澳大利亚国家IPC指南-1.前言

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1.Introduction 前言

Effective infection prevention and control is central to providing high quality healthcare for patients and a safe working environment for those that work in healthcare settings.
有效的感染预防和控制对于为患者提供高质量的医疗保健和为在医疗机构工作的人员提供安全的工作环境至关重要。

有效的感染预防和控制对于为患者提供高质量的医疗保健和为在医疗机构工作的人员提供安全的工作环境至关重要。
（1）Healthcare associated infection is preventable
（1）医疗相关感染是可以预防的医疗保健相关感染是可以预防的
Healthcare associated infections (HAIs) are infections acquired as a direct or indirect result of healthcare
医疗保健相关感染 （HAI） 是因医疗保健而直接或间接获得的感染[10]. There is international evidence to suggest a considerable infection burden exists among long-term care residents however in Australia there are few published studies on the rate of infection
.有国际证据表明，长期护理居民存在相当大的感染负担，然而，在澳大利亚，关于感染率的已发表研究很少[1] [2] [3] [4]. In Australian acute healthcare facilities, there are around 165,000 HAIs each year
.在澳大利亚的急症医疗机构中，每年约有 165,000 名 HAI[7]. This makes HAIs the most common complication affecting patients in hospital. As well as causing unnecessary pain and suffering for patients and their families, these adverse events prolong hospital stays and are costly to the health system. Approximately 7% of hospitalised patients will acquire a HAI, with an estimated increase to the cost of a patient's admission of 8.6%
.这使得 HAI 成为影响住院患者的最常见并发症。这些不良事件不仅会给患者及其家属带来不必要的痛苦和折磨，还会延长住院时间，并给卫生系统带来高昂的代价。大约 7% 的住院患者将获得 HAI，估计患者入院费用增加 8.6%[8]. The problem does not just affect patients and workers in hospitals — HAIs can occur in any healthcare setting, including office-based practices (e.g. general practice clinics, dental clinics, community health facilities), the setting in which paramedics work and long-term care facilities. Any person working in or entering a healthcare facility is at risk. However, healthcare associated infection is a potentially preventable adverse event rather than an unpredictable complication and it is possible to significantly reduce the rate of HAIs through effective infection prevention and control.
.该问题不仅影响医院的患者和工作人员——HAI 可能发生在任何医疗环境中，包括基于办公室的实践（例如全科诊所、牙科诊所、社区卫生设施）、护理人员工作的环境和长期护理设施。任何在医疗机构工作或进入医疗机构的人都处于危险之中。然而，医疗保健相关感染是一种潜在的可预防的不良事件，而不是不可预测的并发症，并且可以通过有效的感染预防和控制显着降低 HAI 的发生率。
医疗保健相关感染（healthcare related infections， HAI）是直接或间接由医疗保健引起的感染[10]。有国际证据表明，长期护理居民存在相当大的感染负担，但在澳大利亚，关于感染率的已发表研究很少[1] [2] [3] [4]。在澳大利亚的急症医疗机构中，每年约有165,000例HAI[7]。这使得 HAI 成为影响住院患者的最常见并发症。这些不良事件不仅会给患者及其家属带来不必要的痛苦和折磨，还会延长住院时间，并给卫生系统带来高昂的代价。约7%的住院患者会获得HAI，估计患者入院费用增加8.6%[8]。该问题不仅影响医院的患者和工作人员——HAI 可能发生在任何医疗环境中，包括基于办公室的实践（例如全科诊所、牙科诊所、社区卫生设施）、护理人员工作的环境和长期护理设施。任何在医疗机构工作或进入医疗机构的人都处于危险之中。然而，医疗保健相关感染是一种潜在的可预防的不良事件，而不是不可预测的并发症，并且可以通过有效的感染预防和控制显着降低 HAI 的发生率。
（2）Infection prevention and control is everybody’s business
（2）感染防控是每个人的事感染预防和控制是每个人的事Understanding the modes of transmission of infectious organisms and knowing how and when to apply the basic principles of infection prevention and control is critical to the success of an infection control program. This responsibility applies to everybody working in and visiting a healthcare facility, including administrators, staff, patients and carers. Infection prevention and control is integral to clinical care and often requires a range of strategies to be successful. It should not be considered as an additional set of practices but as part of standard care.
了解传染性生物体的传播方式，并知道如何以及何时应用感染预防和控制的基本原则，对于感染控制计划的成功至关重要。这项责任适用于在医疗机构工作和访问医疗机构的每个人，包括管理人员、工作人员、患者和护理人员。感染预防和控制是临床护理不可或缺的一部分，通常需要一系列策略才能成功。它不应被视为一组额外的实践，而应被视为标准护理的一部分。
了解传染性生物体的传播方式，并知道如何以及何时应用感染预防和控制的基本原则，对于感染控制计划的成功至关重要。这项责任适用于在医疗机构工作和访问医疗机构的每个人，包括管理人员、工作人员、患者和护理人员。感染预防和控制是临床护理不可或缺的一部分，通常需要一系列策略才能成功。它不应被视为一组额外的实践，而应被视为标准护理的一部分。
Successful approaches for preventing and reducing harms arising from HAIs involve applying a risk-management framework to manage ‘human’ and ‘system’ factors associated with the transmission of infectious agents. This approach ensures that infectious agents, whether common (e.g. gastrointestinal viruses) or evolving (e.g. influenza or multi-resistant organisms), can be managed effectively.
预防和减少 HAI 造成的危害的成功方法包括应用风险管理框架来管理与传染性病原体传播相关的“人”和“系统”因素。这种方法确保了传染性病原体，无论是常见的（如胃肠道病毒）还是进化的（如流感或多重耐药微生物），都可以得到有效管理。
预防和减少 HAI 造成的危害的成功方法包括应用风险管理框架来管理与传染性病原体传播相关的“人”和“系统”因素。这种方法确保了传染性病原体，无论是常见的（如胃肠道病毒）还是进化的（如流感或多重耐药微生物），都可以得到有效管理。
Involving patients and their carers is essential to successful infection prevention and control in clinical care. Patients need to be sufficiently informed to be able to participate in reducing the risk of transmission of infectious agents.
让患者及其护理人员参与进来对于在临床护理中成功预防和控制感染至关重要。患者需要充分了解情况，以便能够参与降低传染性病原体传播的风险。
让患者及其护理人员参与进来对于在临床护理中成功预防和控制感染至关重要。患者需要充分了解情况，以便能够参与降低传染性病原体传播的风险。
（3）Aim 目标

By assisting healthcare workers to improve the quality of the care they deliver, these Guidelines aim to promote and facilitate the overall goal of infection prevention and control: the creation of safe healthcare environments through the implementation of evidence-based practices that minimise the risk of transmission of infectious agents.
通过协助医护人员提高他们提供的护理质量，这些指南旨在促进和促进感染预防和控制的总体目标：通过实施循证实践创造安全的医疗环境，将传染性病原体的传播风险降至最低。
通过协助医护人员提高他们提供的护理质量，这些指南旨在促进和促进感染预防和控制的总体目标：通过实施循证实践创造安全的医疗环境，将传染性病原体的传播风险降至最低。
（4）Scope 使用范围

The Guidelines provide a nationally accepted approach to infection prevention and control, focusing on core principles and priority areas for action. They provide a basis for healthcare workers and healthcare facilities to develop detailed protocols and processes for infection prevention and control specific to local settings. The Guidelines have been developed to specifically support improved infection prevention and control in acute health settings. While some of the principles and recommendations described in the Guidelines may be applicable to other health settings, all healthcare facilities should consider the risk of transmission of infection in their setting and implement the Guidelines and its recommendations according to their specific setting and circumstances.
该指南提供了一种全国公认的感染预防和控制方法，重点关注核心原则和优先行动领域。它们为医护人员和医疗机构制定针对当地环境的感染预防和控制的详细协议和流程提供了基础。该指南的制定旨在专门支持改善急性卫生环境中的感染预防和控制。虽然《指南》中描述的一些原则和建议可能适用于其他卫生环境，但所有医疗机构都应考虑其环境中的感染传播风险，并根据其具体环境和情况实施《指南》及其建议。
该指南提供了一种全国公认的感染预防和控制方法，重点关注核心原则和优先行动领域。它们为医护人员和医疗机构制定针对当地环境的感染预防和控制的详细协议和流程提供了基础。该指南的制定旨在专门支持改善急性卫生环境中的感染预防和控制。虽然《指南》中描述的一些原则和建议可能适用于其他卫生环境，但所有医疗机构都应考虑其环境中的感染传播风险，并根据其具体环境和情况实施《指南》及其建议。
This approach is underpinned by a risk-management framework to ensure the basic principles of infection prevention and control can be applied to a wide range of healthcare settings including hospitals, day procedure units, office-based practice, long-term care facilities, remote area health services, home and community nursing and emergency services. It is recognised that the level of risk may differ according to the different types of facility and therefore some recommendations should be justified by risk assessment. When implementing these recommendations all healthcare facilities need to consider the risk of transmission of infection and implement according to their specific setting and circumstances.
这种方法以风险管理框架为基础，以确保感染预防和控制的基本原则可以应用于广泛的医疗环境，包括医院、日间手术室、办公室诊所、长期护理机构、偏远地区卫生服务、家庭和社区护理以及紧急服务。人们认识到，风险水平可能因不同类型的设施而异，因此应通过风险评估来证明某些建议的合理性。在实施这些建议时，所有医疗机构都需要考虑感染传播的风险，并根据其具体环境和情况实施。
这种方法以风险管理框架为基础，以确保感染预防和控制的基本原则可以应用于广泛的医疗环境，包括医院、日间手术室、办公室诊所、长期护理机构、偏远地区卫生服务、家庭和社区护理以及紧急服务。人们认识到，风险水平可能因不同类型的设施而异，因此应通过风险评估来证明某些建议的合理性。在实施这些建议时，所有医疗机构都需要考虑感染传播的风险，并根据其具体环境和情况实施。
The evidence base for the Guidelines addresses the highest level of risk of infection transmission in the healthcare setting, and has predominantly been drawn from the acute-care setting. The recommendations should be read in the context of the evidence base and the advice on the practical application of the recommendations. Case studies giving examples of risk assessments have been included to help illustrate how these recommendations can be applied to other settings.
该指南的证据基础涉及医疗机构中感染传播的最高风险，主要来自急症护理机构。阅读这些建议时，应结合证据基础和关于建议的实际应用的建议。书中列举了风险评估实例的案例研究，以帮助说明如何将这些建议应用于其他环境。
该指南的证据基础涉及医疗机构中感染传播的最高风险，主要来自急症护理机构。阅读这些建议时，应结合证据基础和关于建议的实际应用的建议。书中列举了风险评估实例的案例研究，以帮助说明如何将这些建议应用于其他环境。
The Guidelines make reference to but do not include detailed information on:
《指引》提及但未包括以下方面的详细信息：
《指引》提及但未包括以下方面的详细信息：

• infectious diseases 感染性疾病
• pandemic planning 大流行规划
• the reprocessing of reusable medical instruments or devices
  可重复使用的医疗器械或器械的再处理可重复使用的医疗器械或器械的再处理
• work health and safety 工作健康与安全
• hospital hotel services such as food services, laundry services or waste disposal
  医院酒店服务，如餐饮服务、洗衣服务或废物处理医院酒店服务，如餐饮服务、洗衣服务或废物处理
• engineering/health facility design.
  工程/卫生设施设计。
  工程/卫生设施设计。
  
  

（5)Target Audience 目标受众

The Guidelines are for use by all those working in acute health care settings —this includes healthcare workers, management and support staff.
该指南供所有在急症医疗机构工作的人员使用，包括医护人员、管理人员和支持人员。该指南供所有在急症医疗机构工作的人员使用，包括医护人员、管理人员和支持人员。As some of the principles and recommendations described in this guideline may be applicable to other health care settings, individuals working in other health care settings may also find the guidelines useful.
由于本指南中描述的一些原则和建议可能适用于其他医疗机构，因此在其他医疗机构工作的个人也可能发现该指南有用。由于本指南中描述的一些原则和建议可能适用于其他医疗机构，因此在其他医疗机构工作的个人也可能发现该指南有用。

(6)Structure of the Guidelines
(6)准则的结构指南的结构The Guidelines are based around the following core principles:
《指引》基于以下核心原则：《指南》基于以下核心原则：

• an understanding of the modes of transmission of infectious agents and of risk management
  了解传染性病原体的传播方式和风险管理了解感染性病原体的传播方式和风险管理
• effective work practices that minimise the risk of transmission of infectious agents
  有效的工作实践，将传染性病原体的传播风险降至最低有效的工作实践，将传染性病原体的传播风险降至最低
• governance structures that support the implementation, monitoring and reporting of infection prevention and control work practices
  支持实施、监测和报告感染预防和控制工作实践的治理结构支持实施、监测和报告感染预防和控制工作实践的治理结构
• compliance with legislation, regulations and standards relevant to infection control.
  遵守与感染控制相关的法律、法规和标准。遵守与感染控制相关的法律、法规和标准。
  
  

The sections of the Guidelines are based on these core principles and are organised according to the likely readership:
《指南》各部分基于这些核心原则，并根据可能的读者群进行组织：《指南》各部分基于这些核心原则，并根据可能的读者群进行组织：
Section 2 presents background information that should be read by everyone working in healthcare (for example as orientation or as part of annual review)—this includes important basics of infection prevention and control, such as the main modes of transmission of infectious agents and the application of risk-management principles. This part of the guidelines does not include recommendations.
第 2 节介绍了每个从事医疗保健工作的人都应该阅读的背景信息（例如作为指导或作为年度审查的一部分）——这包括感染预防和控制的重要基础知识，例如传染性病原体的主要传播方式和风险管理原则的应用。指南的这一部分不包括建议。
第 2 节介绍了每个从事医疗保健工作的人都应该阅读的背景信息（例如作为指导或作为年度审查的一部分）——这包括感染预防和控制的重要基础知识，例如感染性病原体的主要传播方式和风险管理原则的应用。指南的这一部分不包括建议。
Section 3 is specific to the practice of healthcare workers and support staff, and outlines effective work practices that minimise the risk of transmission of infectious agents.
第 3 节专门针对医护人员和支持人员的实践，并概述了将传染性病原体传播风险降至最低的有效工作实践。
第 3 节专门针对医护人员和支持人员的实践，并概述了将感染性病原体传播风险降至最低的有效工作实践。
Section 4 describes the responsibilities of management of healthcare facilities, including governance structures that support the implementation, monitoring and reporting of effective work practices. The chapters outline the main components of a systems approach to facility-wide infection prevention and control, giving guidance on management and staff responsibilities, protection of healthcare workers, requirements for education and training of all staff, considerations for facility design, and other important activities such as surveillance and antimicrobial stewardship.
第 4 节描述了医疗机构管理的责任，包括支持实施、监测和报告有效工作实践的治理结构。这些章节概述了全设施感染预防和控制系统方法的主要组成部分，就管理和员工责任、医护人员的保护、所有员工的教育和培训要求、设施设计的考虑因素以及其他重要活动（如监测和抗菌药物管理）提供了指导。
第 4 节描述了医疗机构管理的责任，包括支持实施、监测和报告有效工作实践的治理结构。这些章节概述了全设施感染预防和控制系统方法的主要组成部分，就管理和员工责任、医护人员的保护、所有员工的教育和培训要求、设施设计的考虑因素以及其他重要活动（如监测和抗菌药物管理）提供了指导。
Appendices 1-3 provide additional advice on putting the recommendations into practice, risk-management case studies and resources, and the guideline development process.
附录 1-3 提供了有关将建议付诸实践、风险管理案例研究和资源以及指南制定过程的额外建议。
附录 1-3 提供了有关将建议付诸实践、风险管理案例研究和资源以及指南制定过程的额外建议。
(7)Evidence Base 证据基础

The Guidelines are based on the best available evidence and knowledge of the practicalities of clinical procedures. They draw from other work in this area, including the previous national infection control guidelines, international infection control guidelines, systematic literature reviews, literature reviews and horizon scans conducted to inform the development of these Guidelines, work on HAI prevention from the Australian Commission on Safety and Quality in Health Care (ACSQHC), national discipline-based infection control guidelines, and Australian Standards relevant to infection prevention and control. Australian data are used wherever available. Further information is available in Appendix 3: Process Report.
该指南基于现有的最佳证据和对临床程序实用性的知识。他们借鉴了该领域的其他工作，包括以前的国家感染控制指南、国际感染控制指南、系统文献综述、文献综述和地平线扫描，为这些指南的制定提供信息，澳大利亚卫生保健安全与质量委员会 （ACSQHC） 的 HAI 预防工作，国家基于学科的感染控制指南， 以及与感染预防和控制相关的澳大利亚标准。只要有，就会使用澳大利亚的数据。更多信息请见附录3：过程报告。
该指南基于现有的最佳证据和对临床程序实用性的知识。他们借鉴了该领域的其他工作，包括以前的国家感染控制指南、国际感染控制指南、系统文献综述、文献综述和地平线扫描，为这些指南的制定提供信息，澳大利亚卫生保健安全与质量委员会 （ACSQHC） 的 HAI 预防工作，国家基于学科的感染控制指南， 以及与感染预防和控制相关的澳大利亚标准。只要有，就会使用澳大利亚的数据。更多信息请见附录3：过程报告。(8)Recommendations, Practice Statements and Statutory Requirements
(8)建议、实务声明及法定要求建议、实践声明及法定要求All recommendations are based on systematic reviews, with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach providing the evidence to decision framework which determined the structure and final wording of each recommendation. Each recommendation has an accompanying strength which reflects the quality of the evidence underpinning the recommendation and additional factors relating to the harms and benefits of the intervention:
所有建议均基于系统评价，GRADE（建议评估、制定和评价分级）方法为决策框架提供证据，该框架决定了每项建议的结构和最终措辞。每项建议都有相应的优势，反映了支持该建议的证据质量以及与干预的危害和益处相关的其他因素：所有建议均基于系统评价，GRADE（建议评估、制定和评价分级）方法为决策框架提供证据，该框架决定了每项建议的结构和最终措辞。每项建议都有相应的优势，反映了支持该建议的证据质量以及与干预的危害和益处相关的其他因素：Strong Recommendation: Confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects. Overall the recommendation is based on high quality evidence and is strongly recommended for implementation.
强烈建议：确信遵守建议的预期效果大于不良效果。总体而言，该建议基于高质量的证据，强烈建议实施。强烈推荐：确信遵守建议的预期效果大于不良效果。总体而言，该建议基于高质量的证据，强烈建议实施。Weak/Conditional Recommendation: Concludes that the desirable effects of adherence to a recommendation probably outweigh the undesirable effects. Overall the recommendation is based on supportive evidence and a strong theoretical rationale and is recommended for implementation.
弱/有条件建议：得出结论，遵守建议的良好影响可能大于不良影响。总体而言，该建议基于支持性证据和强有力的理论依据，并建议实施。弱/有条件建议：得出结论，遵守建议的良好影响可能大于不良影响。总体而言，该建议基于支持性证据和强有力的理论依据，并建议实施。The Guidelines also include Practice Statements and Statutory Requirements:
《指引》亦包括实务陈述及法定规定：《指引》亦包括实际陈述及法定规定：Practice Statement: Set for areas which are not covered by a systematic review of the evidence, but where the provision of clinical guidance is deemed important. The development of practice statements is primarily based on best practice as advised by expert consensus and aligned with the GRADE approach where available evidence and judgements are considered together however a strength is not assigned.
实践声明：适用于证据系统审查未涵盖的领域，但提供临床指导被认为很重要的领域。实践声明的制定主要基于专家共识建议的最佳实践，并与GRADE方法保持一致，其中现有证据和判断被一并考虑，但未分配强度。实践声明：适用于证据系统审查未涵盖的领域，但提供临床指导被认为很重要的领域。实践声明的制定主要基于专家共识建议的最佳实践，并与GRADE方法保持一致，其中现有证据和判断被一并考虑，但未分配强度。Statutory Requirement: This advice reflects a practice statement or recommendation. The terminology ‘statutory requirement’ is used to further indicate where there is also a mandated requirement/s by the Commonwealth or the States/Territories, which must be considered when implementing the advice at the local level. It is important to note that statutory requirements vary across states and territories, and in their applicability to health service delivery sectors and settings.
法定要求：本建议反映实务声明或建议。“法定要求”一词用于进一步表明英联邦或各州/地区在哪些地方也有强制性要求，在地方一级实施建议时必须考虑这些要求。需要注意的是，各州和领地的法定要求各不相同，其对卫生服务提供部门和环境的适用性也各不相同。
法定要求：此建议反映了实务声明或建议。“法定要求”一词用于进一步表明英联邦或各州/地区在哪些地方也有强制性要求，在地方一级实施建议时必须考虑这些要求。需要注意的是，各州和领地的法定要求各不相同，其对卫生服务提供部门和环境的适用性也各不相同。The formatting of each recommendation and practice statement is as follows:
每项建议和做法声明的格式如下：每项建议和做法声明的格式如下：Research Evidence: Defines the research question underpinning the recommendation in the PICO (population, intervention, comparator, outcomes) format.
研究证据：以 PICO（人口、干预、比较、结果）格式定义支撑建议的研究问题。
研究证据：以 PICO（人群、干预、比较、结果）格式定义支持建议的研究问题。
Key Information: Captures key information relating to the certainty of the evidence, harms and benefits of the intervention, values and preferences of the target population, resource and other considerations.
关键信息：捕获与证据质量、干预措施的危害和益处、目标人群的价值观和偏好、资源和其他考虑因素相关的关键信息。
关键信息：捕获与证据质量、干预措施的危害和益处、目标人群的价值观和偏好、资源和其他考虑因素相关的关键信息。
Rationale: Provides overarching justification for the stated advice.
理由：为所述建议提供总体理由。理由：为所述建议提供总体理由。Practical Information: Provides practical guidance on how each recommendation or practice statement can be put into practice.
实用信息：就如何将每项建议或实践声明付诸实践提供实用指导。实践信息：就如何将每个建议或实践声明付诸实践提供实用指导。Adaptation: The GRADE approach allows for the adoption, adaptation or creation of de novo recommendations from existing quality guidelines. This section captures the adoption or adaption of guidance from the 2010 edition of NHMRC’s Australian Guidelines for the Prevention and Control of Infection in Healthcare
适应：GRADE方法允许采用、调整或创建现有质量指南的重新建议。本节记录了 2010 年版 NHMRC 的《澳大利亚医疗保健感染预防和控制指南》中指南的采用或改编[9]
调整：GRADE方法允许采用、调整或创建现有质量指南的重新建议。本节摘录了2010年版NHMRC的《澳大利亚医疗保健感染预防和控制指南》中指南的采用或改编[9].
References: Provides the full citations for the interactive references cited within each recommendation or practice statement.
参考文献：为每项建议或实践声明中引用的交互式参考文献提供完整的引文。
参考文献：为每项建议或实践声明中引用的交互式参考文献提供完整的引文。(9)Supporting Resources 支持资源

Supporting resources are available for healthcare workers, patients and health facility managers to assist with implementation of the Guidelines. These materials are available to download under '
为医护人员、患者和卫生机构管理人员提供支持资源，以协助实施《指南》。这些材料可在”Companion Resources 配套资源' at the end of these guidelines or from the
' 在这些指南的末尾或从NHMRC website NHMRC 网站.
为医护人员、患者和卫生机构管理人员提供支持资源，以协助实施《指南》。这些材料可在这些指南末尾的“配套资源”下下载，也可以从 NHMRC 网站下载。

补充内容 (2024-5-21 08:48):
https://mp.weixin.qq.com/mp/appm ... 247527750&fr...

aaalxl

谢谢老师的分享，学习了。

梅花丁

路过下载学习了，感谢老师的分享