基层医院呼吸道传播疾病的管理及预防控制

目的为了规范基层医院对呼吸道传播疾病各环节的管理和预防控制。方法采取医院感染预防控制措施,完善规章制度、加强感染科的建设、重点人群监测和管理、规范消毒隔离措施、重视人员防护、医疗废物的管理。结果呼吸道传染病患者在就诊过程中,能及时有效地控制疾病的传播,未发生院内的交叉感染,提高了医务人员医院感染知识。结论基层医院采取各项医院感染预防控制措施,对保障患者就诊安全和医务人员职业安全具有重要的意义。     

医院内HIV/AIDS管理与职业防护

目的加强人类免疫缺陷病毒（HIV）感染者和获得性免疫缺陷综合征（AIDS）医院感染管理，增强医务人员职业安全防护意识，防止HIV在医院范围内的传播。方法建立了HIV／AIDS监测报告管理制度，积极开展AIDS知识培训，认真做好医院内HIV初筛检测；严格医疗器械消毒灭菌与医疗废物管理，规范医疗护理操作程序和职业暴露后处理流程。结果医护人员对HIV／AIDS的防范意识明显增强，能及早发现患者，及时采取有效的防护和消毒隔离措施，HIV／AIDS患者平均确诊天数较以往明显缩短。结论加强医院内HIV／AIDS管理与监控，重视医务人员职业暴露安全教育，可有效地防止AIDS在医院内传播和减少医务人员职业暴露的发生。     

重症监护病房多药耐药鲍氏不动杆菌医院感染调查分析

目的 调查多药耐药鲍氏不动杆菌造成医院感染的原因及传播途径,探讨预防控制对策. 方法 对2008年10月重症监护病房(ICU)发生下呼吸道多药耐药鲍氏不动杆菌医院感染8例患者进行流行病学分析. 结果 ICU13 d内陆续发生8例患者下呼吸道多药耐药鲍氏不动杆菌医院感染,8例患者均有严重的基础疾病,7例患者使用呼吸机,2例患者下呼吸道标本中分离出同一克隆株的多药耐药鲍氏不动杆菌. 结论 ICU布局流程不合理、个别医务人员无菌观念淡薄、无菌操作执行不严格、手卫生落实不到位和使用呼吸机辅助通气、应用广谱抗菌药物等因素可能引起下呼吸道多药耐药鲍氏不动杆菌医院感染.     

综合性医院中呼吸道传染病医院感染的防控

呼吸道传染病疫惰已成为突出的公共卫生问题,综合性医院在呼吸道传染病防控中起着至关重要的作用。在患者就诊过程中及日寸采取医院感染防控的各项措施,对控制疾病播散、保障患者就诊安全和医务人员职业安全具有重要意义。综合性医院呼吸道传染病的医院感染防控措施应包括：完善的规章制度、各部门联防联控、加强感染性疾病科的软硬件建设、重点人群的监测与管理、正确的消毒隔离措施、重视人员防护和手卫生、医疗废物的规范管理。     

设置SARS病区缓冲间预防医院感染

根据目前国内外研究表明,严重急性呼吸综合征(SARS)具有传染性强、传播速度快、多途经传播、人群普遍易感、有医院和家庭聚集性发病现象、目前尚无特效药物治疗、尚无疫苗进行有效预防的特点.值得注意的是本次医务人员感染占相当比例[1].因此,医院在积极收治非典患者的同时,高度重视医院感染管理制度落实,做好预防医务人员医院内感染具有十分重要的现实意义.我院在实施SARS病区缓冲间工作制度,强化医院感染管理控制方面做了作了一些探索,取得满意效果,现报告如下.     

中国丙型病毒性肝炎医院感染防控指南

丙型病毒性肝炎是一种主要经血液传播的疾病,丙型病毒性肝炎病毒(HCV)慢性感染可导致肝脏慢性炎症坏死及纤维化,部分患者可发展为肝硬化甚至肝细胞癌(HCC),对患者的健康和生命危害极大,已成为严重的社会和公共卫生问题.由于丙型病毒性肝炎患者症状隐匿,我国HCV感染的诊断率及抗病毒治疗率均较低,因此,在人群中存在较多的隐匿传染源.隐匿性传染源的广泛存在使HCV的院内传播成为HCV传播的途径之一,明显增加医务人员的暴露风险.为了切断HCV在医院内的传播途径,降低丙型病毒性肝炎的发病率,进一步加强对患者和医务人员的保护,中华医学会医院感染控制分会组织有关专家制定了该指南,供相关人员参考.     

一起护理带状疱疹患者所致医务人员水痘暴发的调查与处理

目的明确一起护理带状疱疹患者所致医务人员水痘暴发事件的流行病学特征,为水痘和带状疱疹的医院感染防控提供依据。方法对山东省烟台市某三级医院2018年12月重症监护病房(ICU)内临床诊断为水痘的医务人员进行流行病学调查,分析流行病学特征及发病原因。结果 2018年12月17—19日,该院ICU共报告4名医务人员罹患水痘,其中有3名护士、1名护工,潜伏期内均看护过2床的带状疱疹患者,且距发病最长潜伏期内未接触过其他水痘和(或)发热出疹病例,判断为一起护理带状疱疹引起的医务人员医院感染暴发事件,通过积极采取隔离、接种疫苗、培训等措施,处置及时,未出现后续病例。结论带状疱疹患者作为水痘的传染源不容忽视,治疗护理时严格执行空气隔离、接触隔离、标准预防等措施,可有效防控水痘-带状疱疹病毒医院感染的发生。     

医院感染现患率调查分析

目的了解我院医院感染现患情况,进一步提高全院医务人员的医院感染控制意识,评价医院感染控制工作。结果调查住院患者329人,医院感染现患率为3·6%;综合重症监护室现患率25·0%;下呼吸道感染占33·3%;抗生素使用率53·7%;神经内、外科病种、神志不清、气管切开、尿道插管等是医院感染的高危因素。结论神经内、外科系统为感染高发科室,加强对有较严重基础疾病患者的监控,合理使用抗生素对降低医院感染率,减轻患者经济负担有着重要意义。     

一起护理带状疱疹患者所致医务人员水痘暴发的调查与处理

目的 明确一起护理带状疱疹患者所致医务人员水痘暴发事件的流行病学特征，为水痘和带状疱疹的医院感染防控提供依据。方法 对山东省烟台市某三级医院2018年12月重症监护病房（ICU）内临床诊断为水痘的医务人员进行流行病学调查，分析流行病学特征及发病原因。结果 2018年12月17-19日，该院ICU共报告4名医务人员罹患水痘，其中有3名护士、1名护工，潜伏期内均看护过2床的带状疱疹患者，且距发病最长潜伏期内未接触过其他水痘和（或）发热出疹病例，判断为一起护理带状疱疹引起的医务人员医院感染暴发事件，通过积极采取隔离、接种疫苗、培训等措施，处置及时，未出现后续病例。结论 带状疱疹患者作为水痘的传染源不容忽视，治疗护理时严格执行空气隔离、接触隔离、标准预防等措施，可有效防控水痘-带状疱疹病毒医院感染的发生。     

麻醉相关因素与下呼吸道医院感染的研究

目的探讨气管插管全身麻醉患者院内下呼吸道感染的相关因素和有效的预防措施。方法从麻醉机回路内、病毒/细菌过滤器和气管插管全身麻醉患者口腔和支气管内吸取的分泌物做细菌培养。结果术前采样的15台未消毒的麻醉机中有8台细菌培养呈阳性;每例患者术中口腔、支气管分泌物及术后病毒/细菌过滤器均分离出相同细菌;使用一次性病毒/细菌过滤器的病例,术后从麻醉机内和一次性病毒/细菌过滤器麻醉机采样未捡出细菌;未使用一次性病毒/细菌过滤器的病例,术后麻醉机内可分离出与口腔相同的细菌。结论研究结果提示麻醉机很易受到手术患者的污染,而麻醉机的循环使用可将病原菌传播到下一个手术患者,是导致气管插管全身麻醉患者手术后下呼吸道医院感染的重要因素。     

Hepatitis C virus: an important occupational hazard?

Infection with Hepatitis C virus (HCV) is estimated to affect 3% of the world's population and is an important cause of liver disease. It is most commonly transmitted by percutaneous exposure. Although current evidence does not suggest an increased prevalence of HCV infection among healthcare workers, transmission of infection following occupational exposure has been demonstrated. An average transmission rate of 1.8%, following percutaneous injury, has been reported. The risk of transmission is higher from patients with viraemia, as measured by a positive polymerase chain reaction for HCV RNA. After exposure to HCV, healthcare workers should be actively followed up, initially using a test to detect viral RNA. This may facilitate earlier diagnosis and treatment. Recent reports in the UK, of transmission of infection to patients from HCV infected healthcare workers, have prompted a review of the appropriateness of HCV infected individuals undertaking exposure prone procedures.     

Lack of SARS transmission among healthcare workers, United States

Healthcare workers accounted for a large proportion of persons with severe acute respiratory syndrome (SARS) during the worldwide epidemic of early 2003. We conducted an investigation of healthcare workers exposed to laboratory-confirmed SARS patients in the United States to evaluate infection-control practices and possible SARS-associated coronavirus (SARS-CoV) transmission. We identified 110 healthcare workers with exposure within droplet range (i.e., 3 feet) to six SARS-CoV-positive patients. Forty-five healthcare workers had exposure without any mask use, 72 had exposure without eye protection, and 40 reported direct skin-to-skin contact. Potential droplet- and aerosol-generating procedures were infrequent: 5% of healthcare workers manipulated a patient's airway, and 4% administered aerosolized medication. Despite numerous unprotected exposures, there was no serologic evidence of healthcare-related SARS-CoV transmission. Lack of transmission in the United States may be related to the relative absence of high-risk procedures or patients, factors that may place healthcare workers at higher risk for infection.     

Occupational risk factors in Parkinson's disease

BACKGROUND: An apparent excess of teachers and healthcare workers among the Parkinson's disease patients of a large tertiary care movement disorders clinic suggested the hypothesis that high exposure to viral (or other) respiratory infections in these occupations might be a risk factor for Parkinson's disease. METHODS: A case-control study of the association between occupation and Parkinson's disease was conducted. Cases (414) were all Parkinson's disease patients seen at the University of British Columbia Hospital Movement Disorders Clinic between 1986 and 1993, residing in Greater Vancouver, and under 65 in 1991. Controls (6,659) were randomly selected from the 1991 Canadian Census. FINDINGS: Parkinson's disease was associated with teaching (OR 2.50, 95% CI 1.67-3.74) and occupation in healthcare services (OR 2.07, 95% CI 1.34-3.20), but there were several other substantial associations, both positive and negative. INTERPRETATION: While referral bias cannot be ruled out, the authors find the consistency of the overall pattern of associations with the respiratory infection hypothesis striking.     

Transmission of Middle East Respiratory Syndrome Coronavirus Infections in Healthcare Settings,Abu Dhabi

Middle East respiratory syndrome coronavirus (MERS-CoV) infections sharply increased in the Arabian Peninsula during spring 2014. In Abu Dhabi, United Arab Emirates, these infections occurred primarily among healthcare workers and patients. To identify and describe epidemiologic and clinical characteristics of persons with healthcare-associated infection, we reviewed laboratory-confirmed MERS-CoV cases reported to the Health Authority of Abu Dhabi during January 1, 2013–May 9, 2014. Of 65 case-patients identified with MERS-CoV infection, 27 (42%) had healthcare-associated cases. Epidemiologic and genetic sequencing findings suggest that 3 healthcare clusters of MERS-CoV infection occurred, including 1 that resulted in 20 infected persons in 1 hospital. MERS-CoV in healthcare settings spread predominantly before MERS-CoV infection was diagnosed, underscoring the importance of increasing awareness and infection control measures at first points of entry to healthcare facilities.     

Hepatitis B virus, hepatitis C virus and other blood-borne infections in healthcare workers: guidelines for prevention and management in industrialised countries

The Viral Hepatitis Prevention Board (VHPB) convened a meeting of international experts from the public and private sectors in order to review and evaluate the epidemiology of blood-borne infections in healthcare workers, to evaluate the transmission of hepatitis B and C viruses as an occupational risk, to discuss primary and secondary prevention measures and to review recommendations for infected healthcare workers and (para)medical students. This VHPB meeting outlined a number of recommendations for the prevention and control of viral hepatitis in the following domains: application of standard precautions, panels for counselling infected healthcare workers and patients, hepatitis B vaccination, restrictions on the practice of exposure-prone procedures by infected healthcare workers, ethical and legal issues, assessment of risk and costs, priority setting by individual countries and the role of the VHPB. Participants also identified a number of terms that need harmonization or standardisation in order to facilitate communication between experts.     

Possible SARS coronavirus transmission during cardiopulmonary resuscitation

Infection of healthcare workers with the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) is thought to occur primarily by either contact or large respiratory droplet transmission. However, infrequent healthcare worker infections occurred despite the use of contact and droplet precautions, particularly during certain aerosol-generating medical procedures. We investigated a possible cluster of SARS-CoV infections in healthcare workers who used contact and droplet precautions during attempted cardiopulmonary resuscitation of a SARS patient. Unlike previously reported instances of transmission during aerosol-generating procedures, the index case-patient was unresponsive, and the intubation procedure was performed quickly and without difficulty. However, before intubation, the patient was ventilated with a bag-valve-mask that may have contributed to aerosolization of SARS-CoV. On the basis of the results of this investigation and previous reports of SARS transmission during aerosol-generating procedures, a systematic approach to the problem is outlined, including the use of the following: 1) administrative controls, 2) environmental engineering controls, 3) personal protective equipment, and 4) quality control.     

Anti-SARS-CoV immunoglobulin G in healthcare workers, Guangzhou, China

To determine the prevalence of inapparent infection with severe acute respiratory syndrome (SARS) among healthcare workers, we performed a serosurvey to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1,147 healthcare workers in 3 hospitals that admitted SARS patients in mid-May 2003. Among them were 90 healthcare workers with SARS. As a reference group, 709 healthcare workers who worked in 2 hospitals that never admitted any SARS patients were similarly tested. The seroprevalence rate was 88.9% (80/90) for healthcare workers with SARS and 1.4% (15/1,057) for healthcare workers who were apparently healthy. The seroprevalence in the reference group was 0.4% (3/709). These findings suggest that inapparent infection is uncommon. Low level of immunity among unaffected healthcare workers reinforces the need for adequate personal protection and other infection control measures in hospitals to prevent future epidemics.     

Epidemiology of community-acquired methicillin-resistant Staphylococcus aureus skin infections among healthcare workers in an outpatient clinic.

We describe an investigation of soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains in 2 healthcare workers employed in an outpatient clinic for patients with human immunodeficiency virus infection. Cultures of environmental samples from multiple surfaces in the clinic grew toxin-producing CA-MRSA strains, suggesting fomites may play a role in the transmission of these strains of MRSA.     

SARS in hospital emergency room

Thirty-one cases of severe acute respiratory syndrome (SARS) occurred after exposure in the emergency room at the National Taiwan University Hospital. The index patient was linked to an outbreak at a nearby municipal hospital. Three clusters were identified over a 3-week period. The first cluster (5 patients) and the second cluster (14 patients) occurred among patients, family members, and nursing aids. The third cluster (12 patients) occurred exclusively among healthcare workers. Six healthcare workers had close contact with SARS patients. Six others, with different working patterns, indicated that they did not have contact with a SARS patient. Environmental surveys found 9 of 119 samples of inanimate objects to be positive for SARS coronavirus RNA. These observations indicate that although transmission by direct contact with known SARS patients was responsible for most cases, environmental contamination with the SARS coronavirus may have lead to infection among healthcare workers without documented contact with known hospitalized SARS patients.     

SARS in healthcare facilities, Toronto and Taiwan

The healthcare setting was important in the early spread of severe acute respiratory syndrome (SARS) in both Toronto and Taiwan. Healthcare workers, patients, and visitors were at increased risk for infection. Nonetheless, the ability of individual SARS patients to transmit disease was quite variable. Unrecognized SARS case-patients were a primary source of transmission, and early detection and intervention were important to limit spread. Strict adherence to infection control precautions was essential in containing outbreaks. In addition, grouping patients into cohorts and limiting access to SARS patients minimized exposure opportunities. Given the difficulty in implementing several of these measures, control measures were frequently adapted to the acuity of SARS care and level of transmission within facilities. Although these conclusions are based only on a retrospective analysis of events, applying the experiences of Toronto and Taiwan to SARS preparedness planning efforts will likely minimize future transmission within healthcare facilities.