Risk Factors for SARS Transmission from Patients Requiring Intubation: A Multicentre Investigation in Toronto, Canada

被引：205

作者：

Raboud, Janet ^{[1
,2
]}

Shigayeva, Altynay ^{[3
]}

McGeer, Allison ^{[2
,3
,4
]}

Bontovics, Erika ^{[5
]}

Chapman, Martin ^{[6
,7
]}

Gravel, Denise ^{[8
]}

Henry, Bonnie ^{[9
]}

Lapinsky, Stephen ^{[3
,10
]}

Loeb, Mark ^{[11
]}

McDonald, L. Clifford ^{[12
]}

Ofner, Marianna ^{[2
,8
]}

Paton, Shirley ^{[8
]}

Reynolds, Donna ^{[13
]}

Scales, Damon ^{[7
,10
]}

Shen, Sandy ^{[1
]}

Simor, Andrew ^{[4
,7
]}

Stewart, Thomas ^{[3
,10
]}

Vearncombe, Mary ^{[4
,7
]}

Zoutman, Dick ^{[14
]}

Green, Karen ^{[3
]}

机构：

[1] Univ Hlth Network, Div Infect Dis, Toronto, ON, Canada

[2] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[3] Mt Sinai Hosp, Toronto, ON M5G 1X5, Canada

[4] Univ Toronto, Dept Lab Med & Pathol, Toronto, ON, Canada

[5] Ontario Minist Hlth & Long Term Care, Toronto, ON, Canada

[6] Univ Toronto, Dept Anesthesia, Toronto, ON, Canada

[7] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada

[8] Publ Hlth Agcy Canada, Ottawa, ON, Canada

[9] British Columbia Ctr Dis Control, Vancouver, BC, Canada

[10] Univ Toronto, Dept Med, Toronto, ON, Canada

[11] McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada

[12] Ctr Dis Control & Prevent, Atlanta, GA USA

[13] Durham Reg Hlth Dept, Whitby, ON, Canada

[14] Queens Univ, Dept Microbiol & Immunol, Kingston, ON K7L 3N6, Canada

来源：

PLOS ONE | 2010年 / 5卷 / 05期

关键词：

ACUTE RESPIRATORY SYNDROME; HEALTH-CARE WORKERS; HOSPITAL WORKERS; OUTBREAK; INFECTION; TUBERCULOSIS; PRECAUTIONS; EXPOSURE; RUBELLA; SPREAD;

D O I：

10.1371/journal.pone.0010717

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background: In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission. Methods: A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission. Results: 45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90%) participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004) or ECG (OR = 3.52, p = .002), unprotected eye contact with secretions (OR = 7.34, p = .001), patient APACHE II score >= 20 (OR = 17.05, p = .009) and patient Pa0(2)/Fi0(2) ratio <= 59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients. Conclusion: Close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients.

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