Yu 2007.
| Methods | Case‐control study to analyse the risk factors associated with nosocomial outbreaks of SARS in hospital wards in Guangzhou and Hong Kong, China. The study was designed with the individual hospital wards as the units for data collection and analysis. Case wards were hospital wards in which super spreading events of SARS occurred, and control wards were hospital wards in which patient(s) with SARS were admitted, but no super spreading events occurred. A super spreading event is defined as the development of ≥ 3 new cases of SARS in a ward during the period from 2 to 10 days after the admission of an identifiable index patient or as the development of a cluster of ≥ 3 new cases of SARS in a ward during a period of 8 days but without any known sources of SARS | |
| Participants | Eighty‐six wards in 21 hospitals in Guangzhou and 38 wards in 5 hospitals in Hong Kong were included in the study. One ward in Guangzhou and 2 wards in Hong Kong did not participate and they were excluded from the analysis | |
| Interventions | Information related to 2 factors was collected: (1) environmental and administrative factors and (2) host factors. Environmental and administrative factors included physical factors, procedural or situational factors, and administrative factors pertaining to each ward. Host factors included symptoms, severity or dependency (for activities of daily living and behaviour changes), treatment or intervention, and comorbidity of the identified index patient in a case ward or in the first patient with SARS admitted in a control ward | |
| Outcomes | Laboratory: serological evidence: no Effectiveness: SARS (no definition) Safety: N/A | |
| Notes | The authors conclude that environmental risk factors were significantly associated with the occurrence of a super spreading event (clustering of ≥ 3 cases) included minimum distance between beds of ≤ 1 m and performance of resuscitation in the ward. Use of BIPAP ventilation and use of oxygen were the significant risk factors associated with the host patient. Of the administrative factors, allowing staff with symptoms to work also increased the risk. Providing adequate washing or changing facilities for staff was protective As disaggregate data are not reported we did not extract numerator/denominator data | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | N/A |
| Allocation concealment (selection bias) | Unclear risk | N/A |
| Blinding (performance bias and detection bias) All outcomes | Unclear risk | N/A |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | N/A |
| Selective reporting (reporting bias) | Unclear risk | N/A |
AEs: adverse events AFH: Armed Forces Hospital ARI: acute respiratory infection ASR: adverse skin reactions A&E: accident and emergency BIPAP: Bilevel Positive Airway Pressure CCC: Child Care Centre CIs: confidence intervals CDC: Centers for Disease Control and Prevention CMF:citric acid: malic acid: sodium lauryl sulfate (a virucidal mixture added to tissue paper) CoV: coronavirus C‐RCT: cluster‐randomised controlled trial CXR: chest X‐ray DCC: daycare centre FRI: febrile respiratory illness GI: gastro‐intestinal HCW: healthcare worker HFH: Hanoi French Hospital HH: hand hygiene HR: high risk ICU: intensive care unit ILI: influenza‐like illness IRR: incident rate ratio ITT: intention‐to‐treat LRTI: lower respiratory tract infection m: metre MCU: medical convalescent unit MDCK: Madin Darby canine kidney cell line MS: monkey‐derived cell line N/A: not applicable NICU: neonatal intensive care unit NOS: Newcastle‐Ottawa Scales NTS: National Skin Centre OR: odds ratio PCR: polymerase chain reaction PCU: physical conditioning unit PPE: personal protective equipment RCT: randomised controlled trial RDS: respiratory distress syndrome RR: risk ratio RTI: respiratory tract infection RT‐PCR: reverse‐transcriptase polymerase chain reaction RSV: respiratory syncytial virus SAB: surfactant, allantoin and benzalkonium chloride SARS: severe acute respiratory syndrome SD: standard deviation SOPs: standard operating procedures S/S: signs/symptoms SOB: shortness of breath SCBU: special care baby unit UHR‐I: ultra high‐risk infection UHR‐S: ultra high‐risk SARS URTI: upper respiratory tract infection WBC: white blood cell WHO: World Health Organization