Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany.
J Hosp Infect. 2020 Mar;104(3):256-260. doi: 10.1016/j.jhin.2019.12.010.
One hundred years ago, many healthcare- associated infections (HAIs) had an exogenous origin, which means they were caused by micro-organisms from other patients, healthcare workers or the hospital environment. A smaller proportion was due to endogenous micro-organisms from the patients' own microbial flora. Meanwhile, many improvements have been achieved. The majority of devices used for diagnosing and treating the patients are now single- use items. The disinfection and sterilization measures used for reprocessing the remaining devices are on a very high safety level (at least in high-income countries) and cross- transmission via instruments is a very rare seldom event. Hand hygiene has also improved substantially. We have observed an increase in hand rub consumption of more than 100% during the last 12 years in Germany. For these measures the 'one size fits all approach' is appropriate because they have to be applied for all patients independent of their diseases and pathogens. Today, we see a small percentage of exogenous HAIs. The majority of HAI have an endogenous origin. Of course, it is still necessary to focus on basic or standard infection-control measures to prevent transmission of micro-organisms. However, the majority of HAIs have an endogenous origin now. Thus our measures should not only focus on preventing transmission of microorganisms, but also on prevention of infections. Therefore, a personalized infection prevention approach is now appropriate and examples will be presented.
一百年前，许多医院获得性感染（HAI）具有外源性来源，这意味着它们是由来自其他患者、医护人员或医院环境中的微生物引起的。较小比例的感染是由患者自身微生物区系中的内源性微生物引起的。同时，也取得了许多进展。现在，用于诊断和治疗患者的大多数设备都是一次性使用的。用于重新处理剩余设备的消毒和灭菌措施具有非常高的安全水平（至少在高收入国家），并且通过仪器进行的交叉传播是非常罕见的事件。手部卫生也有了显著改善。我们观察到，在过去 12 年中，德国的手部消毒剂消耗量增加了 100%以上。对于这些措施，“一刀切”的方法是合适的，因为它们必须应用于所有患者，而不取决于他们的疾病和病原体。如今，我们看到外源性 HAI 的比例很小。大多数 HAI 具有内源性来源。当然，仍然需要关注基本或标准的感染控制措施，以防止微生物的传播。然而，现在大多数 HAI 具有内源性来源。因此，我们的措施不仅应侧重于防止微生物的传播，还应侧重于预防感染。因此，现在适合采取个性化的感染预防方法，将举例说明。
