended questions to assess changes in disinfection practices within hospitals, private practices, and dental practices. To ensure that the data were most representative of the United States, all states were ranked based on 28 health metrics tracked by the Kaiser Family Foundation. Those that ranked closest to the national average were Arizona, Florida, Illinois, Michigan, Pennsylvania, and Virginia. Healthcare facilities within these states were called at random and asked about changes in disinfection practices, specifically regarding the disinfectant type, product concentration, changes in the frequency of cleaning, and changes in the cleaning method. Additional data such as demographics, hospital ward type, and practice type were also obtained. Results QAC-based disinfectants were one of the most commonly used products in the surveyed hospitals, private practices, and dental practices both before and throughout the pandemic. Among all the medical facilities surveyed, approximately 80 to 90% indicated an increase in the frequency of cleaning. Within private practices, approximately 80 to 90% increased both spraying and wiping, while within dental practices, 75% increased wiping and only 60% increased spraying. Over 80% of hospitals reported an increase in all methods of disinfection within each ward type. The number of dental practices using QAC-containing disinfectants increased due to the pandemic. In hospitals, the class of disinfectant varied considerably by ward, but overall fewer of them used QAC-based disinfectants and more relied on peroxide-containing disinfectants. Conclusions This study identified increases in the disinfection frequency and changes to disinfection products within healthcare settings as a result of the COVID-19 pandemic. The predominant use of QAC-based products and the increased frequency of disinfection are important findings as they indicate heightened exposure. Emerging literature has identified adverse health outcomes in both animals and humans from contact with QACs. Increased disinfection during a pandemic or disease outbreak is critical to control the spread of disease; however, further research is needed to investigate whether the use of QAC-containing disinfectants to combat COVID-19 results in unintended disease burden in the healthcare workers.

摘要

引言

季铵化合物(QACs)是大多数被批准用于对抗严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的消毒剂中的活性成分,SARS-CoV-2是2019冠状病毒病(COVID-19)的病原体。尽管QACs被广泛使用,但它们与动物的不育和出生缺陷有关,并且已被证明会以剂量依赖的方式增加人类促炎细胞因子、降低线粒体功能并破坏甾醇生物合成途径。本研究调查了在应对COVID-19大流行期间,医疗机构中基于QAC的消毒剂的使用是否增加,并旨在揭示QAC暴露增加可能带来的负面健康后果。

方法

本假设通过使用电话调查工具进行探索,该工具包含开放式和封闭式问题,以评估医院、私人诊所和牙科诊所消毒措施的变化。为确保数据最能代表美国,根据凯撒家庭基金会跟踪的28项健康指标对所有州进行排名。排名最接近全国平均水平的是亚利桑那州、佛罗里达州、伊利诺伊州、密歇根州、宾夕法尼亚州和弗吉尼亚州。随机致电这些州内的医疗机构,询问消毒措施的变化,特别是消毒剂类型、产品浓度、清洁频率的变化以及清洁方法的变化。还获取了其他数据,如人口统计学、医院病房类型和诊所类型。

结果

在整个大流行之前和期间,基于QAC的消毒剂都是被调查的医院、私人诊所和牙科诊所中最常用的产品之一。在所有接受调查的医疗机构中,约80%至90%表示清洁频率增加。在私人诊所中,约80%至90%的诊所增加了喷洒和擦拭,而在牙科诊所中,75%的诊所增加了擦拭,只有60%的诊所增加了喷洒。超过80%的医院报告每个病房类型的所有消毒方法都有所增加。由于大流行,使用含QAC消毒剂的牙科诊所数量增加。在医院中,消毒剂的类别因病房而异,但总体而言,使用基于QAC的消毒剂的医院较少,更多的医院依赖含过氧化物的消毒剂。

结论

本研究发现,由于COVID-19大流行,医疗机构内的消毒频率增加且消毒产品发生了变化。基于QAC的产品的主要使用以及消毒频率的增加是重要发现,因为它们表明暴露增加。新出现的文献已经确定动物和人类接触QACs都会产生不良健康后果。在大流行或疾病爆发期间增加消毒对于控制疾病传播至关重要;然而,需要进一步研究调查使用含QAC的消毒剂对抗COVID-19是否会给医护人员带来意外的疾病负担。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6063/11710878/125b6ab50be6/cureus-0016-00000075382-i01.jpg

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