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.

Autor: Brock RC; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK., Goudie RJB; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK., Peters C; Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow, UK., Thaxter R; Infection Control, Cambridge University Hospitals, Cambridge, UK., Gouliouris T; Department of Infectious Diseases, Cambridge University Hospitals, Cambridge, UK; Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK., Illingworth CJR; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK., Conway Morris A; Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK; The John Farman ICU, Cambridge University Hospitals, Cambridge, UK., Beggs CB; Carnegie School of Sport, Leeds Beckett University, Leeds, UK; Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, UK., Butler M; Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, UK., Keevil VL; Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, UK. Electronic address: v.keevil@nhs.net.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2024 Oct 05; Vol. 155, pp. 1-8. Date of Electronic Publication: 2024 Oct 05.
DOI: 10.1016/j.jhin.2024.09.017
Abstrakt: 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.
Competing Interests: Conflict of interest statement CB is an expert witness in Module 3 of the UK COVID-19 Inquiry, and has received financial remuneration for his work in this capacity. MB and CP have undertaken work for FreshAirNHS, a non-profit campaigning organization advocating for airborne mitigations within the NHS; they have not received any financial remunerations for this work. ACM sits on the scientific advisory board of Cambridge Infection Diagnostics, and has received speaking fees from bioMérieux, Fischer and Paykel, ThermoFisher and Boston Scientific.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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