Respiratory virus shedding in a cohort of on-duty healthcare workers undergoing prospective surveillance.
Respiratory virus shedding in a cohort of on-duty healthcare workers undergoing prospective surveillance.
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DOI：
10.1086/669857
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发表时间：
2013-04
影响因子：
4.5
通讯作者：
Talbot TR
中科院分区：
文献类型：
--
作者：
Esbenshade JC;Edwards KM;Esbenshade AJ;Rodriguez VE;Talbot HK;Joseph MF;Nwosu SK;Chappell JD;Gern JE;Williams JV;Talbot TR
医疗保健相关的呼吸道病毒传播是一个值得关注的患者安全问题。从2009年11月至2010年4月，在一家三级儿童医院的一组医护人员（HCW）中进行了流感病毒监测，每两周采集一次鼻拭子。如果受试者报告呼吸道症状，则采集额外标本。通过多重PCR检测来自患病HCW的样本和随机选择的来自无症状受试者的样本中的其他呼吸道病毒。从170例入组受试者中采集了1404份鼻拭子。在监测期间，流感的流行水平非常低，74.2%的受试者接受了流感疫苗接种。在任何标本中均未检出流感病毒。对来自有症状受试者的所有119份样本和来自无症状受试者的200份样本进行多重呼吸道病毒PCR分析，共获得42份阳性样本; 7份（16.7%）来自无症状受试者。当控制性别和医生或护士职业时，病毒脱落与任何症状的报告（OR 13.06，p<0.0001，95%CI 5.45-31.28）和年轻年龄（OR 0.96，p=0.023，95%CI 0.92-0.99）相关。在监测期后，46%的受试者报告在上一个流感季节期间患有流感样疾病。在这个队列中，HCW在生病时工作是常见的，在有症状的人中病毒脱落也是如此。无症状的病毒脱落不常见，但确实发生过。医护人员在生病时应避免履行病人护理职责，人员配备应满足他们的需要。
Healthcare-associated transmission of respiratory viruses is a concerning patient safety issue. Surveillance for influenza virus among a cohort of healthcare workers (HCWs) was conducted in a tertiary care children’s hospital from November 2009 until April 2010, using biweekly nasal swab collection. If a subject reported respiratory symptoms, an additional specimen was collected. Specimens from ill HCWs and a randomly selected sample from asymptomatic subjects were tested for additional respiratory viruses by multiplex PCR. From 170 enrolled subjects, 1404 nasal swabs were collected. Influenza circulated at very low levels during the surveillance period and 74.2% of subjects received influenza vaccination. Influenza was not detected in any specimen. Multiplex respiratory virus PCR analysis of all 119 samples from symptomatic subjects and 200 specimens from asymptomatic subjects yielded a total of 42 positive specimens; 7 (16.7%) in asymptomatic subjects. Viral shedding was associated with report of any symptom (OR 13.06, p<0.0001, 95% CI 5.45-31.28) and younger age (OR 0.96, p=0.023, 95% CI 0.92-0.99) when controlled for gender and occupation of physician or nurse. After the surveillance period, 46% of subjects reported working while ill with an influenza-like illness during the previous influenza season. In this cohort, HCWs working while ill was common, as was viral shedding among those with symptoms. Asymptomatic viral shedding was infrequent, but did occur. HCWs should refrain from patient care duties while ill, and staffing contingencies should accommodate them.
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