Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures
Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures
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DOI：
10.1371/journal.pone.0056278
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发表时间：
2013-02-13
期刊：
影响因子：
3.7
通讯作者：
Thomson, Gail
中科院分区：
文献类型：
--
作者：
Thompson, Katy-Anne;Pappachan, John V.;Thomson, Gail
背景：在呼吸道感染暴发期间，卫生保健工作者（HCW）的医院感染（e. G.甲型H1N1流感（2009年）是公共卫生政策制定者的一个重大关切。世界卫生组织（WHO）定义的“气溶胶生成程序”（AGPs）被认为会增加气溶胶传播给医务人员的风险，但目前没有足够的数据来准确量化风险或建立风险倾向程序的层次结构。方法/主要发现：这项研究测量了接受AGP的H1N1阳性患者附近气溶胶中H1N1（2009）RNA的量，以帮助量化传播给HCW的潜在风险。有99个采样的机会（窗口），共产生198个五月阶段的分析，在大小范围0.86-7.3 μ m。考虑到第2阶段（4-7.3 μ m）和第3阶段（0.86-4 μ m）包括一个样本，在10名（25.6%）患者的14份（14.1%）空气样本中检测到病毒RNA。23个空气样本收集，而潜在的AGP正在进行，其中6（26.1%）含有病毒RNA;与之相反，在未进行WHO 2009定义的AGP时采集了76份5月样本，其中8份（10.5%）含有病毒RNA（未校正OR = 2.84（95% CI 1.11-7.24））校正OR = 4.31（0.83-22.5））。结论/意义：由于我们的样本量较小，我们发现AGP不会显著增加H1N1（2009）阳性气溶胶采样的概率（OR（95% CI）= 4.31（0.83-22.5）。尽管在对重症监护患者进行各种AGP时检测到H1N1（2009）阳性气溶胶的概率高于基线率（即在没有AGP的情况下），但没有达到显著性，但存在AGP分级的趋势，将支气管镜检查以及呼吸和气道吸痰置于基线（背景）值之上。此外，还需要进行更大规模的研究，但这些初步发现可能对感染控制团队有益。
Background: Nosocomial infection of health-care workers (HCWs) during outbreaks of respiratory infections (e. g. Influenza A H1N1 (2009)) is a significant concern for public health policy makers. World Health Organization (WHO)-defined 'aerosol generating procedures' (AGPs) are thought to increase the risk of aerosol transmission to HCWs, but there are presently insufficient data to quantify risk accurately or establish a hierarchy of risk-prone procedures.Methodology/Principal Findings: This study measured the amount of H1N1 (2009) RNA in aerosols in the vicinity of H1N1 positive patients undergoing AGPs to help quantify the potential risk of transmission to HCWs. There were 99 sampling occasions (windows) producing a total of 198 May stages for analysis in the size ranges 0.86-7.3 mu m. Considering stages 2 (4-7.3 mu m) and 3 (0.86-4 mu m) as comprising one sample, viral RNA was detected in 14 (14.1%) air samples from 10 (25.6%) patients. Twenty three air samples were collected while potential AGPs were being performed of which 6 (26.1%) contained viral RNA; in contrast, 76 May samples were collected when no WHO 2009 defined AGP was being performed of which 8 (10.5%) contained viral RNA (unadjusted OR = 2.84 (95% CI 1.11-7.24) adjusted OR = 4.31 (0.83-22.5)).Conclusions/Significance: With our small sample size we found that AGPs do not significantly increase the probability of sampling an H1N1 (2009) positive aerosol (OR (95% CI) = 4.31 (0.83-22.5). Although the probability of detecting positive H1N1 (2009) positive aerosols when performing various AGPs on intensive care patients above the baseline rate (i.e. in the absence of AGPs) did not reach significance, there was a trend towards hierarchy of AGPs, placing bronchoscopy and respiratory and airway suctioning above baseline (background) values. Further, larger studies are required but these preliminary findings may be of benefit to infection control teams.