|
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。 | 
发表于 2011-9-25 12:19
发表于 2012-2-25 01:12