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首页> 外文期刊>BMC Public Health >Effectiveness of control measures to prevent occupational tuberculosis infection in health care workers: a systematic review
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Effectiveness of control measures to prevent occupational tuberculosis infection in health care workers: a systematic review

机译：预防医护人员职业性结核感染的控制措施的有效性：系统综述

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A number of guideline documents have been published over the past decades on preventing occupational transmission of tuberculosis (TB) infection in health care workers (HCWs). However, direct evidence for the effectiveness of these controls is limited particularly in low-and middle-income (LMIC) countries. Thus, we sought to evaluate whether recommended administrative, environmental and personal protective measures are effective in preventing tuberculin skin test conversion among HCWs, and whether there has been recent research appropriate to LMIC needs. Using inclusion criteria that included tuberculin skin test (TST) conversion as the outcome and longitudinal study design, we searched a number of electronic databases, complemented by hand-searching of reference lists and contacting experts. Reviewers independently selected studies, extracted data and assessed study quality using recommended criteria and overall evidence quality using GRADE criteria. Ten before-after studies were found, including two from upper middle income countries. All reported a decline in TST conversion frequency after the intervention. Among five studies that provided rates, the size of the decline varied, ranging from 35 to 100%. Since all were observational studies assessed as having high or unclear risk of bias on at least some criteria, the overall quality of evidence was rated as low using GRADE criteria. We found consistent but low quality of evidence for the effectiveness of combined control measures in reducing TB infection transmission in HCWs in both high-income and upper-middle income country settings. However, research is needed in low-income high TB burden, including non-hospital, settings, and on contextual factors determining implementation of recommended control measures. Explicit attention to the reporting of methodological quality is recommended. This systematic review was registered with PROSPERO in 2014 and its registration number is CRD42014009087 .
机译：在过去的几十年中，已经发布了许多指南文件，旨在防止卫生保健工作者（HCW）的职业性传播结核病（TB）感染。但是，有关这些控制措施有效性的直接证据尤其有限，特别是在中低收入（LMIC）国家。因此，我们试图评估建议的行政，环境和个人防护措施是否有效防止医护人员之间结核菌素皮肤试验的转变，以及最近是否有适合LMIC需求的研究。使用包括结核菌素皮肤试验（TST）转换作为结果和纵向研究设计的纳入标准，我们搜索了许多电子数据库，并通过人工搜索参考列表和联系专家进行了补充。审稿人独立选择研究，提取数据并使用推荐标准评估研究质量，并使用GRADE标准评估整体证据质量。发现了十项前后研究，其中两项来自中高收入国家。干预后，所有人均报告TST转换频率下降。在提供比率的五项研究中，下降的幅度从35％到100％不等。由于所有观察性研究均至少在某些标准上有较高或不清楚的偏倚风险，因此使用GRADE标准将整体证据质量评为低。我们发现，在高收入和中高收入国家/地区，采取综合控制措施减少医护人员结核病感染传播有效性的证据质量始终如一，但证据不足。但是，需要针对低收入，高结核病负担（包括非医院环境）以及确定建议的控制措施的实施的背景因素进行研究。建议特别注意方法学质量的报告。该系统评价于2014年在PROSPERO注册，注册号为CRD42014009087。

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