美国CDC应对灾后避难所疫情暴发的指南集合贴

David

右手心斑竹请求，特开此贴，愿意为地震灾区尽自己的微薄之力。由于内容较多，希望大家一起帮忙翻译，尽快给前线的战友提供第一手参考资料。:handshake :handshake
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Infection Control Guidance for Community Evacuation Centers Following Disasters
灾后社区避难所感控指南
These recommendations provide basic infection control guidance to prevent exposure to or transmission of infectious diseases in temporary community evacuation centers.
这些推荐措施提供了基本的感控指南，预防在临时搭建的定居点可能产生的传染病传播。
Community evacuation centers include medium and large-scale, organized, temporary accommodations for persons displaced from their homes (e.g., following natural disasters such as hurricanes, floods, and earthquakes). Evacuation facilities may be residential (e.g., dormitories or campsites) or non-residential (e.g., sports stadiums and churches), with varying degrees of sanitary infrastructure.  Individuals in evacuation centers are required to share living spaces and sanitary facilities and may be exposed to crowded conditions.  Evacuees may have health problems including traumatic injuries, infectious diseases, and chronic illnesses such as renal failure.
社区避难所包括中等或大型的有组织的收容因飓风、洪水、地震等自然灾害而无家可归者的临时场所。避难所可以是住宅区（如宿舍、野营地）或非住宅区（如体育场，教堂），但都含有不同程度的卫生设施。在避难所的个人需要和他人在拥挤的条件下共用生活和卫生设施。避难者可能有一些基础疾病包括创伤，传染病和慢性疾病例如肾衰。
1. General Infection Prevention for Residential Evacuation Centers
针对定居点的感控预防概述
Use of appropriate infection prevention measures by all staff and evacuees can reduce the spread of infectious diseases.
医护人员和避难者都采用合适的感控措施能够有效减少传染病的播散
  (1) Staff and residents should wash their hands with soap and water frequently.
       医护人员和避难者应经常用流水和皂液洗手
  (2) Children should be assisted in washing their hands with soap and water frequently.
       儿童应当在成人协助下用流水和皂液洗手
  (3)Alcohol hand gels are an effective addition to hand washing, and a reasonable temporary substitute when soap and clean water are not readily available.
     酒精擦手液是临时代替洗手的有效方式，特别在没有皂液和净水的情况下。
  (4)Alcohol hand gel should be positioned throughout the evacuation center, especially at the beginning of food service lines and outside of toilet facilities.
    酒精擦手液应当被放置于能够覆盖整个避难所的区域，特别在领取分发食物处的首端和厕所门口。
  (5)Encourage good personal hygiene practices including the following:
    良好的个人卫生习惯包括：
        Cover your cough with tissues, disposing tissues in the trash, or with your hands. Wash your hands or use alcohol hand gel after coughing. If possible, tissues should be provided in evacuation center living areas.
        咳嗽时用纸巾包裹痰液，再丢进垃圾桶。之后再用水或酒精擦手液洗手。如果可能的话，避难所的生活区应当为人们提供纸巾。
       Follow good hygienic practices during food preparation.
       准备食物时遵循良好的卫生措施。
       Do not share eating utensils or drinking containers.
       不要公用饭勺筷子或饮水容器。
       Do not share personal care items such as combs, razors, toothbrushes, or towels with any one else.
       不要共用个人物品如梳子、剃须刀，牙刷或毛巾。
  (6)Facilities should be adequate to allow residents to bathe at least twice weekly.
       避难所应当提供足够的设施，至少要保证避难者一周两次的洗澡需要。
  (7)Laundry facilities should be available to allow appropriate laundering of clothes and bed linens.
       要有合适的洗衣晾晒被单的设施
2.Hand Hygiene
  手卫生
After an emergency, it can be difficult to find running water. However, it is still important to wash your hands to avoid illness. It is best to wash your hands with soap and water but, when water isn’t available, you can use alcohol hand gels made for cleaning hands. Below are some tips for washing your hands with soap and water and with alcohol hand gel.
紧急情况下很难找到流动水用于洗手。但是，洗手仍然是避免疾病传播的重要措施。最好用皂液和流水洗手。但是当没有流水的时候，可以用酒精擦手液代替。下面有一些小贴士可能会有帮助：
   When should you wash your hands or use an alcohol hand gel?
    什么时候应当洗手或用酒精擦手液？
   Before eating food.
    吃东西之前
After handling uncooked foods, particularly raw meat, poultry, or fish.*
   取生食物之前，特别是生肉，鸡鸭鱼等
After going to the bathroom.
   进盥洗室以后
After changing a diaper or cleaning up a child who has gone to the bathroom.
   帮婴儿换尿布或小孩大便以后
Before and after tending to someone who is sick.
  看望病人前后
Before and after treating a cut or wound.
  处理伤口前后
After blowing your nose, coughing, or sneezing.
  擤鼻涕，咳嗽或打喷嚏之后
After handling an animal or animal waste.
  处理动物或动物尸体之后
After handling garbage.
  处理垃圾之后
* Food handlers should wash hands with soap and water before beginning work, and before returning to work from any toilet visit or break. Alcohol hand gel should not be substituted in food handlers.
  注：准备处理食物的人应当在工作前和任何原因中途返回工作场所前用皂液和流水洗手。这类情况下酒精擦手液不应当作为洗手的代替品。
3.Cleaning the Living Area
  清洁生活区域
Keeping surfaces and items clean helps to reduce the spread of infections to residents and staff.
保持物品表面干净可以有助于减少医护人员和避难者传染病的播散
(1) Clean surfaces with a household detergent when visibly dirty and on a regular schedule:
当物品表面有可见的脏物时，按以下顺序用家用清洁剂清洗：
Kitchens and bathrooms should be cleaned daily and as necessary.
厨房和盥洗室应当每天清洗，如果有必要应随时清除污物。
Living areas should be cleaned at least weekly and more often if necessary.
生活区域应当至少每周清洗一次，如果必要增加次数。
Bed frames, mattresses and pillows should be cleaned/laundered between occupants.
床框床垫和枕头应当在变更使用者期间清洗。
Other furniture should be cleaned weekly and as needed.
其他家具每周清洗一次。
Spills should be cleaned up immediately
溅出液应当立即处理。
(2) Sanitize (i.e., reduce microbial contamination to safer levels) high-risk surfaces using a household disinfectant (e.g., a product with a label stating that it is a sanitizer) or a mixture of 1 teaspoon of household bleach in 1 quart of clean water (mixed fresh daily). High-risk surfaces include:
消毒（以减少微生物污染的风险）高风险的物品表面。可以使用家用消毒剂（任何贴有消毒剂标签的产品均可）或漂白液（混有1勺家用漂白粉加1.14升清水），每日新鲜配制。高风险物品表面包括：
Food preparation surfaces.
准备食物的区域
Surfaces used for diaper changing.
换洗尿布的区域
Surfaces soiled with body fluid (e.g., vomitus, blood, feces)
被体液污染的区域（如呕吐物，血液，排泄物）
4.Laundry
洗衣
(1)Garments heavily soiled with stool should be handled carefully, wearing gloves, and placed in a plastic bag for disposal. If stool can easily be removed using toilet paper, the garment may be laundered as described below.
  被粪便大量污染的衣服应当戴手套小心处理，然后置于塑料袋内弃置。如果粪便容易清除，则衣服可以按下列方式处理。
(2) Wash clothing in a washing machine using normal temperature settings and laundry detergent.
   使用洗衣机清洗衣服（正常温度，一般洗衣剂）
(3) Household bleach can be used in the rinse water at normal concentrations
   可以在漂洗水里加入正常浓度的家用漂白液。
(4) Dry clothes in a dryer, if possible.
   如果可能的话使用干衣机。
(5) There is no need to disinfect the tubs of washers or tumblers of dryers if cycles are run until they are completed.
   不需要消毒处理洗衣机的管道。
(6) Make sure donated clothing is washed before distribution.
   分发捐赠来的衣物前必须确保清洗干净。
5.Garbage
  垃圾杂物
(1) Waste disposal should comply with local requirements including disposal of regulated medical waste such as syringes and needles.
医疗废弃物处理应当按照当地的制度处理，特别是针头和注射器。
(2) Facilities should provide for proper disposal of syringes and needles used for medications. Containers designed for sharp waste disposal should be placed where sharp items are used. A heavy plastic laundry detergent bottle with a lid may be used if official sharps containers are not available.
  应当提供合适的锐器盒用于放置枕头和注射器。锐器盒应当放置于使用锐器最多的地方。如果没有提供正式的锐器盒，一个带有盖子的厚塑料洗洁剂瓶子可以替代。
(3) Use trash receptacles lined with plastic bags that can be securely tied shut.
  使用可以安全扣紧的废料桶
(4) Trash bags should not be overfilled.
  垃圾袋不可装的太满
(5) Place trash in an area separated from the living spaces, preferably in trash bins.
  垃圾存放区域应当与生活区隔离
(6 )Have waste pick-ups scheduled frequently—daily, if possible.
  每天定时收集运送垃圾。
(7) Separate medical waste from household waste for pickup; follow local guidelines for pickup of medical waste.
  
6.Special Considerations for Non-Residential Evacuation Centers
Non-residential evacuation centers such as stadiums and churches have limited capacity for providing sanitary and food preparation facilities. Bathing and laundry resources are also likely to be limited. In general, it is preferable for non-residential facilities to be used only for very short-term evacuation. Food-service and laundry should be provided from external sources rather than attempting to set up poorly controlled on-site alternatives or allowing residents to attempt these activities individually.
The ability to clean surfaces in non-residential settings may be limited by the size or other physical characteristics of the facility. This increases the importance of hand hygiene. However, such facilities are also likely to have limited availability of hand washing sinks. Thus, additional attention should be paid to positioning alcohol hand gel dispensers in convenient locations throughout the living areas and at the beginning of food service lines, and ensuring that all arriving residents are instructed on their use and availability.
Open sleeping areas should be set up to prevent crowding, ideally with at least 3 feet separating each cot from the next.
7.Management of Persons with Infectious Diseases in Evacuation Centers
The arrival of evacuees who may have open wounds, symptomatic infections, and unrecognized or incubating infectious diseases, combined with potential for crowding and limited sanitary infrastructure, increases the risk of infections spreading among residents and between residents and staff. In particular, respiratory infections, diarrheal diseases and skin infections or infestations are prone to spread under these conditions.  Before entering an evacuation center, all residents should be screened for the following conditions:
Fever
Cough
Skin rash or sores
Open wounds
Vomiting
Diarrhea
Persons with any of the above conditions should be admitted to the evacuation center only after appropriate medical evaluation and care. Residents of the center should be instructed to report any of the above conditions to the center staff.  If a potentially infectious condition is identified in a person already residing at the evacuation center, the ill individual(s) should be separated from other residents or transferred to a special needs evacuation center (see below). A separate area or room should be identified in advance to be used to house potentially infectious residents awaiting evaluation or transfer. If several residents with similar symptoms are identified, they may be housed together in one area. However, cots should still be separated by at least 3 feet. A dedicated restroom should be identified if possible and reserved for use of the ill individuals only. More than one separate area may be needed if more than one illness is identified in the population, e.g., an area for people with diarrhea, and another area for people with a cough and fever. Such separate areas will need to have extra staff members dedicated to monitoring people housed there and ensuring that the area is kept clean and appropriately supplied.
Staff members with any of the above symptoms should not work in the evacuation center, but should seek medical evaluation for assessment and clearance prior to returning to work. Staff members working with residents who have symptoms of illness should use Standard Precautions (defined below) for any interactions that require potential contact with body fluids, and should place particular emphasis on hand hygiene.
Each evacuation center should have a clear plan for transferring individuals with potentially communicable diseases from the evacuation center to an appropriate healthcare facility. This includes plans for having ill individuals with respiratory symptoms wear a paper mask while awaiting evaluation or transfer. A waiting area should be designated that is separate from the main center living areas, but which can be closely monitored by center staff. A system for identifying and notifying the receiving facility must be in place.
8.Special-Needs Evacuation Centers
Special-needs evacuation centers are places that can provide safe refuge to those individuals who require supervision by a healthcare professional. They include:
People with minor health or medical conditions that require professional observation, assessment, and maintenance beyond the capabilities of the general evacuation center staff or facility.
People with infectious diseases whose care requires protective equipment or isolation that are not available at the general evacuation center.
People who require assistance with activities of daily living or more skilled nursing care but do not require hospitalization.
People who need medications or monitoring by health professionals.
Standard Precautions* should be used whenever working with ill individuals, to protect residents and staff from exposure to recognized and unrecognized sources of infection.
Transmission-Based Precautions, including personal protective equipment (e.g., gloves, masks, and gowns) and isolation of ill individuals in separate rooms or areas, are based on the type(s) of symptoms an ill individual has.  These precautions should be used when appropriate in the special-needs evacuation center.  If possible, special-needs evacuation center staff should have access to healthcare personnel who are trained in infection control.
9.*Standard Precautions (summary): During the care of any ill individual, personnel should:
Wear gloves if hand contact with blood, body fluids, respiratory secretions or potentially contaminated surfaces is expected.
Wear a disposable gown if clothes might become soiled with a patient’s blood, body fluids or respiratory secretions.
Change gloves and gowns after each patient encounter and wash hands or use alcohol hand gel immediately after removing gloves.
Wash hands or use alcohol hand gel before and after touching a patient, after touching the patient’s environment, or after touching the patient’s respiratory secretions, whether or not gloves are worn.
When hands are visibly dirty or contaminated with respiratory secretions, wash hands with soap (either plain or antimicrobial) and water.

David

nfection Control Recommendations for Prevention of Transmission of Respiratory Illnesses in Disaster Evacuation Centers
People crowded together in places such as in evacuation centers are vulnerable to outbreaks of respiratory illness. In some cases, such as with influenza, the disease can spread very rapidly in these settings and may have important health consequences for residents and workers. This document provides guidance on some simple measures can help prevent transmission.
Facts about Spread of Respiratory Diseases
Asthma and chronic obstructive pulmonary disease (COPD) are noninfectious, chronic illnesses that can cause coughing, wheezing, and shortness of breath. Persons with asthma or COPD can suffer exacerbations as a result of infectious respiratory diseases. They are also at risk of exacerbations due to increased exposure to environmental asthma triggers and lack of their routine medications.
Many of the germs that cause respiratory diseases spread in respiratory droplets caused by coughing and sneezing. These germs usually spread from person to person when they are in close contact with one another, though sometimes people become infected by touching something with respiratory germs on it and then touching their mouth or nose.
In general, the best way to avoid spread of respiratory disease is to avoid contact with respiratory droplets or secretions. Things that can help include the following:
Perform hand hygiene regularly.
Help ill persons to contain respiratory droplets that result from their coughing and sneezing (see Respiratory Hygiene/Cough Etiquette).
Minimize contact with persons with symptoms of respiratory illness.
Avoid sharing personal items such as eating/drinking utensils, toothbrushes, and towels, especially with ill persons.
Maintain a clean environment.
Some respiratory illnesses, such as influenza, can be prevented with a vaccine. Check with local health officials to see if vaccination is appropriate in your evacuation center.
Early Detection of Respiratory Diseases Among Evacuation Center Residents and Workers
Screening for respiratory disease among residents and evacuation center workers
To prevent the transmission of respiratory infections in evacuation centers, efforts should be made to identify ill persons and implement appropriate infection control measures as soon as possible. In addition, certain ill persons should be referred for medical evaluation in order to ensure appropriate diagnosis and treatment. Early diagnosis can be an important part of prevention.
If possible, screen for respiratory illness among residents and workers upon initial evacuation center admission/registration.
Ask every resident and worker about the presence of the following symptoms of respiratory illness:
Cough
Sneezing
Sore throat
Fever
Wheezing
Shortness of breath
Night sweats
Runny nose
Weight loss
Ask persons with respiratory symptoms if they have asthma or COPD (including emphysema).
Any person meeting one of the following criteria should be referred for medical evaluation:
Any person with respiratory symptoms that are accompanied by fever, wheezing, or shortness of breath;
any person with a chronic cough (a cough that persists for weeks or months) that is accompanied by either fever, night sweats, or weight loss; and
any person with respiratory symptoms who also has asthma or COPD.
If residents do not have symptoms of respiratory illness upon initial evacuation center admission/registration, tell them to report any new respiratory symptoms to staff when they first occur.
Infection Control Measures to Prevent the Spread of Respiratory Diseases
General measures for all evacuation center staff and residents
Wash hands regularly. This is especially important after touching surfaces or objects that might be contaminated with respiratory droplets, or after touching persons who are ill with respiratory symptoms. Alcohol hand gels are an adequate substitute when soap and clean water are not readily available. (See Infection Control Guidance for Community Evacuation Centers Following Disasters.)
Maintain a clean living environment. If frequently touched surfaces are contaminated with respiratory secretions:
Wipe up visible material with paper towels and dispose of used towels in a plastic garbage bag
Disinfect using any standard household disinfectant
Maintain good personal hygiene techniques including the following:
Do not share eating utensils or drinking containers
Do not share other personal articles such as toothbrushes or towels with any one else
To reduce the potential for spread of droplets between evacuation center residents, staff should separate sleeping cots by 3 feet, if possible.
Measures for persons with symptoms of respiratory illness
Provide symptomatic residents with information on preventing spread of illness by practicing respiratory hygiene/cough etiquette, which includes the following measures to contain respiratory secretions:
Cover the nose/mouth when coughing or sneezing;
Use tissues to contain respiratory secretions and dispose of the tissues in the nearest waste receptacle after use;
Perform hand hygiene (e.g., hand washing with soap and water, or alcohol hand gel) after having contact with respiratory secretions and contaminated objects/materials.
When possible, evacuation centers should ensure the availability of materials for adhering to respiratory hygiene/cough etiquette for residents:
Provide tissues and a receptacle for used tissue disposal (e.g. paper or plastic bag).
Provide personal dispenser of alcohol hand gel; where sinks are available, ensure that supplies for hand washing (i.e., soap, disposable towels) are consistently available.
Separate sick persons and close contacts such as family groups from other residents until 24 hours after the symptoms have resolved. If possible, put them in a separate room or, alternatively, place sick people in a separate section of the evacuation center away from other residents who are not sick . If this is not possible, encourage persons with respiratory illness to stay at least 3 feet away from those not providing direct care and support.
Persons who are not ill should avoid close contact with the sick persons (e.g., kissing, hugging, hand shaking, other direct touching, talking within 3 feet), except as necessary for care and support.
Evacuation center workers who are symptomatic should be excused from work.

David

nfection Control Recommendations for Prevention of Transmission of Diarrheal Diseases in Evacuation Centers
People crowded together in places such as in evacuation centers are vulnerable to outbreaks of vomiting and diarrhea. These illnesses can be caused by many different germs including bacteria, parasites and, more commonly, viruses. One of the most common viruses that cause this illness are noroviruses (Norwalk-like viruses). Diagnosis of illness through collection and testing of specimens should always be undertaken to confirm the cause of an outbreak.
Facts about Spread of Diarrheal Diseases
People can become infected with germs that cause diarrhea by:
Eating food or drinking liquids contaminated with diarrhea-causing germs,
Touching surfaces or objects contaminated with the diarrhea-causing germs and then touching their own mouth, nose, or eyes.
Sharing personal items such as towels and toothbrushes.
Having contact with an infected person, for example, by:
Being present while someone is vomiting
Sharing food or eating from the same utensils
Caring for a sick person
Shaking hands with a person who did not wash hands after using the bathroom or changing a diaper
Not washing hands after changing diapers or before eating or preparing food.
Infection Control Measures to Prevent the Spread of Diarrheal Diseases
General measures for all staff and evacuation center residents
Wash hands regularly with soap and water.
Alcohol hand gels are an adequate substitute when soap and clean water are not readily available.
Maintain a clean living environment.
Maintain good personal hygiene including the following:
Follow good hygienic practices during food preparation.
Do not share eating utensils or drinking containers.
Do not share personal toilet articles such as toothbrushes or towels with anyone else.
Facilities should be adequate to allow residents to bathe at least twice weekly.
Laundry facilities should be available to allow appropriate laundering of clothes and bed linens.
Measures for sick persons
If persons in the evacuation center are sick with diarrheal diseases, evacuation center staff should:
Provide residents with information about gastroenteritis. Ask sick persons about the type and frequency of symptoms (including whether they have fever or bloody diarrhea) to determine if medical care is necessary.
Separate sick persons from other residents until 24 hours after diarrhea and vomiting stop. Sick children should be accompanied by only one responsible adult. The same adult should stay with the child until 24 hours after symptoms stop. If possible, put them in a separate room or, alternatively, place sick people in a separate section of the evacuation center away from evacuation center residents who are not sick. Designated areas should have full time staff supervision to ensure that the area is properly cleaned and appropriately supplied.
Designate toilets for use only by persons who are sick.
Serve food to ill persons away from persons who are not sick, if possible.
Provide residents with plastic bags (e.g., small bathroom trash can liners) to contain vomit and to dispose of diapers.
Provide residents with supplies to clean up spills, especially vomit and stool.
Maintaining a clean living environment and disinfection of surfaces
1) Wiping up areas soiled with vomit or stool
It is important to remove vomit and stool quickly because they may contain a large number of disease-causing germs and be highly contagious. The vomit or stool must be cleaned up before disinfecting, or the disinfectant will not work.
Wear disposable gloves during cleaning. If you expect that liquid may splash, wear a disposable mask and cover gown or apron, if available.
Do not use a vacuum cleaner to clean up vomit or stool. Wipe up the material with paper towels and dispose of used towels in a plastic garbage bag. Rinse areas with water.
For carpeted areas, use absorbent materials such as kitty litter to absorb liquid, and dispose as above.
Disinfect areas as instructed below.
2) Disinfecting surfaces (both routine and after cleaning a soiled area)
Hard surfaces
Some germs can persist on hard surfaces and be a source of infection. Hard surfaces that are frequently touched, such as door knobs and hand rails, should be disinfected at least 3-4 times a day, if possible.
Wear gloves.*
Use diluted household bleach (1000 ppm sodium hypochlorite or 5 tablespoons of 6% household bleach to 1 gallon of water).**
Wet surfaces with the diluted bleach allow the area to remain wet for 10 minutes, if possible.
Allow to air dry.
Remove gloves and discard in plastic bag.
Wash hands with soap and water or use alcohol hand gel immediately after removing gloves.
Public restrooms
Clean all fixtures of visible soil as necessary.
Wipe surfaces with a disinfectant such as diluted household bleach (1000 ppm sodium hypochlorite or 5 tablespoons of 6% household bleach to 1 gallon of water) *
Pay particular attention to doorknobs, toilet seats, taps, etc.
Allow surfaces to remain wet for 10 minutes, if possible.
Allow to air dry.
Remove gloves and discard in plastic bag.
Wash hands with soap and water or use alcohol hand gel immediately after removing gloves.
* When diluting the disinfectants, wear eye protection to prevent splashes into the eyes.
** Chorine solution is the disinfectant of choice. Household bleach without thickeners, scents, or additives should be used. Chlorine solutions can be made weekly, if in a bottle that no light passes through; otherwise, they should be made daily. Bottles should be labeled with the date and concentration of the solutions.
Other measures to keep restrooms clean and prevent the spread of disease
Keep restrooms supplied with paper towels and hand soap.
Post signs to remind people to wash hands after restroom use.
If feasible, provide hands free exit from the toilet room, for example:
By propping the doors open
Or, by providing paper towels (with appropriately placed waste bin) for use to open door.
Handling of soiled clothing and linen
Garments heavily soiled with stool should be handled carefully by wearing gloves, and placing garments in a plastic bag for disposal. If stool can easily be removed using toilet paper, the garment may be laundered as described below. Lightly soiled clothing (stained by no solids attached) may be washed as described below.
Wash clothing in a washing machine, preferably with hot water (temperature ≥165°F).
Use household detergents for washing clothing.
Household bleach can be used in the rinse water.
Dry clothes in a hot dryer (temperature ≥ 171°F).
There is no need to disinfect the tubs of washers or tumblers of dryers if cycles are run until they are completed.
Hands should be washed with soap and water or cleaned with alcohol hand gel after handling soiled linens.
Handling of household and medical waste
Contact local authorities to determine local requirements for disposal of household and medical waste (items soiled with vomit and stool, or other body fluids).
Use trash receptacles lined with plastic bags accepted by local trash pick up that can be securely tied.
Do not overfill bags.
Place trash in an area separated from the living spaces, preferably in trash bins.
Separate medical waste from household waste for pick-up; follow local guidelines for pick-up of medical waste.
Have waste pick-ups scheduled frequently, daily if possible.
Hands should be washed with soap and water or cleaned with alcohol hand gel after handling household or medical waste.
Measures for food service operations
Ensure that proper food safety and sanitation procedures are followed (see link to guidelines for storing, cooking and preparing food safely at the end of this document). Measures for prevention of cross-contamination during serving, hand hygiene, and cleaning of dining room surfaces are:
Serving food
Provide hand washing facilities or alcohol hand gel at the beginning of food service lines.
If possible, ensure that food is served to residents. Do not allow self-service buffets.
Ensure that the plate is not handled by the resident until the end of the line; do not pass plates back and forth between the resident and the server.
Ensure that plates are not reused for second servings.
Have staff handle trays and utensils; do not allow self-service of trays, utensils, plates, and cups.
Serve food in individual portions rather than shared “family-style”.
Wear disposable gloves when serving food.
Hand hygiene
Provide alcohol hand gels for residents at the start of the serving line, if feasible.
Provide hand washing facilities for food handlers.
Food handlers should wash hands with soap and water before beginning work, and before returning to work from any toilet visit or break.
Food handlers should change their gloves anytime they touch soiled or non-food service surfaces or items, e.g., the floor, their nose or mouth, dirty dishes, etc, and also after using the bathroom.
Cleaning of dining room surfaces such as tables and chairs
Clean surfaces frequently throughout the day, including at the beginning and end of meal service times.
Clean visible soil from surfaces first,
Wipe down cleaned surfaces with diluted household bleach solution (1000 ppm i.e., 5 tablespoons of 6% household bleach to 1 gallon of water) and allow to air dry.
Persons cleaning should wear disposable gloves.
Wash hands with soap and water or use alcohol hand gel immediately after removing gloves.
Monitoring Foodhandlers for illness
Carefully monitor for worker health by providing a sign-in log for workers, staff, and volunteers attesting to health status and fitness to work in the food operation.
Any worker with diarrheal illness should go home and not return until at least 24 hours after diarrhea and vomiting stop.

David

act Sheet: Keep Food and Water Safe After a Disaster or Power Outage
Food
Food may not be safe to eat during and after an emergency. Safe water for drinking, cooking, and personal hygiene includes bottled, boiled, or treated water. Your state, local, or tribal health department can make specific recommendations for boiling or treating water in your area.
Identify and throw away food that may not be safe to eat.
Throw away food that may have come in contact with flood or storm water.
Throw away food that has an unusual odor, color, or texture.
Throw away perishable foods (including meat, poultry, fish, eggs and leftovers) that have been above 40 degrees Fahrenheit (F) for 2 hours or more.
Thawed food that contains ice crystals or is 40 degree F or below can be refrozen or cooked.
Throw away canned foods that are bulging, opened, or damaged.
Food containers with screw-caps, snap-lids, crimped caps (soda pop bottles), twist caps, flip tops, snap-open, and home canned foods should be discarded if they have come into contact with floodwater because they cannot be disinfected.
If cans have come in contact with floodwater or storm water, remove the labels, wash the cans, and dip them in a solution of 1 cup of bleach in 5 gallons of water. Relabel the cans with a marker. Include the expiration date.
Do not use contaminated water to wash dishes, brush your teeth, wash and prepare food, wash your hands, make ice, or make baby formula.
Store food safely.
While the power is out, keep the refrigerator and freezer doors closed as much as possible.
Add block ice or dry ice to your refrigerator if the electricity is expected to be off longer than 4 hours. Wear heavy gloves when handling ice.
Feeding Infants and Young Children
Breastfed infants should continue breastfeeding. For formula-fed infants, use ready-to-feed formula if possible. If using ready-to-feed formula is not possible, it is best to use bottled water to prepare powdered or concentrated formula. If bottled water is not available, use boiled water. Use treated water to prepare formula only if you do not have bottled or boiled water.
If you prepare formula with boiled water, let the formula cool sufficiently before giving it to an infant.
Clean feeding bottles and nipples with bottled, boiled, or treated water before each use.
Wash your hands before preparing formula and before feeding an infant. You can use alcohol-based hand sanitizer for washing your hands if the water supply is limited
Clean and sanitize food-contact surfaces.
CDC recommends discarding wooden cutting boards, baby bottle nipples, and pacifiers . These items cannot be properly sanitized if they have come into contact with contaminated flood waters. Clean and sanitize food-contact surfaces in a four-step process:
Wash with soap and warm, clean water.
Rinse with clean water.
Sanitize by immersing for 1 minute in a solution of 1 teaspoon of chlorine bleach (5.25%, unscented) per gallon of clean water.
Allow to air dry.
Related Resources
USDA Meat and Poultry Hotline: 1-888-MPHotline.
Available for consumers questions and concerns about food safety.
USDA Alert: Keeping Food Safe During Flooding and Power Outages
USDA Food Safety Information related to Hurricane Katrina
Hand Hygiene After a Disaster
When to wash your hands & how to do it without running water…
Sanitation and Hygiene
Basic hygiene during the emergency period…
Keeping Food Safe in an Emergency, U.S. Department of Agriculture
General fact sheet and FAQs on food and water safety including guidance on when to discard perishable foods
Provides resources on food safety related to fires, floods, hurricanes, power outages, etc.
Food Safety Office, CDC
Comprehensive food safety information
Food Safety Information for Hurricane Aftermath, FDA
Tips to help people protect their health & food supply
Being Prepared, American Red Cross
Comprehensive site on preparing for emergencies including power outages
Water
Water may not be safe to drink, clean with, or bathe in after an emergency such as a hurricane or flood. During and after a disaster, water can become contaminated with microorganisms, such as bacteria, sewage, agricultural or industrial waste, chemicals, and other substances that can cause illness or death. This fact sheet offers the following guidance to help you make sure water is safe to use:
Listen to and follow public announcements. Local authorities will tell you if tap water is safe to drink or to use for cooking or bathing. If the water is not safe to use, follow local instructions to use bottled water or to boil or disinfect water for cooking, cleaning, or bathing.
Use only bottled, boiled, or treated water for drinking (however, see guidance in the Food section for infants), cooking or preparing food, washing dishes, cleaning, brushing your teeth, washing your hands, making ice, and bathing until your water supply is tested and found safe. If your water supply is limited, you can use alcohol-based hand sanitizer for washing your hands.
If you use bottled water, be sure it came from a safe source. If you do not know that the water came from a safe source, you should boil or treat it before you use it.
Boiling water, when practical, is the preferred way to kill harmful bacteria and parasites. Bringing water to a rolling boil for 1 minute will kill most organisms. Boiling will not remove chemical contaminants. If you suspect or are informed that water is contaminated with chemicals, seek another source of water, such as bottled water.
If you can't boil water, you can treat water with chlorine tablets, iodine tablets, or unscented household chlorine bleach (5.25% sodium hypochlorite). If you use chlorine tablets or iodine tablets, follow the directions that come with the tablets. If you use household chlorine bleach, add 1/8 teaspoon (~0.75 milliliter [mL]) of bleach per gallon of water if the water is clear. For cloudy water, add 1/4 teaspoon (~1.50 mL) of bleach per gallon. Mix the solution thoroughly and let it stand for about 30 minutes before using it. Treating water with chlorine tablets, iodine tablets, or liquid bleach will not kill many parasitic organisms. Boiling is the best way to kill these organisms.
Do not rely on water disinfection methods or devices that have not been recommended or approved by local health authorities. Contact your local health department for advice about water treatment products that are being advertised.
Use water storage tanks and other types of containers with caution. For example, fire truck storage tanks and previously used cans or bottles may be contaminated with microbes or chemicals. Water containers should be thoroughly cleaned, then rinsed with a bleach solution before use.
Clean surfaces thoroughly with soap and water, then rinse.
For gallon- or liter-sized containers, add approximately 1 teaspoon (4.9 mL) household bleach (5.25%) with 1 cup (240 mL) water to make a bleach solution.
Cover the container and agitate the bleach solution thoroughly, allowing it to contact all inside surfaces. Cover and let stand for 30 minutes, then rinse with potable water.
Flooded, private water wells will need to be tested and disinfected after flood waters recede. If you suspect that your well may be contaminated, contact your local, state, or tribal health department or agriculture extension agent for specific advice. See Disinfecting Wells After an Emergency for general instructions.
Practice basic hygiene. Wash your hands with soap and bottled water or warm water that has been boiled or disinfected. Wash your hands before preparing food or eating, after toilet use, after participating in clean-up activities, and after handling articles contaminated with floodwater or sewage. Use an alcohol-based hand sanitizer to wash your hands if you have a limited supply of clean water.

David

lean Hands Save Lives: Emergency Situations
After an emergency, finding running water can be difficult. However, keeping your hands clean helps you avoid getting sick. It is best to wash your hands with soap and warm water for 20 seconds. However, when water is not available, you can use alcohol-based hand products made for washing hands (sanitizers).
When should you wash your hands?
Examples include:
Before preparing or eating food
After going to the bathroom
After changing diapers or cleaning up a child who has gone to the bathroom
Before and after caring for someone who is sick
After handling uncooked foods, particularly raw meat, poultry, or fish
After blowing your nose, coughing, or sneezing
After handling an animal or animal waste
After handling garbage
Before and after treating a cut or wound
After handling items contaminated by flood water or sewage
Using alcohol-based hand sanitizers
When your hands are visibly dirty, you should wash them with soap and warm water when available. However, if soap and water are not available, use alcohol-based hand sanitizers.
Apply product to the palm of one hand.
Rub hands together.
Rub the product over all surfaces of hands and fingers until your hands are dry.
Note: the volume needed to reduce the number of germs on hands varies by product.
Washing with soap and water
Place your hands together under water (warm water if possible).
Rub your hands together for at least 20 seconds (with soap if possible). Wash all surfaces well, including wrists, palms, backs of hands, fingers, and under the fingernails.
Clean the dirt from under your fingernails.
Rinse the soap from your hands.
Dry your hands completely with a clean towel if possible (this helps remove the germs). However, if towels are not available it is okay to air dry your hands.
Pat your skin rather than rubbing to avoid chapping and cracking.
If you use a disposable towel, throw it in the trash.
Remember: If soap and water are not available, use an alcohol-based hand sanitizer.

无极紫晶

非常好！继续努力！等待着.....:victory: :victory:

幸福

谢！耐心等待你的翻译。:lol :handshake

星火

lean Hands Save Lives: Emergency Situations紧急情况时,手卫生拯救生命
After an emergency, finding running water can be difficult. However, keeping your hands clean helps you avoid getting sick. It is best to wash your hands with soap and warm water for 20 seconds. However, when water is not available, you can use alcohol-based hand products made for washing hands (sanitizers).
在发生紧急情况以后，找到自来水可用是困难的。 那么，保持您的手干净可以帮助您避免患病。 洗您的手用肥皂和温暖的水洗20秒是最佳的。 然而，当水不可利用时，您可以洗手(清洁剂)使用含酒精的手消毒剂。
谢谢乔斑!很重要经验!!

楚楚

确实很好，可是执行谈何容易？大家想想，即使不是在灾害期间，又有多少医疗机构能够完完全全做到这些呢？但是在灾害期间，在自然条件十分恶劣的情况下，做到这些又多么重要和必要！如果让政府部门，让卫生行政部门认识到这些事情看似平常但对预防传染病的传播非常必要，认识到预防在大灾面前是多么有价值，并且采取一定的强制措施，就太好了．因此建议这次会议内容再增加＂卫生部门应该如何应对灾后疫情暴发＂的专题，不知道大会组委怎么认为？

桂花香

.Special Considerations for Non-Residential Evacuation Centers
非居住疏散中心的特别考虑
Non-residential evacuation centers such as stadiums and churches have limited capacity for providing sanitary and food preparation facilities. Bathing and laundry resources are also likely to be limited. In general, it is preferable for non-residential facilities to be used only for very short-term evacuation. Food-service and laundry should be provided from external sources rather than attempting to set up poorly controlled on-site alternatives or allowing residents to attempt these activities individually.
非居住疏散中心如体育馆和教堂提供卫生和食物准备的设施有限，洗浴和洗涤资源也多半有限，非居住中心应用于很短时间的疏散，食物供应和洗衣应从外部提供而非尝试在内部搭建不好控制的临时供应点或允许中心内的人们这样做。
因为临时居住的人数与厕所的比例可能很高，非居住疏散设施特别需要频繁的和有指导的清洁并维持设施的卫生。分派在疏散中心的人们应负责管理每个洗手间，控制每次使用洗手间的人数，保证至少每小时用消毒剂擦拭表面，同时保证基本物品如肥皂、擦手纸和厕所用纸的供应。
The ability to clean surfaces in non-residential settings may be limited by the size or other physical characteristics of the facility. This increases the importance of hand hygiene. However, such facilities are also likely to have limited availability of hand washing sinks. Thus, additional attention should be paid to positioning alcohol hand gel dispensers in convenient locations throughout the living areas and at the beginning of food service lines, and ensuring that all arriving residents are instructed on their use and availability.
非居住疏散中心的清洁能力可能因为中心的大小或其他特点受到限制，这更突显手卫生的重要性，然而，这样的设施内洗手池数量也可能会有限，因此，更要注意在整个区域内在方便的地方和供应食物开始时配备酒精擦手剂，同时保证所有到达的人员得到这些清洁设施并受到使用这些设施的指导。
Open sleeping areas should be set up to prevent crowding, ideally with at least 3 feet separating each cot from the next.
露宿的区域设置应避免拥挤，每个小屋（帐篷？）之间的理想距离至少3尺。
仓促翻译，错误在所难免！

桂花香

.Management of Persons with Infectious Diseases in Evacuation Centers
疏散中心内传染病人的管理
The arrival of evacuees who may have open wounds, symptomatic infections, and unrecognized or incubating infectious diseases, combined with potential for crowding and limited sanitary infrastructure, increases the risk of infections spreading among residents and between residents and staff. In particular, respiratory infections, diarrheal diseases and skin infections or infestations are prone to spread under these conditions.  Before entering an evacuation center, all residents should be screened for the following conditions:
到来的被疏散人员可能有开放的伤口，有症状的感染，以及尚未确认或处于潜伏期的传染病，结合潜在的拥挤和有限的卫生设施，增加了感染在居留的人群之间以及居留者和工作人员之间的扩散，特别是呼吸道感染，腹泻疾病和皮肤感染都很容易在这样的情况下传播。进入疏散中心之前，所有居留者应就以下情况进行筛查。
Fever
Cough
Skin rash or sores
Open wounds
Vomiting
Diarrhea
发热
咳嗽
皮疹或皮肤疼痛
开放伤口
呕吐
腹泻
Persons with any of the above conditions should be admitted to the evacuation center only after appropriate medical evaluation and care. Residents of the center should be instructed to report any of the above conditions to the center staff.  If a potentially infectious condition is identified in a person already residing at the evacuation center, the ill individual(s) should be separated from other residents or transferred to a special needs evacuation center (see below).
任何具有上述症状之一者应被限制进入疏散中心，只有在适当的医疗评估和治疗后才能进入，中心的居留者应被告知向工作人员报告是否存在上述情况，如果潜在的感染状况被确定，感染者应与其他居留者隔离或转移道特别的疏散中心（见后）。
A separate area or room should be identified in advance to be used to house potentially infectious residents awaiting evaluation or transfer. If several residents with similar symptoms are identified, they may be housed together in one area. However, cots should still be separated by at least 3 feet. A dedicated restroom should be identified if possible and reserved for use of the ill individuals only. More than one separate area may be needed if more than one illness is identified in the population, e.g., an area for people with diarrhea, and another area for people with a cough and fever. Such separate areas will need to have extra staff members dedicated to monitoring people housed there and ensuring that the area is kept clean and appropriately supplied.
应事先确定一个隔离区或房子作为潜在感染居留者等待评估或转移。如果几个有类似症状的居留者被确定，应安置在相同的区域。然而，房屋之间的距离仍应至少为3尺。如果可能，应确定一个好的洗手间只供给病人使用。如果人群中确定有多于一种疾病，应需要多于一间隔离房。例如，一个区域供腹泻病人，另外的区域供咳嗽和发热病人使用。这样的隔离区域将需要更多的工作人员来查看房间内的病人并保证这些区域保持清洁和适当的物品供应。
Staff members with any of the above symptoms should not work in the evacuation center, but should seek medical evaluation for assessment and clearance prior to returning to work. Staff members working with residents who have symptoms of illness should use Standard Precautions (defined below) for any interactions that require potential contact with body fluids, and should place particular emphasis on hand hygiene.
有上述任何症状之一的工作人员不应在疏散中心内工作，但应寻求医疗评估并在恢复工作之前确定（能工作）。照顾有症状的居留者的工作人员应在需要接触体液的操作时采取标准预防（定义见后）的措施并且应该特别强调手卫生。
Each evacuation center should have a clear plan for transferring individuals with potentially communicable diseases from the evacuation center to an appropriate healthcare facility. This includes plans for having ill individuals with respiratory symptoms wear a paper mask while awaiting evaluation or transfer. A waiting area should be designated that is separate from the main center living areas, but which can be closely monitored by center staff. A system for identifying and notifying the receiving facility must be in place.
每个疏散中心应有为从疏散中心转移具有潜在传染病人到医疗机构的清洁计划，这包括具有呼吸道症状的病人在等待评估或转移时佩戴纸口罩。应该指定一个地方作为等待区，这个区域应与主要的中心生活区分开，但又要能够得到中心工作人员的严密照看。要有确定和通知接收机构的系统。
不当之处，敬请指正！

桂花香

想再翻译一些，可是因工作需要又要离开医院几天，无法上网。遗憾！

David

后社区避难所感控指南
这些推荐措施提供了基本的感控指南，预防在临时搭建的定居点可能产生的传染病传播。
社区避难所包括中等或大型的有组织的收容因飓风、洪水、地震等自然灾害而无家可归者的临时场所。避难所可以是住宅区（如宿舍、野营地）或非住宅区（如体育场，教堂），但都含有不同程度的卫生设施。在避难所的个人需要和他人在拥挤的条件下共用生活和卫生设施。避难者可能有一些基础疾病包括创伤，传染病和慢性疾病例如肾衰。
1.针对定居点的感控预防概述
医护人员和避难者都采用合适的感控措施能够有效减少传染病的播散
  (1) 医护人员和避难者应经常用流水和皂液洗手
  (2) 儿童应当在成人协助下用流水和皂液洗手
  (3) 酒精擦手液是临时代替洗手的有效方式，特别在没有皂液和净水的情况下。
  (4) 酒精擦手液应当被放置于能够覆盖整个避难所的区域，特别在领取分发食物处的首端和厕所门口。
  (5) 良好的个人卫生习惯包括：
       a.咳嗽时用纸巾包裹痰液，再丢进垃圾桶。之后再用水或酒精擦手液洗手。如果可能的话，避难所的生活区应当为人们提供纸巾。
       b.准备食物时遵循良好的卫生措施。
       c.不要公用饭勺筷子或饮水容器。
       d.不要共用个人物品如梳子、剃须刀，牙刷或毛巾。
  (6) 避难所应当提供足够的设施，至少要保证避难者一周两次的洗澡需要。
  (7) 要有合适的洗衣晾晒被单的设施
2. 手卫生
紧急情况下很难找到流动水用于洗手。但是，洗手仍然是避免疾病传播的重要措施。最好用皂液和流水洗手。但是当没有流水的时候，可以用酒精擦手液代替。下面有一些小贴士可能会有帮助：
     什么时候应当洗手或用酒精擦手液？
    a.吃东西之前  
b.取生食物之前，特别是生肉，鸡鸭鱼等
c.进盥洗室以后   
d.帮婴儿换尿布或小孩大便以后
e.看望病人前后  
f..处理伤口前后
  g.擤鼻涕，咳嗽或打喷嚏之后
h.处理动物或动物尸体之后
  i.处理垃圾之后
  注：准备处理食物的人应当在工作前和任何原因中途返回工作场所前用皂液和流水洗手。这类情况下酒精擦手液不应当作为其代替品。
3.清洁生活区域
保持物品表面干净可以有助于减少医护人员和避难者传染病的播散
(1) 当物品表面有可见的脏物时，按以下顺序用家用清洁剂清洗：
厨房和盥洗室应当每天清洗，如果有必要应随时清除污物。
生活区域应当至少每周清洗一次，如果必要增加次数。
床框床垫和枕头应当在变更使用者期间清洗。
其他家具每周清洗一次。
溅出液应当立即处理。
(2) 消毒（以减少微生物污染的风险）高风险的物品表面。可以使用家用消毒剂（任何贴有消毒剂标签的产品均可）或漂白液（混有1勺家用漂白粉加1.14升清水），每日新鲜配制。高风险物品表面包括：
a.准备食物的区域
b.换洗尿布的区域
c.被体液污染的区域（如呕吐物，血液，排泄物）
4.洗衣
(1) 被粪便大量污染的衣服应当戴手套小心处理，然后置于塑料袋内弃置。如果粪便容易清除，则衣服可以按下列方式处理。
(2) 使用洗衣机清洗衣服（正常温度，一般洗衣剂）
(3) 可以在漂洗水里加入正常浓度的家用漂白液。
(4)  如果可能的话使用干衣机。
(5) 不需要消毒处理洗衣机的管道。
(6)  分发捐赠来的衣物前必须确保清洗干净。
5. 垃圾杂物
(1) 医疗废弃物处理应当按照当地的制度处理，特别是针头和注射器。
(2)  应当提供合适的锐器盒用于放置枕头和注射器。锐器盒应当放置于使用锐器最多的地方。如果没有提供正式的锐器盒，一个带有盖子的厚塑料洗洁剂瓶子可以替代。
(3) 使用可以安全扣紧的废料桶
(4)  垃圾袋不可装的太满
(5) 垃圾存放区域应当与生活区隔离
(6 ) 每天定时收集运送垃圾。
(7) 将垃圾收集区与生活区分开，遵循当地的医疗垃圾处置规范。
6. 非居住疏散中心的特别考虑
非居住疏散中心如体育馆和教堂提供卫生和食物准备的设施有限，洗浴和洗涤资源也多半有限，非居住中心应用于很短时间的疏散，食物供应和洗衣应从外部提供而非尝试在内部搭建不好控制的临时供应点或允许中心内的人们这样做。
因为临时居住的人数与厕所的比例可能很高，非居住疏散设施特别需要频繁的和有指导的清洁并维持设施的卫生。分派在疏散中心的人们应负责管理每个洗手间，控制每次使用洗手间的人数，保证至少每小时用消毒剂擦拭表面，同时保证基本物品如肥皂、擦手纸和厕所用纸的供应。
非居住疏散中心的清洁能力可能因为中心的大小或其他特点受到限制，这更突显手卫生的重要性，然而，这样的设施内洗手池数量也可能会有限，因此，更要注意在整个区域内在方便的地方和供应食物开始时配备酒精擦手剂，同时保证所有到达的人员得到这些清洁设施并受到使用这些设施的指导。
露宿的区域设置应避免拥挤，每个小屋（帐篷？）之间的理想距离至少3尺。
7. 疏散中心内传染病人的管理
到来的被疏散人员可能有开放的伤口，有症状的感染，以及尚未确认或处于潜伏期的传染病，结合潜在的拥挤和有限的卫生设施，增加了感染在居留的人群之间以及居留者和工作人员之间的扩散，特别是呼吸道感染，腹泻疾病和皮肤感染都很容易在这样的情况下传播。进入疏散中心之前，所有居留者应就以下情况进行筛查。
a.发热
b.咳嗽
c.皮疹或皮肤疼痛
d.开放伤口
e.呕吐
f.腹泻
任何具有上述症状之一者应被限制进入疏散中心，只有在适当的医疗评估和治疗后才能进入，中心的居留者应被告知向工作人员报告是否存在上述情况，如果潜在的感染状况被确定，感染者应与其他居留者隔离或转移道特别的疏散中心（见后）。
应事先确定一个隔离区或房子作为潜在感染居留者等待评估或转移。如果几个有类似症状的居留者被确定，应安置在相同的区域。然而，房屋之间的距离仍应至少为3尺。如果可能，应确定一个好的洗手间只供给病人使用。如果人群中确定有多于一种疾病，应需要多于一间隔离房。例如，一个区域供腹泻病人，另外的区域供咳嗽和发热病人使用。这样的隔离区域将需要更多的工作人员来查看房间内的病人并保证这些区域保持清洁和适当的物品供应。
有上述任何症状之一的工作人员不应在疏散中心内工作，但应寻求医疗评估并在恢复工作之前确定（能工作）。照顾有症状的居留者的工作人员应在需要接触体液的操作时采取标准预防（定义见后）的措施并且应该特别强调手卫生。
每个疏散中心应有为从疏散中心转移具有潜在传染病人到医疗机构的清洁计划，这包括具有呼吸道症状的病人在等待评估或转移时佩戴纸口罩。应该指定一个地方作为等待区，这个区域应与主要的中心生活区分开，但又要能够得到中心工作人员的严密照看。要有确定和通知接收机构的系统。

临海听涛

原帖由 David 于 2008-5-15 16:29 发表

                               
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