Sehulster Lynne, Chinn Raymond Y W
Division of Healthcare Quality Promotion, National Center for Infectious Diseases.
MMWR Recomm Rep. 2003 Jun 6;52(RR-10):1-42.
The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.
除了在免疫功能低下的患者中，医疗保健机构环境很少与疾病传播相关。然而，意外接触环境病原体（如曲霉菌属和军团菌属）或空气传播病原体（如结核分枝杆菌和水痘-带状疱疹病毒）可导致患者出现不良后果，并使医护人员患病。环境感染控制策略和工程控制可有效预防这些感染。通过以下措施可将医疗保健相关感染和假性暴发的发生率降至最低：1）正确使用清洁剂和消毒剂；2）妥善维护医疗设备（如自动内镜清洗消毒机或水疗设备）；3）遵守血液透析的水质标准以及特殊护理环境（如空气传播感染隔离病房、防护性环境或手术室）的通风标准；4）及时处理设施内的水侵入问题。通常不建议进行常规环境采样，除非是在血液透析环境中进行水质测定以及在其他根据流行病学原则进行采样且结果可直接应用于感染控制决策的情况下。本报告回顾了以往预防医疗保健机构中与环境相关感染的指南和策略，并提出了建议。这些建议包括：1）有研究支持的循证建议；2）联邦机构（如食品药品监督管理局、美国环境保护局、美国劳工部职业安全与健康管理局以及美国司法部）的要求；3）建筑和设备专业组织（如美国建筑师协会、医疗仪器促进协会以及美国供热、制冷与空调工程师协会）的指南和标准；4）从科学理论或原理推导得出的建议；5）基于感染控制和工程实践的经验性意见。报告还提出了一系列绩效指标，作为评估感染控制工作的一种手段。
