Predicting Airborne Infection Risk: Association Between Personal Ambient Carbon Dioxide Level Monitoring and Incidence of Tuberculosis Infection in South African Health Workers.
Predicting Airborne Infection Risk: Association Between Personal Ambient Carbon Dioxide Level Monitoring and Incidence of Tuberculosis Infection in South African Health Workers.
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DOI：
10.1093/cid/ciac183
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发表时间：
2022-10-12
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影响因子：
--
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在结核病高发病率国家的医院中，结核病传播率很高，但目前尚无有效的方法来评估医院设计和功能对空气传播风险的影响。我们假设个人环境二氧化碳（CO2）监测可以作为卫生工作者（HWs）中与结核病感染风险相关的再呼吸空气暴露的替代测量。我们分析了南非开普敦138名HWs的基线和重复（12个月）干扰素γ释放试验（IGRA）结果。随机选取一组基线QFT-Plus （QuantiFERON Plus）阴性的HWs进行个人环境二氧化碳监测。年结核感染率（IGRA转换率）高（34%）。初级医生IGRA基线阳性的可能性低于其他医护人员（OR, 0.26; P = 0.005），但IGRA转换风险相似。使用定量QFT-Plus阈值（≥0.35 IU/mL （P < 0.02）或≥1 IU/mL (P < 0.01)），与非IGRA转换者相比，IGRA转换者的CO2水平中位数更高。中位CO2水平可预测IGRA转化（比值比[OR]， 2.04; P = 0.04，≥1 IU/mL阈值）。有序逻辑回归表明，每增加100 ppm CO2中位数，重复定量IGRA结果的几率增加近2倍（OR, 1.81; P = 0.01），表明存在剂量依赖性反应。卫生保健工作者面临较高的职业结核病风险。中位二氧化碳水平增加（表明通风不良和/或占用率高）与HW结核感染的可能性增加有关。个人环境二氧化碳监测可能有助于采取有针对性的干预措施，减少结核病在医疗机构的传播，并帮助卫生工作者自我监测职业风险，这对2019年冠状病毒病等其他空气传播感染也有影响。南非等国家的卫生工作者面临着很高的职业结核病风险。个人平均环境二氧化碳（CO2）水平的增加与结核病感染的可能性增加有关。二氧化碳监测可能有助于采取有针对性的干预措施，减少卫生设施中的结核病传播。
High rates of tuberculosis (TB) transmission occur in hospitals in high-incidence countries, yet there is no validated way to evaluate the impact of hospital design and function on airborne infection risk. We hypothesized that personal ambient carbon dioxide (CO2) monitoring could serve as a surrogate measure of rebreathed air exposure associated with TB infection risk in health workers (HWs). We analyzed baseline and repeat (12-month) interferon-γ release assay (IGRA) results in 138 HWs in Cape Town, South Africa. A random subset of HWs with a baseline negative QuantiFERON Plus (QFT-Plus) underwent personal ambient CO2 monitoring. Annual incidence of TB infection (IGRA conversion) was high (34%). Junior doctors were less likely to have a positive baseline IGRA than other HWs (OR, 0.26; P = .005) but had similar IGRA conversion risk. IGRA converters experienced higher median CO2 levels compared to IGRA nonconverters using quantitative QFT-Plus thresholds of ≥0.35 IU/mL (P < .02) or ≥1 IU/mL (P < .01). Median CO2 levels were predictive of IGRA conversion (odds ratio [OR], 2.04; P = .04, ≥1 IU/mL threshold). Ordinal logistic regression demonstrated that the odds of a higher repeat quantitative IGRA result increased by almost 2-fold (OR, 1.81; P = .01) per 100 ppm unit increase in median CO2 levels, suggesting a dose-dependent response. HWs face high occupational TB risk. Increasing median CO2 levels (indicative of poor ventilation and/or high occupancy) were associated with higher likelihood of HW TB infection. Personal ambient CO2 monitoring may help target interventions to decrease TB transmission in healthcare facilities and help HWs self-monitor occupational risk, with implications for other airborne infections including coronavirus disease 2019. Health workers in countries like South Africa face a high occupational tuberculosis (TB) risk. Increasing average personal ambient carbon dioxide (CO2) levels were associated with higher likelihood of TB infection. CO2monitoring may help target interventions to decrease TB transmission in health facilities.
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影响因子：
2.9
作者：
Adu, Prince A.;Yassi, Annalee;Spiegel, Jerry M.
通讯作者：
Spiegel, Jerry M.
影响因子：
0.6
作者：
Ehrlich, Rodney;van de Water, Nick;Yassi, Annalee
通讯作者：
Yassi, Annalee
DOI：
10.1016/s2213-2600(17)30060-7
发表时间：
2017-04
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Andrews JR;Nemes E;Tameris M;Landry BS;Mahomed H;McClain JB;Fletcher HA;Hanekom WA;Wood R;McShane H;Scriba TJ;Hatherill M
通讯作者：
Hatherill M
影响因子：
10
作者：
Winje, Brita Askeland;White, Richard;Kran, Anne Marte Bakken
通讯作者：
Kran, Anne Marte Bakken
DOI：
10.1164/rccm.201409-1704oc
发表时间：
2015-03-01
影响因子：
24.7
作者：
Andrews, Jason R.;Hatherill, Mark;Scriba, Thomas J.
通讯作者：
Scriba, Thomas J.