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医院获得性感染预防指南。

Guidelines for prevention of hospital acquired infections.

作者信息

Mehta Yatin, Gupta Abhinav, Todi Subhash, Myatra Sn, Samaddar D P, Patil Vijaya, Bhattacharya Pradip Kumar, Ramasubban Suresh

机构信息

Institute of Critical Care and Anesthesiology, Medanta- The Medicity, Gurgaon, India.

Critical Care, Medanta - The Medicity, Gurgaon, India.

出版信息

Indian J Crit Care Med. 2014 Mar;18(3):149-63. doi: 10.4103/0972-5229.128705.

Abstract

These guidelines, written for clinicians, contains evidence-based recommendations for the prevention of hospital acquired infections Hospital acquired infections are a major cause of mortality and morbidity and provide challenge to clinicians. Measures of infection control include identifying patients at risk of nosocomial infections, observing hand hygiene, following standard precautions to reduce transmission and strategies to reduce VAP, CR-BSI, CAUTI. Environmental factors and architectural lay out also need to be emphasized upon. Infection prevention in special subsets of patients - burns patients, include identifying sources of organism, identification of organisms, isolation if required, antibiotic prophylaxis to be used selectively, early removal of necrotic tissue, prevention of tetanus, early nutrition and surveillance. Immunodeficient and Transplant recipients are at a higher risk of opportunistic infections. The post tranplant timetable is divided into three time periods for determining risk of infections. Room ventilation, cleaning and decontamination, protective clothing with care regarding food requires special consideration. Monitoring and Surveillance are prioritized depending upon the needs. Designated infection control teams should supervise the process and help in collection and compilation of data. Antibiotic Stewardship Recommendations include constituting a team, close coordination between teams, audit, formulary restriction, de-escalation, optimizing dosing, active use of information technology among other measure. The recommendations in these guidelines are intended to support, and not replace, good clinical judgment. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of evidence supporting the recommendation, so that readers can ascertain how best to apply the recommendations in their practice environments.

摘要

这些为临床医生编写的指南包含了预防医院获得性感染的循证建议。医院获得性感染是导致死亡和发病的主要原因,给临床医生带来了挑战。感染控制措施包括识别有医院感染风险的患者、遵守手卫生规范、遵循标准预防措施以减少传播以及减少呼吸机相关性肺炎(VAP)、中心静脉导管相关血流感染(CR-BSI)、导尿管相关尿路感染(CAUTI)的策略。环境因素和建筑布局也需要加以强调。特殊患者群体(如烧伤患者)的感染预防包括识别病原体来源、鉴定病原体、必要时进行隔离、选择性使用抗生素预防、尽早清除坏死组织、预防破伤风、早期营养支持和监测。免疫缺陷患者和移植受者发生机会性感染的风险更高。移植后的时间表分为三个时间段以确定感染风险。房间通风、清洁和消毒、防护服以及与食物相关的注意事项都需要特别考虑。根据需求确定监测和监督的优先级。指定的感染控制团队应监督这一过程,并协助收集和整理数据。抗生素管理建议包括组建团队、团队之间密切协调、审核、药品处方限制、降阶梯治疗、优化给药剂量、积极使用信息技术等措施。这些指南中的建议旨在支持而非取代良好的临床判断。建议通过一个字母来评定,该字母表示建议的强度,以及一个罗马数字来表示支持该建议的证据质量,以便读者能够确定如何在其临床实践环境中最好地应用这些建议。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5193/3963198/7df5c99883f5/IJCCM-18-149-g001.jpg

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