Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review.
Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review.
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DOI：
10.1136/bmj.b3675
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发表时间：
2009-09-21
期刊：
影响因子：
--
通讯作者：
Rivetti A
中科院分区：
文献类型：
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作者：
Jefferson T;Del Mar C;Dooley L;Ferroni E;Al-Ansary LA;Bawazeer GA;van Driel ML;Foxlee R;Rivetti A
目的系统回顾物理干预有效阻断或减少呼吸道病毒传播的证据。数据来源：Cochrane图书馆、Medline、OldMedline、Embase和CINAHL，没有语言或出版限制。数据精选研究任何预防呼吸道病毒传播的干预措施(隔离、隔离、社会距离、屏障、个人防护和卫生)。对研究设计的搜索包括随机试验、队列、病例对照、交叉、前后和时间序列研究。在扫描标题、摘要和全文文章作为第一个过滤器之后，使用标准化的表格来评估其余的资格。对随机研究的偏倚风险进行评估，包括分配序列的生成、分配的隐藏、盲化和随访。对非随机研究是否存在潜在的混杂因素进行了评估，并将其归类为偏倚的低、中或高风险。资料综合：纳入59篇研究中的58篇。所有四个随机对照试验和大多数集群随机对照试验的研究质量都很差；观察性研究的质量参差不齐。对6项病例对照研究的Meta分析表明，物理措施对预防严重急性呼吸综合征的传播非常有效：每天洗手10次以上(优势比0.45，95%可信区间0.36-0.57；需要治疗的次数=4，95%可信区间3.65-5.52)，戴口罩(0.32，0.25-0.40；NNT=6，4.54-8.03)，戴N95口罩(0.09，0.03-0.30；NNT=3，2.37至4.06)，戴手套(0.43，0.29至0.65；NNT=5，4.15至15.41)，穿长袍(0.23，0.14至0.37；NNT=5，3.37至7.12)，以及洗手、口罩、手套和长袍合计(0.09，0.02至0.35；NNT=3，2.66至4.97)。这一组合也有效地阻断了流感在家庭中的传播。最高质量的分组随机试验表明，可以通过卫生措施在幼儿和家庭内防止呼吸道病毒的传播。更不舒服和更昂贵的N95口罩优于简单的医用口罩的证据有限，但它们会引起皮肤刺激。在正常洗手中添加杀病毒药物或防腐剂以减少呼吸道疾病的增量效果仍不确定。在入境口岸进行筛查等全球措施没有得到适当的评估。社会距离有效的证据有限，特别是在与接触风险有关的情况下--即风险越高，距离时间越长。结论一些阻断或减少呼吸道病毒传播的措施的常规长期实施可能是困难的。然而，许多简单和低成本的干预措施减少了流行性呼吸道病毒的传播。应该投入更多的资源来研究哪些物理干预是最有效、最灵活和最具成本效益的方法，以最大限度地减少急性呼吸道感染的影响。
Objective To review systematically the evidence of effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses. Data sources Cochrane Library, Medline, OldMedline, Embase, and CINAHL, without restrictions on language or publication. Data selection Studies of any intervention to prevent the transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection, and hygiene). A search of study designs included randomised trials, cohort, case-control, crossover, before and after, and time series studies. After scanning of the titles, abstracts and full text articles as a first filter, a standardised form was used to assess the eligibility of the remainder. Risk of bias of randomised studies was assessed for generation of the allocation sequence, allocation concealment, blinding, and follow-up. Non-randomised studies were assessed for the presence of potential confounders and classified as being at low, medium, or high risk of bias. Data synthesis 58 papers of 59 studies were included. The quality of the studies was poor for all four randomised controlled trials and most cluster randomised controlled trials; the observational studies were of mixed quality. Meta-analysis of six case-control studies suggested that physical measures are highly effective in preventing the spread of severe acute respiratory syndrome: handwashing more than 10 times daily (odds ratio 0.45, 95% confidence interval 0.36 to 0.57; number needed to treat=4, 95% confidence interval 3.65 to 5.52), wearing masks (0.32, 0.25 to 0.40; NNT=6, 4.54 to 8.03), wearing N95 masks (0.09, 0.03 to 0.30; NNT=3, 2.37 to 4.06), wearing gloves (0.43, 0.29 to 0.65; NNT=5, 4.15 to 15.41), wearing gowns (0.23, 0.14 to 0.37; NNT=5, 3.37 to 7.12), and handwashing, masks, gloves, and gowns combined (0.09, 0.02 to 0.35; NNT=3, 2.66 to 4.97). The combination was also effective in interrupting the spread of influenza within households. The highest quality cluster randomised trials suggested that spread of respiratory viruses can be prevented by hygienic measures in younger children and within households. Evidence that the more uncomfortable and expensive N95 masks were superior to simple surgical masks was limited, but they caused skin irritation. The incremental effect of adding virucidals or antiseptics to normal handwashing to reduce respiratory disease remains uncertain. Global measures, such as screening at entry ports, were not properly evaluated. Evidence was limited for social distancing being effective, especially if related to risk of exposure—that is, the higher the risk the longer the distancing period. Conclusion Routine long term implementation of some of the measures to interrupt or reduce the spread of respiratory viruses might be difficult. However, many simple and low cost interventions reduce the transmission of epidemic respiratory viruses. More resources should be invested into studying which physical interventions are the most effective, flexible, and cost effective means of minimising the impact of acute respiratory tract infections.