医院获得性感染的预防：更新指南

医院获得性感染的预防：更新指南 2014年12月21日 ⁄ 指南导读, Prevention of Healthcare-Associated Infections: Updated Guidance

Laura A. Stokowski, RN, MS Reviewed by: Deborah S. Yokoe, MD, MPH December 10, 2014

From MEDSCAPE website

2008年，美国健康卫生流行病学会(Society for Healthcare Epidemiology of America, SHEA)与其合作者美国感染性疾病学会，美国医院协会，感染控制和流行病学专业协会以及联合委员会共同发布了有关预防医院获得性感染(HAI)循证策略的综合概要。2014年，对这一概要进行了更新，以反映HAI预防领域的最新证据。

In 2008, the Society for Healthcare Epidemiology of America (SHEA) published a comprehensive compendium of evidence-based strategies to prevent healthcare-associated infections (HAIs) with its partners, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and the Joint Commission.[1] In 2014, this compendium was updated to reflect new evidence in the field of HAI prevention.[2]

本套幻灯片总结了有关预防HAI的基本和最新策略的推荐意见，为一线医疗工作者(HCP)提供参考。全部概要针对各种HAI分为不同章节，并有单独一章讨论手卫生。

This slideshow provides the highlights of recommended basic and advanced strategies to prevent HAIs, and are aimed at frontline healthcare personnel (HCP). The complete compendium, divided into separate chapters on each HAI with an additional chapter on hand hygiene, is available here.

概要全文涉及预防策略、行为指标、监测、报告、实施策略、干预实例的细节，以及不予推荐的措施。

Full-text chapters provide further details on prevention strategies, performance measures, surveillance, reporting, implementation strategies, and examples of interventions and approaches that are not recommended.

Images from CDC/Alamy/Science Source

导管相关性泌尿系感染 Catheter-Associated Urinary Tract Infection (CAUTI) CAUTI最主要的危险因素是尿管(UC)留置时间。为减少UC过度应用： The chief risk factor for CAUTI is the duration that a urinary catheter (UC) remains in situ. To reduce overuse of UCs:

 明确本单位使用UC的适应症

 Develop facility indications for use of UCs;

 教育HCP有关替代UC的其他措施；以及

 Educate HCP about alternatives to UCs; and

 仅在必要时置入UC，且仅当有适应症时继续保留

 Insert UCs only when necessary, and leave in only as long as indications remain. Read SHEA's 2014 CAUTI prevention update. Image from Dreamstime

CAUTI的预防 CAUTI Prevention 基本措施 The basics:

 采用严格无菌操作技术，使用无菌物品（手套，隔离衣，海绵，消毒剂，润滑剂）

 Use strict aseptic insertion technique with sterile supplies (gloves, drapes, sponges,

disinfectant, lubricant);  采用无菌密闭引流系统

 Maintain a sterile closed drainage system;

 固定UC及管路防止牵拉

 Secure UC and tubing to prevent traction;

 确保尿液引流通畅

 Maintain unobstructed urine flow;

 常规进行手卫生

 Use routine hand hygiene;

 如果发生污染、脱开或渗漏，更换UC和尿液收集系统；且

 Replace the UC and collection system if contaminated, disconnected, or leaking; and

 采用无菌技术从无针头留样口或引流袋留取标本  Take samples aseptically from a needleless port or drainage bag.

考虑制定有关术后尿潴留的处理方案，如由护士进行间断置管及采用膀胱扫描。强调有效的策略及改进空间。与一线HCP共享资料以监测CAUTI预防措施的效果。

Consider a protocol for managing postoperative urinary retention, such as nurse-directed intermittent catheterization and use of bladder scanners. Spotlight effective strategies and areas for improvement. Share data with frontline HCP to track CAUTI prevention progress.

Image from Dreamstime

手术部位感染 Surgical-Site Infection (SSI) SSI是当前最常见且医疗费用最高的HAI。基本的措施包括： SSIs are now the most common and most costly HAI. The basics:

 根据指南应用预防性抗生素

 Give antimicrobial prophylaxis according to guidelines;

 避免清除手术部位的毛发；不要使用剃须刀

 Avoid removing hair from the operative site; don't use razors;

 控制术后血糖水平

 Control postoperative blood glucose levels;

 维持围手术期体温正常  Maintain perioperative normothermia;

 注意改善机械通气患者的组织氧合

 Give supplemental oxygen to improve tissue oxygenation to patients on mechanical

ventilation;  如无禁忌，采用含酒精的备皮药物

 Use an alcohol-containing skin prep agent unless there are contraindications;

 胃肠道/胆道手术时使用放渗漏的塑料护皮贴

 Use impervious plastic wound protectors for gastrointestinal/biliary tract surgery;

 使用清单以改进最佳医疗实践的依从性，并进行监测

 Use a checklist to improve compliance with best practices, and perform surveillance; and

 对手术室人员、患者及其家属进行有关SSI预防的教育

 Educate operating room staff, patients, and families about SSI prevention.

Read SHEA's 2014 SSI prevention update. Image from Science Photo Library

难辨梭状芽孢杆菌感染 Clostridium difficile Infection (CDI)

CDI的危险因素包括抗生素暴露或入住医疗机构。CDI能够使住院日延长3-6天。CDI的危险因素包括氟喹诺酮、其他抗生素及抑制胃酸。受到污染的物品和环境是CDI的重要来源。

The risk factors for CDI include exposure to antibiotics or to healthcare settings. CDI increases length of stay by 3-6 days. The risk factors for CDI now include fluoroquinolones, other