Favero M S, Maynard J E, Leger R T, Graham D R, Dixon R E
Ann Intern Med. 1979 Dec;91(6):872-6. doi: 10.7326/0003-4819-91-6-872.
For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infective. It is now known that patients with hepatitis A do not pose a problem of disease transmission through direct contact with blood, and although blood of patients with hepatitis B may be infective, the virus is not transmitted via feces. The enteric route is the principal mode of transmission for hepatitis A, but maximal levels of hepatitis A virus excretion occur before the onset of jaundice. Non-A, non-B hepatitis is similar epidemiologically to hepatitis B. Thus, the major thrust for caring for patients hospitalized with viral hepatitis is toward blood precautions; the same precautions used when handling feces, urine, and excretions from all other hospitalized patients are appropriate for patients admitted with a diagnosis of hepatitis A.
多年来，因病毒性肝炎住院的患者一直被分为两类进行隔离——肠道隔离和血液隔离。这种策略是基于无法区分甲型肝炎和乙型肝炎，以及认为任何一种类型患者的粪便和血液都可能具有传染性这一假设。现在已知，甲型肝炎患者不会因直接接触血液而产生疾病传播问题，并且虽然乙型肝炎患者的血液可能具有传染性，但病毒不会通过粪便传播。肠道途径是甲型肝炎的主要传播方式，但甲型肝炎病毒排泄的最高水平出现在黄疸出现之前。非甲非乙型肝炎在流行病学上与乙型肝炎相似。因此，护理因病毒性肝炎住院患者的主要重点是采取血液隔离措施；处理所有其他住院患者的粪便、尿液和排泄物时所采用的相同预防措施适用于诊断为甲型肝炎的入院患者。
