Modelling the risk of SARS-CoV-2 infection through PPE doffing in a hospital environment
Modelling the risk of SARS-CoV-2 infection through PPE doffing in a hospital environment
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通过在医院环境中脱下个人防护装备来模拟 SARS-CoV-2 感染的风险
DOI：
10.1101/2020.09.20.20197368
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
King M
中科院分区：
文献类型：
--
作者：
King M
在对SARS-CoV-2阳性患者进行护理后，在脱下个人防护装备（PPE）期间的自我污染是卫生保健工作者（HCW）关注的问题。工作人员可能会下意识地通过不正确地摘下手套而受到污染，因此量化这种风险对安全工作程序至关重要。呼吸道病房的HCW表面接触序列使用离散时间马尔可夫钦进行建模：静脉滴注护理，血压监测和医生查房。在护理过程中，病毒RNA在手套上的积累使用随机递归关系进行建模。随后，随着病例量的增加，HCW在一小部分病例中丢弃了个人防护装备并污染了自己。使用剂量-反应方法对这种接触的感染风险进行了量化。通过参数化研究分析了以下因素的影响：1a)增加病房患者人数，1b) COVID-19病例比例，2)轮班时间，3)接触受污染个人防护装备的概率。感染风险的驱动因素是表面污染和表面接触次数。100% COVID-19病房的医护人员的风险不到50% COVID-19病房的2倍（1.6%对1%），而5% COVID-19病房的风险降至每班0.1% （sd=0.6%）。静脉滴注护理的风险高于血压监测（1.1% vs 1% p<0.0001），而医生查房的风险为0.6% （sd=0.8%）。建议包括有监督的个人防护装备脱下程序，如“脱下伙伴”计划，最大限度地遵守脱下后的手部卫生，并对远离患者附近的表面进行有针对性的表面清洁。在卫生保健环境中，特别是在COVID-19病房，脱下个人防护装备期间因自我污染造成的感染风险是一个重要问题。在高工作量轮班期间的疲劳可能导致错误的频率增加，从而有暴露的风险。工作人员轮班时间和病房内COVID-19患者数量与工作人员下班后自我污染的风险呈正相关。考虑到患者区以外的生物气溶胶沉积的额外风险，清洁远离患者的表面与清洁传统的“高接触表面”同样重要。
Self-contamination during doffing of personal protective equipment (PPE) is a concern for healthcare workers (HCW) following SARS-CoV-2 positive patient care. Staff may subconsciously become contaminated through improper glove removal, so quantifying this risk is critical for safe working procedures. HCW surface contact sequences on a respiratory ward were modelled using a discrete-time Markov chin for: IV-drip care, blood pressure monitoring and doctors’ rounds. Accretion of viral RNA on gloves during care was modelled using a stochastic recurrence relation. The HCW then doffed PPE and contaminated themselves in a fraction of cases based on increasing case load. The risk of infection from this exposure was quantified using a dose-response methodology. A parametric study was conducted to analyse the effect of: 1a) increasing patient numbers on the ward, 1b) the proportion of COVID-19 cases, 2) the length of a shift and 3) the probability of touching contaminated PPE. The driving factors for infection risk were surface contamination and number of surface contacts. HCWs on a 100% COVID-19 ward were less than 2-fold more at risk than on a 50% COVID ward (1.6% vs 1%), whilst on a 5% COVID-19 ward, the risk dropped to 0.1% per shift (sd=0.6%). IV-drip care resulted in higher risk than blood pressure monitoring (1.1% vs 1% p<0.0001), whilst doctors’ rounds produced a 0.6% risk (sd=0.8%). Recommendations include supervised PPE doffing procedures such as the “doffing buddy” scheme, maximising hand hygiene compliance post-doffing and targeted surface cleaning for surfaces away from the patient vicinity.ImportanceInfection risk from self-contamination during doffing PPE is an important concern in healthcare settings, especially on a COVID-19 ward. Fatigue during high workload shifts may result in increased frequency of mistakes and hence risk of exposure. Length of staff shift and number of COVID-19 patients on a ward correlate positively with the risk to staff through self-contamination after doffing. Cleaning of far-patient surfaces is equally important as cleaning traditional “high-touch surfaces”, given that there is an additional risk from bioaerosol deposition outside the patient zone.
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影响因子：
4.9
作者：
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DOI：
--
发表时间：
2017
期刊：
影响因子：
--
作者：
M. King;Camargo;Adriana Matamoros Veloza;A. Sleigh;C. Noakes
通讯作者：
C. Noakes
影响因子：
4.9
作者：
Wilson, Amanda M.;Reynolds, Kelly A.;Canales, Robert A.
通讯作者：
Canales, Robert A.
影响因子：
6.9
作者：
King, M-F.;Noakes, C. J.;Waters, L.
通讯作者：
Waters, L.
影响因子：
4.4
作者：
Wilson AM;Reynolds KA;Sexton JD;Canales RA
通讯作者：
Canales RA