Why Did Outbreaks of Severe Acute Respiratory Syndrome Occur in Some Hospital Wards but Not in Others?
Identifieur interne : 001903 ( Ncbi/Merge ); précédent : 001902; suivant : 001904Why Did Outbreaks of Severe Acute Respiratory Syndrome Occur in Some Hospital Wards but Not in Others?
Auteurs : Ignatius T. Yu ; Zhan Hong Xie [République populaire de Chine] ; Kelvin K. Tsoi ; Yuk Lan Chiu ; Siu Wai Lok ; Xiao Ping Tang [République populaire de Chine] ; David S. Hui ; Nelson Lee ; Yi Min Li [République populaire de Chine] ; Zhi Tong Huang [République populaire de Chine] ; Tao Liu [République populaire de Chine] ; Tze Wai Wong ; Nan Shan Zhong [République populaire de Chine] ; Joseph J. SungSource :
- Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America [ 1058-4838 ] ; 2007.
Abstract
Url:
DOI: 10.1086/512819
PubMed: 17366443
PubMed Central: 7107862
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Yu</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="aff2"><institution>Department of Community and Family Medicine</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Xie, Zhan Hong" sort="Xie, Zhan Hong" uniqKey="Xie Z" first="Zhan Hong" last="Xie">Zhan Hong Xie</name><affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Guangzhou Institute of Respiratory Diseases, Guangzhou Medical College</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Tsoi, Kelvin K" sort="Tsoi, Kelvin K" uniqKey="Tsoi K" first="Kelvin K." last="Tsoi">Kelvin K. Tsoi</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Chiu, Yuk Lan" sort="Chiu, Yuk Lan" uniqKey="Chiu Y" first="Yuk Lan" last="Chiu">Yuk Lan Chiu</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Lok, Siu Wai" sort="Lok, Siu Wai" uniqKey="Lok S" first="Siu Wai" last="Lok">Siu Wai Lok</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Tang, Xiao Ping" sort="Tang, Xiao Ping" uniqKey="Tang X" first="Xiao Ping" last="Tang">Xiao Ping Tang</name><affiliation wicri:level="1"><nlm:aff id="aff5"><institution>Guangzhou No. 8 People's Hospital</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Hui, David S" sort="Hui, David S" uniqKey="Hui D" first="David S." last="Hui">David S. Hui</name><affiliation><nlm:aff id="aff3"><institution>Department of Medicine and Therapeutics, The Chinese University of Hong Kong</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name><affiliation><nlm:aff id="aff3"><institution>Department of Medicine and Therapeutics, The Chinese University of Hong Kong</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Li, Yi Min" sort="Li, Yi Min" uniqKey="Li Y" first="Yi Min" last="Li">Yi Min Li</name><affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Guangzhou Institute of Respiratory Diseases, Guangzhou Medical College</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Huang, Zhi Tong" sort="Huang, Zhi Tong" uniqKey="Huang Z" first="Zhi Tong" last="Huang">Zhi Tong Huang</name><affiliation wicri:level="1"><nlm:aff id="aff6"><institution>Second Affiliated Hospital, Zhongshan University</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Liu, Tao" sort="Liu, Tao" uniqKey="Liu T" first="Tao" last="Liu">Tao Liu</name><affiliation wicri:level="1"><nlm:aff id="aff7"><institution>Guangdong Provincial Hospital of Traditional Chinese Medicine</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Wong, Tze Wai" sort="Wong, Tze Wai" uniqKey="Wong T" first="Tze Wai" last="Wong">Tze Wai Wong</name><affiliation><nlm:aff id="aff2"><institution>Department of Community and Family Medicine</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Zhong, Nan Shan" sort="Zhong, Nan Shan" uniqKey="Zhong N" first="Nan Shan" last="Zhong">Nan Shan Zhong</name><affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Guangzhou Institute of Respiratory Diseases, Guangzhou Medical College</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Sung, Joseph J" sort="Sung, Joseph J" uniqKey="Sung J" first="Joseph J." last="Sung">Joseph J. Sung</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="aff3"><institution>Department of Medicine and Therapeutics, The Chinese University of Hong Kong</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17366443</idno><idno type="pmc">7107862</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107862</idno><idno type="RBID">PMC:7107862</idno><idno type="doi">10.1086/512819</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">000F05</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F05</idno><idno type="wicri:Area/Pmc/Curation">000F05</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000F05</idno><idno type="wicri:Area/Pmc/Checkpoint">000E67</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000E67</idno><idno type="wicri:Area/Ncbi/Merge">001903</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Why Did Outbreaks of Severe Acute Respiratory Syndrome Occur in Some Hospital Wards but Not in Others?</title><author><name sortKey="Yu, Ignatius T" sort="Yu, Ignatius T" uniqKey="Yu I" first="Ignatius T." last="Yu">Ignatius T. Yu</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="aff2"><institution>Department of Community and Family Medicine</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Xie, Zhan Hong" sort="Xie, Zhan Hong" uniqKey="Xie Z" first="Zhan Hong" last="Xie">Zhan Hong Xie</name><affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Guangzhou Institute of Respiratory Diseases, Guangzhou Medical College</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Tsoi, Kelvin K" sort="Tsoi, Kelvin K" uniqKey="Tsoi K" first="Kelvin K." last="Tsoi">Kelvin K. Tsoi</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Chiu, Yuk Lan" sort="Chiu, Yuk Lan" uniqKey="Chiu Y" first="Yuk Lan" last="Chiu">Yuk Lan Chiu</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Lok, Siu Wai" sort="Lok, Siu Wai" uniqKey="Lok S" first="Siu Wai" last="Lok">Siu Wai Lok</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Tang, Xiao Ping" sort="Tang, Xiao Ping" uniqKey="Tang X" first="Xiao Ping" last="Tang">Xiao Ping Tang</name><affiliation wicri:level="1"><nlm:aff id="aff5"><institution>Guangzhou No. 8 People's Hospital</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Hui, David S" sort="Hui, David S" uniqKey="Hui D" first="David S." last="Hui">David S. Hui</name><affiliation><nlm:aff id="aff3"><institution>Department of Medicine and Therapeutics, The Chinese University of Hong Kong</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name><affiliation><nlm:aff id="aff3"><institution>Department of Medicine and Therapeutics, The Chinese University of Hong Kong</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Li, Yi Min" sort="Li, Yi Min" uniqKey="Li Y" first="Yi Min" last="Li">Yi Min Li</name><affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Guangzhou Institute of Respiratory Diseases, Guangzhou Medical College</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Huang, Zhi Tong" sort="Huang, Zhi Tong" uniqKey="Huang Z" first="Zhi Tong" last="Huang">Zhi Tong Huang</name><affiliation wicri:level="1"><nlm:aff id="aff6"><institution>Second Affiliated Hospital, Zhongshan University</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Liu, Tao" sort="Liu, Tao" uniqKey="Liu T" first="Tao" last="Liu">Tao Liu</name><affiliation wicri:level="1"><nlm:aff id="aff7"><institution>Guangdong Provincial Hospital of Traditional Chinese Medicine</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Wong, Tze Wai" sort="Wong, Tze Wai" uniqKey="Wong T" first="Tze Wai" last="Wong">Tze Wai Wong</name><affiliation><nlm:aff id="aff2"><institution>Department of Community and Family Medicine</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author><author><name sortKey="Zhong, Nan Shan" sort="Zhong, Nan Shan" uniqKey="Zhong N" first="Nan Shan" last="Zhong">Nan Shan Zhong</name><affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Guangzhou Institute of Respiratory Diseases, Guangzhou Medical College</institution>,<addr-line>Guangzhou, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Guangzhou</wicri:regionArea></affiliation></author><author><name sortKey="Sung, Joseph J" sort="Sung, Joseph J" uniqKey="Sung J" first="Joseph J." last="Sung">Joseph J. Sung</name><affiliation><nlm:aff id="aff1"><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="aff3"><institution>Department of Medicine and Therapeutics, The Chinese University of Hong Kong</institution>,<addr-line>Hong Kong</addr-line></nlm:aff></affiliation></author></analytic><series><title level="j">Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</title><idno type="ISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><p><bold><italic>Background</italic></bold>. Most documented “superspreading events” of severe acute respiratory syndrome (SARS) occurred in hospitals, but the underlying causes remain unclear. We systematically analyzed the risk factors for nosocomial outbreaks of SARS among hospital wards in Guangzhou and Hong Kong, China.</p><p><bold><italic>Methods</italic></bold>. A case-control study was conducted. Case wards were hospital wards in which superspreading events of SARS occurred, and control wards were wards in which patients with SARS were admitted, but no subsequent nosocomial outbreaks occurred. Information on environmental and administrative factors was obtained through visits to the wards and interviews with ward managers or nursing officers. Relevant information about host factors was abstracted from the medical records. Logistic regression analyses were used to identify the major risk factors for superspreading events.</p><p><bold><italic>Results</italic></bold>. Eighty-six wards in 21 hospitals in Guangzhou and 38 wards in 5 hospitals in Hong Kong were included in the study. Six risk factors were significant in the final multiple-logistic regression model: minimum distance between beds of ≤1 m (odds ratio [OR], 6.94; 95% confidence interval [CI], 1.68–28.75), availability of washing or changing facilities for staff (OR, 0.12; 95% CI, 0.02–0.97), whether resuscitation was ever performed in the ward (OR, 3.81; 95% CI, 1.04–13.87), whether staff members worked while experiencing symptoms (OR, 10.55; 95% CI, 2.28–48.87), whether any host patients (index patient or the first patient with SARS admitted to a ward) required oxygen therapy (OR, 4.30; 95% CI, 1.00–18.43), and whether any host patients required bi-level positive airway pressure ventilation (OR, 11.82; 95% CI, 1.97–70.80).</p><p><bold><italic>Conclusions</italic></bold>. Our results revealed that factors that were associated with the ward environment and administration were important in nosocomial outbreaks of SARS. The lessons learned from this study remain very important and highly relevant to the daily operation of hospital wards if we are to prevent nosocomial outbreaks of other respiratory infections in the future.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Li, Y" uniqKey="Li Y">Y Li</name></author><author><name sortKey="Yu, Its" uniqKey="Yu I">ITS Yu</name></author><author><name sortKey="Xu, Pc" uniqKey="Xu P">PC Xu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yu, Its" uniqKey="Yu I">ITS Yu</name></author><author><name sortKey="Li, Y" uniqKey="Li Y">Y Li</name></author><author><name sortKey="Wong, Tw" uniqKey="Wong T">TW Wong</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Shen, Z" uniqKey="Shen Z">Z Shen</name></author><author><name sortKey="Ning, F" uniqKey="Ning F">F 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Clin. Infect. Dis</journal-id><journal-id journal-id-type="hwp">cid</journal-id><journal-id journal-id-type="publisher-id">cid</journal-id><journal-title-group><journal-title>Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</journal-title></journal-title-group><issn pub-type="ppub">1058-4838</issn><issn pub-type="epub">1537-6591</issn><publisher><publisher-name>The University of Chicago Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">17366443</article-id><article-id pub-id-type="pmc">7107862</article-id><article-id pub-id-type="doi">10.1086/512819</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles and Commentaries</subject><subj-group subj-group-type="category-toc-heading"><subject>Major Articles</subject></subj-group></subj-group></article-categories><title-group><article-title>Why Did Outbreaks of Severe Acute Respiratory Syndrome Occur in Some Hospital Wards but Not in Others?</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Yu</surname><given-names>Ignatius T.</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Xie</surname><given-names>Zhan Hong</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Tsoi</surname><given-names>Kelvin K.</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Chiu</surname><given-names>Yuk Lan</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lok</surname><given-names>Siu Wai</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tang</surname><given-names>Xiao Ping</given-names></name><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Hui</surname><given-names>David S.</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Nelson</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Yi Min</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Huang</surname><given-names>Zhi Tong</given-names></name><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Liu</surname><given-names>Tao</given-names></name><xref ref-type="aff" rid="aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Wong</surname><given-names>Tze Wai</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Zhong</surname><given-names>Nan Shan</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Sung</surname><given-names>Joseph J.</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="corresp" rid="cor1"></xref><pmc-comment>joesung@cuhk.edu.hk </pmc-comment>
</contrib></contrib-group><aff id="aff1"><label>1</label><institution>Centre for Emerging Infectious Diseases</institution>,<addr-line>Hong Kong</addr-line></aff><aff id="aff2"><label>2</label><institution>Department of Community and Family Medicine</institution>,<addr-line>Hong Kong</addr-line></aff><aff id="aff3"><label>3</label><institution>Department of Medicine and Therapeutics, The Chinese University of Hong Kong</institution>,<addr-line>Hong Kong</addr-line></aff><aff id="aff4"><label>4</label><institution>Guangzhou Institute of Respiratory Diseases, Guangzhou Medical College</institution>,<addr-line>Guangzhou, China</addr-line></aff><aff id="aff5"><label>5</label><institution>Guangzhou No. 8 People's Hospital</institution>,<addr-line>Guangzhou, China</addr-line></aff><aff id="aff6"><label>6</label><institution>Second Affiliated Hospital, Zhongshan University</institution>,<addr-line>Guangzhou, China</addr-line></aff><aff id="aff7"><label>7</label><institution>Guangdong Provincial Hospital of Traditional Chinese Medicine</institution>,<addr-line>Guangzhou, China</addr-line></aff><author-notes><corresp id="cor1">Reprints or correspondence: Dr. Joseph J. Sung, Centre for Emerging Infectious Disease, The Chinese University of Hong Kong, 2/F, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China (<email>joesung@cuhk.edu.hk</email>).</corresp></author-notes><pub-date pub-type="ppub"><day>15</day><month>4</month><year>2007</year></pub-date><pub-date pub-type="epub" iso-8601-date="2007-04-15"><day>15</day><month>4</month><year>2007</year></pub-date><pub-date pub-type="pmc-release"><day>15</day><month>4</month><year>2007</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>44</volume><issue>8</issue><fpage>1017</fpage><lpage>1025</lpage><history><date date-type="received"><day>17</day><month>11</month><year>2006</year></date><date date-type="accepted"><day>5</day><month>1</month><year>2007</year></date></history><permissions><copyright-statement>© 2007 Infectious Diseases Society of America</copyright-statement><copyright-year>2007</copyright-year><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p></license></permissions><self-uri xlink:href="44-8-1017.pdf"></self-uri><abstract><title>Abstract</title><p><bold><italic>Background</italic></bold>. Most documented “superspreading events” of severe acute respiratory syndrome (SARS) occurred in hospitals, but the underlying causes remain unclear. We systematically analyzed the risk factors for nosocomial outbreaks of SARS among hospital wards in Guangzhou and Hong Kong, China.</p><p><bold><italic>Methods</italic></bold>. A case-control study was conducted. Case wards were hospital wards in which superspreading events of SARS occurred, and control wards were wards in which patients with SARS were admitted, but no subsequent nosocomial outbreaks occurred. Information on environmental and administrative factors was obtained through visits to the wards and interviews with ward managers or nursing officers. Relevant information about host factors was abstracted from the medical records. Logistic regression analyses were used to identify the major risk factors for superspreading events.</p><p><bold><italic>Results</italic></bold>. Eighty-six wards in 21 hospitals in Guangzhou and 38 wards in 5 hospitals in Hong Kong were included in the study. Six risk factors were significant in the final multiple-logistic regression model: minimum distance between beds of ≤1 m (odds ratio [OR], 6.94; 95% confidence interval [CI], 1.68–28.75), availability of washing or changing facilities for staff (OR, 0.12; 95% CI, 0.02–0.97), whether resuscitation was ever performed in the ward (OR, 3.81; 95% CI, 1.04–13.87), whether staff members worked while experiencing symptoms (OR, 10.55; 95% CI, 2.28–48.87), whether any host patients (index patient or the first patient with SARS admitted to a ward) required oxygen therapy (OR, 4.30; 95% CI, 1.00–18.43), and whether any host patients required bi-level positive airway pressure ventilation (OR, 11.82; 95% CI, 1.97–70.80).</p><p><bold><italic>Conclusions</italic></bold>. Our results revealed that factors that were associated with the ward environment and administration were important in nosocomial outbreaks of SARS. The lessons learned from this study remain very important and highly relevant to the daily operation of hospital wards if we are to prevent nosocomial outbreaks of other respiratory infections in the future.</p></abstract></article-meta></front></pmc><affiliations><list><country><li>République populaire de Chine</li></country></list><tree><noCountry><name sortKey="Chiu, Yuk Lan" sort="Chiu, Yuk Lan" uniqKey="Chiu Y" first="Yuk Lan" last="Chiu">Yuk Lan Chiu</name><name sortKey="Hui, David S" sort="Hui, David S" uniqKey="Hui D" first="David S." last="Hui">David S. Hui</name><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name><name sortKey="Lok, Siu Wai" sort="Lok, Siu Wai" uniqKey="Lok S" first="Siu Wai" last="Lok">Siu Wai Lok</name><name sortKey="Sung, Joseph J" sort="Sung, Joseph J" uniqKey="Sung J" first="Joseph J." last="Sung">Joseph J. Sung</name><name sortKey="Tsoi, Kelvin K" sort="Tsoi, Kelvin K" uniqKey="Tsoi K" first="Kelvin K." last="Tsoi">Kelvin K. Tsoi</name><name sortKey="Wong, Tze Wai" sort="Wong, Tze Wai" uniqKey="Wong T" first="Tze Wai" last="Wong">Tze Wai Wong</name><name sortKey="Yu, Ignatius T" sort="Yu, Ignatius T" uniqKey="Yu I" first="Ignatius T." last="Yu">Ignatius T. Yu</name></noCountry><country name="République populaire de Chine"><noRegion><name sortKey="Xie, Zhan Hong" sort="Xie, Zhan Hong" uniqKey="Xie Z" first="Zhan Hong" last="Xie">Zhan Hong Xie</name></noRegion><name sortKey="Huang, Zhi Tong" sort="Huang, Zhi Tong" uniqKey="Huang Z" first="Zhi Tong" last="Huang">Zhi Tong Huang</name><name sortKey="Li, Yi Min" sort="Li, Yi Min" uniqKey="Li Y" first="Yi Min" last="Li">Yi Min Li</name><name sortKey="Liu, Tao" sort="Liu, Tao" uniqKey="Liu T" first="Tao" last="Liu">Tao Liu</name><name sortKey="Tang, Xiao Ping" sort="Tang, Xiao Ping" uniqKey="Tang X" first="Xiao Ping" last="Tang">Xiao Ping Tang</name><name sortKey="Zhong, Nan Shan" sort="Zhong, Nan Shan" uniqKey="Zhong N" first="Nan Shan" last="Zhong">Nan Shan Zhong</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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