Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014
Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014
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DOI：
10.1016/j.ajic.2015.09.016
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发表时间：
2016-03-01
影响因子：
4.9
通讯作者：
Kilmarx, Peter H.
中科院分区：
文献类型：
--
作者：
Dunn, Angela C.;Walker, Tiffany A.;Kilmarx, Peter H.
背景：在历史上最大的埃博拉病毒病（EVD）暴发中，EVD的医院传播增加了该疾病的传播。我们报告了塞拉利昂的2例病例，其中患者在不知情的情况下被送入综合医院病房（1个儿科病房和1个产科病房），使卫生保健工作者、护理人员和其他患者暴露于埃博拉病毒病。这两名患者在普通病房死亡，后来被确认感染了埃博拉病毒病。我们启动了接触者追踪并评估了继发性感染的风险因素，以指导防控建议。方法：回顾病历资料，建立患者症状发作指标。对卫生保健工作者、患者和护理人员进行了访谈，以确定暴露和个人防护装备（PPE）的使用情况。每天对接触者进行埃博拉病毒病症状监测。对出现埃博拉病毒病症状的人进行了隔离和检测。结果：共发现接触者82人：卫生工作者64人，护理人员7人，患者4人，新生儿4人，患者子女3人。7名接触者出现症状并经埃博拉病毒病检测呈阳性：2名卫生保健工作者（1名护士和1名医院清洁工）、2名护理人员、2名新生儿和1名患者。感染护士在仅戴短手套PPE的儿科指标患者内放置静脉导管，医院清洁工在戴短手套PPE的产科病房指标患者的手术室进行清洁。产科病房指数患者的护理人员和新生儿接触她的体液。感染患者及其新生儿与产科病房索引患者共用病房和厕所。医院工作人员没有使用足够的个人防护装备。没有向护理人员提供个人防护装备。结论：埃博拉病毒病的识别延迟和个人防护装备不足可能导致暴露和继发感染。及早发现埃博拉病毒病和适当的个人防护装备可能减少了与体液的直接接触。限制非卫生保健工作者接触，改善个人防护装备的获取，以及加强对孕妇、儿童和住院患者的筛查方法，可能有助于减少埃博拉病毒病在一般卫生保健机构中的传播。由爱思唯尔公司代表感染控制和流行病学专业人员协会出版。
Background: In the largest Ebola virus disease (EVD) outbreak in history, nosocomial transmission of EVD increased spread of the disease. We report on 2 instances in Sierra Leone where patients unknowingly infected with EVD were admitted to a general hospital ward (1 pediatric ward and 1 maternity ward), exposing health care workers, caregivers, and other patients to EVD. Both patients died on the general wards, and were later confirmed as being infected with EVD. We initiated contact tracing and assessed risk factors for secondary infections to guide containment recommendations.Methods: We reviewed medical records to establish the index patients' symptom onset. Health care workers, patients, and caregivers were interviewed to determine exposures and personal protective equipment (PPE) use. Contacts were monitored daily for EVD symptoms. Those who experienced EVD symptoms were isolated and tested.Results: Eighty-two contacts were identified: 64 health care workers, 7 caregivers, 4 patients, 4 newborns, and 3 children of patients. Seven contacts became symptomatic and tested positive for EVD: 2 health care workers (1 nurse and 1 hospital cleaner), 2 caregivers, 2 newborns, and 1 patient. The infected nurse placed an intravenous catheter in the pediatric index patient with only short gloves PPE and the hospital cleaner cleaned the operating room of the maternity ward index patient wearing short gloves PPE. The maternity ward index patient's caregiver and newborn were exposed to her body fluids. The infected patient and her newborn shared the ward and latrine with the maternity ward index patient. Hospital staff members did not use adequate PPE. Caregivers were not offered PPE.Conclusions: Delayed recognition of EVD and inadequate PPE likely led to exposures and secondary infections. Earlier recognition of EVD and adequate PPE might have reduced direct contact with body fluids. Limiting nonhealth-care worker contact, improving access to PPE, and enhancing screening methods for pregnant women, children, and inpatients may help decrease EVD transmission in general health care settings. Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc.