全文大家译：医疗机构隔离预防指南2007版

潮水

Isolation2007.pdf (1.33 MB, 下载次数: 100861)

2007-9-21 12:41 上传

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这个是美国医院感染控制顾问委员会（HICPAC）和美国CDC于2OO7年制定的医疗机构隔离指南，全文共219页，内容包括前言、相关传染病的预防控制、重点科室预防、预防医院感染的基本要素（组织、人员、监测、教育、手卫生和个人防护）、标准预防等。应该是当前医院感染控制领域最新的指南。现把全文分割为几个部分，分前言、IA-IB、IC、ID、IE-IF、IIA-IIC、IID-IIF、IIG-IIK、IIL-IIN、IIIA-IIIF、PARTIV、TABLES等11块内容，本人现认领前言和IC两块，请大家以回贴方式踊跃参与认领译文！

潮水

这是一项大工程啊！大家要多多支持啊！

全文219页，目前申领情况如下！（不断更新中）

潮水：1-11页（已完成）、20-31页
楚楚：129-130页（已完成）
wshh1975：74-92页
柳莲飘飘：12-20页（其中14-20页已完成）
右手心：38-40页（已完成）、47-49 页
蜗牛：49-56页（已完成）
王传清：12-40页

[ 本帖最后由 潮水 于 2008-3-30 21:35 编辑 ]

一枝梅

我非常想,但汗颜:L :L :L :L :L :L ,只有盼XDMM的了!!!:lol :lol :lol :lol

右手心

W斑竹真有魄力,这么长的文献都有勇气,恩,大家加油哦!!
偶资力最低,我就认领一个IE-IF吧,嘿嘿:loveliness:

潮水

热烈欢迎梅版加盟啊！:lol :lol :lol

潮水

大家很期待哦！一起努力！:handshake

一枝梅

这叫什么来着，那壶不响提那壶，我真无这方面得能力哦！！！想参与，但——————嘿嘿！！！:lol :lol :lol :lol :lol

楚楚

看到小弟弟、小妹妹们这么敬业，又这么辛苦，俺感到很过意不去的，俺聊表一下心意认领P129-130，因为俺觉得这两页稍微简单一点。:L :L
很少从事翻译工作，实在没有底气，见笑了，请大家多多指正。:$ :$

Figure（插图）.

Example of Safe Donning and Removal of Personal

Protective Equipment (PPE)（安全配戴和除去个人防护用品示例）

DONNING PPE（配戴个人防护用品）

GOWN（隔离衣）

ƒ Fully cover torso from neck to knees, arms to end of wrist, and wrap around the back（完全遮盖从脖子到膝部、肩部到手腕的整个身体，然后在背部包裹）

ƒ Fasten in back at neck and waist（在颈后和腰后系紧）

MASK OR RESPIRATOR(口罩或口鼻罩)

ƒ Secure ties or elastic band at middle of head and neck（在头的中部和颈后固定带子或弹性带）

ƒ Fit flexible band to nose bridge（与鼻梁吻合严密）

ƒ Fit snug to face and below chin（与面部和下巴吻合严密）

ƒ Fit-check respirator（吻合测试的口鼻罩）

GOGGLES/FACE SHIELD（护目镜/面罩）

ƒ Put on face and adjust to fit（带上并且调整合适）

GLOVES（手套）

ƒ Use non-sterile for isolation（使用非无菌手套用于隔离）

ƒ Select according to hand size（选择适合手部大小的手套）

ƒ Extend to cover wrist of isolation gown（拉上盖住隔离衣的袖口）

SAFE WORK PRACTICES（安全的工作习惯）

ƒ Keep hands away from face（手不要接触面部）

ƒ Work from clean to dirty（工作从洁到污）

ƒ Limit surfaces touched（限制接触物体表面）

ƒ Change when torn or heavily contaminated（当破损或严重污染时更换）

ƒ Perform hand hygiene（执行手卫生）

REMOVING PPE（脱个人防护用品）

Remove PPE at doorway before leaving patient room or in anteroom（在病房门门口或缓冲间脱掉个人防护用品）

GLOVES（手套）

ƒ Outside of gloves are contaminated!（手套的外部是污染的）

ƒ Grasp outside of glove with opposite gloved hand; peel off（戴手套的一只手抓住手套的外部，扯掉手套）

ƒ Hold removed glove in gloved hand（戴手套的手握住脱下来的手套）

ƒ Slide fingers of ungloved hand under remaining glove at wrist（脱掉手套的手指在腕部伸进手套内）

GOGGLES/FACE SHIELD（护目镜/面罩）

ƒ Outside of goggles or face shield are contaminated!（护目镜或面罩的外部是污染的）

ƒ To remove, handle by “clean” head band or ear pieces（从清洁的系带处或镜架处移去）

ƒ Place in designated receptacle for reprocessing or in waste container（放在指定的容器内再处理或废物容器内）

GOWN（隔离衣）

ƒ Gown front and sleeves are contaminated!（隔离衣的前面和袖子都是污染的）

ƒ Unfasten neck, then waist ties（解开脖子处的系带，然后是腰部的系带）

ƒ Remove gown using a peeling motion; pull gown from each shoulder toward the same hand（渐进式脱掉隔离衣；从每侧肩部向同侧手部拉下隔离衣）

ƒ Gown will turn inside out（把隔离衣翻转）

ƒ Hold removed gown away from body, roll into a bundle and discard into waste or linen receptacle（握住脱下来的隔离衣，卷成团然后丢进废物袋或布袋里）

MASK OR RESPIRATOR（口罩或口鼻罩）

ƒ Front of mask/respirator is contaminated – DO NOT TOUCH!（口罩或口鼻罩的前部是污染的—不要接触！）

ƒ Grasp ONLY bottom then top ties/elastics and remove（只能抓住下部、解开系带，然后取下）

ƒ Discard in waste container（丢入废物容器）

HAND HYGIENE（手卫生）

Perform hand hygiene immediately after removing all PPE!（移去所有的个人防护用品以后马上执行手卫生）

[ 本帖最后由 楚楚 于 2007-9-22 23:24 编辑 ]

潮水

先把该指南的内容提要发上来，翻译量很大，只能细水常流了！呵呵！有些地方好象不顺请大家指教！

EXECUTIVE SUMMARY
The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 updates and expands the 1996 Guideline for Isolation Precautionsin Hospitals. The following developments led to revision of the 1996 guideline:
1. The transition of healthcare delivery from primarily acute care hospitals to other healthcare settings (e.g., home care, ambulatory care, free-standing specialty care sites, long-term care) created a need for recommendations that can be applied in all healthcare settings using common principles of infection control practice, yet can be modified to reflect setting-specific needs. Accordingly, the revised guideline addresses the spectrum of healthcare delivery settings.Furthermore, the term “nosocomial infections“ is replaced by “healthcareassociated infections” (HAIs) to reflect the changing patterns in healthcare delivery and difficulty in determining the geographic site of exposure to an infectious agent and/or acquisition of infection.
2. The emergence of new pathogens (e.g., SARS-CoV associated with the severe acute respiratory syndrome [SARS], Avian influenza in humans), renewed concern for evolving known pathogens (e.g., C. difficile, noroviruses, communityassociated MRSA [CA-MRSA]), development of new therapies (e.g., gene therapy), and increasing concern for the threat of bioweapons attacks, established a need to address a broader scope of issues than in previous isolation guidelines.
3. The successful experience with Standard Precautions, first recommended in the1996 guideline, has led to a reaffirmation of this approach as the foundation for preventing transmission of infectious agents in all healthcare settings. New additions to the recommendations for Standard Precautions are Respiratory Hygiene/Cough Etiquette and safe injection practices, including the use of a mask when performing certain high-risk, prolonged procedures involving spinal canal punctures (e.g., myelography, epidural anesthesia). The need for a recommendation for Respiratory Hygiene/Cough Etiquette grew out of observations during the SARS outbreaks where failure to implement simple source control measures with patients, visitors, and healthcare personnel with respiratory symptoms may have contributed to SARS coronavirus SARS-CoV) transmission. The recommended practices have a strong evidence base. The
continued occurrence of outbreaks of hepatitis B and hepatitis C viruses in ambulatory settings indicated a need to re-iterate safe injection practice recommendations as part of Standard Precautions. The addition of a mask for certain spinal injections grew from recent evidence of an associated risk for developing meningitis caused by respiratory flora.
4. The accumulated evidence that environmental controls decrease the risk of lifethreatening fungal infections in the most severely immunocompromised patients(allogeneic hematopoietic stem-cell transplant patients) led to the update on the components of the Protective Environment (PE).
5. Evidence that organizational characteristics (e.g., nurse staffing levels and composition, establishment of a safety culture) influence healthcare personnel adherence to recommended infection control practices, and therefore are important factors in preventing transmission of infectious agents, led to a new emphasis and recommendations for administrative involvement in the development and support of infection control programs.
6. Continued increase in the incidence of HAIs caused by multidrug-resistant organisms (MDROs) in all healthcare settings and the expanded body of knowledge concerning prevention of transmission of MDROs created a need for more specific recommendations for surveillance and control of these pathogensthat would be practical and effective in various types of healthcare settings.
   This document is intended for use by infection control staff, healthcare epidemiologists,healthcare administrators, nurses, other healthcare providers, and persons responsible for developing, implementing, and evaluating infection control programs for healthcare settings across the continuum of care. The reader is referred to other guidelines and websites for more detailed information and for recommendations concerning specialized infection control
problems.

内容提要（Executive summary）（P7-8）

隔离预防指南：2007年版医疗机构传染病预防是1996年版医院隔离预防指南的更新和扩充，下列情况的发生和发展导致1996年版指南的修改：
1．医疗机构服务形式的变化从最初的急症护理医院到其他形式保健机构（例如：家庭护理、医疗门诊、独立专科医院、长期保健），需要建立一个能够适用于所有形式医疗机构传染病预防的指南，但也可以根据特殊需要进行修改。据此，新版指南覆盖了不同形式医疗机构。此外，院内感染被医源性感染替代以反映不同形式医疗机构的改变和很难决定某个传染病和（或）获得性感染的暴露的具体位置。
2．新的病原体的出现（例如：与严重急性呼吸系统综合征[SARS]相关的SARS冠状病毒，人类禽流感），更新的已知的病原体（例如：艰难梭菌、诺如病毒、社区相关MRSA[CA-MRSA]），新疗法的发展（如：基因疗法），以及不断引起关注的生物武器袭击，必须建立一个比以前隔离预防指南覆盖面更大的指南。
3．1996年版指南推荐的标准预防的成功经验表明已经在所有形式医疗机构成为了传染病预防的基础。新增加了呼吸道卫生/咳嗽礼仪和安全注射行为标准预防建议，包括在进行高危行为和进行延长椎管穿刺时使用面罩（例如：脊髓造影，硬膜外麻醉）。在SARS爆发时为那些不会采取简单预防措施的病人、访视者和有呼吸道症状的医护人员提供一个预防SARS传播的关于呼吸道卫生/咳嗽礼仪的指南。这个推荐指南有强大的科学依据。乙肝和丙肝病毒感染爆发在医疗门诊的不断出现提示需要一个作为标准预防的一部分安全注射指南。增加椎管注射的最新的证据是呼吸道致病菌引起的开放性脑炎的增加。
4．最新证据表明环境控制能降低大多数免疫低下病人真菌感染的危险性（异基因造血干细胞移植患者），导致更新环境预防的部分。
5．证据显示组织特性（例如护理人员水平和组成，安全文化的建立）能影响医务人员医院感染控制措施的执行，因此是传染病预防中的一个重要的因素。这也导致在传染病控制项目的支持和发展中行政介入是一个新重点和推荐部分。
6．在各种医疗机构由多重耐药菌引起的医院感染的不断增加和加强预防多重耐药病原体传播知识宣传需要一个更特殊的监测和控制指南能够有效适用于各种医疗机构。
该指南适用于传染病控制专业人员、医院流行病学专业人员、医院管理人员、护理人员、其他医疗保健提供者和负责参与制定、执行和评估医院感染控制项目人员。读者可参考提供更详细信息和专门传染病控制问题的其他指南和网站

[ 本帖最后由 wzcdcyxh 于 2007-9-25 09:17 编辑 ]

icchina

这项工作很重要，很有意义！
本论坛要保持我国医院感染管理领域中最重要的网站，需要不断地突破，不断地挑战自我！
全新的方式，全新的理念，全新的知识，领引我国医院感染管理工作，是本论坛的目标和追求！
非常感谢版主们的辛勤劳动，同时特别期待不是版主的会员积极加盟和支持，共同完成这项庞大的翻译工程！您的参与对论坛的兴旺、对我国感染控制事业的朝着正确的方向发展，十分重要！

石桥wshh1975

我领第四章:Recommendations,第74-92页!

彩虹天堂

IA-IB,不知有没有人已经翻译了。
如果还没，我认领吧。不知版主什么时候要，最好有个时间期限。
如果翻译的快，我还可以领其它部分来。

潮水

欢迎参加译文认领！IA-IB还没有人认领，内容较多，时间以暂定为2周。

右手心

我翻译的IE-IF,请各位老师多指教哦 !


随着复杂疾病新诊疗技术的出现, 我们需要定位针对特殊病人群体的感染控制挑战.
免疫妥协的病人.
先天性免疫缺陷或获得性疾病(例如由治疗引起的免疫缺陷)在接受医疗时增加了各种感染的危险性,并且贯穿于整个医疗方针中. 缺乏特定的免疫系统决定了更加容易获得某种类型的感染.(例如,病毒感染常与T细胞免疫缺陷有关,真菌和细菌性感染常发生于中性粒细胞减少的病人).一般来说,免疫缺陷的病人可以与其他病人处于同一环境中,但是要尽可能小的减少对其他病人传染性感染的暴露,如流感或其他呼吸系统的病毒.越大剂量化学药物法治疗早期白细胞增多症,越可能导致延长中性粒细胞减少症的治疗周期,抑制免疫系统的其他部分,延长感染危险的时期,增加对选择组别的额外警惕性监测关注,针对越来越新的和更大强度的免疫抑制剂用于治疗各病种(如风湿性性疾病,肠炎等).免疫抑制的病人广泛的分布于医疗系统中,而非一个特定的病人群.(如血癌).预防免疫缺陷病人感染的指导已经出台.出台的数据支持将免疫抑制病人集中于一个”保护环境”中.其中三条指导进一步说明这些免疫缺陷病人的特殊需要,包括预防性用抗菌药,建立一个保护环境,从建筑学角度来预防金葡菌和其他环境霉菌的感染.越强的使用化学药物治疗中性粒细胞减少症或者移植物抗宿主反应,其治疗周期也跟着延长,感染的危险性和持续”保护环境”的时间也需要比传统的治疗延长100天.
囊性纤维化病人
需特殊考虑建立囊性纤维化病人的感染控制措施.与其他病人相比,此类病人需要额外的保护,防止被污染了的呼吸治疗仪器引发感染.如葱头假单孢菌和铜绿假单孢菌属具有独特的临床和预示意义.在囊性纤维化病人中葱头假单孢菌增加了感染的发病率和死亡率,同时延长了慢性铜绿假单胞菌属感染的发现时期,也许是长期临床治疗所致.
在医护房间中, 在成人和儿童的囊性纤维化患者中,葱头假单孢菌的传播已经被证实.处于与社会的多种接触,在集中营里,在同胞兄弟姐妹中也非常显著的出现囊性纤维化的病人.成功的感染控制方法在于阻止呼吸道分泌物的传播,包括将每个囊性纤维化病人隔离于一个回廊或者房间.(包括有卫生间的单独病房).对环境的物体表面和被呼吸道分泌物污染的仪器消毒,排除胸腔理疗环节,分散囊性纤维化病人.囊性纤维化基金会发表了一致推荐使用且有证可依的囊性纤维化病人感染控制的文件.
   
新疗法中可能传播的感染.
基因治疗.
基因治疗已经尝试大量用于病毒带菌者,包括不可逆转病毒,腺病毒,腺伴随病毒和痘类病毒的复制株.但意外的反对限制了基因治疗的流行.
基因治疗的感染危害目前还是猜想.但是,可能发生基因体内的重组和后继突然出现转录基因改变的病原,致使需要精细的监护.极大的关注转录复活病毒的使用,尤其是牛痘疫苗.发表的文献,没有资料描述病毒从一个基因治疗受体传播到另外一个个体,但是监护还是在进行公开推荐,监测基因治疗的感染控制问题贯穿于整个基因治疗.

通过血液,器官和其他组织的感染传播
尽管是供体经过了筛查,通过生物品传播的病原菌感染虽然几率小但确实存在.通过输血或移植传播的感染报道包括西尼罗病毒感染,巨细胞病毒感染, 传染性海绵样脑病, 丙型肝炎,梭菌属感染,还有链球菌属, 疟疾, 巴贝西虫病, 南美洲锥虫病, 淋巴细胞性脉络丛脑膜炎, 狂犬病.所以当受体接受生物品时,慎重考虑可能的感染来源是非常重要的.

异体移植
将非人类的细胞,组织,官移植到人身上,可能将人暴露于动物传播的病原菌下.
我们不仅要关心被人所知的动物病原菌的传播 (如猪组织带来的毛线虫病),也要关心移入细胞,组织,器官给免疫抑制受体带来的未知动物传播的病原菌感染.可能伴随猪组织移植的感染已经有记载,.来自U.S.公共医疗机构的指导,发表了很多关于这个正在发展的异体移植学科引起的感染疾病和感染控制问题.这个领域的工作正在前进.

右手心

另外我继续认领ＰＡＲＴ２的ＩＣ－ＩＤ吧，大家也积极来参与哦！还长着呢，嘿嘿

[ 本帖最后由 右手心 于 2007-9-29 12:32 编辑 ]

右手心

原帖由 wzcdcyxh 于 2007-9-29 10:59 发表

                               
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欢迎参加译文认领！IA-IB还没有人认领，内容较多，时间以暂定为2周。

Ｗ版主，您也继续啊，嘿嘿，我们可少不了你哦！

无极紫晶

我代表坐享其成的会员们给你们当啦啦队啦！你们加油啊！谢谢哦！:cool :cool

潮水

最近有点忙，好象我有点落后哦！:$ 努力翻译中......:lol

[ 本帖最后由 wzcdcyxh 于 2007-9-29 14:00 编辑 ]

紫言

真想能帮上忙 可能力有限
惭愧:$

潮水

Parts I - III: Review of the Scientific Data Regarding Transmission of InfectiousAgents in Healthcare Settings
Part I reviews the relevant scientific literature that supports the recommended prevention and control practices. As with the 1996 guideline,the modes and factors that influence transmission risks are described in detail. New to the section on transmission are discussions of bioaerosols and of how droplet and airborne transmission may contribute to infection transmission. This became a concern during the SARS outbreaks of 2003, when transmission associated with aerosol-generating procedures was observed. Also new is a definition of “epidemiologically important organisms” that was developed to assist in the identification of clusters of infections that require investigation (i.e. multidrug-resistant organisms, C. difficile). Several other pathogens that hold special infection control interest (i.e., norovirus, SARS, Category A bioterrorist agents, prions, monkeypox, and the hemorrhagic fever viruses) also are discussed to present new information and infection control lessons learned from experience with these agents. This section of the guideline also presents information on infection risks associated with specific healthcare settings and patient populations.
    Part II updates information on the basic principles of hand hygiene, barrier precautions, safe work practices and isolation practices that were included in previous guidelines. However, new to this guideline, is important information on healthcare system components that influence transmission risks, including those under the influence of healthcare administrators. An important administrative priority that is described is the need for appropriate infection control staffing to meet the ever-expanding role of infection control professionals in the modern, complex healthcare system. Evidence presented also demonstrates another administrative concern, the importance of nurse staffing levels, including numbers of appropriately trained nurses in ICUs for preventing HAIs. The role of the clinical microbiology laboratory in supporting infection control is described to emphasize the need for this service in healthcare facilites. Other factors that influence transmission risks are discussed i.e., healthcare worker adherence to recommended infection control
practices, organizational safety culture or climate, education and training
Discussed for the first time in an isolation guideline is surveillance of healthcare-associated infections. The information presented will be useful to new infection control professionals as well as persons involved in designing or responding to state programs for public reporting of HAI rates.
Part III describes each of the categories of precautions developed by the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Centers for Disease Control and Prevention (CDC) and provides guidance for their application in various healthcare settings. The categories of Transmission-Based Precautions are unchanged from those in the 1996 guideline: Contact, Droplet, and Airborne. One important change is
the recommendation to don the indicated personal protective equipment (gowns, gloves, mask) upon entry into the patient’s room for patients who are on Contact and/or Droplet Precautions since the nature of the interaction with the patient cannot be predicted with certainty and contaminated environmental surfaces are important sources for transmission of pathogens.
In addition, the Protective Environment (PE) for allogeneic hematopoietic stem cell transplant patients, described in previous guidelines, has been updated.
Tables, Appendices, and other Information
There are several tables that summarize important information: 1) a summary of the evolution of this document; 2) guidance on using empiric isolation precautions according to a clinical syndrome; 3) a summary of infection control recommendations for category A agents of bioterrorism; 4) components of Standard Precautions and recommendations for their application; 5) components of the Protective Environment; and 6) a glossary of definitions used in this guideline. New in this guideline is a figure that shows a recommended sequence for donning and removing personal protective equipment used for isolation precautions to optimize safety and prevent self-contamination during removal.
Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions
Appendix A consists of an updated alphabetical list of most infectious agents and clinical conditions for which isolation precautions are recommended. A preamble to the Appendix provides a rationale for recommending the use of one or more Transmission-Based Precautions, in addition to Standard Precautions, based on a review of the literature and evidence demonstrating a real or potential risk for person-to-person transmission in healthcare settings.The type and duration of recommended precautions are presented with additional comments concerning the use of adjunctive measures or other relevant considerations to prevent transmission of the specific agent. Relevant citations are included.
Pre- Publication of the Guideline on Preventing Transmission of MDROs
New to this guideline is a comprehensive review and detailed ecommendations for prevention of transmission of MDROs. This portion of the guideline was published electronically in October 2006 and updated in November, 2006 (Siegel JD, Rhinehart E, Jackson M, Chiarello L and HICPAC. Management of Multidrug-Resistant Organisms in Healthcare Settings 2006 www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf), and is considered a part of the Guideline for Isolation Precautions. This section provides a detailed review of the complex topic of MDRO control in healthcare settings and is intended to provide a context for evaluation of MDRO at individual healthcare settings. A rationale andinstitutional requirements for developing an effective MDRO control program are summarized. Although the focus of this guideline is on measures to prevent transmission of MDROs in healthcare settings, information concerning the judicious use of antimicrobial agents is presented since such practices are intricately related to the size of the reservoir of
MDROs which in turn influences transmission (e.g. colonization pressure). There are two tables that summarize recommended prevention and control practices using the following seven categories of interventions to control MDROs: administrative measures, education of healthcare personnel, judicious antimicrobial use, surveillance, infection control precautions,
environmental measures, and decolonization. Recommendations for each category apply to and are adapted for the various healthcare settings. With the increasing incidence and prevalence of MDROs, all healthcare facilities must prioritize effective control of MDRO transmission. Facilities should identify prevalent MDROs at the facility, implement control measures, assess the effectiveness of control programs, and demonstrate decreasing MDRO rates. A set of intensified MDRO prevention interventions is presented to be added
1) if the incidence of transmission of a target MDRO is NOT decreasing despite implementation of basic MDRO infection control measures, and 2) when the first case(s) of an epidemiologically important MDRO is identified within a healthcare facility.
Summary
This updated guideline responds to changes in healthcare delivery and addresses new concerns about transmission of infectious agents to patients and healthcare workers in the United States and infection control. The primary objective of the guideline is to improve the safety of the nation’s healthcare delivery system by reducing the rates of HAIs.


第一-三部分：医疗机构传染病概述
第一部分：回顾关于支持预防和控制措施的科研文献，与1996年版指南相比，现在的传染危险因素和传播方式描述将更加详细。新增加了与传染病传播有关的生物、空气飞沫和空气传播讨论部分，气溶胶形成并参与传播在SARS传播期间引人关注。一个新的定义“流行病学上重要的有机体”被发展起来参与传染源的调查（如：多重耐药菌：艰难梭菌），也讨论了一些需要采取特殊预防和控制措施的传染源（如：诺瓦克病毒、SARS、一些生物恐怖病原体、朊毒体、猴痘和新疆出血热等）的控制信息和经验。指南的这部分也介绍了特殊医疗机构和特殊病人传播危险因素。
第二部分：更新了包括以前指南在内的关于手部卫生、标准预防、安全操作规程和隔离措施的基本原则。然而，对于新的指南，重要的一点是影响传播危险因素的医院内部系统组织，包括医院管理者的影响。在一个现代而又复杂的医疗系统内，行政的优先权是保证医院感染管理人员以合理应付不断扩大的医院传染病控制范围。证据显示医院管理人员必须注意到的是护理人员的水平，包括为预防在重症监护室医源性感染的经过适当培训的护理人员。在医疗机构设施中临床微生物实验室是传染病控制中的重要的服务部门。其他影响传染病传播的危险因素也被讨论到，例如执行传染病控制措施的依从性、组织安全文化和氛围、教育和培训等。预防指南首先讨论的是医源性感染的监测，这些监测资料将有助于传染病控制专家设计好国家医源性感染公共报告系统。
第三部分：描述了HICPAC和CDC为各种不同医疗机构提供的提高标准的预防的分类指南，1996年版指南的传播途径分类没有改变：接触和空气飞沫和空气传播。一个重要的改变是推荐使用个人防护设备（防护衣、手套和面罩）在进入病房给那些不能确定是否被重要传染源污染但可以通过接触和空气飞沫传播的病人执行操作时。此外还增加了造血干细胞移植病人环境预防指南。
统计表，附录和其他信息
有几个表格摘录了重要内容：
1．这份指南的演变历程
2．根据临床症状使用标准预防指引
3．A类生物恐怖病原体的一览表
4．标准预防的措施和建议及其应用
5．环境预防的组成部分
6．该指南的词汇定义，在指南中有一个新的插图为了个人安全和在消毒过程防止自我感染展示了个人防护用品的穿脱程序。

附录A：根据不同的传染源和条件选择隔离方式和期限。附录A按照对最新的传染源和临床症状的隔离预防按照字母顺序进行排列。附录序言提示除了参考指南推荐的以外，应该参考一个或更多的基于传播方式的预防，在医疗机构和有文献和证据证实人传染人的事实和潜在危险。推荐隔离预防的类型和期限也增加了对预防特殊传染病传播采取的辅助措施和其他相关建议，有关引用文献也包括在内。
预防MDROs的传播指南的试行版
这个新指南全面回顾和详细的阐述预防MDROs指南的试行情况。这部分的指南已经在2006年10月以电子方式出版，在11月进行了更新（Siegel JD, Rhinehart E, Jackson M, Chiarello L and HICPAC. 2006医疗机构MDROs管理指南www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf），它隔离预防指南的一部分。这部分为医疗机构控制MDROs提供了多种措施的详细描述并扩大到为个体医疗诊所MDROs感染状况评估。并总结出为有效的控制MDROs的一些可行的和建设性的要求。尽管该指南的焦点是针对在医疗机构预防MDROs传播的措施，该指南也关注合理使用抗生素，因为这样能干扰MDROs选择宿主的规模（如定植压力）。有两个表格总结了预防和控制MDROs的7点干预措施：管理措施；医护人员教育；抗生素合理使用；监测；传染源的预防和控制；环境措施和非定植化。每一条推荐的控制措施都适用和适宜于各种医疗机构。随着MDROs的流行和感染的增加，医疗机构必须优先采取有效控制传播MDROs的措施。医疗机构应查明本机构MDROs的流行情况，采取控制措施，评估控制措施效果，以确定降低MDROs感染率。增加必要扩大MDROs预防干预的条件：1.尽管采取了指南的基本预防控制措施但感染率没有下降。2.在医疗机构具有一个重要流行病学意义的首发病例被确认时。
总之：该指南的更新是为适应医疗机构的变化和传递有关传染病传播给病人和医护人员的新信息在美国传染病控制方面。指南的首要目的是为了提高全国医疗卫生系统的安全性，减少医源性感染的发生。

[ 本帖最后由 wzcdcyxh 于 2007-10-5 22:40 编辑 ]