隔离病房内呼吸道传染性疾病气溶胶吸入感染风险  

The risk of aerosol transmission of respiratory infectious diseases in the isolation ward

作　　者：郭伟旗 李鹏辉 刘硕[4,5] 徐新喜 刘荔 Weiqi Guo;Penghui Li;Shuo Liu;Xinxi Xu;Li Liu(School of Architecture,Tsinghua University,Beijing 100084,China;Laboratory of Eco-Planning&Green Building,Ministry of Education,Tsinghua University,Beijing 100084,China;Department of Blood Transfusion,the 923rd Hospital of the Joint Logistics Support Force of PLA,Nanning 530021,China;State Key Laboratory of Green Building,Xi’an University of Architecture and Technology,Xi’an 710055,China;College of Architecture,Xi’an University of Architecture and Technology,Xi’an 710055,China;Systems Engineering Institute,Academy of Military Sciences,PLA,Tianjin 300161,China)

机构地区：[1]清华大学建筑学院,北京100084 [2]清华大学生态规划与绿色建筑教育部重点实验室,北京100084 [3]中国人民解放军联勤保障部队第九二三医院输血科,南宁530021 [4]西安建筑科技大学绿色建筑全国重点实验室,西安710055 [5]西安建筑科技大学建筑学院,西安710055 [6]军事科学院系统工程研究院,天津300161

出　　处：《科学通报》2024年第7期854-865,共12页Chinese Science Bulletin

基　　金：国家自然科学基金(52178080)资助。

摘　　要：医疗机构的院内感染给患者、医护人员和国家造成了巨大的健康和社会经济损失.气溶胶可以携带多种致病微生物,是院内感染的重要传播途径.量化确定医疗机构内的病原微生物浓度与感染风险对于减少院感发生和应对新发突发传染病具有重要意义.本研究以新型冠状病毒(severe acute respiratory syndrome coronavirus 2,SARSCoV-2)为例,针对医院隔离病房,将计算流体动力学(computational fluid dynamics,CFD)与定量微生物风险评估(quantitative microbial risk assessment,QMRA)相结合,建立了气溶胶传播感染风险定量评估模型.基于该模型,计算了隔离病房空气中的病毒浓度,定量评估了医护人员的吸入感染风险,分析了活动强度、个人防护、病毒变异、感染者个体差异等因素对感染风险的影响.结果表明,病房内的感染风险分布具有明显的空间异质性;吸入感染风险与个人活动强度和防护情况密切相关,高活动强度下的感染风险能达到中等活动强度的2倍左右;使用N95口罩可明显降低医护人员的吸入感染风险,无防护状态下的吸入感染风险是使用N95口罩时的3~10倍;毒株变异和个体差异会对感染风险产生明显影响,应该密切关注并及时调整防控策略.研究结果可以为医疗机构的感染防控提供理论依据和技术支持.Nosocomial infections have caused significant health and socio-economic losses to patients,healthcare workers,and the nation.Aerosols can carry various pathogens and serve as important media for the transmission of nosocomial infections.Airborne transmission is a crucial pathway for nosocomial infections.During routine diagnosis,treatment,and epidemic prevention and control,healthcare workers often need to have close contact with patients and are exposed to aerosols exhaled by patients.Calculating the concentration of pathogens in hospitals and assessing the infection risk is of great significance in reducing the occurrence of nosocomial infections and responding to newly emerging infectious diseases.Currently,most studies on infection risk assessment are based solely on simulations of spatial and temporal distributions of aerosols exhaled by patients,making it difficult to accurately calculate the distribution of viral concentration and infection risk.In this study,the computational fluid dynamics(CFD)method is employed to simulate the dispersion and deposition of aerosols exhaled by infected patients in the isolation ward at Wuhan Huoshenshan Hospital.A quantitative microbial risk analysis(QMRA)model is developed to evaluate the risk of both inhalation and surface contact infections within the mentioned ward,taking into consideration uncertainties regarding viral loads,virus half-life,deposition on respiratory tracts,ventilation,protective measures,and personnel activity.Subsequently,the risk distribution within the isolation ward and the probability of infection among medical staff under various conditions are calculated.The findings of this study reveal significant spatial heterogeneity in the risk distribution within the negative isolation ward.The transport and deposition of viral aerosols are strongly influenced by airflow dynamics and ventilation systems,resulting in the formation of high-risk areas within the ward.Moreover,it is observed that the risk of inhalation infection is closely associated with th

关 键 词：隔离病房 院内感染 气溶胶传播 计算流体动力学模拟 感染风险评估 

分 类 号：R183.3[医药卫生—流行病学]