Efficacy of air cleaning units for preventing SARS-CoV-2 and other hospital-acquired infections on medicine for older people wards: a quasi-experimental controlled before-and-after study

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-10-05 DOI:10.1016/j.jhin.2024.09.017

R.C. Brock , R.J.B. Goudie , C. Peters , R. Thaxter , T. Gouliouris , C.J.R. Illingworth , A. Conway Morris , C.B. Beggs , M. Butler , V.L. Keevil

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Abstract

Background

Nosocomial infections are costly, and airborne transmission is increasingly recognized as important for spread. Air cleaning units (ACUs) may reduce transmission, but little research has focused on their effectiveness on open wards.

Aim

To assess whether ACUs reduce nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), or other, infections on older adult inpatient wards.

Methods

This was a quasi-experimental before-and-after study on two intervention–control ward pairs in a UK teaching hospital. Infections were identified using routinely collected electronic health record data during 1 year of ACU implementation and the preceding year (‘core study period’). Extended analyses included 6 months of additional data from one ward pair following ACU removal. Hazard ratios (HRs) were estimated through Cox regression controlling for age, sex, ward and background infection risk. The time that the ACUs were switched on was also recorded for Intervention Ward 2.

Findings

ACUs were initially feasible, but compliance reduced towards the end of the study (average operation in first vs second half of ACU time on Intervention Ward 2: 77% vs 53%). In total, 8171 admissions for >48 h (6112 patients, median age 85 years) were included. Overall, the incidence of ward-acquired SARS-CoV-2 was 3.8%. ACU implementation was associated with a non-significant trend of lower hazard for SARS-CoV-2 infection [HR core study period 0.90, 95% confidence interval (CI) 0.53–1.52; HR extended study period 0.78, 95% CI 0.53–1.14]. Only 1.5% of admissions resulted in other notable ward-acquired infections.

Conclusion

ACUs may reduce SARS-CoV-2 infection to a clinically meaningfully degree. Larger studies could reduce uncertainty, perhaps using a crossover design, and factors influencing acceptability to staff and patients should be explored further.

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空气净化装置对预防老年人病房 SARS-CoV-2 和其他医院获得性感染的功效：一项前后对照的准实验研究。

背景：非医院感染的成本很高，而空气传播越来越被认为是传播的重要因素。空气净化装置（ACU）可以减少传播，但很少有研究关注其在开放式病房中的效果。目的：评估空气净化装置是否可以减少老年人住院病房中的非典型肺炎-CoV-2 或其他感染：方法：对英国一家教学医院的两对干预-对照病房进行前后对比的准实验研究。在实施 ACU 的一年和前一年（"核心研究期"），通过常规收集的电子健康记录数据确定感染情况。扩展分析包括取消 ACU 后一对病房 6 个月的额外数据。通过控制年龄、性别、病房和背景感染风险的 Cox 回归估算出危险比 (HR)。干预病房2.的研究结果也记录了ACU的开启时间：研究结果：ACU 最初是可行的，但在研究结束时，依从性有所下降（干预病房 2 ACU 上半年与下半年的平均手术率分别为 77% 与 53%）。研究纳入了 8171 名住院时间超过 48 小时的患者（6112 名患者，中位年龄为 85 岁）。总体而言，病房获得性 SARS-CoV-2 的发病率为 3.8%。实施 ACU 后，SARS-CoV-2 感染的风险呈下降趋势，但并不显著（核心研究期间的 HR 为 0.90，95% CI 为 0.53，1.52；扩展研究期间的 HR 为 0.78，95% CI 为 0.53，1.14）。只有1.5%的入院患者发生了其他明显的病房感染：ACU可在一定程度上减少SARS-CoV-2感染。更大规模的研究可以减少不确定性，也许可以采用交叉设计，同时应进一步探讨影响员工和患者接受程度的因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.