Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Crit Care Med. 2010 Apr;38(4 Suppl):e103-9. doi: 10.1097/CCM.0b013e3181c6697a.
The first hints of a global public health crisis emerged with the identification of a new strain of H1N1 influenza A in March and April 2009 in Mexico City. By June 11, the World Health Organization had declared the outbreak of 2009 H1N1 a global pandemic. Now, with the continued growing presence of 2009 H1N1 on the global scene, much attention has been focused on the key role of personal protective equipment in healthcare infection control. Much less emphasis has been placed on specific interventions that may minimize the increased infectious risk commonly associated with critical care delivery. Given the frequency of high-risk respiratory procedures such as intubation and delivery of aerosolized medications in the intensive care unit, the delivery of critical care presents unique infection control challenges and unique opportunities to augment usual infection control practice with specific source-control efforts. Here, we summarize data regarding risks to critical care healthcare workers from previous respiratory virus outbreaks, discuss findings from the early 2009 H1N1 experience that suggest reasons for increased concern for those delivering critical care, and review best available evidence regarding strategies for source control in respiratory and critical care delivery.
2009 年 H1N1 新型流感在墨西哥城出现后，全球公共卫生危机初现端倪。2009 年 6 月 11 日，世界卫生组织宣布，2009 年 H1N1 疫情已经成为全球性大流行。随着 2009 年 H1N1 流感继续在全球蔓延，人们越来越关注个人防护设备在医疗保健感染控制中的关键作用。然而，对于可能降低与重症监护相关的感染风险的具体干预措施，关注度则较低。由于在重症监护病房中经常进行高风险的呼吸程序，例如插管和雾化药物的输送，因此重症监护的提供带来了独特的感染控制挑战，并为通过特定的源头控制措施来增强常规感染控制实践提供了独特的机会。在这里，我们总结了先前呼吸道病毒暴发对重症监护医护人员的风险数据，讨论了 2009 年初 H1N1 经验中的发现，这些发现表明对提供重症监护的人员应更加关注，并回顾了有关呼吸和重症监护中源头控制策略的最佳现有证据。
