控制艰难梭菌播散的感控措施综述

David

Clinical Microbiology and Infection
Volume 14 Infection control measures to limit the spread of Clostridium difficile Page 2-20, May 2008

Abstract
Infection control measures to limit the spread of Clostridium difficile
控制艰难梭菌播散的感控措施综述
R.-P. Vonberg11Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany, E. J. Kuijper22Leiden University Medical Centre, Leiden, The Netherlands, M. H. Wilcox33Department of Microbiology, Leeds Teaching Hospitals and University of Leeds, Leeds, UK, F. Barbut44Unité d’Hygiène et de Lutte contre les Infections Nosocomiales, Hôpital Saint-Antoine, Paris, France, P. Tüll55European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden, P. Gastmeier11Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany, on behalf of the European C. difficile-Infection Control Group and the European Centre for Disease Prevention and Control (ECDC), P. J. van den Broek22Leiden University Medical Centre, Leiden, The Netherlands, A. Colville66Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK, B. Coignard77Institut de Veille Sanitaire, Saint-Maurice, France, T. Daha88The Dutch Working Party Infection Control, Leiden, S. Debast99Meander Medical Centre, Amersfoort, The Netherlands, B. I. Duerden1010Department of Health, London, UK, S. van den Hof1111Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands, T. van der Kooi1111Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands, H. J. H. Maarleveld22Leiden University Medical Centre, Leiden, The Netherlands, E. Nagy1212Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary, D. W. Notermans1111Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands, J. O’Driscoll1313Stoke Mandeville Hospital, Stoke Mandeville, Buckinghamshire, UK, B. Patel1414Health Protection Agency, London, UK, S. Stone1515Academic Department of Geriatric Medicine, Hampstead Campus, Royal Free and University College Medical School, London, UK and C. Wiuff1616Health Protection Scotland, Glasgow, UK1Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany, 2Leiden University Medical Centre, Leiden, The Netherlands, 3Department of Microbiology, Leeds Teaching Hospitals and University of Leeds, Leeds, UK, 4Unité d’Hygiène et de Lutte contre les Infections Nosocomiales, Hôpital Saint-Antoine, Paris, France, 5European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden, 6Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK, 7Institut de Veille Sanitaire, Saint-Maurice, France, 8The Dutch Working Party Infection Control, Leiden, 9Meander Medical Centre, Amersfoort, The Netherlands, 10Department of Health, London, UK, 11Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands, 12Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary, 13Stoke Mandeville Hospital, Stoke Mandeville, Buckinghamshire, UK, 14Health Protection Agency, London, UK, 15Academic Department of Geriatric Medicine, Hampstead Campus, Royal Free and University College Medical School, London, UK and 16Health Protection Scotland, Glasgow, UK


Abstract

Clostridium difficile-associated diarrhoea (CDAD) presents mainly as a nosocomial infection, usually after antimicrobial therapy. Many outbreaks have been attributed to C. difficile, some due to a new hyper-virulent strain that may cause more severe disease and a worse patient outcome. As a result of CDAD, large numbers of C. difficile spores may be excreted by affected patients. Spores then survive for months in the environment; they cannot be destroyed by standard alcohol-based hand disinfection, and persist despite usual environmental cleaning agents. All these factors increase the risk of C. difficile transmission. Once CDAD is diagnosed in a patient, immediate implementation of appropriate infection control measures is mandatory in order to prevent further spread within the hospital. The quality and quantity of antibiotic prescribing should be reviewed to minimise the selective pressure for CDAD. This article provides a review of the literature that can be used for evidence-based guidelines to limit the spread of C. difficile. These include early diagnosis of CDAD, surveillance of CDAD cases, education of staff, appropriate use of isolation precautions, hand hygiene, protective clothing, environmental cleaning and cleaning of medical equipment, good antibiotic stewardship, and specific measures during outbreaks. Existing local protocols and practices for the control of C. difficile should be carefully reviewed and modified if necessary.

星火

制艰难梭菌播散的感控措施综述或指南
包括CDAD的早期诊断，CDAD监测案例，职业教育，适当的隔离措施，手卫生，防护服装，环境卫生和消毒医疗设备，合理应用抗菌药物，以及CDAD爆发时感控策略等。
谢谢D斑的提供！辛苦啦:handshake