Masks Prevent Hospital-acquired COVID-19: A Single Hospital Experience in Taiwan

口罩可預防醫護同仁新冠病毒感染－台灣某家準醫學中心臨床照護經驗為例

蘇文麟(Wen-Lin Su) ； 曾奕翔(I-Shiang Tzeng) ； 楊美貞(Mei-Chen Yang) ； 林淑如(Shu-Ju Lin) ； 吳秉昇(Ping-Sheng Wu) ； 趙有誠(You-Chen Chao)

《內科學誌》 32卷1期 (2021/02) Pp. 32-39

https://doi.org/10.6314/JIMT.202102_32(1).05

摘要

To estimate the hospital attack rate of coronavirus disease 2019 (COVID-19) and the stratified basic reproduction number (R_0) of its causative agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a hospital setting in Taiwan. A total of 138 healthcare workers (HCWs) in a hospital who were exposed to COVID-19 within a patient household (January 14 to March 7, 2020) were divided into two groups, based on their exposure level. All HCWs received throat swab SARS-CoV-2 RT-PCR detection twice. Routine infection control policies included environmental disinfection, use of personal protective equipment (PPE), and hand hygiene per Taiwan Centers for Disease Control guideline. The estimated attack rate and the R_0 were calculated. Compared with the ＂low-risk＂ exposure group, the ＂high-risk＂ exposure group was less likely to have used partial PPE, and more likely to have had contact time ＞1 hour, performed ＂aerosol-production＂ tasks, and developed symptoms during quarantine. None of the HCWs in either group acquired COVID-19. All HCWs wore surgical masks and performed routine environmental disinfection. Estimated R_0 was 1.46 and 0 for household and HCW models, respectively, implying that the index patient did not transmit COVID-19. Using masks may help prevent hospital-acquired COVID-19.

關鍵字

Basic reproduction number ； COVID-19 ； Masks ； Personal protective equipment ； SARS-CoV-2

並列摘要

2003年SARS流行之後，台灣疾病管制署（TCDC）制定了醫院感染控制指南。隨著2019年底另一次新冠病毒疫情（COVID-19）的爆發，醫院獲得感染的風險成為新冠病毒傳播的重要問題。因此，本研究旨在估計醫院的疾病侵襲率（attack rate）和基本再生數（R_0）。於2020年1月14日至2020年3月7日，台灣某一家準醫學中心總共138名醫護人員（HCW）在醫療服務工作中接觸新冠病毒感染（COVID-19）的個案，根據其暴露風險分為兩組比較。所有醫護人員兩次接受咽拭子新冠病毒SARS-CoV-2RT-PCR檢測。醫院遵從常規的感染控制政策，包括疾病管制署制定指南進行環境消毒，使用個人防護設備（PPE）和遵從手部衛生。並且依照實際家庭群聚與醫護同仁的感染情形計算出估計的疾病侵襲率和基本再生數。與“低風險”暴露組相比，“高風險”暴露組執行醫療業務時使用完整PPE的可能性較小，較多接觸時間超過1小時，執行“氣霧生成”業務的可能性較高，並且在隔離期間較多出現呼吸道症狀，然而兩組的所有HCW均無感染COVID-19；分析所有醫護人員在執行醫療業務都戴著口罩，並進行了常規環境清潔；家庭傳染和醫護人員傳染模式的估計R_0分別為1.46和0，這表明該院照顧COVID-19患者並未傳播新冠病毒。醫護人員使用口罩可能有助於預防醫院獲得新冠病毒感染。