【 讨论】中国卫生部和美国CDC，该相信谁？

星火

http://www.dxy.cn/bbs/post/view?bid=126&id=15937320&sty=1&tpg=1&age=0
1.中国卫生部发文《医用外科口罩即可满足甲型H1N1流感个人防护需求》——“专家指出，甲型H1N1流感主要通过飞沫传播，合格的医用外科口罩即可满足个人防护需求。身体健康的公众在日常生活和正常的社会活动中，不建议佩戴口罩。如需与甲型H1N1流感患者接触，或长时间处于人员密集且不通风的场所，则应当通过佩戴口罩进行个人防护。”
http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s3582/200911/44423.htm

2.然后同样在卫生部网站看了《甲型H1N1流感医院感染控制技术指南（试行）》讲解课件，文中强调确诊的患者要戴外科口罩，对于医生的预防措施中有关口罩的有：有可能被血液、体液、分泌物等物质喷溅污染时，应选择相应的防护用品，包括外科口罩、防护镜或面罩、隔离衣或防水围裙等。

http://61.49.18.65/publicfiles/business/htmlfiles/mohyzs/s3586/200905/40640.htm

3.然后今天新英格兰医学杂志上看见在美国CDC的文件《Novel H1N1 Influenza
and Respiratory Protection for Health Care Workers》——“Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use were not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from 4 to 90%.4 These masks — which are open on the sides, top, and bottom — may be useful in source control when worn by a patient, but even then, there is evidence that material escapes around the mask's margins after a sneeze or forcible cough.”——到目前为止没有令人信服的证据表明外科口罩可以提供预防H1N1感染的有效防护。外科口罩的设计并不是用来预防流感的，并且测试显示气溶胶粒子对其的穿透能力在4-90%之间。

随后明确指出N95口罩才能达到预防标准。

http://content.nejm.org/cgi/content/full/361/19/1823?query=TOC
www.cdc.gov/h1n1flu/guidelines_infection_control.htm

于是产生疑问
1.对普通群众，为何文生部指出“与甲型H1N1流感患者接触，或长时间处于人员密集且不通风的场所，则应当通过佩戴口罩进行个人防护。”？接触患者时都才带外科口罩作为预防措施？
2.对医护人员，为何卫生部还要将外科口罩作为防护措施之一。
3.为何美国CDC明确指出医护人员或普通人接触患者时不应该带外科口罩而应该带N95？
4.美国CDC做了测试外科口罩无效，中国卫生部也做了测试？有效还是无效？既然卫生部已经发文说外科口罩可以预防，那姑且相信做了测试，那两国一正一反的结果，相信谁？！

新英格兰这样级别的期刊的文章，显示出对医护人员的防护比较重视，不知国内相同级别的期刊有无专门保护医护人员的文章登载？

市场价外科口罩0.5元/个，N95口罩7元/个，希望不是钱的因素而被别人卖！

我们连自己都不知道怎样保护自己，还要去保护患者？

也可能是我理解错误，也请预防医学的战友解惑，致谢。

青霉素

N95口罩有专门的标准吗？与外科防护口罩有哪些区别？谁有请上传看看。
医用口罩是不是这样界定？
https://bbs.sific.com.cn/viewthre ... hlight=%BF%DA%D5%D6

阳光

1# zhangfh
是啊，非常非常地疑惑，到底该信谁？

学感控

我们医院在6月份收治了21例甲流患儿，都有家里人陪护，家属陪护时都佩戴外科口罩，患儿经治疗全部康复出院，陪护没有一个人发生院内感染，这或许是佩戴了外科口罩起到了作用吧，外科口罩在防护方面还是有一定的效果，我的观点不知是否正确，请大家批评指正！

柳莹依

按照外科口罩的国标是可以预防飞沫传播的.因其能有效阻隔5μm的飞沫颗粒达90%,应该来说医务人员与甲流病人的日常接触是可以有效防护的，国外关于外科口罩与N95口罩（正式名称应该叫医用防护口罩）在预防季节性流感方面的效果无显著差异的论文也是不少的。当然在进行高风险操作如插管、支纤镜检查及给痰量大的病人吸痰时是建议配戴医用防护口罩的。zhang老师所说的N95口罩7元/个，这个应该是3M公司的那种，其实国产的医用防护口罩是1.35元/个。我院是甲流重症病例定点收治医院，一直用的就是国产的医用防护口罩。当然也有医师在做插管时戴的是3M公司的医用防护口罩。没问题。
有些人对我国关于医用防护口罩的国标不太熟悉，以为只有拱形的那种才是，其实国标中即有长方形的也有拱形的标准。看看这个帖子。https://bbs.sific.com.cn/viewthre ... B%C1%F8%D3%A8%D2%C0
对老外也要小心哟。在供应室的监测中，本来爬行卡就可以代替生物监测，欧洲都采用，但老美不。记得供应室护长讲在一个培训班上有人向来讲学的老美问到这个问题时，老美回答：老美有这么多生产生物监测指示剂及培养仪的厂家怎么办？老美有时是讲的好听，事情临头的时候可是另一个样子的，现在金融危机后不就表现出强烈的贸易保护主义？

风雨同舟

5# 柳莹依


同意柳版主的观点：飞沫传播带外科口罩是有效的，医务人员近距离操作，有喷溅可能时，戴医用防护口罩比较妥当。:ffff

楚楚

5# 柳莹依
:victory: 我很赞同！http://www.apic.org//AM/Template.cfm?Section=Home1美国三大院感巨头强烈呼吁白宫修改2009年H1N1指南，把N95使用到更需要的地方去，防控甲流一次性外科口罩足亦。在这一点上我国卫生部新修订的甲流医院感染控制技术指南是英明的。
LEADING SCIENTIFIC ORGANIZATIONS URGE WHITE HOUSE
TO MODIFY 2009 H1N1 GUIDANCE FOR HEALTHCARE WORKERS AND
ISSUE MORATORIUM ON OSHA ENFORCEMENT
Infectious Diseases Prevention Experts Say Current Guidelines
Are Not Supported By Science; Could Have
Dangerous Consequences for Patients and Healthcare Workers
(Arlington, VA)--Three leading scientific organizations specializing in infectious diseases prevention issued a letter to President Obama today expressing their significant concern with current federal guidance concerning the use of personal protective equipment (PPE) by healthcare workers in treating suspected or confirmed cases of 2009 H1N1 influenza. The Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC) urged the administration to modify the guidance and issue an immediate moratorium on Occupational Safety and Health Administration’s (OSHA) enforcement of the current requirements.
Federal PPE guidance and requirements issued recently by the Centers for Disease Control and Prevention (CDC) and OSHA include the use of fit-tested N95 respirators by healthcare workers rather than the use of standard surgical masks. According to these organizations--representing scientists, infectious disease specialists and healthcare professionals dedicated to healthcare quality, safety and infection control--this guidance does not reflect the best available scientific evidence. Their letter to the White House cited two recent studies demonstrating that the use of N95 respirators does not offer additional protection over that provided by the use of surgical masks.
Mark Rupp, MD, president of SHEA called the current requirements “deeply flawed” and expressed his concern over the “potential for considerable untoward consequences” that could result from the guidance. Among the consequences, Rupp cited significant confusion among healthcare professionals and administrators and the potential for further limiting the availability of the already scarce respirators in situations where they are truly warranted.
“During a time of a national emergency, healthcare professionals need clear, practical and evidence-based guidance from the government,” said Richard Whitley MD, president of IDSA. “The current guidance is not supported by the best-available science
and only serves to create skepticism toward federal public and occupational health decision-making.”
“The supply of N95 respirators is rapidly being depleted in our healthcare facilities,” said APIC 2009 President Christine Nutty, RN, MSN, CIC. “We are concerned that there won’t be an adequate supply to protect healthcare workers when TB patients enter the healthcare system.”
The organizations have provided input to federal agencies including the CDC regarding the handling of 2009 H1N1 influenza in the past and say they stand ready to continue to lend their knowledge and expertise as the pandemic advances.

龙文鞭影

关于口罩防护看看这个：真吓人
如何预防H1N1 - 来自医生的忠告
How to Prevent H1N1 - Best Advice So Far
（如何预防H1N1 - 来自医生的忠告）


Most N95 respirators are designed to filter 95% particulates of 0.3µ, while the size of H1N1 virus is about 0.1µ. Hence, dependence on N95 to protect against H1N1 is like protecting against rain with an umbrella made of mosquito net.

N95口罩是用来阻隔95%的0.3μ微粒，而H1N1病毒的大小是0.1μ左右。所以，靠N95口罩防H1N1就像用蚊帐来挡雨。


Tamiflu does not kill but prevents H1N1 from further proliferation till the virus limits itself in about 1-2 weeks (its natural cycle). H1N1, like other Influenza A viruses, only infects the upper respiratory tract and proliferates (only) there. The only portals of entry are the nostrils and mouth/ throat. In a global epidemic of this nature, it's almost impossible not coming into contact with H1N1 in spite of all precautions.

流感疫苗不是用来杀死H1N1病毒，它只能抑制病毒在其1-2周的自然生存周期中繁衍，H1N1跟其他Ａ型流感的病毒一样，感染部位只限于上呼吸道，并在那繁殖，它的唯一入侵途径是口鼻喉，这种全球性的流感，几乎无人能置身事外。

Contact with H1N1 is not so much of a problem as proliferation is.

但接触到H1N1病毒，并不像H1N1传染的问题那么严重．

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps - not fully highlighted in most official communications- can be practiced (instead of focusing on how to stock N95 or Tamiflu):

当你身体健康，尚未出现H1N1感染症状时，更实用有效的办法，是用以下几种简单的方式来防止H1N1病毒在你体内繁殖、出现病症、及恶化成继发感染（而不是只关注储备N95或流感疫苗）：

1. Frequent hand-washing (well highlighted in all official communications).

常洗手（在所有的官方警示中，都有重点强调）

2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat or bathe).

手绝不碰脸....除非是要吃东西或洗脸


3. Gargle twice a day with warm salt water (use Listerine if you don't trust salt). H1N1 takes 2-3 days after initial infection in the throat/nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.

每天用温盐水（或李斯德林漱口水，如果你不太相信盐水有效的话）漱口两次。H1N1在鼻喉腔内经过2-3天，才开始增生并出现症候，简单的盐水漱口可以抑制病毒繁衍，等于是健康人的流感疫苗，千万不要小看这看似简单、花费不多，但是很有效的办法。

4.. Similar to 3 above, clean your nostrils at least once every day with warm salt water. Not everybody may be good at Jala Netior Sutra Neti (very good Yoga asanas to clean nasal cavities), but blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.

以上三点之外，每天用温盐水清洗鼻孔至少一次，不是每个人都会用专业的清洗鼻腔的办法，但吸口气用力将鼻内物质喷出，最后以棉花棒沾温盐水清洁鼻孔。这对降低鼻中的病毒量非常有效。

5. Boost your natural immunity with foods that are rich in Vitamin C  (Amlaand other citrus fruits). If you have to  supplement with Vitamin C  tablets, make sure that it also has Zinc to boost  absorption.     

更多的食用富含维他命Ｃ的食物（如柑橘类的水果），可增加自身免疫力。如果只能服维生素C片，尽管选用含锌的以提高维生素C的吸收。


6. Drink as much of warm liquids as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction.  They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.  

多喝温开水或热汤，功效和漱口一样，只是方向相反。随着热水或汤水被喝到胃里的病毒是无法生存、传染或发作的。


7. All these are simple ways to prevent, within means of most households

桂花香

我院甲流隔离病区用 的也是国产的医用防护口罩，效果不错，医务人员接待了不少甲流病人，没有发生感染。