Fisher Ann, Dembry Louise M
aInternal Medicine Department, Section of Infectious Diseases, Yale University School of Medicine, New Haven bVA Connecticut Healthcare System, West Haven, Connecticut, USA.
Curr Opin Infect Dis. 2017 Aug;30(4):440-447. doi: 10.1097/QCO.0000000000000382.
Gastrointestinal outbreaks in the healthcare setting cause increased morbidity and mortality in an already vulnerable population. Optimization of infection prevention measures can be a challenge in healthcare settings. This review describes new literature that may change the traditional infection prevention approach to such outbreaks.
Asymptomatic carriers of both norovirus and Clostridium difficile can pose risk of transmission to others and the environment. Rapid recognition and diagnosis can decrease the extent of an outbreak. No-touch technologies for environmental disinfection are new and effective tools. Infection prevention consultant services and systems redesign can augment efforts to control baseline infection rates and outbreaks. Antimicrobial stewardship continues to be essential to prevent C. difficile infection.
New approaches are needed to stem the tide of norovirus and C. difficile clusters and outbreaks in healthcare settings. Accurate recognition, testing, and implementation of infection prevention measures can be supported with rapid testing modalities, access to updated guidelines and no-touch disinfection systems. The work-environment culture should be carefully assessed and restructured using human engineering models to promote effective infection prevention practices. Antimicrobial stewardship initiatives are needed at the bedside and at national levels.
医疗机构内的胃肠道疫情在本就脆弱的人群中会导致发病率和死亡率上升。在医疗机构中，优化感染预防措施可能是一项挑战。本综述介绍了可能改变此类疫情传统感染预防方法的新文献。
诺如病毒和艰难梭菌的无症状携带者都可能对他人和环境构成传播风险。快速识别和诊断可降低疫情的规模。用于环境消毒的非接触式技术是新型有效工具。感染预防顾问服务和系统重新设计可加强控制基线感染率和疫情的努力。抗菌药物管理对于预防艰难梭菌感染仍然至关重要。
需要新方法来遏制医疗机构中诺如病毒和艰难梭菌聚集性感染及疫情的浪潮。快速检测方式、获取最新指南和非接触式消毒系统可支持准确识别、检测和实施感染预防措施。应使用人体工程学模型仔细评估和重塑工作环境文化，以促进有效的感染预防措施。床边和国家层面都需要开展抗菌药物管理倡议。
