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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epi curve of confirmed cases of SARS-CoV-2 infection by date of PCR confirmation &#40;A&#41;&#44; and symptomatic cases by date of onset &#40;B&#41;&#44; for COVID-19 outbreak in a medical ward&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">HCW&#58; healthcare workers&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since the emergence of COVID-19&#44; a significant number of SARS-CoV-2 infections have occurred in healthcare workers &#40;HCWs&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; In the first pandemic wave&#44; 12&#37; of the confirmed infections in Italy occurred in HCWs&#44; while in Spain this percentage exceeded 16&#37;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Several nosocomial outbreaks of COVID-19 were also reported&#44; affecting both HCWs and inpatients<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Respiratory droplets and direct contact &#40;person-to-person&#41;&#44; or more rarely indirect contact &#40;fomites&#41;&#44; have been considered to be the main routes of transmission of SARS-CoV-2<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; whereas potential transmission via aerosols has been a subject of controversy<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission played an important role&#44; and to detail the measures taken to control it&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Setting</span><p id="par0020" class="elsevierStylePara elsevierViewall">The outbreak occurred in an Internal Medicine ward of a 350-bed teaching hospital serving a population of about 200&#44;000 inhabitants&#46; The ward can hold 28 patients in 13 double rooms and two single rooms and is located on the seventh floor of an eleven-storey building that was opened in 1989 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">There is a shared air conditioner located in the hospital terrace for both the rooms and working areas&#44; and this supplies primary air to the inductors located in the entrance area of each room&#46; This inductor mixes the primary air under pressure with the room air&#46; The air supply for the corridor and ward hallway is provided by another air conditioner&#46; Extraction of air from the rooms occurs in the toilet of the rooms through a vertical box that ends on the terrace where the extractor fan is located&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">When the outbreak took place&#44; the incidence of SARS-CoV-2 infection in the previous 14 days was about 200 cases per 100&#44;000 inhabitants in the area served by the hospital&#46; Therefore&#44; some measures had already been taken at the hospital before the outbreak occurred&#46; Family visits had mostly been banned and limited to end-of-life situations or patients requiring special care&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Universal polymerase chain reaction &#40;PCR&#41; testing of patients prior to hospital admission was implemented&#46; Protection of HCWs had also been stepped up with the use of FFP2 respirators and distancing measures had been adopted in shared workspaces and dining areas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All SARS-CoV-2 infected patients were admitted to specific wards with enhanced personal protection measures&#46; All HCWs received additional training on the use of personal protective equipment through videos and face-to-face sessions&#46; The frequency of cleaning and disinfection of surfaces was increased&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Case definition</span><p id="par0045" class="elsevierStylePara elsevierViewall">Persons under investigation &#40;PUI&#41; were defined as patients hospitalized on the ward between 30 November and 6 December 2020 and HCWs working the ward during this same period&#46; Permanent HCWs were defined as those who had worked at least one full working day on the ward&#44; and occasional HCWs were defined as those who had worked less than a full working day on the ward where the outbreak occurred&#46; A confirmed case was defined as a PUI with a positive PCR test for SARS-CoV-2 regardless of symptomatic status&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Subjects with a history of confirmed SARS-CoV-2 infection in the last three months were excluded from the study&#46; SARS-CoV-2 reverse transcription PCR &#40;RT-PCR&#41; was performed on mucus obtained from nasopharyngeal swabs by a commercial kit &#40;Allplex&#8482; 2019-nCoV Assay&#44; Seegene&#44; Republic of Korea&#41; according to the manufacturer&#8217;s instructions&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Descriptive analysis was performed using attack rates expressed as the percent of individuals with positive PCR among the persons at risk&#46; Attack rates were compared using the chi-squared test or Fisher&#8217;s exact test as appropriate&#46; A value of <span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;05 was considered to indicate significance&#46; The SPSS software package &#40;version 15&#46;0&#41; was used for the statistical analysis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Compliance with ethical standards</span><p id="par0060" class="elsevierStylePara elsevierViewall">The local ethics committee &#40;reference number 02-21-101-045&#41; approved this study&#46; Both patients and HCWs gave verbal informed consent for PCR samples to be obtained&#46; Written informed consent for participation was waived because all the interventions and collected data were included in the hospital infection control protocols for care purposes&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">No identifying information about the participating patients or HCWs has been included&#46; The study complied with the principles of the 1964 Helsinki Declaration and its later amendments&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Description of the outbreak</span><p id="par0070" class="elsevierStylePara elsevierViewall">On 6 December 2020&#44; a PCR for SARS-CoV-2 was performed on a patient who was admitted to the ward on 2 December due to the presence of respiratory superinfection&#46; The result was positive&#46; The antigen test and PCR for SARS-CoV-2 performed on admission had been negative in this patient&#44; as well as in all patients admitted to the ward&#46; The patient was being treated with bronchodilators by nebulisation&#46; During the same period another patient was receiving nebulisation in another room &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Three other patients presented with low-grade fever on the same day&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">According to the hospital infection control protocols&#44; all patients admitted to the ward were screened with PCR on 6 December and 13 patients tested positive&#46; A second PCR performed 24&#8239;h later on all patients on the ward confirmed positivity in these 13 patients and was positive in 6 more patients&#46; PCR was also performed on four patients discharged from the ward over the previous five days and was positive in two of them&#46; In the following days&#44; PCR screening was carried out on all HCWs who had worked the ward during the previous week at any time&#46; Overall&#44; 21 patients and 44 HCWs tested positive&#46; None of the HCWs reported having recent community contact with a person with COVID-19&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The screening results and attack rates are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The attack rate in patients was 80&#46;8&#37; and only five tested negative&#46; Among HCWs&#44; the attack rate was significantly higher in those who had worked at least one full working day on the ward &#40;56&#46;3&#37;&#59; 95&#37; CI 44&#46;1&#8211;68&#46;4&#41; than in those who had occasionally been on the ward &#40;25&#46;8&#37;&#59; 95&#37; CI 10&#46;4&#8211;41&#46;2&#59; <span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;005&#41;&#46; On the other hand&#44; from December 4 to 13&#44; only five &#40;0&#46;2&#37;&#41; of the approximately 2300 HCWs who worked in other areas of the hospital were diagnosed with COVID-19&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Overall&#44; 17 cases &#40;9 patients and 8 HCWs&#41; were asymptomatic&#44; and 46 cases &#40;11 patients and 35 HCWs&#41; had a low-grade fever&#59; some of them also had headache and&#47;or cough&#46; One patient and one HCW developed severe pneumonia requiring admission to the intensive care unit&#46; Both cases eventually recovered&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the epi curve of cases by PCR confirmation date and by date of onset in symptomatic cases&#46; In all symptomatic cases&#44; symptoms appeared between December 4 and 13&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The Physical Resources Department reported that on 3 December &#40;three days before the first positive case was detected&#41; two extractor fans were found to be defective&#44; affecting the ventilation of three rooms&#44; and they had been replaced&#46; Therefore&#44; for a few days &#40;the precise moment when they stopped working is unknown&#41; the three affected rooms lacked an adequate number of air changes&#46; In two of these rooms&#44; patients were receiving bronchodilator therapy by nebulisation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Samples from one of the outbreak patients were sent to a reference centre &#40;Hospital Universitari Germans Trias i Pujol&#44; Badalona&#44; Spain&#41; for molecular study of SARS-CoV-2&#46; This analysis identified variant B&#46;1&#46;177&#47;20A&#46;EU1&#44; ruling out the possibility of variant B&#46;1&#46;1&#46;7&#44; with greater intrinsic transmission capacity&#44; which at that time was starting to circulate in Spain&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Control measures adopted</span><p id="par0100" class="elsevierStylePara elsevierViewall">Many actions were taken&#46; The ward where the outbreak occurred was closed&#44; the infected patients were transferred to a COVID ward and the three uninfected patients were quarantined&#46; All affected HCWs were placed on sick leave and their contacts quarantined&#46; The PCR screening protocol was modified by screening the HCWs throughout the hospital every two weeks&#46; In addition&#44; a second screening of all patients at five days post-admission was established&#46; Personal protection was enhanced to perform aerosol-generating procedures&#46; A nebulisation system&#44; with vibrating mesh devices which keep the masks airtight&#44; was implemented&#44; and extra protection with surgical masks over the nebuliser masks was added&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding ventilation&#44; a horizontal air extraction system was installed in the window area of the rooms in order to pull all the air in the room from the door to the window&#44; and the air extractors located on the terrace were replaced by more powerful ones&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Since the emergence of COVID-19&#44; several hospital outbreaks of SARS-CoV-2 infection have been reported&#44; though for most of them the attack rate was much lower than that observed in the current study<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9&#8211;11</span></a>&#46; Higher attack rates have been reported in nursing home outbreaks&#44; although in these cases disease transmission had occurred over an extended period of time<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;12</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In the literature on hospital outbreaks&#44; the proposed mechanism of transmission is by droplet or direct contact&#44; either between patients&#44; between HCWs&#44; or between both groups&#44; while possible transmission by aerosols does not seem to be considered<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;11&#44;13</span></a>&#44; except in two recently reported outbreaks<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; However&#44; there is increasing evidence for the possibility of aerosol transmission of SARS-CoV-2<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;16&#8211;18</span></a>&#46; As such&#44; aerodynamic studies provide evidence supporting this form of transmission<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In addition&#44; community outbreaks of COVID-19 have been reported in which infection is difficult to explain without aerosol transmission<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; In these outbreaks&#44; the transmission rate has been very high&#46; The nosocomial outbreak we describe is characterised by a high attack rate&#44; as well as explosive development in a few days&#44; in addition to the coincidence in time of a breakdown in the air extractors in some rooms of the ward&#44; which could have caused an increase in pressure in these rooms and the spread of contaminated aerosols to the corridor and the rest of the ward&#46; In two rooms affected by the breakdown&#44; patients were receiving bronchodilator therapy by nebulisation&#44; which is an aerosol-generating procedure&#46; All these features make it very likely that airborne transmission played a determining role in the development of the outbreak&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The initial source of the outbreak could have been a HCW who had acquired the infection in the community or&#44; more likely&#44; a patient who at admission was in the pre-symptomatic phase of the disease and still had a negative PCR&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">This study has a number of limitations&#46; The main limitation is that molecular typing of SARS-CoV-2 strains was not performed in all cases&#44; and it is possible that some of the infected HCWs may have acquired the infection outside the hospital&#46; Another limitation of the study is that air sampling of the ward where the outbreak occurred was not conducted to investigate the presence of SARS-CoV-2&#46; However&#44; it should be noted that when the outbreak was detected&#44; the defective extractor fans had already been repaired&#44; so there was little chance of detecting the presence of the virus in the ward air&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; with this study we report a nosocomial outbreak of SARS-CoV-2 infection whose characteristics make it very likely that airborne transmission contributed to the high attack rate observed in the affected ward&#46; Efforts for the prevention of nosocomial outbreaks should take into account the possible airborne dissemination of the virus&#44; and the importance of properly functioning ventilation systems and architectural design&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">This study has not received any public&#44; commercial or private sector funding&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection&#44; it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19&#46; The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020&#46; All cases were confirmed by a positive PCR test for SARS-CoV-2&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">From December 5 to December 17&#44; 21 patients and 44 healthcare workers &#40;HCWs&#41; developed a nosocomial SARS-CoV-2 infection&#46; Fifty-one of the 65 cases &#40;78&#46;5&#37;&#41; were diagnosed between December 6 and 9&#46; The attack rate in patients was 80&#46;8&#37;&#46; Among HCWs&#44; the attack rate was higher in those who had worked at least one full working day in the ward &#40;56&#46;3&#37;&#41; than in those who had occasionally been in the ward &#40;25&#46;8&#37;&#59; <span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;005&#41;&#46; Three days before the first positive case was detected&#44; two extractor fans were found to be defective&#44; affecting the ventilation of three rooms&#46; Sixteen cases were asymptomatic&#44; 48 cases had non-severe symptoms&#44; and 2 cases required admission to the intensive care unit&#46; All patients eventually recovered&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The high attack rate&#44; the explosive nature of the outbreak&#44; and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A pesar de los datos cada vez mayores que respaldan la importancia de la transmisi&#243;n a&#233;rea en la infecci&#243;n por el SARS-CoV-2&#44; en la inmensa mayor&#237;a de los brotes nosocomiales descritos de COVID-19 no se ha considerado relevante&#46; El objetivo de este estudio consiste en describir un brote nosocomial de infecci&#243;n por el SARS-CoV-2 cuyas caracter&#237;sticas indican que la transmisi&#243;n por aerosoles desempe&#241;&#243; un papel importante&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se trata de un an&#225;lisis descriptivo de un brote nosocomial de infecci&#243;n por el SARS-CoV-2 en una planta de Medicina Interna que tuvo lugar en diciembre de 2020&#46; Todos los casos se confirmaron mediante una PCR positiva para SARS-CoV-2&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Entre el 5 y el 17 de diciembre&#44; 21 pacientes y 44 profesionales sanitarios contrajeron una infecci&#243;n nosocomial por el SARS-CoV-2&#46; De los 65 casos&#44; 51 &#40;78&#44;5&#37;&#41; se diagnosticaron entre el 6 y el 9 de diciembre&#46; La tasa de ataque en los pacientes fue del 80&#44;8&#37;&#46; Entre los profesionales sanitarios&#44; la tasa de ataque fue mayor en los que hab&#237;an trabajado al menos una jornada laboral completa en la planta &#40;56&#44;3&#37;&#41; que en los que hab&#237;an estado ocasionalmente en ella &#40;25&#44;8&#37;&#59; p&#8239;&#61;&#8239;0&#44;005&#41;&#46; Tres d&#237;as antes de detectar el primer caso positivo se identific&#243; una aver&#237;a en dos extractores de aire&#44; que afect&#243; a la ventilaci&#243;n de tres habitaciones&#46; Diecis&#233;is casos cursaron de forma asintom&#225;tica&#44; 48 manifestaron s&#237;ntomas leves y 2 precisaron ingreso en la unidad de cuidados intensivos&#46; Todos los casos se recuperaron finalmente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La elevada tasa de ataque&#44; la naturaleza explosiva del brote y la coincidencia en el tiempo con la aver&#237;a de los extractores de aire en algunas habitaciones de la planta indican que la transmisi&#243;n a&#233;rea desempe&#241;&#243; un papel fundamental en el desarrollo del brote&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Andr&#233;s M&#44; Garc&#237;a M-C&#44; Fajardo A&#44; Grau L&#44; Pagespetit L&#44; Plasencia V&#44; et al&#46; Brote nosocomial de COVID-19 en una planta de medicina interna&#58; probable transmisi&#243;n a&#233;rea&#46; Rev Clin Esp&#46; 2022&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.rce.2022.04.001">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;rce&#46;2022&#46;04&#46;001</span></p>"
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          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1049
            "Ancho" => 2925
            "Tamanyo" => 372912
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hospitalization ward floor plan where the SARS-CoV-2 infection outbreak occurred&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PR&#58; patient room&#59; EE&#58; emergency exit&#59; NA&#58; nursing area&#59; MA&#58; medical area&#59; C&#58; corridor&#59; MR&#58; meeting room&#59; LO&#58; lobby&#59; RE&#58; room for explorations&#59; B&#58; bathroom&#59; S&#58; secretariat&#59; L&#58; lift&#46; V&#58; room with faulty ventilation&#59; Black dot&#58; rooms where bronchodilator therapy by nebulisation was carried out&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1458
            "Ancho" => 2500
            "Tamanyo" => 150063
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epi curve of confirmed cases of SARS-CoV-2 infection by date of PCR confirmation &#40;A&#41;&#44; and symptomatic cases by date of onset &#40;B&#41;&#44; for COVID-19 outbreak in a medical ward&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">HCW&#58; healthcare workers&#46;</p>"
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      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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            "detalle" => "Table "
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        "tabla" => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive PCR &#40;N&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Performed PCR &#40;N&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Attack rate &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Admitted during the outbreak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Discharged in the previous 5 days&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Permanent healthcare workers on the ward</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">a</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nurses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nurse assistants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doctors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medical students&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cleaning personnel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Administrative staff&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Occasional healthcare workers on the ward</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                        "paginaInicial" => "139"
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                          0 => array:2 [
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                    0 => array:2 [
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                  ]
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                    0 => array:2 [
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                            4 => "T&#46; Laurentius"
                            5 => "L&#46;C&#46; Bollheimer"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s42399-020-00597-2"
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                        "tituloSerie" => "SN Compr Clin Med"
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                        "volumen" => "26"
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                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nosocomial outbreak of COVID-19 by possible airborne transmission leading to a superspreading event"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "G&#46;K&#46; Siu"
                            3 => "S&#46;C&#46; Wong"
                            4 => "L&#46;S&#46; Cheng"
                            5 => "M&#46;S&#46; Wong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/ciab313"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "73"
                        "paginaInicial" => "e1356"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33851214"
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                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "SARS-CoV-2 infection among health care workers despite the use of surgical masks and physical distancing - the role of airborne transmission"
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                        0 => array:2 [
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                          "autores" => array:6 [
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                            2 => "N&#46; Marcus"
                            3 => "V&#46; Hoffer"
                            4 => "M&#46; Gafner"
                            5 => "S&#46; Hadas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ofid/ofab036"
                      "Revista" => array:3 [
                        "tituloSerie" => "Open Forum Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "It is time to address airborne transmission of COVID-19"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Morawska"
                            1 => "D&#46;K&#46; Milton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/ciaa939"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2020"
                        "volumen" => "71"
                        "paginaInicial" => "2311"
                        "paginaFinal" => "2313"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32628269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of airborne particles and environmental considerations in the transmission of SARS-CoV-2"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Shao"
                            1 => "S&#46; Ge"
                            2 => "T&#46; Jones"
                            3 => "M&#46; Santosh"
                            4 => "L&#46;F&#46;O&#46; Silva"
                            5 => "Y&#46; Cao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.gsf.2021.101189"
                      "Revista" => array:3 [
                        "tituloSerie" => "Geosci Front"
                        "fecha" => "2021"
                        "volumen" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ten scientific reasons in support of airborne transmission of SARS-CoV-2"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Greenhalgh"
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                            2 => "K&#46;A&#46; Prether"
                            3 => "Z&#46; Tufekci"
                            4 => "D&#46; Fisman"
                            5 => "R&#46; Schooley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(21)00869-2"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2021"
                        "volumen" => "397"
                        "paginaInicial" => "1603"
                        "paginaFinal" => "1605"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Liu"
                            1 => "Z&#46; Ning"
                            2 => "Y&#46; Chen"
                            3 => "M&#46; Guo"
                            4 => "Y&#46; Liu"
                            5 => "N&#46;K&#46; Gali"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41586-020-2271-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "2020"
                        "volumen" => "582"
                        "paginaInicial" => "557"
                        "paginaFinal" => "560"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32340022"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High SARS-CoV-2 attack rate following exposure at a choir practice &#8211; Skagit County&#44; Washington&#44; March 2020"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Hamner"
                            1 => "P&#46; Dubbel"
                            2 => "I&#46; Capron"
                            3 => "A&#46; Ross"
                            4 => "A&#46; Jordan"
                            5 => "J&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15585/mmwr.mm6919e6"
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Morb Mortal Wkly Rep"
                        "fecha" => "2020"
                        "volumen" => "69"
                        "paginaInicial" => "606"
                        "paginaFinal" => "610"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32407303"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community outbreak investigation of SARS-CoV-2 transmission among bus riders in Eastern China"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Shen"
                            1 => "C&#46; Li"
                            2 => "H&#46; Dong"
                            3 => "Z&#46; Wang"
                            4 => "L&#46; Martinez"
                            5 => "Z&#46; Sun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamainternmed.2020.5225"
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                        "tituloSerie" => "JAMA Intern Med"
                        "fecha" => "2020"
                        "volumen" => "180"
                        "paginaInicial" => "1665"
                        "paginaFinal" => "1671"
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                    ]
                  ]
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Original article
Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission
Brote nosocomial de COVID-19 en una planta de medicina interna: probable transmisión aérea
M. Andrésa,
Corresponding author
lagida@hotmail.com

Corresponding author.
, M.-C. Garcíaa, A. Fajardoa, L. Graub, L. Pagespetitb, V. Plasenciac, I. Martínezd, C. Abadíae, A. Sanahujaf, F. Bellaa
a Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
b Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
c Laboratorio de Microbiología, CATLAB, Viladecavalls (Barcelona), Spain
d Servicio de Prevención de Riesgos Laborales, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
e Servicio de Salud Laboral, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
f Departamento de Recursos Físicos, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain

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