米国CDC关于透析血流感染的干预BUNDLE

蓝鱼o_0

透析病人易发生血流感染，因此推行“Collaborative Approach to Prevention of Bloodstream Infections in Dialysis”很有必要，
上传一份米国CDC关于此类疾病的BUNDLE。目前为英文版，中文版稍后上传

蓝鱼o_0

回复 1# 蓝鱼o_0

参考楼下意见，修改翻译稿。敬请指正！
        1. Surveillance and feedback using NHSN Conduct monthly surveillance for BSIs and other dialysis events and enter events into CDC’s National Healthcare Safety Network (NHSN). Calculate facility rates and compare to rates across other facilities using NHSN. Facilities should actively share results with front-line clinical staff.
        用NHSN进行监测和反馈。逐月进行BSI和其他透析事件事件的监测，将事件录入CDC的NHSN，用NHSN比较不同透析机间的使用率。
        2. Chlorhexidine for skin antisepsis Use an alcohol-based chlorhexidine (>0.5%) solution as the first line agent for skin antisepsis, particularly for central line insertion and during dressing changes. Povidone-iodine, preferably with alcohol, or 70% alcohol are alternatives. 洗必泰皮肤消毒。用酒精为基础的洗必泰溶液可作为首选消毒剂，特别是中央线插管的病例。碘伏醇溶液或者70%的乙醇也可。
        3. Hand hygiene audits Perform monthly hand hygiene audits with feedback of results to clinical staff. 手卫生。每月进行手卫生依从性监测和反馈。
        4. Catheter care/ vascular access observations Perform monthly or quarterly audits of catheter care and accessing practices to ensure adherence to facility protocols. This includes following recommended procedures and maintaining aseptic technique while connecting and disconnecting catheters and during dressing changes. Share results with front-line clinical staff. 导管护理。每月或每季度进行导管护理和瘘管核查，确保设备使用操作指导的依从性。这包括以下建议的程序和在连接和断开导管以及更换敷料时遵守无菌原则。与临床一线治疗人员分享结果。
        Patient education/engagement Provide standardized, basic education to all patients on topics including care of vascular access, hand hygiene, risks related to catheter use, recognizing signs of infection, and instructions for access management when away from the dialysis unit. 病患教育和安排。给所有病患提供标准，基本的知识扫盲，包括血管侵入护理，手卫生，导管应用的危险性，感染指征的确定以及移除透析机后侵入导管的管理和说明。
        6. Staff education and competency Provide regular training of staff on infection control topics, including care of access and aseptic technique. Perform evaluation of competency for skills such as catheter care and accessing at least every 6-12 months and upon hire. 职工教育和资质。定期对职工进行感控培训，包括造瘘护理技术和消毒方法。每6-12个月以及在岗时进行导管护理技巧和造瘘技术竞争评估。
        7. Catheter reduction Incorporate efforts within the facility (e.g., through patient education, vascular access coordinator) to reduce catheters by identifying barriers to permanent vascular access placement and catheter removal. 导管减少。通过多种途径，采用血管造瘘减少放置导管。

gemao

2. Chlorhexidine for skin antisepsis Use an alcohol-based chlorhexidine (>0.5%) solution as the first line agent for skin antisepsis, particularly for central line insertion and during dressing changes. Povidone-iodine, preferably with alcohol, or 70% alcohol are alternatives. 洗必泰皮肤消毒。用酒精为基础的洗必泰溶液进行第一时间消毒，特别是中央线插管的病例。碘伏醇溶液或者70%的乙醇也可。
first line agent 应为 第一线的药物，换句话说，就是首选药物。
central line insertion  直译是中央线，但转换为中心血管或中心静脉是否更好？

gemao

4. Catheter care/ vascular access observations Perform monthly or quarterly audits of catheter care and accessing practices to ensure adherence to facility protocols. This includes following recommended procedures and maintaining aseptic technique while connecting and disconnecting catheters and during dressing changes. Share results with front-line clinical staff. 导管护理/血管侵入观察。每月或每季度进行导管护理和侵入行为审计，以确保遵守设施的初衷。这包括以下建议的程序和保持无菌技术在连接和断开导管换药过程。与临床一线治疗人员分享结果
vascular access直译为血管的途径、通路，在临床中是指血管造瘘这种透析途径。
audit的原意是审计、审核、稽查等意思，在这里是否可以变通为统计分析？
ensure adherence to facility protocols 翻译成  确保设备使用操作指导的依从性。protocol往往指用于指导使用的小册子，或说明书。
dressing changes   翻译成 更换敷料更好。换药这个词是中国人发明的，西医中没有换药只有换敷料。中医喜欢在伤口上撒粉，是换药。
保持无菌技术在连接和断开导管换药过程。是否可变为： 在连接和断开导管以及更换敷料时遵守无菌原则（操作）。

gemao

6. Staff education and competency Provide regular training of staff on infection control topics, including care of access and aseptic technique. Perform evaluation of competency for skills such as catheter care and accessing at least every 6-12 months and upon hire. 职工教育和补偿。定期对职工进行感控培训，包括侵入护理技术和消毒方法。没6-12个月进行导管护理技巧和侵入技术竞争评估。

competency应为资质
at least every 6-12 months and upon hire. 至少每6-12个月以及在上岗时

gemao

7. Catheter reduction Incorporate efforts within the facility (e.g., through patient education, vascular access coordinator) to reduce catheters by identifying barriers to permanent vascular access placement and catheter removal. 导管减少。多方协作、努力以确定最适合的移除导管的时间。

此条的意思是通过多种途径，采用血管造瘘减少放置导管。

蓝鱼o_0

回复 4# gemao

这些词汇有些是我不明白的，有些事我了解过程而找不到词汇翻译的，
感谢您的批评指正，对我帮助很大！

蓝鱼o_0

回复 6# gemao

可能这个专业性较强，我不甚了解了，您可否指导：“   
通过血管造瘘为什么比降低导管应用控制感染效果好呢？可否从专业角度说明”

谢谢！

米奇朋克

两位都是高手，已经学习了，谢谢！

gemao

我不是肾病专业的，具体也不好说。但是从长期静脉置管的角度来说，需要长期置管的病人建议使用皮下泵，即把静脉导管的一端连接皮下泵，埋置在皮下，使用时直接注射到泵中。长时间置管是感染的通路，采用造瘘后，等于暴露的机会减少，而且还增加一层皮肤的保护。
希望专业人事能补充。

蓝鱼o_0

回复 10# gemao

感谢您的释疑！

lxm1231

你不但英文水平高，还挺幽默，美国叫米国，有创意，有意思