预防和控制流感在养老院暴发管理的最佳证据总结

Summary of the Best Available Evidence for the Prevention and Control of Influenza Outbreaks in Nursing Homes

背景目前我国流感疫苗覆盖率较低,一旦暴发将加剧医疗压力。目的总结预防和控制流感在养老院暴发的最佳证据,以强化养老院管理者以及工作人员对流感的重视。方法计算机检索万方数据知识服务平台(Wanfang Data)、维普网(VIP)、中国知网(CNKI)、中国生物医学文献数据库(CBM)、中华人民共和国民政部官网、Cochrane Library、PubMed、Medline、Joanna Briggs Institute(JBI)循证卫生保健中心图书馆、Up to Date、Ovid数据库及美国疾病控制与预防中心(CDC)官网关于预防和控制养老院流感暴发的临床指南、系统评价、专家共识、队列研究、随机对照试验、横断面研究。检索时间为建库至2020-02-12。分别采用AGREEⅡ、AMSTAR、JBI循证卫生保健中心专家共识评价标准(2017年澳大利亚版本)、2016版JBI循证卫生保健中心队列研究评价标准、Jadad评分量表、2017版JBI循证卫生保健中心横断面研究质量评价工具进行质量评价。最后采用2014年澳大利亚版本JBI循证卫生保健中心证据分级及证据推荐级别系统进行证据汇总、评价和等级划分。结果本研究最终纳入文献17篇,其中临床指南5篇、系统评价2篇、专家共识3篇、队列研究2篇、随机对照试验4篇、横断面研究1篇。5篇临床指南中各领域≥60%的数目为6的有3篇,推荐级别为A级的有5篇。2篇系统评价的质量评价结果均为准予纳入。3篇专家共识的质量评价结果均为准予纳入。2篇队列研究的质量评价结果显示文献质量均较高,允许纳入。4篇随机对照试验的质量评价结果均为准予纳入。1篇横断面研究的质量评价结果为文献属于高质量文献,允许纳入。证据汇总最终得出27条预防和控制养老院流感暴发的最佳证据,包含环境、人员管理、预防措施以及疫苗接种影响因素4个方面。结论总结和分析国内外养老院流感暴发预防与控制的相关文献得出接种流感疫苗仍是目前控制流感的最佳方法,养老院管理者及工作人员应当提高对流感重视程度,优化流感预防管理模式。

Background At present,the coverage rate of influenza vaccine in China is low,once outbreak,it will increase the medical pressure.Objective To summarize the best available evidence of preventing and controlling influenza outbreaks in nursing homes,thus strengthening the attention of managers and workers of nursing homes to influenza.Methods Evidence(including clinical guidelines,systematic reviews,expert consensuses,cohort studies,randomized controlled trials,and cross-sectional studies)regarding the containment of influenza outbreak in nursing homes,was searched according to Wanfang Data,VIP,CNKI and CBM,and the official website of Ministry of Civil Affairs of the People's Republic of China,Cochrane Library,PubMed,Medline,Joanna Briggs Institute(JBI)evidence-based health care research center library,Up to Date and Ovid,and the official website of Centers for Disease Control and Prevention,from inception to February 12,2020.Quality evaluation was performed according to the frame of AGREEⅡ,AMSTAR,2017 Joanna Briggs Institute Critical Appraisal Checklist for Text and Opinion Papers,2016 Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies,Jadad Scale,and 2017 Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies.Finally,evidence was summarized,evaluated,and divided following the 2014 Joanna Briggs Institute Levels of Evidence and Grades of Recommendation.Results A total of 17 articles were enrolled,including 5 clinical guidelines,2 systematic reviews,3 expert consensus,2 cohort studies,4 randomized control trials and 1 cross-sectional study.Out of the 5 clinical guidelines,3 had a≥60%score across 6 areas,but all won the A recommendation level.All the systematic reviews and expert consensus were approved for inclusion.Both cohort studies showed a high level of quality,and were allowed to be included.All the randomized control trials were also allowed to be included.One cross-sectional study was evaluated to be high-quality and allowed to be included.We finally extracted 27 items of available best evidence,covering four aspects:environment,personnel management,preventive measures and influencing factors of vaccination.Conclusion Our analysis and summary of the related literature suggested that,influenza vaccination is still the best method for influenza control.Managers and wokers of nursing homes should put their emphasis on influenza and optimize the management model of influenza prevention.