感染预防控制最佳实践(双语)

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JCI’s program leadership and coordination requirement describe the organization’s responsibilities for determining the focus of the IPC program. These requirements indicate that one or more full- or part-time HCWs—as part of their assigned responsibilities or job description(s)—oversee all IPC activities and that the individual(s) be qualified in IPC practices through education, training, experience, or certification. The designation of a particular individual(s) help in the coordination of the multiple facets of the program. The IPC program’s oversight should be appropriate to the organization’s size and risk levels, and the program’s scope and complexity. Although decentralization of IPC leadership can be effective, it sometimes leads to gaps in performance and less accountability. The person(s) designated for the oversight role coordinates the dynamics of program management, including addressing changing infection risk and implementing intervention strategies; ensures inclusion of all programs and services; and generate policies and procedures to guide compliance with best IPC practices. Therefore, it is important for this person(s) to have clinical expertise and program management skills to oversee all the IPC activities.JCI项目的领导和协调要求是机构履行感染预防控制项目要点的职责。这些要求表明一名或多名，专职或兼职的医务人员—作为他们工作职责或岗位描述的部分—监管全部的感染预防控制行为和这(些)人通过教育、培训、实践或认证能胜任感染预防控制工作。指定的特定人员帮助实施项目的多方协调。对感染预防控制项目的监管要适合医疗机构的大小、风险等级，项目的范围、复杂性。虽然下放感染预防控制的权力可能是有效的，有时也会导致实施中的缺陷和缺乏责任。监管指定人员的角色能协调项目管理的力度，包括控制改变感染风险和实施干预策略；确保包涵所有项目和服务；形成策略和规程去指导遵循感染预防控制的最佳实践。由具有临床专业知识和项目管理经验的(这些)人员去监管所有的感染预防控制行动是非常重要的。These requirements also call for program management by designating those persons or group that monitors and coordinates IPC activities in the organization and directs the coordination of IPC activities. This group must include representatives from at least medicine, nursing, IPC (for example, health care epidemiologist, infection control physician, IPC officers, and infection control nurse), and housekeeping. Other may be included as appropriate to the organization. IPC activities involve individuals in every department or service who perform nearly every function within a health care organization.这些要求也提醒这些指定的人或团队在医疗机构内应用管理手段监控协调感染预防控制工作，配合指导感染预防控制工作。这个团队必须包括至少来自医生、护士、感染预防控制(例如：卫生保健流行病学家、感控医生、感染预防控制官员、感控护士)和内务管理方面的代表。另外可酌情纳入一些组织领导的代表。感染预防控制工作涉及到医疗服务机构内部每个部门和几乎为每一项工作服务的所有人员。When the program oversight activities reside with a committee, it is incumbent on the organization to provide each member with education and training as well as clearly defined roles and responsibilities. See Chapter 5 for more discussion of multidisciplinary oversight team.当项目监管工作归于一个委员会管理时，它必须在机构中为每位成员提供教育和培训，明确其角色和职责。更多的讨论见第五章，多学科监管小组。These JCI standard are also focused on grounding the IPC program in science, practice guidelines, regulation, and technology and providing sufficient resources to establish that scientific and technological foundation. JCI requires that the IPC program be based on current scientific knowledge, accepted practice guideline, and applicable laws and regulations. Current scientific information is required to understand and implement effective surveillance and control activities; practice guideline provide information on preventive practices and infections associated with clinical services; and applicable laws and regulations define elements of the basic program and reporting requirements. Many of these guidelines are available online from government agencies and from professional societies. See Appendix 2 for selected website and organizations providing practice guidelines. JCI requirements also state that leaders provide adequate resources to support the IPC program, particularly via information-management systems. Such systems are key resources to support the tracking of risks, rates, and trends in health care-associated infections (HAIs). Leadership roles and responsibilities are discussed in Chapter 5. Functions covered in these standard include date analysis, interpretation, and presentation of findings.这些JCI标准也重点在科学、实践指南、规则、技术及为建立这些科学和技术基础提供充足保障方面围绕着感染预防控制项目。JCI要求这些感染预防控制项目建立在当今的科学知识、依据实践指南、适用的法律和法规的基础上。把握和实施有效的监测和控制活动需要当今的科技信息；实践指南提供预防方法和与临床服务相关感染的信息；适用的法律和法规定义项目的基本要素和报告要求。许多指南能从政府机构和专业团体中获得。见附录2，提供实践指南的网站和组织。JCI要求也声明提供充足资源的向导支持感染预防控制项目，特别是通过信息管理系统。这样的系统是支持跟踪医院感染的风险、比率、动态的关键资源。领导角色和职责的讨论见第五章。这些标准包涵的功能包括资料的分析、解释和调查结果的说明。

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Focus of the Program项目的要点Applicable JCI Standard可实施的JCI标准The following JCI standard are directly applicable this section of text. For complete standard and further compliance information, see Appendix 1下列JCI标准可直接应用于本段。全部的标准和进一步可遵循的信息，见附录1。Ambulatory case非住院医疗IFS.5Clinical Care Program (Certification)临床医疗项目(认证) Clinical Laboratories临床检验室RSM. 6.1*Home Care家庭治疗IPC.4 through IPC.5Hospitals医院IPC.5 through IPC.7.5Long Term Care长期护理机构IPC.4 through IPC.5.5Medical Transport医疗转运BCA.1 through BCA.3Primary Care初级医疗ODS.27through ODS.29* RSM. 6.1 deals with a laboratory using a coordinated process to reduce the risk of infection as a result of exposure to biohazardous materials and waste only.*RSM. 6.1 为降低感染风险对涉及实验室使用情况的协调过程仅看作生物公害和废物暴露的结果。

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Program-focus standards describe the organization’s responsibilities for determining the focus of the IPC program. These requirements emphasize that the organization design and implement a coordinated and comprehensive program and plan to reduce the risks of HAIs for patient and HCWs. Safe, high-quality care for patients and safe work environment for employees are intertwined because employees and patients who become infected can transmit the infection to other patient or HCWs. These standards imply a close working relationship the IPC and employee health services.项目要点标准描述医疗机构决定感染预防控制项目要点的职责。这些要求强调医疗机构要设计和实施一个协调而广泛的项目和计划去降低医院感染对病人和医务人员的风险。为病人营造安全、高质量的治疗和为员工营造安全的工作环境是错综复杂的，因为在医疗机构，员工和病人都可能被感染，且传播感染给其他的病人或医务人员。这些标准意味着感染预防控制与员工的医疗服务是紧密联系在一起的工作。Under these standards, the IPC program is guided by a plan that addresses infection issues that are epidemiologically important to the organization. This requires assessing risks and key issues that pertain to particular infections, populations, environment, and other factors that are specific to the organization. In addition, the standard requires that the IPC program be designed to be appropriate to the organization’s size, geographic location, services, and patient. A facility that treats primarily trauma patient rather than pediatric or cancer patients or is an ambulatory care center rather than an acute inpatient facility must address the issues most relevant to its patients, services, and setting. Organizations in very rural settings may have challenges that differ from those of facilities in urban settings. Conditions that should be considered in assessing geographic and environmental influence on infection include the following:根据这些标准，感染预防控制项目是指导医疗机构控制感染问题的重大流行病学计划。必须评估医疗机构中有关特殊的感染、总体、环境及其他因素等特殊风险和重要问题。另一方面，标准要求感染预防控制项目的设计要适合机构的大小、地理位置、服务类型和病人。一个机构治疗的主要是外伤病人而不是儿科或肿瘤病人，或一个门诊治疗中心而不是急诊住院机构，要解决的问题必须与它的病人、服务类型和设施相关。设置在很远的乡村机构所面临的挑战与那些设置在城市的机构是不同的。评估地理和环境对感染的影响，应考虑以下几方面的条件：●Natural environmental disruptions—floods, hurricanes, earthquakes, and other events●自然环境的破坏—洪水、飓风、地震和其他事件●Temperature variations—tropical versus cold●气候变化—热带遇到冷空气●Vector density—mosquitoes, rodents●媒介物密度—蚊虫、啮齿动物●Contaminated water sources or lack of water●污染水资源或缺水●Ecological changes—deforestation, global warming, air pollution, and so forth●生态变化—砍伐森林、全球变暖、空气污染等等●War, migrations, displaced persons●战争、迁移、难民●Urban versus rural—congested housing versus agricultural environments●城市与乡村—拥挤的房屋与农业环境●Availability, lack of, or disruption of services●可用的，服务的缺乏或破坏Another key element of the requirements is that the IPC program include surveillance activities that are proactive and systematic. Surveillance (see Box 3-2) or the observing of practice and collecting of infection data, is essential to identify endemic (usual) infection and outbreaks (unusual infections or numbers of infections above the usual endemic rates). Not only must the surveillance activities help the IPC professionals identify ongoing or unusual infections, but the IPC program must have the capability to investigate infection clusters or outbreak to identify which infections are occurring and why, the source, the source, the mode of transmission, processes contributing to the infections, and potential solution to resolve the outbreak and to stop the infections. Once this information is clear, it should be used to implement prevention strategies that will prevent the recurrence of the infection in the future.JCI要求的另一个重要要素是要求感染预防控制项目包含监测活动要有前瞻性和系统性。对过程的监测(见插入框3-1)或观察和感染资料收集，基本上要确定是地方性(一般地)感染还是暴发(不寻常的感染或感染的数量高于一般地方性的比率)。必要的监测活动不仅帮助感染预防控制专业人员识别平常的或不寻常的感染，而且感染预防控制项目能调查确定感染发生聚集或暴发的原因、感染源、传播方式、导致感染的过程、解决暴发和控制感染的潜在办法。一旦信息清晰，将能实施预防策略，预防将来感染的再发生。

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Box 3-2  Surveillance插入框3-2  监测
According to the US Centers for Disease Control and Prevention (US CDC), surveillance “is the ongoing systematic collection, analysis, and interpretation of health data for purposes of improving health and safety.”1根据美国疾病预防控制中心(US CDC)，监测的定义为：“为改善医疗和安全的目的，不间断系统地收集、分析和说明医疗的数据。1”Surveillance allows hospital personnel to identify risks and areas for improvement, to target infection-reducing initiatives, and to monitor progress toward reducing the number and spread of infections within a facility, as well as allowing IPC and other HCWs to do the following2-5:监测使医院工作人员发现风险和需要改进的地方，以主动降低感染为目标，在医院内监控降低感染的数量和传播的进程，让感染预防控制和其他医务人员做下面这些2-5：●Establish endemic rates of HAIs.●确定医院感染的本底率。●Identify outbreaks.●识别暴发。●Search out cases of a specific disease.●查找特殊疾病的原因●Determine whether processes used to prevent and to control infection are functioning properly.●确定用于预防和控制感染的过程是否正常。●Check the success of any changes made to a system or process.●查看使得一个系统或过程成功的任何改变。●Monitor the occurrence of adverse outcomes to identify potential risk factor.●监察不良后果的出现，确定潜在风险因素。●Ensure compliance with federal and state regulations and accreditation requirements.●确保服从联邦和州的法规和委派要求。●Monitor injuries and identify risk factor for occupation injuries in HCWs.●监控伤害和鉴别医务人员发生伤害的危险因素。●Help with health care and support HCW education efforts.●帮助医疗服务和努力支持医务人员的教育。References1. US Centers for Disease Control and Prevention. Surveillance. (Updated 8 Oct 2010) Accessed 18 Apr 2011. http://www.cdc.gov/niosh/topics/surveillance2. The Joint Commission. The Joint Commission Infection Prevention and Control Handbook for Hospitals. Oak Brook, IL: Joint Commission Resources, 2009.3. Lautenbach E, Woeltje KF, Malani PN. Society for Healthcare Epidemiology of America. Practical Healthcare Epidemiology, Chicago: University of Chicago Press, 2010.4. Yokoe DS, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008 Oct,29 Suppl 1:S12-21.5. Association for Professionals in Infection Control and Epidemiology (APIC). APIC Text of Infection Control and Eipdemiology, 3rd ed. Washington, DC: APIC, 2009.

jcyyhlb

谢谢老师学习了，老师辛苦了。

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*************************************************************************************************CASE STUDY 3-1  Reprocessing single-Use Devices (Canada)案例研究 3-1 一次性使用的器械的重用 (加拿大)Sandra Callery, RN, MHSc, CICIntroduction引言The finance department at Sunnybrook Health Sciences Centre (SHSC) asked for cost-saving measures throughout the hospital. The operations director for the operating room (OR) and outpatient procedures requested that the Reprocessing Steering Committee (the Committee) consider approving the reuse of some high-cost single-use devices (SUDs) that are used in the cardiac catheterization unit and OR. Currently the hospital’s policy on reuses state that it would not consider reprocessing any critical or semicritical SUD within the institution. However, if area or user chooses to have an SUD reprocessed by a third party, the third must provide documentation to the Committee that it follows the methodology and validation processes as outlined by an establish regulatory body, such as the US Food and Drug Administration (US FDA).森尼布鲁克健康科学中心(SHSC)财政部要求在整个医院开展节约成本措施。手术室和门诊手术室手术主任请求器械重用指导委员会(简称委员会)考虑批准一些高成本的一次性使用的器械在心导管术单元和手术室重用。目前医院的政策再次规定在机构内不考虑高度危险或中度危险的一次性使用的器械的重用。然而，如果区域或使用者应第三方的要求选择一次性使用的器械的重用，第三方必须向委员会提供遵循监管机构如美国食品药品管理局的方案和制度文件。Methods方法The Committee reviewed government regulation regarding reprocessing SDUs, including liability. The Committee established the hospital’s weighted criteria at the time of submission of request for purchase (RFP). The responses to the RFPs were assessed by the Committee. Reference checks were conducted. Prior to selection, a site tour of the licensed reprocessor’s facility was conducted by the Committee to review practices and procedures and to ensure that it had been certified by a regulatory authority or an accredited quality system auditor to ensure the cleanliness, sterility, safety, and functionality of the reprocessed equipment/devices. In addition, the Committee verified its ability to 委员会收到政府关于一次性使用的器械重用的法规，包括责任。该委员会确认了医院在请求购物时提交的加权标准。回答请求购物需委员会评估。证明已经进行了检查。在此之前的选择，一个由委员会领导对授权重用设施限期检查的机构对设施进行检查处理的做法得到了管理机构的肯定，能重用的设备/设施被可信任的质检员认为是清洁、无菌、安全，在功能上是可用的。另一方面，委员会证明它们能：a) track and label equipement/devices;a)追踪和标记设备/设施；b) recall improperly reprocessed medical equipement/devices;b)召回不宜再使用的医疗设备/设施；c) test for pyrogens;c)检查致热源；d) report adverse events;d)报告不良事件；e) provide good manufacturing procedures;e)提供好的修理工序；f) establish the maximum number of reuses specific for each device.f)确保每个设施能重用的最大次数。The Committee collaborated with the prospective third party reprocessors to determine eligible instruments and to perform a cost-benefit analysis.委员会与潜在的第三方合作修理确定合格的器械并做成本效益分析。Staff and departments involved included representation from senior leadership and the following teams and departments: IPC, OR, ambulatory care, central reprocessing, and materials management. The Committee has a reporting structure to the IPC Committee and the Medical Advisory Committee of the hospital.涉及的员工和部门包括上层领导的代表和下列团队与部门：感染预防控制、手术室、门诊、器械修理中心和材料管理部门。委员会有条理地向医院感染预防控制委员会和医学顾问委员会报告。Results结果Canadian regulations do not recommend the reprocessing of SUDs by health care institutions unless the reprocessing is done by a licensed reprocessor. Submissions were reviewed by a hospital committee, site tours were conducted, and SHSC selected a licensed repocessor to reprocess 100 different critical SUD items, with annual saving of more than $300,000.加拿大法规不同意一次性医疗服务器械的重用，除非得到许可修理后的重用产品。意见书经医院一个委员会评审，限期机构分析，SHSC选择重用100种不同危险等级的一次性使用的器械品种的重用，每年节约30万美元。Lessons Learned经验教训Careful consideration and execution must be used when entering into reprocessing of SUDs, including the following tips:必须实行一次性使用的器械重用时，应仔细考虑以下几点：●Provide adequate time for discussion with the Committee members and to the reporting committees.●提供充足的时间给委员会成员讨论，并报告委员会。●Ensure adequate representation of affected hospital services/programs during preliminary discussions.●在初步讨论时，确保影响医院服务/程序的成员广泛参与。●Do homework by reviewing hospital policies regarding hospital liability.●为修订医院关于医院职责的政策作准备工作。●Develop exclusion and inclusion criteria.●制订排除和入选标准。●Keep physicians and surgeons informed of the decisions throughout the process.●在讨论的整个过程，尊重内科医生和外科医生的意见。●Ensure that hospital policies and procedures give clear direction on the hospital’s position and ongoing monitoring of compliance with the reprocessing protocols.●确保医院政策和规程在医院工作和持续改进方面符合重用协议。*************************************************************************************************

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A policy that identifies the process for ensuring proper handling of expired supplies, including IV fluids, catheters, sutures, and others, must be in place and enforced. This policy may are include the frequency of examining supplies to determine whether they are near expiration or have expired; a process, such as “first in-first out”, to reduce the amount of expired supplies; and the way expired supplies are removed from general stores or shelves and supply rooms on patient units.一个政策规定对过期用品，如静脉液体、导管、缝合物和其他物品，要确保把它们放在一起，进行妥善处理。这个政策可能只包括经常决定检查的物品，不管它是接近到期还是已经过期。一个步骤，如“一进一出”，减少过期物品的数量；这种方式使过期物品从一般物品中、货架上或病房的仓库中移出。JCI standards also call for risk reduction in the processes of disposing of blood and blood components as well as infectious waste and body fluids from any organization area, including the mortuary and postmortem areas. These waste must be handled and disposed in a manner that protects the employees who are disposing of the waste and the environment where the waste reside or are disposed (eliminated) to prevent the transmission of infectious agents in the waste and fluids. Similar requirements are in place regarding sharps and needles, with particular focus on the containers that are uses to hold used sharps, the method of disposal of the containers, and surveillance of the disposal process. The sharps disposal process should be consistent with safe practices; local, regional, or national laws; and other regulations. The organization may manage this process or contract with an outside agency to dispose of sharps and needle.JCI标准也呼吁减少在处理血液和成份血过程中的风险，象感染性废物和来自任何机体组织区域中的体液一样，包括太平间和检验尸体的地方。这些废物必须处理，在处理过程中要保护处理废物的员工和处理废物地方的环境或消除废物有，防止废物和液体中的感染性因子的传播。对于锐器和针头也有类似的要求，特别要关注持有锐器的容器，关注处理容器的方法，监测处理的过程。对锐器的处理过程要考虑安全操作；当地、地区和国家的法律及其他法规。医疗机构可以管理这一过程或与外部处理这些锐器和针头的人员签订合同。Kitchen sanitation, food preparation and handling, and mechanical and engineering control (such as system ventilation, biological hoods, and other) should be managed to minimize or to eliminate infection risk.厨房环境卫生，食物的准备和处理，机械和工程控制(象通风系统、食品柜和其他)将进行管理，减少或消除感染风险。JCI standards require organization to reduce the risk of infection in the facility during demolition, construction, and renovation and to consider, among other factors, air quality, dust, and other risks to patients or HCWs. It is essential that infection control HCWs be involved in construction and renovation from the beginning to the end of process to ensure that infection prevention risk are addressed. This and other related content are discussed further in Chapters 5 and 6.JCI要求医疗机构在机构拆除、建设、维修期间考虑其他因素、空气质量、灰尘和其他对病人或医务人员的风险，减少感染的风险。在建设、维修从开始到结束的期间必须控制对医务人员的感染，确保控制感染，防止风险。这个和其他相关的内在讨论见第五章和第六章。

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Isolation Procedures隔离规程Applicable JCI Standard可实施的JCI标准The following JCI standard are directly applicable this section of text. For complete standard and further compliance information, see Appendix 1下列JCI标准可直接应用于本段。全部的标准和进一步可遵循的信息，见附录1。
Ambulatory case非住院医疗

Clinical Care Program (Certification)临床医疗项目(认证)

Clinical Laboratories临床检验室

Home Care家庭治疗

Hospitals医院
IPC.8
Long Term Care长期护理机构
IPC.6
Medical Transport医疗转运
BCA.6
Primary Care初级医疗

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Isolation standards require that patient—especially when immunosuppressed—as well as visitors and HCWs be protected from infections via barriers and isolation. Precautions regarding airborne transmission are especially important components of this requirement, including JCI’s preference that patients with airborne infections be isolated in negative- pressure rooms until the infections are no longer communicable. For organization unable to construct negative-pressure rooms, an acceptable alternative is a high-efficiency particulate air (HEPA) filtration system that functions at the rate of at least 12 air exchanges per hour. When neither a negative-pressure room nor HEPA filtration is available, organizations must have a policy and a procedure for how to manage for short periods of time patients who spread infection by the airborne route.隔离标准要求病人特别是免疫力低下者同探访者和医务人员要通过屏障和隔离防止感染。空气传播的预防措施是这一要求的重要组成部分，包括JCI也倾向将空气传播感染的病人隔离在负压病房，直到感染不能再传播。没有负压病房的医疗机构，可以用一种高效粒子空气(HEPA)滤过系统替代，高效粒子空气(HEPA)滤过系统具有每小时交换12次空气的功能。当既没有负压病房，又没有HEPA滤过时，医疗机构要有一个策略和规程去管理病人短期间通过空气传播感染的途径。In addition, these JCI requirement indicate that the organization must have a strategy to deal with an influx of patients with contagious infectious diseases. This will require advance planning and forethought, including the careful education of HCWs in the management of such patient.另一方面，这些JCI要求指出医疗机构必须要有一个策略去处理感染性疾病在病人中的蔓延。也要求提出深谋远虑的计划，包括对管理这样的病人的医务人员的细心教育。

鬼才

Barrier Techniques and Hand Hygiene屏障技术和手卫生Applicable JCI Standard可实施的JCI标准The following JCI standard are directly applicable this section of text. For complete standard and further compliance information, see Appendix 1下列JCI标准可直接应用于本段。全部的标准和进一步可遵循的信息，见附录1。Ambulatory case非住院医疗IFS.7Clinical Care Program (Certification)临床医疗项目(认证) Clinical Laboratories临床检验室 Home Care家庭治疗IPC. 6Hospitals医院PCI.8 and PCI.9Long Term Care长期护理机构IPC.7Medical Transport医疗转运BCA.4Primary Care初级医疗ODS.16 and ODS.24.3JCI’s barrier-technique and hand-hygiene requirements indicate that gloves, masks, soap, and disinfectants be available and used correctly when required. Hand-hygiene materials, barrier techniques, antiseptics, and disinfecting agent are fundamental to IPC. The organization must identify those situation in which masks and gloves are required and ensure that the products are available and accessible. Fox example, soap, alcohol hand preparations, and disinfectants should be located in those areas where hand hygiene and disinfecting procedures are required. Organization should also adopt and post hand-hygiene guidelines in appropriate areas throughout the organization. (The use of guidelines is scored at IPSG.5, ME 2; see “Infection Prevention and Control and the International Patient Safety Goals,” beginning on page 47, for more details.) HCWs must be educated in proper hand-wasting and disinfecting procedures.JCI的屏障技术和手卫生要求指出，当需要时，手套、口罩、肥皂和消毒剂必须有可供使用的，而且要正确使用。手卫生材料、屏障技术、防腐剂(人用消毒剂)和消毒剂对感染预防控制策略非常重要。医疗机构必须确定在那些情况需要用口罩和手套，并确保这些产品是能用的且易于接触到。例如，肥皂、含醇手消剂和消毒剂要放在那些需要进行手卫生和消毒操作的地方。医疗机构也要接受手卫生指南，且在整个医疗机构合适的地方张贴手卫生指南。(指南使用的评分在IPSG.5, ME 2；更详细的见“感染预防控制与国际病人安全目标”，本书第47页。) 医务人员必须进行适当的洗手和消毒规程教育。