Krause P J, Gross P A, Barrett T L, Dellinger E P, Martone W J, McGowan J E, Sweet R L, Wenzel R P
University of Connecticut School of Medicine, Farmington.
Infect Control Hosp Epidemiol. 1994 Mar;15(3):193-9. doi: 10.1086/646889.
The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all health care workers who lack immunity to measles. Although the primary emphasis is on health care workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the standard.
We considered advocating the use of measles vaccine rather than MMR but chose the latter because it also protects against mumps and rubella and because it is more readily available.
The desired outcome is a reduction in the nosocomial transmission of measles.
Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune health care workers is not universal, whereas such outbreaks have not been reported in institutions with universal immunization. VALUES AND VALIDATION: We consulted more than 50 infectious-disease experts in epidemiology, government, medicine, nursing, obstetrics and gynecology, pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a consensus.
BENEFITS, HARMS, AND COSTS: The consequences of the transmission of measles (and of mumps and rubella) in a health care institution include not only the morbidity and mortality attributable to the disease, but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to health care workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccines should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should entail no expense to health care workers; the precise cost to institutions is unknown, but the expense would be mitigated by prevention of measles outbreaks.
We recommend MMR vaccination of all health care workers who lack immunity to measles.
The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.
本质量标准的目的是通过确保所有对麻疹无免疫力的医护人员普遍接种麻疹-腮腺炎-风疹（MMR）疫苗，预防医院内麻疹传播。虽然主要重点是医院的医护人员，但其他场所（如诊所、疗养院和学校）的人员也包括在内。这些机构的指定人员将负责执行该标准。
我们曾考虑提倡使用麻疹疫苗而非MMR疫苗，但选择了后者，因为它还能预防腮腺炎和风疹，且更易于获取。
期望的结果是减少医院内麻疹传播。
虽然缺乏直接的对比研究，但在未对无免疫力的医护人员普遍进行麻疹免疫接种的机构中，曾有医院内麻疹暴发的报道（最近的一次是在1992年），而在普遍接种疫苗的机构中未报告此类暴发。
我们咨询了50多位传染病领域的专家，涵盖流行病学、政府部门、医学、护理、妇产科、儿科和外科等领域。鉴于在标准实施方面存在分歧，我们通过小组讨论达成了共识。
益处、危害与成本：医疗机构中麻疹（以及腮腺炎和风疹）传播的后果不仅包括该疾病导致的发病和死亡，还包括评估和控制疫情的巨大成本以及采取控制措施时对医院常规工作的严重干扰。实施该标准后，对医护人员的潜在危害包括MMR疫苗的不良反应，不过只要遵循推荐的接种程序，疫苗反应应极小。该标准的实施对医护人员不应产生费用；各机构的确切成本尚不清楚，但预防麻疹暴发可减轻费用负担。
我们建议对所有对麻疹无免疫力的医护人员接种MMR疫苗。
美国传染病学会（IDSA）临床事务委员会质量标准小组委员会制定了该标准。该小组委员会由IDSA的代表（格罗斯博士和麦高恩博士）、美国医院流行病学学会（温泽尔博士）、外科感染学会（德林杰博士）、儿科传染病学会（克劳斯博士）、疾病控制与预防中心（马托内博士）、妇产科传染病学会（斯威特博士）以及感染控制从业者协会（巴雷特女士）组成。资金由IDSA和其他合作组织提供。该标准得到了IDSA的认可。
