美国CDC对埃博拉防控个人防护装备使用的强化指南

gemao

CDC FactSheet: Tightened Guidance for U.S. Healthcare Workers on PersonalProtective Equipment for Ebola

关于埃博拉病毒美国医务工作者个人防护设备的强化指南

上海中医药大学附属曙光医院 张亮    译

       The Centers forDisease Control and Prevention (CDC) is tightening previous infection controlguidance for healthcare workers caring for patients with Ebola, to ensure thereis no ambiguity. The guidance focuses on specific personal protective equipment(PPE) health care workers should use and offers detailed step by stepinstructions for how to put the equipment on and take it off safely.

        疾病控制与预防中心（CDC）正在加强之前关于护理感染埃博拉病毒患者的医护人员的感染控制指南，以确保没有任何含糊之处。该指南着重于医护人员应使用的特殊个人防护装备（PPE），并提供了关于如何安全的穿和脱装备的详细步骤说明。

The enhanced guidance is centered on three principles:

本强化指南着重于三个原则：

• All healthcare workers providing care for Ebola patients undergo rigorous     training and be competent with PPE, including taking it on and off in a     systematic manner
• 所有为埃博拉患者提供医疗服务的医护人员都要经过严格的培训，并且有能力使用个人防护装备（PPE），包括系统地穿脱。
• No skin should be exposed when PPE is worn
• 当穿上个人防护装备时应没有皮肤裸露。
• All workers are supervised by a trained monitor who watches each worker don     and doff PPE
  

   •  所有人员在受过训练的监视者的监督下穿脱个人防护装备

All patientstreated at Emory University Hospital, Nebraska Medical Center and the NIHClinical Center have followed the three principles. None of the workers atthese facilities have contracted the illness.

Emory大学医院，Nebraska医学中心和美国国立卫生研究院临床中心治疗的所有患者都遵循的三大原则。这些机构的工作人员没有人被感染此疾病。

Principle #1:Rigorous and repeated training

原则1：严格和反复训练

Training is the essential way to guarantee the effectiveness ofPPE in prevention infection transmission.  Facilities need to ensureall healthcare providers practice numerous times to make sure they understandhow to appropriately use the equipment, especially in the step by step donningand doffing of PPE. CDC and partners will ramp up training offerings forhealthcare personnel across the country to reiterate all the aspects of safe carerecommendations.

培训是保证个人防护装备有效预防感染传播的根本途径。机构必须确保所有医疗服务提供者经过大量实践操作，以保证他们理解如何正确使用个人防护装备，特别是一步步穿脱个人防护装备。疾病预防控制中心和合作伙伴将加大全国医疗人员的培训服务，重申所有安全护理建议。

Principle #2: No skin exposure when PPE isworn

原则二：当穿上个人防护装备时没有皮肤裸露。

Given the intensive and invasive care that US hospitals providefor Ebola patients, the tightened guidelines are more directive in recommendingno skin exposure when PPE is worn. CDC is recommending all of the same PPEincluded in the August 1, 2014 guidance, with the addition of coveralls andsingle-use, disposable hoods. Goggles are no longer recommended as they may notprovide complete skin coverage in comparison to a single use disposable fullface shield. Additionally, goggles are not disposable, may fog after extendeduse, and healthcare workers may be tempted to manipulate them with contaminatedgloved hands. PPE recommended for U.S. healthcare workers caring for patientswith Ebola includes:

由于美国医院为埃博拉病人提供重症监护及有创护理，在强化指南中更直接建议在穿上个人防护装备后没有皮肤暴露。疾病预防控制中心的建议包括2014年8月1日的指南中所有个人防护装备，以及全身工作服和单次使用的一次性头罩。不再推荐护目镜，因为与单次使用一次性面罩相比，其可能无法提供面部全部皮肤覆盖。此外，护目镜不是一次性使用，长时间使用后可能会起雾而诱使医护人员使用带有污染手套的手来操做它们。对美国护理埃博拉患者的医护人员的个人防护装备的建议包括：

• Double     gloves
• Boot     covers that are waterproof and go to at least mid-calf or leg covers
• Single     use fluid resistant or imperable gown that extends to at least mid-calf or     coverall without intergraded hood.
• Respirators,     including either N95 respirators or powered air purifying respirator     (PAPR)
• Single-use,     full-face shield that is disposable
• Surgical     hoods to ensure complete coverage of the head and neck
• Apron     that is waterproof and covers the torso to the level of the mid-calf     should be used if Ebola patients have vomiting or diarrhea  
  

    •双层手套

   •防水靴套，至少覆盖到小腿或脚的中部

   •一次性使用的防水或不渗透的手术衣，一直延伸到至少小腿中部或无兜帽全身工作服。

   •呼吸器，包括N95口罩或电动送风过滤式呼吸器（PAPR）

   •单次使用的一次性全脸型面罩

   •确保完全覆盖头部和颈部的外科头罩

  •如果埃博拉患者有呕吐或腹泻，应该使用能覆盖躯干部到小腿中部水平的防水围裙

The guidancedescribes different options for combining PPE to allow a facility to select PPEfor their protocols based on availability, healthcare personnel familiarity,comfort and preference while continuing to provide a standardized, high levelof protection for healthcare personnel. The guidance includes having:

该指南介绍了组合PPE的不同选项，让医疗机构根据适用性、医护人员熟悉程度、舒适性和喜好等实际情况选择PPE制定操作手册，并不断为医护人员提供标准化，高标准保护。该指南包括有：

• Two     specific, recommended PPE options for facilities to choose from. Both     options provide equivalent protection if worn, donned and doffed     correctly.
• Designated     areas for putting on and taking off PPE. Facilities should ensure that     space and lay-out allows for clear separation between clean and     potentially contaminated areas
• Trained     observer to monitor PPE use and safe removal
• Step-by-step     PPE removal instructions that include:
• Disinfecting     visibly contaminated PPE using an EPA-registered disinfectant wipe prior     to taking off equipment
• Disinfection     of gloved hands using either an EPA-registered disinfectant wipe or     alcohol-based hand rub between steps of taking off PPE.
  

  •两个特别推荐的PPE方法供机构选择。如果正确的穿着，穿脱，这两种方法能提供同样的保护。

  •在指定区域穿、脱个人防护装备。医疗机构应确保在空间上、布局上使清洁区和潜在污染区之间隔离明确。

  •由受过训练的观察者来监督个人防护装备的使用和安全解除。

  •解除PPE的步骤说明，包括：

  •在脱个人防护装备之前，对可见污染的PPE使用EPA注册的消毒剂消毒。

  •在脱PPE的每个步骤之间，使用EPA注册的消毒剂或酒精搓手剂消毒对戴手套的手。

Principle #3:Trained monitor

原则3：经过培训的监督者

CDC isrecommending a trained monitor actively observe and supervise each workertaking PPE on and off. This is to ensure each worker follows the step by stepprocesses, especially to disinfect visibly contaminated PPE. The trainedmonitor can spot any missteps in real-time and immediately address.

CDC建议由一个受过训练的监督者主动观察和监督每个工作人员穿、脱个人防护装备。这是为了确保每个工作人员能遵循流程的每一个步骤，特别是要消毒可见污染的PPE。训练有素的监督者可以当场指出的任何失误并立即解决。

尘埃69

谢谢分享，当穿上个人防护装备时没有皮肤裸露。

草地

单次使用一次性面罩,单次使用的一次性全脸型面罩有何区别,有图么?

gemao

草地 发表于 2014-10-24 10:22
单次使用一次性面罩,单次使用的一次性全脸型面罩有何区别,有图么?

可参见https://bbs.sific.com.cn/forum.ph ... p;page=1#pid2080332

阿丹丹

谢谢老师的分享！周末愉快！

liu1724

下载学习，慢慢消化。基层医院好多防护设施都没有。

宫圆圆

下载学习，慢慢消化。基层医院好多防护设施都没有。