【重奖翻译】急性病医疗机构流行病学和感染控制2011版（欢迎认领）

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Policies and Procedures

In response to endemic or epidemic HAIs, IPs implement evidence-based infection control policies and procedures aimed at the prevention of future events. Policies and procedures are written and developed based on scientific evidence of benefit, legal requirements, state and federal regulatory standards, as well as guidance from professional society guidelines such as HICPAC (294). Infection control programs also work closely with their institution’s occupational health program to institute policies for diagnosing and monitoring infectious diseases in HCWs as well as setting work restrictions for ill employees and instituting vaccination programs. This partnership is imperative, as HCWs represent a potential source of infections transmissible to patients.

政策和程序

对于医院感染流行或者局部爆发，感控人员实施以证据为基础的感染控制政策和程序，以便预防将来相似事件的发生。政策和过程编写和开发基于科学证据的利益，法律规定，州和联邦监管标准，以及如HICPAC（294）专业协会的指导方针。感染控制方案也应该与他们机构职业健康研究所计划紧密合作，以便建立医护人员感染性疾病诊断和监测以及设置患病员工的工作限制和实行疫苗接种计划等制度。这种伙伴关系是必要的，因为医护人员医院感染传播的潜在来源。

Infection Prevention

An imperative function of infection control and hospital epidemiology programs is the prevention of disease transmission. Infection prevention is a priority, with initiatives being led by health care organizations, government and accrediting agencies, legislators, regulators, payers, and consumer advocacy groups. Infection prevention is accomplished through surveillance, outbreak investigation, instituting control measures to stop transmission and abort outbreaks, education and training of health care providers, and instituting effective HAI prevention measures. In 2008, the SHEA and the Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee assembled a task force to create a compendium of evidence-evidence-based recommendations for the prevention of the most common HAIs (363). The compendium includes recommendations for the prevention of SSIs, CLABSIs, CA-UTIs, VAPs, C. difficile, and MRSA (10, 43, 71, 86, 185, 204). These guidelines present practical recommendations for the prevention of HAIs, and they are an invaluable resource for the development and implementation of HAI prevention. The SHEA/IDSA compendium also recommends performance measures for internal monitoring in order to assess the effectiveness of a facility’s HAI prevention program. These documents aim to assist infection control and prevention programs in focusing and prioritizing their HAI prevention efforts. Recent attention has turned to the implementation of a bundle or package of evidence-based interventions to prevent HAIs. Three bundles have been implemented by the Institute for Healthcare Improvements (IHI) as part of the Save 100,000 Lives campaign. The bundles are aimed at preventing CLABSIs, VAPs, and SSIs. As an example, the CLABSI bundle includes (i) HCW education, (ii) hand hygiene, (iii) maximal barrier precautions during catheter insertion, (iv) chlorhexidine skin antisepsis, (v) optimal site care, (vi) catheter removal, and (vii) practices monitoring CLABSI rates (154). The implementation of the CLABSI prevention bundle has significantly reduced CLABSI rates at multiple institutions (21, 264). The use of a VAP prevention bundle has also led to significant reductions in VAP rates in ICU patients (41, 272). In an effort to reduce SSIs, the CMS has instituted the Surgical Care Improvement Project (SCIP). SCIP measures emphasize a bundle of evidence-based interventions, including (i) improving surgical antimicrobial prophylaxis, (ii) glucose control in cardiac surgery patients, (iii) proper hair removal, (iv) urinary catheter removal, and (v) normothermia (37). Hospital epidemiology and infection control and prevention programs have an important role in working together with health care providers to implement and monitor these evidenced-based practices. (See Table 1 for a detailed description of specific prevention measures.)

预防感染

感染控制及流行病学方案的重要功能是预防疾病传播。预防感染是一个优先事项，由医疗保健机构，政府和评审机构，立法者，监管者，纳税人和消费者权益团体领导并倡议。感染预防是通过监测，爆发调查，实行有些切断传播途径的控制措施，教育和培训卫生保健提供者，并实行有效的​​医院感染预防措施。 2008年，SHEA和美国传染病学会（IDSA）标准和实践指南委员会组建了一个专责小组，以创建为最常见的医院感染（363）预防证据为依据的推荐汇编。该汇编包括了外科切口感染、（SSI），导管相关血流感染（CLA-BSI），导管相关尿路感染（CA-UTI），呼吸机肺炎（VAP），艰难梭菌（CD）和耐耐甲氧西林金黄色葡萄球菌感染等（MRSA）（10，43，71，86，185，204）预防建议。这些准则目前的医院感染预防切实可行的建议，他们是为开发和实施预防HAI的宝贵资源。SHEA/ IDSA汇编还建议内部措施的监控，以评估HAI预防计划的有效性。这些文件的目的在于协助医院感染预防控制工作，确定防控重点和制定预防控制。目前针对医院感染的预防，主要是采取证据为基础的综合处理（BUNDLE）。医疗保健机构（IHI）推行的三个BUNDLE已经完成了“10万人的拯救生命活动”。这些BUNDLE旨在防止CLABSIs，VAPs和SSIs。举例来说，CLABSI包括（i）医护人员培训与教育，（二）手卫生，（三）导管插入前的最大的无菌屏障，（四）洗必泰皮肤消毒，（五）选择最优的穿刺点，（六）拔除尿管，
（七）监测CLABSI发生率的措施（154）。通过CLABSI预防BUNDLE，多个医疗机构CLABSI发生率率显著降低（21，264）。ICU中VAP BUNDLE的推行有效地降低了VAP的发生（41，272）。为了减少SSIS的发生，CMS已经着手实行手术护理改进项目（SCIP）。 SCIP措施，强调了以证据为基础的干预措施，包括（i）改善手术预防性抗生素使用，（ii）胸外病患手术的血糖控制，（三）正确备皮，（四）尿拔除尿管，及（v）体温正常（ 37）。在医护人员实施和监控证据为基础的医院感染预防措施中，医院流行病学和感染控制方案发挥了重要的作用
（具体的预防措施明细见表1）。

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Disinfection, Sterilization, and Cleaning

Invasive medical and surgical procedures have the potential to expose patients to pathogenic microbes and lead to infection. If not properly disinfected or sterilized, medical devices and surgical instruments used in invasive procedures may be the carrier of infectious organisms and may lead to infection. Failure to comply with disinfection and sterilization guidelines has contributed to outbreaks associated with contaminated medical devices and surgical instruments (215, 310, 340). Sterilization kills all microorganisms and high levels of bacterial spores. Sterilization can be performed with steam (autoclave machine), dry heat, or chemical sterilants for heat-sensitive items (284)（既然是热敏感的物质，为什么不选用蒸汽灭菌或者高温灭菌？逻辑上似乎不太通。是否为heat-insensitive items？？）. High-level disinfection kills all microorganisms but does not kill high numbers of bacterial spores. High-level disinfection techniques include pasteurization and chemical sterilants used for heat-sensitive items (284). Intermediate-level disinfection destroys bacteria in the growth phase, mycobacteria, and most viruses and fungi but not bacterial spores. Chlorine-based products, phenolics, and accelerated hydrogen peroxide are all used for intermediate-level disinfection (284). These agents must have documented tuberculocidal activity to be used for intermediate-level disinfection. Low-level disinfection kills bacteria in the growth phase and some fungi and viruses but does not kill mycobacteria or bacterial spores. Nontuberculocidal chlorine-based products, phenolics, accelerated hydrogen peroxide, and quaternary ammonium compounds are used for low-level disinfection (284). Given the importance of disinfection and sterilization in the prevention of the transmission of infectious organisms, guidelines for disinfection and sterilization methods have been created and adopted by infection prevention programs (282, 283).

消毒，杀菌，清洁

侵入性的医疗和手术有可能使患者暴露于致病微生物，导致感染。不适当的消毒或消毒，医疗设备和手术器械在侵入过程中可能成为传染性的生物的载体，并最终导致患者感染。不遵守消毒灭菌指南，导致消毒灭菌不合格，受污染的医疗设备和手术器械（215，310，340）可能导致感染爆发。灭菌可以杀死所有微生物和高水平芽孢，包括蒸汽（高压灭菌机），干热，或热敏感物项（284）的化学灭菌。高水消毒杀死所有微生物，但不杀死一定数量的细菌细菌芽孢。高水平消毒技术包括使用巴氏杀菌和热敏感物的化学消毒（284）。中水平消毒可以杀灭细菌繁殖体，分枝杆菌，大部分病毒和真菌，但不能杀灭芽孢。含氯消毒剂，酚和过氧化氢都属于中水平消毒剂（284）。这些中水平消毒剂必须记录杀结核杆菌活性。低水平消毒可以杀灭细菌繁殖体，一些真菌和病毒，但不会杀死分枝杆菌和芽孢。不能杀灭分支杆菌的含氯消毒产品，酚，加速过氧化氢和季铵化合物属于低水平消毒剂（284）。鉴于消毒和灭菌在预防感染性微生物的传播中的重要性，消毒和灭菌方法的指导原则已经建立并加入感染预防方案（282，283）。

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Recommended disinfection and/or sterilization is based on the risk of infection associated with exposure to particular instruments. Items are categorized as being critical, semi-critical, or noncritical. Critical items are those at a high risk of transmitting infection. These objects are those that enter sterile tissue or the vascular system. Examples of critical items include surgical instruments, cardiac catheters, implants, and ultrasound probes that enter sterile body sites. Critical items should be purchased sterile or undergo sterilization after use. Steam is the preferred sterilization technique (284). Semi-critical items are those that come into contact with non-intact skin or mucous membranes. Examples include respiratory therapy items, anesthesia equipment, and endoscopes. Semi-critical items should undergo high-level disinfection in order to destroy all pathogenic organisms and a majority of bacterial spores (283). Noncritical items are those that come into contact with intact skin. These include virtually all inanimate objects in the health care environment. Examples include blood pressure cuffs, bed rails, linens, countertops, and floors. Noncritical items are unlikely to transmit infectious agents directly to patients (342); however, they contribute to secondary transmission by contaminating HCW hands. Noncritical items should undergo low- to intermediate-level disinfection (283). In addition to the sterilization and disinfection of equipment, cleaning of the environment is also important. Numerous environmental surfaces exist in patient rooms, and studies have documented that a large proportion of these surfaces are missed during routine and terminal cleaning between patients (45). Studies have also shown that patients admitted to hospital rooms previously occupied by patients colonized or infected with C. difficile and drug-resistant organisms are at an increased risk of acquiring these organisms (141; M. Shaughnessy, et al., presented at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy-Infectious Diseases Society of America 46th Annual Meeting, Washington, DC, 25 to 28 October 2008). Interest has shifted to alternative methods of environmental cleaning due to the limitations of current methods. Hydrogen peroxide vapor and UV light are two techniques being explored. Hydrogen peroxide vapor is increasingly employed in health care facilities, as it has been effective in eradicating various pathogens from environmental surfaces and has been associated with a reduced incidence of C. difficile (17, 31, 103). Automated UV light systems have also been associated with decontamination of environmental surfaces (284). Disinfection and sterilization are imperative to prevent the transmission of infectious organisms contaminating invasive medical devices and surgical instruments. Infection prevention and control programs should be actively involved in recommending appropriate disinfection methods and overseeing disinfection and sterilization in their facility. Similarly, programs need to be involved in decisions regarding environmental cleaning techniques. Infection prevention programs need to be aware of disinfection methods used in their facility in order to understand the risk of infection associated with procedures and identify areas for improvement.

推荐的消毒和/或消毒，主要基于接触特定设备感染的风险。器械被归类为关键，半关键，或非关键的。关键器械指能造成交叉污染的传播感染风险的器械。这些器械是进入无菌组织或血管系统。关键器械的例子包括手术器械，心导管，植入物和进入无菌部位的超声探头。关键器械应购买时经过灭菌或者使用后灭菌。蒸汽灭菌的首选技术（284）。 半关键器械是那些接触到非完整皮肤或粘膜。例如包括呼吸治疗器械，麻醉设备，内窥镜。半关键器械应进行高水平消毒，以消灭所有的病原微生物和（283）大多数细菌孢子。非关键的项目是那些接触到完整的皮肤。其中包括几乎所有的医疗环境无生命的物体。例子包括血压计，床栏，床单，台面和地板。非关键项目是不可能将传染源直接传播给患者（342），但它们通过医护人员受传播二次污染。非关键项目应进行低到中等水平消毒（283）。除了杀菌，消毒设备，清洁环境也很重要。多数环境表面主要在病房，研究已经证明，多数表面在病患常规清洁或者终末清洁里被忽略了（45）。研究还表明，病患入住曾经有过艰难梭菌或者多重耐药菌定植的病房极易导致医院获得性艰难梭菌或者多重耐药菌定植或者感染。由于一些方法的局限，人们已经关注了环境清洁的替代方法。过氧化氢蒸气和紫外线灯正在探讨两种技术。过氧化氢蒸汽越来越多地在卫生保健设施，因为它已经从环境中消除表面的各种病原体有效，显著降低获得性艰难梭菌（17，31，103）。自动紫外系统也被用于环境表面消毒（284）。消毒和灭菌被强制用于侵入性的医疗设备和手术器械操作，预防感染性微生物的交叉传播。感染预防和控制程序应选择合适的消毒方法，并对消毒灭菌设备进行过程监督。同样，程序需要在有关环境清洁技术决策。感染预防方案需要清醒地认识设施中使用的消毒方法，以了解感染的风险，并确定相关的程序需要改进的地方。

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Facility Construction and Renovation

Construction, renovation, and maintenance in health care settings can increase the risk of certain HAIs (281). Immunocompromised patients and staff are most at risk for these HAIs. The most common organisms involved are Aspergillus and Legionella species. Everything from large construction and renovation projects to daily maintenance must be assessed for its potential impact and risk of leading to HAIs. Construction and renovation projects must meet guidelines established by government, regulatory, and accreditation agencies. Infection prevention programs should be involved in every step of the process and must work closely with engineers, architects, administrators, clinicians, construction personnel, and maintenance staff (281).

Aspergillus and Legionella species are the leading causes of construction-related HAIs (213, 240, 281). Legionella species are ubiquitous aquatic organisms commonly isolated from water (281). Legionella can be introduced into water systems during construction if pipes become contaminated with soil. Changes in water system pressure, the disruption of water flow, and blind loops can lead to the release of Legionella species growing within biofilms inside pipes. The organism is then transmitted to susceptible individuals by inhaled aerosols or drinking water (281). The most commonly seen clinical manifestation is pneumonia.

Aspergillus species are ubiquitous in soil. Dust and dirt from construction projects harbor Aspergillus spores that can be released into the air and inhaled by susceptible individuals. Other fungi and molds can also grow behind walls or in areas with water damage or high humidity. Molds can cause influenza-like illnesses or hypersensitivity reactions if inhaled, and mold remediation must be undertaken if mold is found (281). More serious complications include lung and sinus infections that are difficult to treat. The Joint Commission recommends that health care facilities follow American Institute of Architects guidelines (6) when undergoing construction or renovation projects (158). When accrediting health care systems, the Joint Commission assesses whether health care facilities comply with guidelines for protecting patients, visitors, and HCWs during construction and renovation (158). It is the responsibility of infection prevention programs, architects, engineers, and administrators to ensure that these guidelines are followed. The most important means to ensure that guidelines are followed is the performance of an infection control risk assessment (ICRA) before construction, renovation, or maintenance projects begin. A multidisciplinary team with expertise in infection prevention, facility design, construction, ventilation, and heating and air-conditioning systems should perform the ICRA for all renovation and construction projects (6, 281). This involves a multistep process that identifies the magnitude of the project and the patient population at risk and then helps identify necessary preventative measures. Examples of prevention measures include protective barriers to minimize dust, HEPA filtration units, and protective attire for construction workers. The team performing the ICRA must also assess whether essential services such as power, gas, water, and sewer might be disrupted and provide contingency plans. The ICRA must also evaluate how patients in adjacent areas will be affected, whether patients in the affected or nearby units should be relocated, and how the project will affect ventilation systems (281). The ICRA process is formalized in the ICRA matrix, a tool that guides the multidisciplinary team to systematically evaluate all issues (281). Prior to opening a newly completed construction or renovation area, infection prevention personnel should inspect the area to ensure that all requirements have been met. Infection prevention expertise is needed for all stages of building and renovation projects to ensure that measures are in place to prevent HAIs. Construction and renovation projects are continuous in most health care settings and another role in which infection prevention personnel must work closely with a multidisciplinary team to protect patients.

Providing Education

IPs also serve an educational role, as they educate and train staff in infection control practices such as isolation precautions, personal protection, and aseptic techniques. IPs are often responsible for infection control training of employees, as required by regulatory agencies such as the Joint Commission and OSHA (294). One of the most effective forms of education is by providing HCWs with surveillance data from their particular unit. This often serves as a catalyst for employee-driven quality improvement programs to decrease HAIs.

Future Directions

Hospital epidemiology and infection control programs have grown over the last 30 years and will most certainly continue to do so. Many programs have taken on new functions with the ultimate goal of patient and HCW safety. For example, many infection control programs have teamed with antimicrobial stewardship programs to improve antimicrobial use. Antimicrobial stewardship programs work with the microbiology laboratory to monitor antimicrobial-resistant organisms and work with clinicians to curtail excessive antimicrobial use as well as educate clinicians on safe antimicrobial practices. Research has also become a large component of infection control programs as we look to better define the epidemiology of HAIs and search for evidencebased interventions to improve patient care. Given the national interest in cutting health care costs and improving patient safety, hospital epidemiology and infection control represent a much-needed practice that will continue to grow.

设施建设及装修
建造，翻建，并在卫生保健机构维护可以增加某些医院感染的危险（281）。对免疫功能低下患者和工作人员在最容易感染这类医院感染。最常见的微生物所涉及的曲霉菌和军团菌。一切从大型建设和改造项目的日常维护必须评估其潜在影响，及导致的医院感染危险。建设和改造项目必须满足政府，监管和认证机构制定的准则。感染的预防计划应渗透到这一进程的每一个步骤，必须与工程师，建筑师，管理人员，临床医生，施工人员和维修人员（281）密切合作。
曲霉菌和军团菌是建筑相关医院感染（213，240，281）的致病原。军团菌是普遍存在的水生微生物，常常在水中可以分离的到（281）。如果在施工期间，管道被土壤污染，军团菌可以进入水系统。在水系统的压力变化，水流受阻，而盲段循环可以导致军团菌在生物膜中被释放进入官腔。这种微生物，可以通过吸入气溶胶或饮水感染易感个体（281）。最常见的临床表现是肺炎。
曲霉菌在土壤中普遍存在。灰尘和污垢从黑海港建设项目，可以释放到空气和易感个体吸入孢子。其他真菌和霉菌也通过水损坏或高湿度在墙壁上生长。霉菌会引起流感样病例，如果吸入则引起过敏反应，霉菌一旦发现必须采取补救措施（281）。更严重的并发症包括肺和鼻窦感染，很难治疗。联合委员会建议，卫生保健设施进行建设或改造项目应遵循美国建筑师学会的指南（6）（158）。当评审的医疗系统，联合委员会评估卫生保健设施在建设和改造时是否符合的指南，保护（158）病人，探视者和医护人员。预防感染方案的要求建筑师，工程师和管理人员必须确保这些指南得到遵守。最重要的措施，确保遵循指南要求在建造，翻建，或维修项目开始之前进行感染控制风险评估（ICRA）。一个在感染的预防知识的多学科团队，包括设施设计，施工，通风，供暖和空调系统，应执行所有改造与建设项目的（6 281）ICRA。这涉及到多步骤的过程，标识项目和风险程度的患者人群，然后确定必要的预防措施。预防措施包括保护屏障，以尽量减少灰尘，HEPA过滤装置，建筑工人的防护服装。该小组还必须执行ICRA评估是否如电力，煤气，自来水，下水道和必要的服务可能会中断，并提供应急计划。该ICRA还必须评估如何在邻近地区的病人会受到影响，无论是在受影响的地区或邻近单位的患者，应重新定位，以及该项目将如何影响通风系统（281）。 ICRA是形​​式化的过程中ICRA矩阵，一个工具，引导多学科小组，有系统地评估所有的问题（281）。在此之前打开一个新落成的建筑或装修面积，预防感染人员要检查，以确保该地区的所有要求都得到满足。感染的预防知识需要体现在建设和改造项目的各个阶段，以确保措施到位，未雨绸缪，预防医院感染。建设和改造项目是连续的，大多数卫生保健机构和其他感染的预防作用，其中的工作人员必须与一个多学科小组，以保护患者的密切合作。
提供教育
感染预防专家也承担教育的作用，因为它们在教育和培训，如隔离措施，个人防护，感染控制和无菌技术人员的操作。感染预防专家为感染控制培训员工，并对联合委员会和OSHA（294）监管机构的要求负责。对教育最有效的形式之一是通过给科室医护人员提供特定的监测数据。这往往成为一个员工质量改进计划的驱动力，以减少医院感染的催化剂。
未来发展方向
医院流行病学和感染控制方案已经发展了30年，以后肯定会继续这样做。许多程序都采取了新的功能，以病人和医护人员安全的最终目标。例如，许多感染控制规划已联同抗菌管理方案，以优化抗生素使用。抗菌管理方案，微生物实验室与临床医生的工作，监察多重耐药菌，抗微生物和工作，以减少过度使用抗生素，以及对医生进行抗菌药物安全使用临床实践教育。研究也已成为感染控制规划的重要部分，如我们期待更好的定义医院感染，并采取证据为基础的干预措施以改善病人护理。如果国家关注削减医疗成本，提高病人安全，医院流行病学和感染控制作为急需的做法的代表，将继续发展壮大。

鬼才

icchina 发表于 2011-6-16 13:16

                               
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回复 1# 蓝鱼o_0

Acute-Care Settings

Acute-Care Settings能否直接翻译成医院？如果翻译成“急性病医疗机构”，在某种场合好象不太恰当。例如：“affecting approximately 2 million persons admitted to acute-care hospitals in the United States each year.”这段话中，把“ acute-care hospitals”意译为“医院”是否好些？

蓝鱼o_0

鬼才 发表于 2011-9-25 12:19

                               
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Acute-Care Settings能否直接翻译成医院？如果翻译成“急性病医疗机构”，在某种场合好象不太恰当。例如： ...

回复 1# 蓝鱼o_0

Acute-Care Settings
不是指急诊科。可以翻译为急性病医疗机构，相对于老年护理院、精神病院等来说的，我国绝大多数的医院，都是属于Acute-Care Settings。

鬼才

蓝鱼o_0 发表于 2011-9-25 19:01

                               
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回复 1# 蓝鱼o_0

Acute-Care Settings

直接翻译为“医院”不行吗？按字译为“急性病医疗机构”多不通俗。

蓝鱼o_0

鬼才 发表于 2011-9-25 19:08

                               
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直接翻译为“医院”不行吗？按字译为“急性病医疗机构”多不通俗。

这是ICCHINA的翻译。我是直接帖出来给您的。

他当时对我的纠正

宁静致远

我已完成”艰难梭菌“部分的翻译，现上传。

宁静致远

gukeju 发表于 2011-10-8 14:17

                               
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我已完成”艰难梭菌“部分的翻译，现上传。

艰难梭菌（CD)
  CD在自然界广泛存在，是1-3%的健康人群的肠道正常菌群【87】，CD临床疾病谱包括无症状携带者、轻度腹泻、严重结肠炎、中毒性巨结肠和死亡。
  CDI在世界范围的发病率在增加【86】，美国出院病人的诊断中有CDI的数量翻了一番，从1996年的82000到2003年的178000【208】。早期研究证实住院是CDI的危险因素。80年代的研究显示，住院成人中的CD定植率高达20-40%，而健康成人的定植率较低，为1-3%【209,333】。研究估计，与CDI相关的住院天数延长3天，费用增加14507.47【235】。
CD可作为结肠正常共生菌存在，当抗菌药物引起肠道菌群失调时，能够繁殖并引起感染。CD繁殖可产生肠毒素（毒素A）和细胞毒素（毒素B）。最近的研究数据提示，毒素B导致结肠损伤和感染的临床表现【193】。
在21世纪初，世界各地的医生们注意到CDI病人中严重病例在增加【15，207】，疾病突出的表现是对治疗反应差，更多的中毒性巨结肠和需结肠切除的病例，导致死亡病例数增加。老年人感染数量增加。引起这些严重病例的CD菌株为BI/NAP1，这种高毒力株较其它菌株产生大量的毒素A和B【338】。与负责下调毒素产生的基因缺失有关，而且对氟喹诺酮高度耐药【15,86,87】。严重CDI（有或无流行株BI/NAP1）病例近来在以往健康个体，无医疗护理暴露的围产期妇女中出现【60,108】。
CD 是常见的医院感染病原菌，可以很快的污染环境。最近一项研究，研究者采集了有症状的CDI患者周围的空气和环境表面样本，发现CD可以从大量的病人周围环境和空气中分离到【23】。分子流行病学检验证实了空气传播、环境污染与CDI病例的相关性，这项发现强调了确诊或疑似CDI患者需要接触隔离并安置在单人病房。
CD芽孢可在物体表面存活长达70天，对传统使用的清洁剂和含醇手卫生产品均有抗性【87,358】。由于CD芽孢对乙醇的抗性，不推荐使用含醇手卫生产品【67】。推荐接触CDI病人后用肥皂和水洗手【86】。未能证明增加含醇手卫生产品的使用是CDI感染率增加的危险因素【114】。然而，肥皂和水仍被推荐优于含醇手卫生产品。
感染预防
新指南（2010）不推荐常规对无症状携带者进行检测。指南推荐对CDI患者在腹泻期间实施接触隔离，鼓励HCW使用肥皂和水进行手卫生的依从性。含氯清洁剂或其它杀芽孢制剂可用于环境去污染。指南也推荐实施抗菌药物管理计划以使可能增加CDI风险的抗菌药物使用频率和疗程最短【72】。

蓝鱼o_0

gukeju 发表于 2011-10-8 14:19

                               
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艰难梭菌（CD)
  CD在自然界广泛存在，是1-3%的健康人群的肠道正常菌群【87】，CD临床疾病谱包括无症状携 ...

欢迎越来越多的会员加入到这个活动中来，从中受益也给其他会员带来分享！

safihu

蓝鱼o_0 发表于 2011-6-27 16:24

                               
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回复 80# 蓝鱼o_0

CLA-BSI 和预防手术部位感染有第四点为拔除尿管这点是如何考虑的？利于患者早日下床活动吗？