某综合性医院传染性非典型肺炎医院内感染的流行病学调查  

Survey on one event of SARS nosocomial infection in a general hospital in Beijing

作　　者：何耀[1] 姜勇[1] 倪彬[1] 邢玉斌[1] 钟光林[1] 费也淳[1] 王磊[1] 孙正基[1] 常青[1] 索继江[1] 陈世平[1] 刘振立[1] 苏元福[1] 朱士俊[1] 

机构地区：[1]解放军总医院老年医学研究所,北京100853

出　　处：《第四军医大学学报》2004年第7期616-620,共5页Journal of the Fourth Military Medical University

基　　金：全军非典型肺炎防治重大科技项目 (0 3F0 2 0 1 )

摘　　要：目的 :分析传染性非典型肺炎 (SARS)医院内感染的流行病学特点和可能的传播途径 .方法 :选择某综合性医院 2 0 0 3年 3～ 4月收治和医院内感染的 34例确诊SARS病例(其中住院患者 1 0例 ,医护人员 2 4例 ) ,进行个案调查和发病所在科室的流行病学侦查 .结果 :①在 3月中旬和下旬有 2个发病高峰 .发病病例的地理分布主要集中住院大楼西单元的5个楼层的 4 ,5 ,6号病房 ,住院患者多年龄较大且合并较严重的基础病 ,而受染的医护人员以工作在一线的中青年为主 ;②输入性病例是导致医院内感染的第一代传染源 ,医院内继发感染的住院者和医护人员是进一步扩散蔓延的第二批传染源 ;③资料分析结果支持近距离空气传播和密切接触传播为本次SARS医院感染的主要传播途径 ,还提示 :可能存在气溶胶经病房排风系统的垂直传播方式 .④示踪剂气体实验显示 :在输入病例所在 7层病房卫生间燃烧熏香 ,在 8,9,1 1 ,1 2 ,1 3层均可以闻到气味 ,提示医院的建筑和排风系统具备病原体气溶胶垂直长距离传播的条件 .结论 :医院内感染是SARS初期暴发流行的主要传播方式 ,医护人员和医院就诊患者是主要的受染人群 .该院医护人员的受染方式前期以医院内传染为主 ,后期以门、急诊窗口岗位受染较为突出 .其传播途径除近距离飞沫传播和密切?AIM: To study the epidemiological characteristics and route of transmission of SARS nosocomial infection. METHODS: Thirty four definite SARS patients (10 inpatients and 24 health care workers) were selected from a general hospital in March and April of 2003. Individual and environment surveys were carried out by a standardized questionnaire of China CDC. Contact history with SARS patient, place and route of infection, and method of protection were included in the survey. RESULTS: (1) Epidemiological characteristics: ① There were 2 peaks of incidence (in mid and end of Mar). ② Distributions by places were confined to Ward 4, 5, 6 on the 7, 8, 12, 13 and 14 floors in west unit of the inpatient building. ③ Among the SARS cases, the inpatients were most elders who had severe original diseases, while the medical staffs were young and middle aged. (2) Source of transmission: Index patients were the first generation source of transmission, and the secondary attacked inpatients and medical staffs were the second generation. (3) Route of transmission: The major transmission routes were near space droplet infection and close contact infection. There was also the probability of aerosol or droplet nuclei infection through air condition and ventilation system. (4) Evaluation of measures of prevention and control: Many measures were carried out, such as control and isolation of the source of transmission, setup of fever clinic and medical observation area, isolation and medical observation of suspected cases, ventilation and disinfection of the ward area, banning of fresh air system and outside visits and strong self prevention for medical staff, and the nosocomial infection was under control eventually. CONCLUSION: Nosocomial infection is the main epidemic form of SARS in the early stage. Health care workers and inpatients in hospitals are the high risk population of SARS. Nosocomial infection of SARS can be prevented and controlled by a series of the efficient measures. More epidemiological and experimental stud

关 键 词：传染性非典型肺炎 医院内感染 流行病学 传播 

分 类 号：R18[医药卫生—流行病学]