A novel cohorting and isolation strategy for suspected COVID-19 cases during a pandemic
A novel cohorting and isolation strategy for suspected COVID-19 cases during a pandemic
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DOI：
10.1016/j.jhin.2020.05.035
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发表时间：
2020-08-01
影响因子：
6.9
通讯作者：
Brown, M.
中科院分区：
文献类型：
--
作者：
Patterson, B.;Marks, M.;Brown, M.
背景：COVID-19大流行为感染预防及控制带来重大挑战。大量疑似COVID-19疾病患者的入院风险超过了保护其他患者免受暴露的能力。临床怀疑和确认性检测之间的延迟增加了问题的复杂性。方法：我们实施了一种分诊工具，旨在最大限度地减少医院获得性COVID-19，特别是在有严重疾病风险的患者中。患者被分配到根据COVID-19的可能性和不良结局风险定义的分类类别。A类（低可能性;高风险）、B类（高可能性;高风险）、C类（高可能性;低风险）和D类（低可能性;低风险）。这决定了单人房间隔离的优先顺序，其中A类最高。当隔离能力有限时，其他组的患者被聚集在一起，并采取额外的干预措施以减少transmission.Results：对93名患者进行了评估，其中79名（85%）在入院期间接受了COVID-19诊断。在没有COVID-19诊断的人中：10人最初被分流到A类; 0到B类; 1到C类和4到D类。因此，所有需要隔离的高风险患者都被安置在单人病房，并受到保护，免受接触。28名（30%）疑似COVID-19患者被评估为低风险（C组和D组），符合队列条件。讨论：应用临床分诊工具来指导隔离和集中决策可能会降低COVID-19在医院获得性传播的风险，特别是对严重疾病风险最高的个人。(C)2020年，卫生保健感染协会。由爱思唯尔有限公司出版。保留所有权利。
Background: The COVID-19 pandemic presents a significant infection prevention and control challenge. The admission of large numbers of patients with suspected COVID-19 disease risks overwhelming the capacity to protect other patients from exposure. The delay between clinical suspicion and confirmatory testing adds to the complexity of the problem.Methods: We implemented a triage tool aimed at minimizing hospital-acquired COVID-19 particularly in patients at risk of severe disease. Patients were allocated to triage categories defined by likelihood of COVID-19 and risk of a poor outcome. Category A (low-likelihood; high-risk), B (high-likelihood; high-risk), C (high-likelihood; low-risk) and D (low-likelihood; low-risk). This determined the order of priority for isolation in single-occupancy rooms with Category A the highest. Patients in other groups were cohorted when isolation capacity was limited with additional interventions to reduce transmission.Results: Ninety-three patients were evaluated with 79 (85%) receiving a COVID-19 diagnosis during their admission. Of those without a COVID-19 diagnosis: 10 were initially triaged to Category A; 0 to B; 1 to C and 4 to D. All high-risk patients requiring isolation were, therefore, admitted to single-occupancy rooms and protected from exposure. Twenty-eight (30%) suspected COVID-19 patients were evaluated to be low risk (groups C and D) and eligible for cohorting. No symptomatic hospital-acquired infections were detected in the cohorted patients.Discussion: Application of a clinical triage tool to guide isolation and cohorting decisions may reduce the risk of hospital-acquired transmission of COVID-19 especially to individuals at the greatest of risk of severe disease. (C) 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.