Daugherty Elizabeth L
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E Monument Street, 5th Floor, Baltimore, MD 21205, USA.
Respir Care. 2008 Feb;53(2):201-12; discussion 212-14.
Maintenance of a safe and stable health care infrastructure is critical to an effective mass casualty disaster response. Both secondary contamination during chemical disasters and hospital-associated infections during epidemic illness can pose substantial threats to achieving this goal. Understanding basic principles of decontamination and infection control during responses to chemical and biologic disasters can help minimize the risks to patients and health care workers. Effective decontamination following toxic chemical exposure should include both removal of contaminated clothing and decontamination of the victim's skin. Wet decontamination is the most feasible strategy in a mass casualty situation and should be performed promptly by trained personnel. In the event of an epidemic, infection prevention and control measures are based on essential principles of hand hygiene and standard precautions. Expanded precautions should be instituted as needed to target contact, droplet, and airborne routes of infectious disease transmission. Specific equipment and measures for critical care delivery may serve to decrease risk to health care workers in the event of an epidemic. Their use should be considered in developing comprehensive disaster response plans.
维持安全稳定的医疗保健基础设施对于有效应对大规模伤亡灾难至关重要。化学灾难期间的二次污染以及流行疾病期间的医院相关感染都可能对实现这一目标构成重大威胁。了解在应对化学和生物灾难时的去污和感染控制基本原则有助于将对患者和医护人员的风险降至最低。有毒化学物质暴露后的有效去污应包括去除受污染的衣物以及对受害者皮肤进行去污。湿式去污是大规模伤亡情况下最可行的策略，应由经过培训的人员及时进行。在发生疫情时，感染预防和控制措施基于手部卫生和标准预防措施的基本原则。应根据需要采取扩大预防措施，以针对传染病传播的接触、飞沫和气溶胶传播途径。在发生疫情时，重症护理的特定设备和措施可能有助于降低医护人员的风险。在制定全面的灾难应对计划时应考虑使用这些设备和措施。
