Healthc Hazard Mater Manage. 1994 Mar;7(6):6-8.
The effective control of ambient biohazards is clearly a team effort. This team includes the EM, the risk manager, the infection control practitioner, purchasing, facilities management, and others. Control measures relate to many different risk factors, such as the environment at the healthcare facility, the healthcare personnel, the procedure, the use of certain devices, or the actual infection host (patient). Usually, only environment-related risk factors are of concern to the EM. For fungal infections, such as Aspergillus, CDC recommends that control of environmental risk factors requires routine maintenance of hospital air-handling systems and the rooms of immunosuppressed patients, as well as extra protection designs when there is new construction. This can be very costly. For Legionella infections, CDC recommends proper design, placement, and maintenance of cooling towers; routine maintenance of water-supply systems; and when contaminated water supplies are identified, appropriate decontamination. CHEM believes that the CDC recommendations are a good way to control these ambient biohazards, but is concerned about some of the costs to meet all the Aspergillus recommendations. Hospitals must weigh costs before proceeding, especially with Category II recommendations that are only "suggested for ... many hospitals." For example, at facilities with no cases of infection, if following the CDC recommendations means that filters need to be changed and ducts cleaned more frequently than usual, the costs may not be worth it. On the other hand, if there have been a series of confirmed cases of nosocomial Aspergillus pneumonia, the cost of HVAC retrofitting or using a portable HEPA filtration systems may be worth it.(ABSTRACT TRUNCATED AT 250 WORDS)
有效控制环境生物危害显然需要团队协作。这个团队包括急诊医学专家、风险经理、感染控制从业人员、采购人员、设施管理人员等。控制措施涉及许多不同的风险因素，如医疗机构的环境、医护人员、操作流程、某些设备的使用或实际感染源（患者）。通常，急诊医学专家只关注与环境相关的风险因素。对于真菌感染，如曲霉菌感染，美国疾病控制与预防中心（CDC）建议，控制环境风险因素需要对医院空气处理系统和免疫抑制患者的病房进行日常维护，以及在新建建筑时采用额外的防护设计。这可能成本很高。对于军团菌感染，CDC建议对冷却塔进行合理设计、放置和维护；对供水系统进行日常维护；当发现供水受污染时，进行适当的去污处理。化学危害工程管理（CHEM）认为，CDC的建议是控制这些环境生物危害的好方法，但担心满足所有曲霉菌相关建议的一些成本。医院在采取行动之前必须权衡成本，特别是对于那些只是“建议许多医院……”的二级建议。例如，在没有感染病例的设施中，如果遵循CDC的建议意味着需要比平时更频繁地更换过滤器和清洁管道，那么成本可能不值得。另一方面，如果已经出现一系列确诊的医院内曲霉菌肺炎病例，那么暖通空调系统改造或使用便携式高效空气过滤器系统的成本可能是值得的。（摘要截选至250字）
