[转帖]牙医院所感染控制SOP作业细则

icchina

<span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';"><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">网上看到的，感觉不是中国大陆制定的。很值得借鉴！</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';"></span>&nbsp;</p><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';"><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">牙医院所感染控制</span><span lang="EN-US"><font face="Times New Roman">SOP</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">作业细则</span></p></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">一、每日开诊前</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">1.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">员工将便服、鞋子换成制服（或工作服）或诊所工作用之鞋子并梳整长发。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">2.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">进行诊间环境清洁。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">3.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">进行治疗台清洁擦拭及其管路消毒，管路出水二分钟，痰盂水槽流水三分钟，抽吸管以新鲜泡制</span><span lang="EN-US"><font face="Times New Roman">0.005</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">～</span><span lang="EN-US"><font face="Times New Roman">0.02%</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">漂白水（</span><span lang="EN-US"><font face="Times New Roman">NaOCl</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">）或</span><span lang="EN-US"><font face="Times New Roman">2.0%</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">冲洗用戊二醛溶液</span><span lang="EN-US"><font face="Times New Roman">(glutaraldehyde)</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">或稀释之碘仿溶液</span><span lang="EN-US"><font face="Times New Roman">(10%)(iodophors) </font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">冲洗管路三分钟。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">4.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">覆盖无法清洗且易污染的设备，如诊疗椅之灯座把手、头套、Ｘ光按扭盘…等。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">5.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">检查所有器械之消毒状况或将前一天已浸泡消毒之器械处理并归位，或将已灭菌妥善之各式器械依类别归位。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">6.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">依当天约诊</span><span lang="EN-US"><font face="Times New Roman">(</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">或预估</span><span lang="EN-US"><font face="Times New Roman">)</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">之患者数及其诊疗项目，准备充足器械及各式感染控制材料。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">7.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">诊间所有桌面尽量净空干净，物品尽量依序放在柜子内保持清洁。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">8.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">牙医院所应就现况，制定感染控制实施流程与计划，全体员工定期讨论、改进、倡导与执行。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">二、诊疗开始前</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">1.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">诊疗椅之诊盘</span><span lang="EN-US"><font face="Times New Roman">(tray)</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">上尽量保持清洁与净空。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">2.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">将患者欲治疗所需之器械摆设定位。</span><font face="Times New Roman">
                        </font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">3.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">病历及Ｘ光片放置在牙医师可见之清洁区内，不要放在治疗盘上。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">4.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">对应诊患者依「全面性预警防范措施」原则（</span><span lang="EN-US"><font face="Times New Roman">universal precaution</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">）详细问诊，包括询问有无全身性疾病，各种传染性疾病，如</span><span lang="EN-US"><font face="Times New Roman">B</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">型肝炎或其带原者等病史</span><span lang="EN-US"><font face="Times New Roman">)</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">5.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">引导患者就位，围上围巾，给予漱口三十秒至一分钟。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">6.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">牙医师及所有诊所牙医助理人员需穿戴防护装置，至少包括口罩与手套，必要时戴面罩。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">三、诊疗中</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">1.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">使用洗牙机头或快速磨牙机头等会喷飞沫气雾之器械时，建议使用面罩。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">2.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">必要时为患者给予眼罩避免残屑掉入患者眼睛。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">3.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">治疗过程依感染控制之各项原则，如「公筷母匙」、「单一剂量」、「单一流程」、「减少飞沫气雾」等执行看诊。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">四、诊疗结束患者离开后</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">1.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">病患治疗完，离开治疗椅后，先将治疗盘上所有医疗弃物收集，并作感染与非感染性、可燃与非可燃性之区分，置于诊间的分类垃圾筒内。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">2.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">治疗后之污染器械（包括手机、检查器械等）收集后，若无马上清除者，可暂存在「维持溶液」（</span><span lang="EN-US"><font face="Times New Roman">holding solution</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">）内，常用</span><span lang="EN-US"><font face="Times New Roman"> 2.0</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">～</span><span lang="EN-US"><font face="Times New Roman">3.2% glutaraldehyde</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">（戊尔醛）</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">，防止污染之血液或唾液干燥，以利清洗。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">3.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">可抛弃之器械（包括吸唾管、漱口杯等）则收集后放入分类之垃圾筒。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">4.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">下一位病患就位前，可用喷式消毒剂或擦拭法，消毒工作台、痰盂、治疗椅台面等，必要时（对看完</span><span lang="EN-US"><font face="Times New Roman">B</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">型肝炎及</span><span lang="EN-US"><font face="Times New Roman">B</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">型肝炎带原者或其它感染性症疾病患者或仪器遭污染者）重新覆盖，然后换上新的治疗巾、器械包、吸唾管等器械。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">5.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">对于有</span><span lang="EN-US"><font face="Times New Roman">B</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">型肝炎或</span><span lang="EN-US"><font face="Times New Roman">B</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">型肝炎带原者等确定感染性疾病之患者，看完牙齿后之所有器械则另外打包消毒。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">6.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">倘若发生针扎事件，依「针扎处理流程」进行处理。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">7.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">牙医师看完一患者需更换一副手套，并勤洗手，若口罩遇湿或污染需更换。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">8.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">牙医相关人员应脱掉手套再写病历、接电话…等，避免造成「交互污染」。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">五、门诊结束后</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">1.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">整理器械、清洗、打包、消毒与灭菌，禁得起高热者，用高温高压灭菌器灭菌，无法加热者，用</span><span lang="EN-US"><font face="Times New Roman">2.0</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">─</span><span lang="EN-US"><font face="Times New Roman">3.2%</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">戊二醛溶液浸泡之。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">2.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">下班前需将环境作初级整理与消毒，垃圾分类及处理，器械经清洗后进锅消毒，若无法灭菌者，亦需浸泡在消毒液内隔天处理，千万不要将诊间之污染物暴露隔夜。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">3.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">管路消毒，放水放气与拆下滤网，彻底清洗。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">4.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">离开诊间前，彻底洗手，必要时更衣换鞋，安全干净地回家。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">5.</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">门诊结束后，应保持通风或使用空气滤净器。</span></p></span>

icchina

<p><br/>上篇经查，来源台湾。另有考评表供下载</p><p></p>

楚楚

胡教授，上传的东东太好了！正在学习中！谢谢！多一句废话：繁体字可以在WORD文档中进行转换。[em01][em01][em01][em01]

gaoxd5

工具-语言-简繁体转换

一枝梅

谢谢！拜读啦！

九月菊花香

已下载,感谢教授的辛勤劳作!一定抽时间拜读.

hzxsdyyywmq

&nbsp;&nbsp;&nbsp;&nbsp; 谢谢胡教授,已下载，一定好好学习。

一休

谢谢胡教授[em02]

yanziym

请教胡教授：我们这里对手术前是否刷手，有两种意见，一是我们的医生（尤其是去大医院进修回来的，）都说可以不刷手，有免刷的消毒剂；二是刷手，每一次检查（省里的、市里的）都要求必须刷手。真不知道该这么好！到底刷还是不刷，专家意见好像也不一致。

如梦如烟

以上细则很好，可操作性强，具用较高的临床指导意义，但有些提法已经过时。比如：若不能及时清洗的牙科手机和器械可放在维持液（2%的戊二醛）里，现在是不主张这样做的，因为这样对牙科手机的伤害非常大，牙科手机不能用戊二醛浸泡。而且现在也不提倡在清洗前用消毒液浸泡器械，应直接从清洗开始。

寂寞的雨

谢谢胡教授！细节决定成败，我们分享了！

常常的小兵

谢谢，
好好好:P

抗感染

好好学习借鉴一下！！谢谢教授！！
:)

快乐

已下载,好好学习借鉴一下！！谢谢教授！！

若寒

已下载,在这里总是能收获很多！谢谢了，胡教授！！

lljjww

学习了，谢谢:victory:

xcjtzslyy

这个细则确实很好，值得推荐

清浅

老师,考评表在哪里下载呀

平安

下载学习，谢谢胡教授！！！

小龙女

拜读了，谢谢教授！