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      Risk analysis on enterovirus contamination in child outpatient departments of medical institutions in Guangdong province

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          Abstract

          Objective To investigate the status of enterovirus contamination in child outpatient departments of medical institutions during different epidemic periods of hand-foot-mouth disease (HFMD) in Guangdong province.

          Methods We conducted three waves of survey at child outpatient departments of medical institutions at different administrative levels in 4 counties or districts with higher HFMD incidence in Guangzhou and Huizhou municipality during pre-peak (January to April), peak (May to July), and post-peak (October to December) period of HFMD epidemics in 2016. Article surface swab specimens were collected in all the child outpatient departments for the detection of HFMD-related enterovirus nucleic acid with fluorogenic quantitative PCR method. Data on monthly incidence rate of HFMD in the regions surveyed were also collected simultaneously.

          Results Totally 1 568 swab specimens were collected in child outpatient departments of 16 medical institutions surveyed. The overall enterovirus positive rate of the specimens was 4.21% and the positive rate (7.34%) of the specimens collected during the peak period of HFMD epidemic was significantly higher than that of those collected during the pre-peak (3.92%) and post-peak period (1.33%) ( χ 2 = 23.90, P < 0.001). There was a significant positive correlation between the positive rate of specimens and the average monthly HFMD incidence rate in the regions surveyed ( r = 0.50, P = 0.67). The positive rate of all the specimens collected in Grade-A secondary hospitals (5.87%) was significantly higher than that of the specimens collected in primary medical institutions (5.71%) and Grade-A tertiary hospitals (2.84%) ( χ 2 = 8.46, P = 0.015). During the peak period of HFMD epidemic, the positive rate of the specimens collected in Grade-A secondary hospitals (11.43%) was significantly higher than that of the specimens collected in primary medical institutions (9. 17%) and Grade-A tertiary hospitals (4.61%) ( χ 2 = 7.07, P = 0.029); but there were no significant differences observed for the specimens collected during other periods of the epidemic ( P > 0.05). For the specimens collected in Grade-A secondary and tertiary hospitals, the positive rate (5.22%) was higher for those collected at 9 o’clock than that for those collected 16 o’clock (3.71%) and at 11 o’clock (2.45%), but the differences were not significant (both P > 0.05). The positive rate of the specimens collected in clinics for health care of healthy children (4.29%) was unsignificantly higher than that of specimens (3.85%) collected in outpatient clinics for the children seeking medical service (P < 0.05). For the specimens collected in the outpatient clinics, higher positive rates were detected for surface swabs of therapeutic tables (6.14%), intravenous transfusion chairs (5.73%) and waiting-room benches (4.76%); while, for the specimens collected in the clinics for health care, higher positive rates were detected for surface swabs of vaccination tables (28.13%) and physical measurement facilities (7.14%) and the positive rates maintained at a higher level (18.18% – 45.45%) for the surface swabs of vaccination tables during the whole period of the HFMD epidemic.

          Conclusion The HFMD-related enterovirus contamination in child outpatient departments of medical institutions is prevalent, especially during peak period of HFMD epidemic and at 9 o'clock of a day, and the most frequently detected contaminations are surfaces of vaccination tables, therapeutic tables, intravenous transfusion chairs and waiting-room benches in outpatients. The results suggest that targeted control measures for the contaminations should be developed.

          Abstract

          【摘 要】 目的 调查广东省手足口病高发地区医疗机构在手足口病不同流行阶段儿童门诊环境肠道病毒污染现况。 方法 在 2016 年手足口病流行前(1 — 3 月)、流行高峰(5 — 7 月)及流行后(10 — 12 月),选取手足口病高发的广州和惠州 2 个地市 4 个县(区)不同等级医疗机构作为调查对象,采集儿童门诊各类物体表面涂抹拭子进行手足口病病原核酸检测;同时收集 2 个地市采样相应月份的手足口病月均发病率。 结果 采集广州和惠州 16 家医疗机构的儿童门诊环境涂抹拭子共 1 568 份,肠道病毒核酸通用引物检测阳性率为 4.21 %。手足口病流行高峰的阳性率(7.34 %)高于流行前(3.92 %)与流行后(1.33 %),差异有统计学意义( χ 2 = 23.90, P = 0.000)。儿童门诊环境阳性率与人群手足口病月均发病率存在正相关关系( r = 0.50, P = 0.67)。二甲医院阳性率(5.87 %)高于未分级医疗机构(5.71 %)和三甲医院(2.84 %),三者差异有统计学意义( χ 2 = 8.46, P = 0.015);在流行高峰,二甲医院阳性率(11.43 %)高于未分级医疗机构(9.17 %)和三甲医院(4.61 %),三者差异有统计学意义( χ 2 = 7.07, P = 0.029),但在流行前和流行后,三者阳性率差异均无统计学意义(均 P > 0.05)。在二甲和三甲医院,9 : 00 时采样阳性率(5.22 %)高于 16 : 00 时(3.71 %)和 11 : 00 时(2.45 %),但差异无统计学意义( P > 0.05)。健康儿童门诊阳性率(4.29 %)高于患病儿童门诊(3.85 %),差异无统计学意义( P > 0.05)。在患病儿童门诊,阳性率居前 3 位的有治疗台(6.14 %)、输液椅(5.73 %)和候诊椅(4.76 %);健康儿童门诊仅疫苗接种台(28.13 %)与婴幼儿发育测量设施(7.14 %)表面检出肠道病毒;疫苗接种台在不同流行期内阳性率均保持较高水平(18.18 % ~ 45.45 %)。 结论 广东省手足口病高发地区医疗机构儿童门诊肠道病毒污染普遍存在,以手足口病流行高峰、门诊开诊日上午 9 : 00 时、门诊中疫苗接种台、治疗台、输液椅和候诊椅等物体表面污染较为严重,应有针对地制定院感防控措施。

          Author and article information

          Journal
          CPH
          Chinese Journal of Public Health
          Chinese Journal of Public Health (China )
          1001-0580
          01 April 2019
          02 July 2018
          : 35
          : 4
          : 427-431
          Affiliations
          [1] 1Institute of Infectious Disease Control and Prevention, Guangzhou Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
          Article
          zgggws1118281
          10.11847/zgggws1118281
          b7d1c7fe-4c2d-4145-8506-34d1b7d2ba81
          © 2019 China Public Health Editorial Department

          This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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          Categories
          Journal Article

          Medicine,Nutrition & Dietetics,Occupational & Environmental medicine,Health & Social care,Infectious disease & Microbiology,Public health
          environmental contamination,child outpatient clinic,medical institution,enterovirus

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