Loftus Randy W
Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Curr Opin Anaesthesiol. 2016 Apr;29(2):192-7. doi: 10.1097/ACO.0000000000000300.
Healthcare-associated infections (HCAIs) are driven by a complex interplay between host defenses, pathogen traits, and pathogen transmission. A better understanding of each of these factors is required to extend infection control beyond antibiotic therapy to improvements in basic preventive measures that can achieve sustained HCAI reductions. The purpose of this article is to review recent advancements in our understanding of these issues for the operating room environment.
The importance and implications of intraoperative bacterial transmission have been solidified, and hyper transmissible, virulent, and antibiotic resistant bacterial strains have been characterized. As a result, a best practice for improved intraoperative infection control has been delineated. Little advancement has been made in our understanding of the efficacy of higher inspired oxygen concentrations, improved postoperative glucose control, perioperative normothermia, and prophylactic antibiotic selection, timing, and dose for HCAI prevention.
Recent work has led to the development of evidence-based hand hygiene, environmental cleaning, patient decolonization, and intravascular catheter design and handling improvement strategies. Evidence suggests that a best practice for postoperative infection control is a multimodal program that utilizes these interventions to target patient, provider, and environmental reservoirs in parallel. The development of novel diagnostic tools for targeted attenuation of hyper virulent, transmissible and resistant strains/strain characteristics is indicated to improve patient decolonization efforts.
医疗保健相关感染（HCAIs）是由宿主防御、病原体特征和病原体传播之间复杂的相互作用所驱动的。为了将感染控制从抗生素治疗扩展到改善基本预防措施，以实现持续降低HCAIs，需要更好地理解这些因素中的每一个。本文的目的是综述我们对手术室环境中这些问题的最新认识进展。
术中细菌传播的重要性和影响已得到明确，并且已经对高传播性、毒性强和耐药的细菌菌株进行了特征描述。因此，已经勾勒出了改善术中感染控制的最佳实践。在我们对提高吸入氧浓度、改善术后血糖控制、围手术期正常体温以及预防性抗生素的选择、时机和剂量对预防HCAIs的效果的理解方面进展甚微。
最近的工作促成了基于证据的手部卫生、环境清洁、患者去定植以及血管内导管设计和处理改进策略的发展。有证据表明，术后感染控制的最佳实践是一个多模式计划，该计划利用这些干预措施同时针对患者、医护人员和环境中的感染源。开发用于针对性减弱高毒力、可传播和耐药菌株/菌株特征的新型诊断工具，对于改善患者去定植工作具有重要意义。
