Pittet Didier
Infection Control Program, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 4, Switzerland.
Am J Infect Control. 2005 Jun;33(5):258-67. doi: 10.1016/j.ajic.2004.11.004.
Health care-associated infection remains a major issue of patient safety. It complicates a significant proportion of patient care deliveries, adds to the burden of resource use, and contributes to unexpected deaths. Early infection control pioneers showed that surveillance and prevention programs can be successful and have set the scene for today's infection control activities. Parameters for success include those to recognize and explain health care-associated infections and implement interventions to decrease infection rates and limit antimicrobial resistance spread. Current major challenges facing infection control programs are reviewed with an emphasis on recent trends in health care delivery systems, together with some vision on future activities and interactions toward such changes. Benchmarking of infection rates is considered inevitable, and, thus, surveillance strategies, adapted to changing health care systems, should improve and emphasize intervention and standardization. Major challenges for the future include antimicrobial use and control of resistances, new materials, emerging pathogens, infection control issues related to transgenic therapy, massive and complete immunosuppression and xenotransplantation, prion diseases, use of fully computerized patient record and data-mining-derived epidemiology, development of evidence-based recommendations for infection control and prevention, addressing cost constraints and newly apparent health care system trends, and health care worker behavior modification.
医疗保健相关感染仍然是患者安全的一个主要问题。它使相当一部分患者护理工作变得复杂，增加了资源使用负担，并导致意外死亡。早期的感染控制先驱表明，监测和预防计划可以取得成功，并为当今的感染控制活动奠定了基础。成功的参数包括识别和解释医疗保健相关感染以及实施干预措施以降低感染率和限制抗菌药物耐药性传播的参数。本文回顾了感染控制计划目前面临的主要挑战，重点关注医疗保健提供系统的近期趋势，以及对未来针对此类变化的活动和互动的一些展望。感染率的基准比较被认为是不可避免的，因此，适应不断变化的医疗保健系统的监测策略应加以改进，并强调干预和标准化。未来的主要挑战包括抗菌药物的使用和耐药性控制、新材料、新出现的病原体、与转基因治疗相关的感染控制问题、大规模和完全免疫抑制及异种移植、朊病毒疾病、完全计算机化患者记录的使用和数据挖掘衍生的流行病学、制定基于证据的感染控制和预防建议、应对成本限制和新出现的医疗保健系统趋势，以及改变医护人员的行为。
