Considerations for Assessing Risk of Provider Exposure to SARS-CoV-2 after a Negative Test
Considerations for Assessing Risk of Provider Exposure to SARS-CoV-2 after a Negative Test
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阴性检测后评估提供者接触 SARS-CoV-2 风险的注意事项
DOI：
10.1097/aln.0000000000003392
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发表时间：
2020
期刊：
影响因子：
8.8
通讯作者：
Van Cleve, Wil
中科院分区：
文献类型：
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作者：
Long, Dustin R.;Sunshine, Jacob E.;Van Cleve, Wil
2019冠状病毒病（COVID-19）是由严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）感染引起的。冠状病毒通过直接接触、飞沫和气溶胶传播。正如在之前的冠状病毒流行中观察到的那样，参与SARS-CoV-2感染患者气道管理的医疗保健专业人员面临暴露和随后感染的高风险。1这种风险在气溶胶生成过程中最为明显，如插管。2020年3月22日，美国麻醉医师协会（绍姆堡，伊利诺伊州）与其他专业组织合作，提供了个人防护设备的使用指南，一些供应商将其解释为建议在大流行期间对所有气溶胶产生程序使用空气传播的预防措施。2在大流行条件下运行的医疗保健系统可能需要平衡工作人员的保护与稀缺资源的分配，包括个人防护设备。解决这一问题的一种策略依赖于对无症状个体的术前检测。最近发表的数据表明，逆转录聚合酶链反应检测SARS-CoV-23的临床敏感性不佳，这可能会导致医疗保健提供者直观地质疑依赖于阴性SARS-CoV-2检测的策略是否明智，特别是在计划高风险手术时，如气管插管。然而，对检测特征的了解不足以指导决策：进行检测的人群中疾病的流行率对检测提供的信息具有关键影响。流行率估计数因不同地点之间的差异（有时很大）而变得复杂，可能无法获得或测量不佳，并且在大流行期间具有内在的动态性。这些不确定性可能会严重影响患者和提供者的安全，并可能影响稀缺资源（如个人防护设备）的利用。
Coronavirus disease 2019 (COVID-19) is caused by infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The transmission of coronaviruses occurs via direct contact, droplets, and aerosols. Healthcare professionals involved in airway management of patients infected with SARS-CoV-2 are at high risk of exposure and subsequent infection, as has been observed in previous coronavirus epidemics. 1 This risk is most pronounced in aerosol-generating procedures such as intubation. On March 22, 2020, the American Society of Anesthesiologists (Schaumburg, Illinois), in partnership with other professional organizations, offered guidance for the use of personal protective equipment that have been interpreted by some providers as recommending the use of airborne precautions for all aerosol-generating procedures during the pandemic. 2Healthcare systems operating under pandemic conditions may need to balance the protection of staff with the allocation of scarce resources, including personal protective equipment. One strategy to address this problem relies on preprocedural testing of asymptomatic individuals. Recent publication of data suggesting imperfect clinical sensitivity of reverse transcription polymerase chain reaction assays for SARS-CoV-23 could lead healthcare providers to intuitively question the wisdom of a strategy that relies on a negative SARS-CoV-2 test, particularly when planning high-risk procedures such as endotracheal intubation. Knowledge of test characteristics, however, is insufficient to guide decision making: the prevalence of the disease in the population for which the test is performed has a critical bearing on the information provided by the test. Prevalence estimates are complicated by the fact that they will differ (sometimes substantially) between different locations, may be unavailable or poorly measured, and will be inherently dynamic during a pandemic. These uncertainties may substantially affect the safety of both patients and providers and may impact the utilization of scarce resources such as personal protective equipment.
致编辑的信——活动时间分配的 PERT 模型
DOI：
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发表时间：
1962
期刊：
影响因子：
--
作者：
C. E. Clark
通讯作者：
C. E. Clark
DOI：
--
发表时间：
2014
期刊：
影响因子：
--
作者：
R. Pouillot
通讯作者：
R. Pouillot