全文大家译：医疗机构隔离预防指南2007版

潮水

不试一下怎么知道自己不行，我们等着你！

彩虹天堂

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2007-10-19 10:55 上传

点击文件名下载附件

IB已经翻译完了，先上传。IA还需点时间。

右手心

最近忙其他事情都把翻译这事耽误了,争取尽快完成我申领的.嘿嘿

桂花香

II.D-II.F好像还没有人认领，我来试试看。可能花的时间会长一些。

西北耗子王

谢谢斑竹的工作，非常想全文翻译，但英语水平实在有限，:L啊！请大家见谅！

zhujun710216

请发给我一部分，试试。

一枝梅

原帖由 zhujun710216 于 2007-11-15 08:12 发表

                               
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请发给我一部分，试试。

你完全可以在前面的文章中下载啊！选择某段后翻译啊！！

同时谢谢你热心的参与！:handshake :handshake

潮水

你看一下前面的贴子，有些已经有人认领了。没有人认领的，你可以发贴认领。
翻译好后，把译文贴上来，注明原文的页码。

桂花香

这是新年给大家的一点礼物，本人认领翻译的部分内容，希望对大家有所帮助，更希望大伙多提宝贵意见。

Guideline for Isolation Precautions: Preventing Transmission
of Infectious Agents in Healthcare Settings 2007
Part ⅡD-G----P49--51
II.D. Hand hygiene
Hand hygiene has been cited frequently as the single most important practice to reduce the transmission of infectious agents in healthcare settings and is an essential element of Standard Precautions. The term “hand hygiene”
includes both handwashing with either plain or antiseptic-containing soap and
water, and use of alcohol-based products (gels, rinses, foams) that do not require the use of water.
II.D. 手卫生
手卫生已经被认为是医疗机构内降低病原体传播的最简单最重要的措施，也是标准预防的基本要素。“手卫生”包括用普通或抗菌肥皂加流动水洗手和使用不需要水的含酒精产品（胶状、液状、泡沫状）
In the absence of visible soiling of hands, approved alcoholbased products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbiocidal activity, reduced drying of the skin, and convenience. Improved hand hygiene practices have been associated with a sustained decrease in the incidence of MRSA and VRE infections primarily in the ICU. The scientific rationale, indications, methods, and products for hand hygiene are summarized in other publications.
肉眼看不见手脏时，优先推荐使用含酒精的产品作为手消毒，因为这类产品具有抗菌优势、干燥时间短并且使用方便。改善的手卫生实践已经确实降低ICU内MRSA和VRE的发生率。其他文献已经阐述了手卫生的科学合理建议、方法和产品。
The effectiveness of hand hygiene can be reduced by the type and length of
fingernails. Individuals wearing artifical nails have been shown to
harbor more pathogenic organisms, especially gram negative bacilli and yeasts, on the nails and in the subungual area than those with native nails. In 2002, CDC/HICPAC recommended (Category IA) that artificial fingernails and extenders not be worn by healthcare personnel who have contact with high-risk patients (e.g., those in ICUs, ORs) due to the association with outbreaks of gramnegative bacillus and candidal infections as confirmed by molecular typing of isolates.
手卫生的效果受到指甲形状和长度的影响。戴假指甲的人比不戴假指甲的人其指甲和甲下区域可隐藏更多的致病菌，特别是革兰阴性杆菌和酵母菌。2002年，CDC/HICPAC 推荐（等级ⅠA）接触高危病人（如ICU，手术室内）的医务人员不应戴假指甲及涂指甲油？，因为分离菌株的分子生物学分型研究证实它与革兰阴性杆菌和念珠菌爆发有关。
The need to restrict the wearing of artificial fingernails by all healthcare personnel who provide direct patient care or by healthcare personnel who have contact with other high risk groups (e.g., oncology, cystic fibrosis patients), has not been studied, but has been recommended by some experts . At this time such decisions are at the discretion of an individual facility’s infection control program. There is less evidence that jewelry affects the quality of hand hygiene. Although hand contamination with potential pathogens is increased with ring-wearing, no studies have related this practice to HCW-to-patient transmission of pathogens.
在为病人提供直接服务的医务人员或接触高危人群（如肿瘤病人，肺囊性纤维化病人）的医务人员中限制戴假指甲的必要性还没有研究，但有一些专家有这样的建议。现阶段，这样的决定根据单个机构的感染控制计划来判断。珠宝影响手卫生的证据还很少。尽管戴戒指会增加手污染病原体的潜在可能，还没有戴戒指与病原体从医务人员传播给病人的相关研究。
II.E. Personal protective equipment (PPE) for healthcare personnel
PPE refers to a variety of barriers and respirators used alone or in combination to protect mucous membranes, airways, skin, and clothing from contact with infectious agents. The selection of PPE is based on the nature of the patient interaction and/or the likely mode(s) of transmission. Guidance on the use of PPE is discussed in Part III.
个人防护用品涉及屏障的多样性，单用呼吸器或结合其他屏障措施来保护粘膜、气道、皮肤和衣服以免接触到感染病原体。防护用品的选择基于病人的反应和/或可能的传播方式。使用防护用品的指引在第三部分讨论。
A suggested procedure for donning and removing PPE that will prevent skin or clothing contamination is presented in the Figure. Designated containers for used disposable or reusable PPE should be placed in a location that is convenient to the site of removal to facilitate disposal and containment of contaminated materials. Hand hygiene is always the final step after removing and disposing of PPE. The following sections highlight the primary uses and methods for selecting this equipment.
避免皮肤或衣服污染的穿脱防护用品的推荐程序见于图中。用于处理或重复使用防护用品的容器应安置在方便脱下来的防护用品和污染物品的处理。手卫生总是在移去、处理防护用品后的最后一步。下面的部分重点阐述这些用品的主要用途和方法。

桂花香

II.E.1. Gloves Gloves are used to prevent contamination of healthcare
personnel hands when 1) anticipating direct contact with blood or body fluids,
mucous membranes, nonintact skin and other potentially infectious material; 2)
having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route e.g., VRE, MRSA, RSV,or 3) handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces. Gloves can protect both patients and healthcare personnel from exposure to infectious material that may be carried on hands.
II.E.1.手套 以下情况手套用于预防医务人员手的污染：1）预料到会直接接触血液或体液、粘膜、不完整皮肤和其他潜在感染性物质；2）直接接触有经接触传播病原体如VRE、MRSA、RSV定植或感染病人；或3）处理或触碰可见或潜在的污染的病人用物和环境表面。手套能保护病人和医务人员免于暴露可能携带在手上的感染性物质。
The extent to which gloves will protect healthcare personnel from transmission of bloodborne pathogens (e.g., HIV, HBV, HCV) following a needlestick or other pucture that penetrates the glove barrier has not been determined. Although gloves may reduce the volume of blood on the external surface of a sharp by 46-86%, the residual blood in the lumen of a hollowbore needle would not be affected; therefore, the effect on transmission risk is unknown.
手套在穿破手套的针刺伤中能在多大程度上保护医务人员免受经血传播病原体如HIV、HBV、HCV等的传染还没有确定。尽管手套可能减少锐器外表面的血量46-86%，但是空心针的内腔剩余血量没有影响，因此，传播的危险仍不明了。
Gloves manufactured for healthcare purposes are subject to FDA evaluation and clearance 730 . Nonsterile disposable medical gloves made of a variety of
materials (e.g., latex, vinyl, nitrile) are available for routine patient care 731. The
selection of glove type for non-surgical use is based on a number of factors,
including the task that is to be performed, anticipated contact with chemicals and chemotherapeutic agents, latex sensitivity, sizing, and facility policies for creating a latex-free environment
用于保护医务人员的手套生产接受FDA的评价和审核。非灭菌处理的医用手套有很多材料（如乳胶、乙烯、丁腈）可供常规病人护理时选择。非外科使用的手套种类的选择考虑多种因素，包括进行的操作，预期接触的化学和化疗药物、乳胶过敏，手套的大小以及创造无乳胶环境的政策等。
For contact with blood and body fluids during non-surgical patient care, a single pair of gloves generally provides adequate barrier protection . However, there is considerable variability among gloves; both the quality of the manufacturing process and type of material influence their barrier effectiveness . While there is little difference in the barrier properties of unused intact gloves, studies have shown repeatedly that vinyl gloves have higher failure rates than latex or nitrile gloves when tested under simulated and actual clinical conditions. 在护理非手术患者接触血液或体液时，戴一副手套通常能提供足够的屏障防护。然而，手套在生产过程和材料的不同会影响其屏障效果。
未使用的不同材料的完整手套屏障性能差别不大，但重复的研究测试已经显示乙烯手套比乳胶或丁腈手套在模拟或实际的临床工作中屏障丧失的几率更高。
For this reason either latex or nitrile gloves are preferable for clinical procedures that require manual dexterity and/or will involve more than brief patient contact. It may be necessary to stock gloves in several sizes. Heavier, reusable utility gloves are indicated for non-patient care activities, such as handling or cleaning contaminated equipment or surfaces .
由于这个原因，乳胶或丁腈作为要求手灵活工作和/或涉及比简单接触病人更多的临床操作的选择。可能需要储备不同型号的手套。较重的重复使用的手套用于非护理病人的操作，如处理或清洗污染的设施或物体表面。
During patient care, transmission of infectious organisms can be reduced by
adhering to the principles of working from “clean” to “dirty”, and confining or
limiting contamination to surfaces that are directly needed for patient care. It may be necessary to change gloves during the care of a single patient to prevent cross-contamination of body sites. It also may be necessary to change gloves if the patient interaction also involves touching portable computer keyboards or other mobile equipment that is transported from room to room.
在护理病人过程中，通过遵循从“清洁”到“脏”的原则以及直接接触病人时控制表面的污染可减少传染性病原体的传播，护理同一个病人时，可能需要在不同的部位直接更换手套以避免交叉污染。如果操作中涉及到接触便携式计算机键盘或其他从一个房间移动到另一个房间的仪器设备时，也可能需要更换手套。
Discarding gloves between patients is necessary to prevent transmission of
infectious material. Gloves must not be washed for subsequent reuse because
microorganisms cannot be removed reliably from glove surfaces and continued glove integrity cannot be ensured. Furthermore, glove reuse has been associated with transmission of MRSA and gram-negative bacilli. When gloves are worn in combination with other PPE, they are put on last. Gloves that fit snugly around the wrist are preferred for use with an isolation gown because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands. 在不同病人之间更换手套是预防传染性病原体传播的需要，手套不可清洗后重复使用，因为手套表面的微生物不能通过清洗有效清除，清洗后的完整性也不保证。而且，重复使用手套已经与MRSA和革兰阴性杆菌的传播有关。当手套与其他防护用品一起使用时，应最后戴手套。穿隔离袍时建议戴紧贴手腕的手套，因为它能够遮盖袍的缝隙，可以为手臂、手腕和双手提供更可靠的防护屏障。
Gloves that are removed properly will prevent hand contamination (Figure). Hand hygiene following glove removal further ensures that the hands will not carry potentially infectious material that might have penetrated through unrecognized tears or that could contaminate the hands during glove removal.
正确的移除手套可以避免手的污染。脱手套后的洗手进一步保证手不再携带可能通过看不见的破损进入或可能在脱手套的过程中污染的潜在传染性物质。

桂花香

II.E.2. Isolation gowns Isolation gowns are used as specified by Standard and Transmission-Based Precautions, to protect the HCW’s arms and exposed body areas and prevent contamination of clothing with blood, body fluids, and other potentially infectious material. The need for and type of isolation gown selected is based on the nature of the patient interaction, including the anticipated degree of contact with infectious material and potential for blood and body fluid penetration of the barrier.
II.E.2隔离袍 隔离袍特别用于标准和基于传播途径的语法来保护医务人员的手臂和暴露的身体区域以避免衣服被血液、体液和其他潜在的传染性物质。隔离的用途和类型选择基于病人的特点，包括预计接触传染性物质的程度和血液和体液渗透屏障的潜在可能。
The wearing of isolation gowns and other protective apparel is mandated by the OSHA Bloodborne Pathogens Standard. Clinical and laboratory coats or jackets worn over personal clothing for comfort and/or purposes of identity are not considered PPE. When applying Standard Precautions, an isolation gown is worn only if contact with blood or body fluid is anticipated.
穿隔离袍和其他服装是OSHA血传性病原体预防标准的要求。作为舒适和/或身份标志目的船在个人衣服外面的工作服货架可不被认为是个人防护设施。当实施标准预防时，预计接触病人血液或体液时只穿一件隔离袍。
However, when Contact Precautions are used (i.e., to prevent transmission of an infectious agent that is not interrupted by Standard Precautions alone and that is associated with environmental contamination), donning of both gown and gloves upon room entry is indicated to address unintentional contact with contaminated environmental surfaces. The routine donning of isolation gowns upon entry into an intensive care unit or other high-risk area does not prevent or influence potential colonization or infection of patients in those areas.然而，当使用接触预防时（如预防不被单纯标准预防阻断的传染性病原体传播），进入隔离间穿隔离袍和戴手套表示强调未预计接触污染的环境表面。常规穿隔离袍进入加护病房或其他高危区域不能预防或影响该区域内病人潜在的定植或感染。
Isolation gowns are always worn in combination with gloves, and with other PPE when indicated. Gowns are usually the first piece of PPE to be donned. Full coverage of the arms and body front, from neck to the mid-thigh or below will ensure that clothing and exposed upper body areas are protected. Several gown sizes should be available in a healthcare facility to ensure appropriate coverage for staff members. 隔离袍总是与手套和其他需要的个人防护用品结合使用。隔离袍总是最先穿的防护用品。遮盖手臂和从颈部到中腰或腰以下的身体前部以保证衣服和暴露的上半身得到保护。应提供几种型号的隔离袍以满足员工的需要。
Isolation gowns should be removed before leaving the patient care area to prevent possible contamination of the environment outside the patient’s room. Isolation gowns should be removed in a manner that prevents contamination of clothing or skin (Figure). The outer, “contaminated”, side of the gown is turned inward and rolled into a bundle, and then discarded into a designated container for waste or linen to contain contamination.隔离袍应在离开病人护理区域以避免对病人房间外环境的可能污染。脱隔离袍应遵循一定的方法来避免污染衣服或皮肤。隔离袍外层、“污染的”的一面应翻转在内卷成束，然后放在盛装废物或污染被服的容器内。

潮水

希望你能继续申领翻译！谢谢！

楚楚

隔离衣是最先穿的防护用品，手套是最后戴的防护用品！我认为如果隔离衣不是一用一换的话，隔离衣最先穿不是最佳选择，大家觉得呢？

桂花香

更正！：
Isolation gowns should be removed before leaving the patient care area to prevent possible contamination of the environment outside the patient’s room. Isolation gowns should be removed in a manner that prevents contamination of clothing or skin (Figure)..隔离袍应在离开病人护理区域前脱下以避免对病人房间外环境的可能污染。脱隔离袍应遵循一定的方法脱下来避免污染衣服或皮肤。

桂花香

隔离衣是最先穿的防护用品，手套是最后戴的防护用品！
我理解应该是完成一次操作需要配戴各种防护用品时的顺序。如果您认为能重复或需要重复使用隔离衣，则另当别论。

桂花香

这是认领的后续部分P52-55。请大家批评指正！
II.E.3. Face protection: masks, goggles, face shields
II.E.3.面部防护：口罩、防护镜、面罩
II.E.3.a. Masks Masks are used for three primary purposes in healthcare
settings: 1) placed on healthcare personnel to protect them from contact with
infectious material from patients e.g., respiratory secretions and sprays of blood or body fluids, consistent with Standard Precautions and Droplet Precautions; 2) placed on healthcare personnel when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents carried in a healthcare worker’s mouth or nose, and 3) placed on coughing patients to limit potential dissemination of infectious respiratory secretions from the patient to others (i.e., Respiratory Hygiene/Cough Etiquette). Masks may be used in combination with goggles to protect the mouth, nose and eyes, or a face shield may be used instead of a mask and goggles, to provide more complete protection for the face, as discussed below. Masks should not be confused with particulate respirators that are used to prevent inhalation of small particles that may contain infectious agents transmitted via the airborne route as described below.
II.E.3.a.口罩 医疗机构内口罩主要用于三种目的：1）提供给员工保护他们免于接触来自病人如呼吸道分泌物和血液、体液喷溅的传染性物质，这与标准预防和飞沫预防相同；2）用于员工进行要求无菌技术操作时保护病人免于暴露在医务人员口腔或鼻腔携带的传染性病原体；3）用于咳嗽病人以限制其传染性呼吸道分泌物从一个病人向另一个病人的潜在传播（如呼吸卫生/咳嗽管理）。口罩可能与防护镜一起使用来保护口腔、鼻子和眼睛或以面罩代替口罩和防护镜，以便提供更完全的面部保护，正如下面讨论的。口罩不应与以下描述的特殊呼吸器混淆，这种呼吸器用于预防吸入可能含有通过空气传播的传染性病原体的微小颗粒。
The mucous membranes of the mouth, nose, and eyes are susceptible portals of entry for infectious agents, as can be other skin surfaces if skin integrity is compromised (e.g., by acne, dermatitis). Therefore, use of PPE to protect these body sites is an important component of Standard Precautions. The protective effect of masks for exposed healthcare personnel has been demonstrated. 口腔、鼻腔和眼睛粘膜，正如皮肤完整性受损（如痤疮、皮炎）时容易受到传染性病原体的入侵。 因此，使用个人防护用品来保护这些身体部位是标准预防中很重要的方面。口罩对于暴露的医务人员的保护已经明确。
Procedures that generate splashes or sprays of blood, body fluids, secretions, or excretions (e.g., endotracheal suctioning, bronchoscopy, invasive vascular procedures) require either a face shield (disposable or reusable) or mask and goggles.The wearing of masks, eye protection, and face shields in specified circumstances when blood or body fluid exposures are likely to occur is mandated by the OSHA Bloodborne Pathogens Standard. Appropriate PPE should be selected based on the anticipated level of exposure.产生血液、体液、分泌物或排泄物的飞溅或喷溅的操作（如气管内吸引、支气管镜检、侵入性血管内操作）需要面罩（一次性或可重复使用的）或口罩和防护镜。在特殊环境里进行可能发生血液或体液暴露的操作佩戴口罩、眼罩、和面罩是OSHA血传性病原体标准的要求。应该根据预计的暴露程度选择适当的防护用品。
Two mask types are available for use in healthcare settings: surgical masks that are cleared by the FDA and required to have fluid-resistant properties, and
procedure or isolation masks. No studies have been published that
compare mask types to determine whether one mask type provides better
protection than another. 医疗机构内应提供两种类型的口罩：通过FDA认定并要求具有防体液特性的外科口罩，和操作或隔离口罩。还没有发表的研究比较两种口罩来哪一种类型防护更好。
Since procedure/isolation masks are not regulated by the FDA, there may be more variability in quality and performance than with surgical masks. Masks come in various shapes (e.g., molded and non-molded), sizes, filtration efficiency, and method of attachment (e.g., ties, elastic, ear loops). Healthcare facilities may find that different types of masks are needed to meet individual healthcare personnel needs.既然操作/隔离口罩由FDA管制，可能其在质量和性能方面较外科口罩更可靠。口罩有各种形状（如模型的和非模型的）、大小、过滤效果，和固定方法（如绑带、弹性的、挂耳环）。医疗机构可能发现需要不同类型的口罩来满足不同医务人员的需求。

桂花香

II.E.3.b.防护镜，面罩 感染控制中眼睛防护的指引已经发表。眼睛防护用于特殊的情况（如防护镜或面罩）取决于暴露的环境、其他使用的防护用品，和个人的视觉需要。个人的眼镜和接触镜（隐形眼镜）不认为有足够的眼睛保护。NIOSH认为，眼睛保护必须是舒适的，提供充足的外部视野，同时必须合适以保证安全。
It may be necessary to provide several different types, styles, and sizes of protective equipment. Indirectly-vented goggles with a manufacturer’s anti-fog coating may provide the most reliable practical eye protection from splashes, sprays, and respiratory droplets from multiple angles. Newer styles of goggles may provide better indirect airflow properties to reduce fogging, as well as better peripheral vision and more size options for fitting goggles to different workers. Many styles of goggles fit adequately over prescription glasses with minimal gaps. While effective as eye protection, goggles do not provide splash or spray protection to other parts of the face. 可能需要提供几种不同的类型、式样和型号的防护用品。非直接排气的防护镜带有生产商配备的防雾套可能提供最可靠的眼睛保护免受来自不同角度的飞溅、喷溅和呼吸飞沫。
更新款式的防护镜可能提供更好的间接气流特性以减少雾气，并提供更好的视野，更多的型号供不同的员工选择。很多款式的防护镜符合镜片大而缝隙小的要求。当防护镜很好保护眼睛时，它并不能对面部的其他区域提供免受飞溅或喷溅。
The role of goggles, in addition to a mask, in preventing exposure to infectious agents transmitted via respiratory droplets has been studied only for RSV. Reports published in the mid-1980s demonstrated that eye protection reduced occupational transmission of RSV. Whether this was due to preventing hand-eye contact or respiratory droplet-eye contact has not been determined. However, subsequent studies demonstrated that RSV transmission is effectively prevented by adherence to Standard plus Contact Precations and that for this virus routine use of goggles is not necessary. 关于防护镜加上口罩预防通过呼吸飞沫传播的传染性病原体暴露的研究仅见于RSV（呼吸道合胞病毒）。发表在80年代中期的文献证明眼睛的保护减少RSV的职业传播。这是由于预防手-眼接触还是呼吸飞沫-眼接触还没有确定。然而，后来的研究证明RSV传播可以通过采取标准预防得到有效阻止，因此对于这种病毒，常规使用防护镜是不必要的。
It is important to remind healthcare personnel that even if Droplet Precautions are not recommended for a specific respiratory tract pathogen, protection for the eyes, nose and mouth by using a mask and goggles, or face shield alone, is necessary when it is likely that there will be a splash or spray of any respiratory secretions or other body fluids as defined in Standard Precautions. Disposable or non-disposable face shields may be used as an alternative to goggles. 很重要的，提醒医务人员即使飞沫预防并没有推荐用于特别的呼吸道病原体，通过使用口罩和防护镜，或单用面罩来保护眼睛、鼻子和口腔以免受到可能出现标准预防里界定的呼吸分泌物或其他体液的飞溅或喷溅是必要的。一次性或重复使用的面罩可作为防护镜的替代。
As compared with goggles, a face shield can provide protection to other facial areas in addition to the eyes. Face shields extending from chin to crown provide better face and eye protection from splashes and sprays; face shields that wrap around the sides may reduce splashes around the edge of the shield. Removal of a face shield, goggles and mask can be performed safely after gloves have been removed, and hand hygiene performed. The ties, ear pieces and/or headband used to secure the equipment to the head are considered “clean” and therefore safe to touch with bare hands. The front of a mask, goggles and face shield are considered contaminated (Figure).与防护镜相比，面罩能提供对面部其他区域和眼睛的保护。从下颚延伸到头顶的面罩可提供更好的防护免受飞溅和喷溅， 边缘有卷折的面罩可能减少其边缘周围的飞溅。面罩、防护镜和口罩的移除应在脱手套后安全进行，并进行手卫生。用于固定防护用品的绑带、耳围和/或头围应认为是“清洁”的，因此可以用裸手接触。口罩、防护镜和面罩的前部认为是污染的。

桂花香

II.E.4. Respiratory protection The subject of respiratory protection as it applies to preventing transmission of airborne infectious agents, including the need for and frequency of fit-testing is under scientific review and was the subject of a CDC workshop in 2004. Respiratory protection currently requires the use of a respirator with N95 or higher filtration to prevent inhalation of infectious particles. Information about respirators and respiratory protection programs is summarized in the Guideline for Preventing Transmission of Mycobacterium tuberculosis in Health-care Settings, 2005 (CDC.MMWR 2005; 54: RR-17 12).
II.E.4. 呼吸保护 呼吸防护指的是应用于防止空气传播病原体的预防，包括在科学观察下测试合适的呼吸需要和频率，是2004年CDC工作间的主要内容。现行的呼吸防护要求使用带有N95或更高过滤效果的呼吸器来预防传染性颗粒的吸入。关于呼吸器和呼吸保护程序概述见2005年预防医疗机构内结核传播的指南。
Respiratory protection is broadly regulated by OSHA under the general industry standard for respiratory protection (29CFR1910.134) which requires that U.S. employers in all employment settings implement a program to protect employees from inhalation of toxic materials. OSHA program components include medical clearance to wear a respirator; provision and use of appropriate respirators, including fit-tested NIOSH-certified N95 and higher particulate filtering respirators; education on respirator use and periodic re-evaluation of the respiratory protection program. 呼吸防护受到OSHA更广泛的监控，在一般的工业呼吸防护标准里，要求美国雇佣者在所有工作场所采取措施保护员工免受毒性物质的吸入。OSHA计划构成包括配戴呼吸器的医学认证、提供和使用合适的呼吸器包括经测试的NIOSH认证的N95和更高颗粒过滤效果的呼吸器、呼吸器使用的教育和定期呼吸防护程序的再评估。
When selecting particulate respirators, models with inherently good fit characteristics (i.e., those expected to provide protection factors of 10 or more to 95% of wearers) are preferred and could theoretically relieve the need for fit testing. Issues pertaining to respiratory protection remain the subject of ongoing debate. Information on various types of respirators may be found at www.cdc.gov/niosh/npptl/respirators/respsars.html and in published studies. A user-seal check (formerly called a “fit check”) should be performed by the wearer of a respirator each time a respirator is donned to minimize air leakage around the facepiece.当选择特别的呼吸器时，应选择其内在良好的合适性（如那些预计为10%或更高到95%的配戴者提供保护）的模型，并且理论上认为可以免于测试其合适性。与呼吸保护有关的问题仍在争论中。各种呼吸器的信息可见于CDC网站和发表的研究文献。使用者密闭测试（以前叫“合适测试”）应该在每次配戴呼吸器时进行以最大限度的减少面部周围的空气泄漏。
The optimal frequency of fit-testng has not been determined; re-testing may be indicated if there is a change in facial features of the wearer, onset of a medical condition that would affect respiratory function in the wearer, or a change in the model or size of the initially assigned respirator. Respiratory protection was first recommended for protection of preventing U.S. healthcare personnel from exposure to M. tuberculosis in 1989. 合适测试的最佳频率还没有确定，如果配戴者的面部形状有改变提示需重复测试，临床状况会影响配戴者的呼吸功能，或改变原来设计的呼吸器的模式或大小。呼吸保护在1989年时最初被推荐用于美国医疗机构内保护医务人员免于暴露在结核菌中。
That recommendation has been maintained in two successive revisions of the Guidelines for Prevention of Transmission of Tuberculosis in Hospitals and other Healthcare Settings. The incremental benefit from respirator use, in addition to administrative and engineering controls (i.e., AIIRs, early recognition of patients likely to have tuberculosis and prompt placement in an AIIR, and maintenance of a patient with suspected tuberculosis in an AIIR until no longer infectious), for preventing transmission of airborne infectious agents (e.g., M. tuberculosis) is undetermined. 这样的建议已经保持在连续两次的指南修订中以预防医院和其他医疗机构内结核的传播。使用呼吸器加上管理和工程方面的控制（如空气传播感染隔离房间、可能患有结核的病人的早期识别并临时安置于隔离间内以及把疑似结核的病人安置在隔离间直至不再有感染）来预防空气传播病原体（如结核菌）传播的更多好处还不肯定。
Although some studies have demonstrated effective prevention of M. tuberculosis transmission in hospitals where surgical masks, instead of respirators, were used in conjunction with other administrative and engineering controls, CDC currently recommends N95 or higher level respirators for personnel exposed to patients with suspected or confirmed tuberculosis. 尽管一些研究已经发现在医院内配戴外科口罩代替呼吸器配合其他管理和工程控制能有效预防结核菌的传播，CDC现在仍推荐当医务人员接触疑似或证实的结核病人时配戴N95口罩或更高水平的呼吸器。
Currently this is also true for other diseases that could be transmitted through the airborne route, including SARS and smallpox, until inhalational transmission is better defined or healthcare-specific protective equipment more suitable for for preventing infection are developed. Respirators are also currently recommended to be worn during the performance of aerosol-generating procedures (e.g., intubation, bronchoscopy, suctioning) on
patients withSARS Co-V infection, avian influenza and pandemic influenza (See Appendix A).现在也发现其他疾病如SARS和天花可能通过空气传播，在吸入传播被更好的界定或更适于预防感染的医疗机构特异性防护设施开发前，目前呼吸器还是被推荐用于对SARS冠状病毒感染、禽流感和流感病人进行产生气溶胶的操作中（如插管、气管切开、复苏）（见附件A）。
Although Airborne Precautions are recommended for preventing airborne
transmission of measles and varicella-zoster viruses, there are no data upon which to base a recommendation for respiratory protection to protect susceptible personnel against these two infections; transmission of varicella-zoster virus has been prevented among pediatric patients using negative pressure isolation alone. Whether respiratory protection (i.e., wearing a particulate respirator) would enhance protection from these viruses has not been studied. 尽管呼吸预防被推荐用于预防麻疹和水痘带状疱疹病毒的空气传播，没有资料用于建议呼吸器用来保护易感人群抵抗这两种感染，在儿科病人中仅仅通过负压房间就可以防止水痘带状疱疹病毒的传播。呼吸保护（如配戴特殊的呼吸器）是否可以提高对这些病毒的保护还没有相关的研究。
Since the majority of healthcare personnel have natural or acquired immunity to these viruses, only immune personnel generally care for patients with these infections. Although there is no evidence to suggest that masks are not adequate to protect healthcare personnel in these settings, for purposes of consistency and simplicity, or because of difficulties in ascertaining immunity, some facilities may require the use of respirators for entry into all AIIRs, regardless of the specific infectious agent. 既然大多数医务人员已经天然具有或获得对这些病毒的免疫，通常只有具有免疫力的员工照顾这些感染病人。虽然没有证据说明口罩不足以保护医务人员，为了一致和简便，或者因为探知免疫功能的困难，一些医疗机构可能要求在进入空气感染隔离病房时使用呼吸器而不考虑是否存在特殊感染病原体。
Procedures for safe removal of respirators are provided (Figure). In some
healthcare settings, particulate respirators used to provide care for patients with M. tuberculosis are reused by the same HCW. This is an acceptable practice providing the respirator is not damaged or soiled, the fit is not compromised by change in shape, and the respirator has not been contaminated with blood or body fluids. There are no data on which to base a recommendation for the length of time a respirator may be reused.脱呼吸器的程序见图。在一些医疗机构，用于结核病人的特殊的呼吸器会被医务人员再重复使用，这是可以接受的，如果呼吸器没有损坏或变脏，合适度没有因形状改变而降低以及呼吸器没有被血液或体液污染。没有资料用于推荐呼吸器可以重复使用的时限。

潮水

忙过这段时间，就重点对付这个指南，希望大家踊跃参与翻译！:handshake :handshake

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