在医疗机构护理疑似或确诊丝状病毒疾病患者的感染预防和控制研究,重点是埃博拉病毒和马尔堡病毒:综合综述

Raphael G Frankfurter, Victoria Willet, Eugene T Richardson, George W. Rutherford, April Baller, J. D. Kelly
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引用次数: 0

摘要

综合综述.PubMed、Embase、Google Scholar、国际卫生组织(如世界卫生组织、美国疾病预防控制中心)的互联网资料来源、收录文献的参考文献和灰色文献。通过与埃博拉疾病和马尔堡疾病以及三个研究目标相关的综合搜索字符串,确定了实验室科学、临床研究和真实世界观察性研究。利用人群、干预或暴露、结果、研究类型和报告特征等框架,审稿人使用预定义的数据提取表和汇总表提取数据并对证据进行严格评估。提取表、摘要表和批判性评估根据纳入的文献而有所不同;我们在可能的情况下使用 QUIPS 偏倚风险工具和内部开发的工具来系统地提取和审查观察性和实验性研究的证据。随后,我们对证据进行了综合和归纳,以提出简要建议。所有与综述问题相关的研究均为:(1)描述性、真实世界研究(即对埃博拉治疗单位各种表面的环境审计)或(2)对照性、实验室研究(即在对照条件下对埃博拉病毒存活性的实验研究),这些研究存在一系列与偏差和外部有效性相关的问题。我们对病毒存活性证据的审查显示,实验室研究结果与现实世界的研究结果之间存在严重脱节。然而,除血液外,病毒在液体中的存活率要高于在干燥体液中的存活率。有证据表明,应使用 0.5% 的次氯酸盐溶液进行消毒。溢出物应覆盖并浸泡 15 分钟后清理干净。现有文献表明,在拥有训练有素的外籍卫生保健人员和既定方案的资源充足的临床环境中,作为职业风险的伊波拉病毒传播是罕见的。尽管非洲公共医疗机构中卫生工作者的感染率很高,但由于所有高质量的研究都是针对感染率较低的外国埃博拉临床医生进行的,因此没有偏倚风险较低的证据来评估各种职业暴露的风险。本综述强调,在丝状病毒疾病流行期间,亟需更高质量的证据为最佳实践提供依据,以确保卫生工作者的安全。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Infection prevention and control studies for care of patients with suspected or confirmed filovirus disease in healthcare settings, with focus on Ebola and Marburg: an integrative review
To review evidence pertaining to methods for preventing healthcare-associated filovirus infections (including the survivability of filoviruses in clinical environments and the chlorine concentration required for effective disinfection), and to assess protocols for determining the risk of health worker (HW) exposures to filoviruses.Integrative review.PubMed, Embase, Google Scholar, internet-based sources of international health organisations (eg, WHO, CDC), references of the included literature and grey literature.Laboratory science, clinical research and real-world observational studies identified through comprehensive search strings that pertained to Ebola disease and Marburg disease and the three research objectives.Using the framework of population, intervention or exposure, outcomes, study types and report characteristics, reviewers extracted data and critically appraised the evidence using predefined data extraction forms and summary tables. The extraction forms, summary tables and critical appraisals varied based on the included literature; we used both the QUIPS Risk-of-Bias tool when possible and an internally developed instrument to systematically extract and review the evidence from observational and experimental studies. Evidence was then synthesised and summarised to create summary recommendations.Thirty-six studies (including duplicates across research questions) were included in our reviews. All studies that related to the review questions were either (1) descriptive, real-world studies (ie, environmental audits of various surfaces in operational Ebola Treatment Units) or (2) controlled, laboratory studies (ie, experimental studies on the survivability of ebolaviruses in controlled conditions), presenting a range of concerns pertaining to bias and external validity. Our reviews of viral survivability evidence revealed significant disconnections between laboratory-based and real-world findings. However, there is greater viral persistence in liquid than dried body fluids, with the possible exception of blood, and ebolaviruses can survive for significant periods of time in dried substrate. Evidence suggests that 0.5% hypochlorite solution should be used for disinfection activity. Spills should be cleaned with covering and soaking for 15 min. Existing literature suggests that within a well-resourced clinical environment with trained, foreign HWs and established protocols, transmission of ebolaviruses as an occupational risk is a rare event. Despite the high rates of HW infections within public African healthcare settings, no evidence with low risk of bias exists to assess the risk of various occupational exposures given that all high-quality studies were conducted on foreign Ebola clinicians who had low overall rates of infection. This review underscores the critical need for better-quality evidence to inform best practices to ensure HW safety during filovirus disease epidemics.
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