Sepkowitz K A
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Ann Intern Med. 1996 Dec 1;125(11):917-28. doi: 10.7326/0003-4819-125-11-199612010-00008.
Health care workers are at occupational risk for a vast array of infections that cause substantial illness and occasional deaths. Despite this, few studies have examined the incidence, prevalence, or exposure-associated rates of infection or have considered infection-specific interventions recommended to maintain worker safety.
To characterize the type and frequency of infections, the recommended interventions, and the costs of protecting health care workers. Part II of this two-part review focuses on infections caused by bloodborne organisms, organisms spread through the oral-fecal route, and organisms spread through direct contact. It also reviews established interventions for controlling transmission.
A MEDLINE search and examination of infectious disease and infection control journals.
All English-language articles and meeting abstracts published from January 1983 to February 1996 related to occupationally acquired infections among health care workers were reviewed. Outbreak- and non-outbreak-associated incidence and prevalence rates were derived, as were costs to prevent, control, and treat infections in health care workers.
Occupational transmission to health care workers was identified for numerous diseases, including infections caused by bloodborne organisms (human immunodeficiency virus, hepatitis B virus, hepatitis C virus, Ebola virus), organisms spread through the oral-fecal route (salmonella, hepatitis A virus), and organisms spread through direct contact (herpes simplex virus, Sarcoptes scabiei). Most outbreak-associated attack rates range from 15% to 40%. Occupational transmission is usually associated with violation of one or more of three basic principles of infection control: handwashing, vaccination of health care workers, and prompt placement of infectious patients into appropriate isolation.
The risk for occupationally acquired infections is an unavoidable part of daily patient care. Occupationally acquired infections cause substantial illness and occasional death among health care workers. Further studies are needed to enhance compliance with established infection control approaches. As health care is being reformed, the risk for and costs of occupationally acquired infection must be considered.
医护人员面临着感染大量疾病的职业风险，这些感染会导致严重疾病甚至偶尔造成死亡。尽管如此，很少有研究调查感染的发病率、患病率或与暴露相关的感染率，也很少考虑为维护工作人员安全而推荐的针对特定感染的干预措施。
描述感染的类型和频率、推荐的干预措施以及保护医护人员的成本。本两部分综述的第二部分重点关注由血源性病原体、经口粪途径传播的病原体以及通过直接接触传播的病原体引起的感染。它还回顾了已确立的控制传播的干预措施。
对MEDLINE进行检索，并查阅传染病和感染控制期刊。
对1983年1月至1996年2月发表的所有与医护人员职业获得性感染相关的英文文章和会议摘要进行了综述。得出了与暴发和非暴发相关的发病率和患病率，以及预防、控制和治疗医护人员感染的成本。
已确定多种疾病可通过职业途径传播给医护人员，包括由血源性病原体（人类免疫缺陷病毒、乙型肝炎病毒、丙型肝炎病毒、埃博拉病毒）、经口粪途径传播的病原体（沙门氏菌、甲型肝炎病毒）以及通过直接接触传播的病原体（单纯疱疹病毒、疥螨）引起的感染。大多数与暴发相关的感染率在15%至40%之间。职业传播通常与违反感染控制的三个基本原则中的一项或多项有关：洗手、医护人员接种疫苗以及及时将感染患者安置到适当的隔离环境中。
职业获得性感染的风险是日常患者护理中不可避免的一部分。职业获得性感染在医护人员中会导致严重疾病甚至偶尔造成死亡。需要进一步研究以提高对既定感染控制方法的依从性。随着医疗保健改革的推进，必须考虑职业获得性感染的风险和成本。
