Rothman Richard E, Irvin Charlene B, Moran Gregory J, Sauer Lauren, Bradshaw Ylisabyth S, Fry Robert B, Josephine Elaine B, Ledyard Holly K, Hirshon Jon Mark
Department of Emergency Medicine, The Johns Hopkins University, Baltimore, MD 21209, USA.
J Emerg Nurs. 2007 Apr;33(2):119-34. doi: 10.1016/j.jen.2007.01.013.
The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients. Threat of contagion exists not only for ED patients but also for visitors, health care workers, and inpatient populations. Potential physical sites for respiratory disease transmission extend from out-of-hospital care, to triage, waiting room, ED treatment area, and the hospital at large. This article presents a summary of the most current information available in the literature about respiratory hygiene in the ED, including administrative, patient, and legal issues. Wherever possible, specific recommendations and references to practical information from the Centers for Disease Control and Prevention are provided. The "Administrative Issues" section describes coordination with public health departments, procedures for effective facility planning, and measures for health care worker protection (education, staffing optimization, and vaccination). The patient care section addresses the potentially infected ED patient, including emergency medical services concerns, triage planning, and patient transport. "Legal Issues" discusses the interplay between public safety and patient privacy. Emergency physicians play a critical role in early identification, treatment, and containment of potentially lethal respiratory pathogens. This brief synopsis should help clinicians and administrators understand, develop, and implement appropriate policies and procedures to address respiratory hygiene in the ED.
急诊科是控制急性呼吸道感染威胁的公共卫生应对计划的重要组成部分。在急诊科实施有效的呼吸道卫生措施对于限制危险呼吸道病原体的传播至关重要，这些病原体包括流感、严重急性呼吸综合征、禽流感和生物恐怖主义制剂，特别是考虑到这些病原体可能无法立即识别。由于患者拥挤、人员配备和资源不足以及免疫功能低下患者数量不断增加，在急诊科维持有效的呼吸道控制措施尤其具有挑战性。传染风险不仅存在于急诊科患者中，也存在于访客、医护人员和住院患者中。呼吸道疾病传播的潜在物理场所从院外护理延伸到分诊、候诊室、急诊科治疗区域以及整个医院。本文总结了文献中有关急诊科呼吸道卫生的最新信息，包括行政、患者和法律问题。只要有可能，就会提供具体建议以及对疾病控制与预防中心实用信息的参考。“行政问题”部分描述了与公共卫生部门的协调、有效的设施规划程序以及医护人员保护措施（教育、人员配备优化和疫苗接种）。患者护理部分涉及可能感染的急诊科患者，包括紧急医疗服务问题、分诊规划和患者转运。“法律问题”讨论了公共安全与患者隐私之间的相互作用。急诊医生在潜在致命呼吸道病原体的早期识别、治疗和控制中发挥着关键作用。这篇简要概述应有助于临床医生和管理人员理解、制定和实施适当的政策和程序，以解决急诊科的呼吸道卫生问题。
