2007－ICAAC－关于艰难梭菌环境污染和消毒的论文－待翻译

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Role of Environmental Contamination and Disinfection in Healthcare-Associated Infections: Clostridium difficile.
LANCE R. PETERSON, MD.;
Evanston Northwestern Healthcare, Evanston, IL.
Introduction: C. difficile is responsible for the majority of healthcare-associated infectious diarrhea and pseudomembranous colitis, and is rapidly increasing in prevalence. Recently there have been two major clinical developments: i) emergence of a hypervirulent form of the disease and ii) the suggestion that metronidazole is less effective now than in the past. Novel ways for improved control are needed.
Background: It is known that C. difficile spores frequently contaminate the hospital environment (P Verity et al, 2001). Various products are used for disinfection within hospitals. While many are effective against vegetative forms of C. difficile, an effective agent needs to inactivate spores for maximal efficiency. Only chlorine-containing germicides have been consistently shown to inactivate C. difficile spores and to cause an immediate prevention of spore germination (WN Fawley et al, 2007).
Clinical Reports: There have been periodic reports of chlorine-containing cleaners being used to successfully lower C. difficile diarrhea rates when used as an environmental disinfectant. These include in a bone marrow transplant unit (JL Mayfield et al, 2000), a general medicine unit with a high endemic rate (MH Wilcox et al, 2003), in ICUs (KM McMullen et al, 2007), and throughout a 3-hospital healthcare organization (DM Hacek et al, 2007).
Conclusion: The implementation of a cleaning program using chlorine-based germicides, particularly for the rooms of C. difficile positive patients, may be a useful step to lower the rate of C. difficile-associated diarrhea and should be considered, particularly in an outbreak setting or with persistently high endemic rates of disease.

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ole of Environmental Contamination and Disinfection in Healthcare-Associated Infections: Clostridium difficile. 医院环境污染和消毒：艰难梭状芽孢杆菌
LANCE R. PETERSON, MD.;
Evanston Northwestern Healthcare, Evanston, IL.
Introduction: C. difficile is responsible for the majority of healthcare-associated infectious diarrhea and pseudomembranous colitis, and is rapidly increasing in prevalence.前言：艰难梭状芽孢杆菌是医院内感染性腹泻和伪膜性结肠炎感染的主要病原体，流行有进一步增加的趋势。Recently there have been two major clinical developments: i) emergence of a hypervirulent form of the disease and ii) the suggestion that metronidazole is less effective now than in the past. Novel ways for improved control are needed.最近有两个主要的临床发现：一个是超恶性毒株的出现，另一个是使用甲硝唑效果比过去下降，必须采取新的控制措施。
Background: It is known that C. difficile spores frequently contaminate the hospital environment (P Verity et al, 2001).背景： 我们知道艰难梭状芽孢杆菌经常污染医院环境(P Verity et al, 2001)。Various products are used for disinfection within hospitals. While many are effective against vegetative forms of C. difficile, an effective agent needs to inactivate spores for maximal efficiency.不同的消毒液在医院中使用，但是最有效的消毒剂应该是可以杀灭芽孢。Only chlorine-containing germicides have been consistently shown to inactivate C. difficile spores and to cause an immediate prevention of spore germination 只有含氯消毒剂能杀灭艰难梭状芽孢杆菌芽孢并进行能及时预防传播(WN Fawley et al, 2007)。
Clinical Reports: There have been periodic reports of chlorine-containing cleaners being used to successfully lower C. difficile diarrhea rates when used as an environmental disinfectant. These include in a bone marrow transplant unit (JL Mayfield et al, 2000), a general medicine unit with a high endemic rate (MH Wilcox et al, 2003), in ICUs (KM McMullen et al, 2007), and throughout a 3-hospital healthcare organization (DM Hacek et al, 2007). 临床报告：有定期报告显示在使用含氯消毒剂进行环境消毒能有效降低艰难梭状芽孢杆菌引起的腹泻。该结果通过医院感染管理组织调查，其中包括一个骨髓移植组、一个一般流行状况的大内科和ICU。
Conclusion: The implementation of a cleaning program using chlorine-based germicides, particularly for the rooms of C. difficile positive patients, may be a useful step to lower the rate of C. difficile-associated diarrhea and should be considered, particularly in an outbreak setting or with persistently high endemic rates of disease.结论：使用含氯消毒进行消毒，特别是对被艰难梭状芽孢杆菌感染的病人房间消毒是降低艰难梭状芽孢杆菌感染率的有效的方法，在爆发和高流行期间更应使用。