病区使用计算机的感染预防和控制

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b]病区使用计算机的感染预防和控制总结
门诊感染预防杂志 (Preventing Infection in Ambulatory Care注：PIAC是APIC编辑出版的季刊。）  2011年3月7日
苏·巴恩斯，全国感染预防和控制主席,美国Kaiser Permanente项目办公室主任
汤姆.W，APIC专业培训董事
   
    科技能够帮助提高病人安全，但也能通过医疗设施导致病人与工作人员间的感染传播。计算机，特别是计算机键盘，在使用触摸时手能够被各种微生物污染。比如，艰难梭状杆菌能够在物体表面生存数月。革兰氏阳性菌，包括VRE、MRSA，可以在干燥物体表面生存几天到几个月。许多革兰氏阴性菌,例如大肠杆菌和绿脓杆菌在设备上可以生存数月。只要有匆忙和疲惫的人，这些微生物就会存在。没有做手部卫生的人使用计算机，可以将微生物携带到计算机键盘，转染下一个使用者。最近的研究显示，随着病区计算机使用的普及与增加，键盘已经成为重要的微生物储蓄地。
    这就是为什么再三强调接触污染物体表面之后和另一个病人或环境之前做手部卫生的重要原因。遗憾的是,在美国手卫生依从性大约仅为40%，在社区、在医院和诊所的多重耐药菌感染都在不断上升。
    帮助降低微生物传播风险的《计算机清洗指南》已经制定。“键盘/鼠标套”做为一个防控策略被使用。该“套”容易装卸，能够使用低、中水平消毒剂消毒。也可使用“可水洗/密封键盘”。Rutala的研究表明，对有套和没有套的键盘，使用广谱低水平消毒剂擦拭5秒，就可以轻易达到消毒效果。不得戴手套操作计算机电脑，使用计算机前必须进行手卫生。键盘和鼠标必须每日消毒，当明显污染或被血液、体液污染立即消毒。
        
病区计算机感染防控准则11条
1、接触病人前和使用计算机前，对于非污染手使用速干消，污染的手使用肥皂洗手。
2、使用计算机不得戴手套。
3、接触计算机后，去多床病室接触病人必须对手做除菌处理 。
4、移动电脑带到另一个病室前，必须被彻底清洁处理。
5、每天和当污染时，清洁洗/消毒计算机表面与键盘，使用医用消毒剂擦拭5秒。
6、至少每天或污染时，对病房的键盘以及类似表面和设备采用相同的方法清洁消毒。
7、对病房的计算机触摸屏，至少每天或污染时和其他水平面和设备一样，采用相同的方法清洁消毒。
8、非触摸式监视器应该按照制造商的说明书和/或者当明显污染时清洁消毒。
9、计算机尽可能安置在离藏污纳垢的地方至少3英尺（1米）以上。
10、计算机和藏污纳垢地之间使用透明塑料挡板隔开，透明塑料挡板能够耐受消毒剂。
11、每天或污染时，挡板应该与其他病区环境的所有水平面一样，经常采用相同的过程进行清洁。
参考文献：略。

Overview: Infection Prevention and Control for Computers in Patient Care Areas
By Sue Barnes, RN, BSN, CIC, National Leader, Infection Prevention and Control, Kaiser Permanente Program Offices, and Tom Weaver, DMD, APIC Director of Professional Practice
|March 07, 2011
   While technology can help to provide better and safer patient care, hardware used can be involved in the transmission of infection between staff and patients.　　
     Computer hardware, especially keyboards, can be contaminated with microorganisms when touched by contaminated hands. Clostridium difficilecan survive on inanimate surfaces for months. Gram positive bacteria, including vancomycin-resistant enterococcus(VRE) and methicillin-resistant staphylococcus aureus(MRSA) can survive days to months on dry surfaces. Many gram-negative species, such as E. coliand P. Aeruginosa can also survive for months on equipment. All it takes is one provider who is over-worked and in a hurry. Computer access without proper hand hygiene can deposit organisms on the keyboard for the next provider. Recent studies support this, showing that keyboards can become significant reservoirs for organisms because of the increased use of computers in patient care areas.
    This is why hand hygiene is critically important after touching surfaces that may be contaminated and before contact with another patient or with the environment. Unfortunately, hand hygiene compliance across the U. S. is about 40% and multi-drug resistant organisms are on the rise in the community and in hospitals and clinics.
        Computer cleaning guidelines have been developed which can help reduce the risk of transmission of organisms. A keyboard/mouse cover can be one strategy used. Covers are easily removed and disinfected with a low or intermediate-level hospital approved disinfectant. Also washable/sealed keyboards may be employed. Rutala's studies indicate that keyboards can be as easily disinfected with or without covers using 5 seconds of friction and a wide range of low level disinfectant solutions. Gloves should not be worn during computer use. And hand hygiene should be performed before using the computer. Keyboards and mice need to be disinfected daily or when visibly soiled or contaminated with blood.
11 Infection Prevention and Control Guidelines for Computers in Patient Care Areas
? Use waterless alcohol degermer for non-soiled hands; soap and water for soiled hands prior to computer use, and prior to touching patients.
? No gloves should be worn during computer use.
? Hands must be de-germed after accessing the computer, before touching patients in multi-bed rooms.
? Roving computers must be cleaned before moving to another patient room.
? Clean/disinfect computer surfaces including keyboards using germicidal wipe containing a hospital disinfectant by wiping surface with friction for 5 seconds once a day and when soiled.　
? Keyboards in patient rooms should be cleaned and disinfected with same process as the other horizontal surfaces and equipment in the patient room, i.e. at least daily and when soiled.
? Touch-screen computer monitors should be cleaned and disinfected with same process as the other horizontal surfaces and equipment in the patient’s room, i.e., at least daily and when soiled.
? Non-touch screen monitors should be cleaned per manufacturer’s instruction and/or when visibly soiled.
? Whenever possible install computer at least 3 feet from sink.
? Splashguard can be used between computer and sink and should be made of clear plastic that can be cleaned using disinfectant products compatible with the plastic.
? Splashguard should be cleaned with same frequency and process as all other horizontal surfaces in the patient care environment, i.e., daily and when soiled.
References
1. Rutala W, et al. "Computer keyboards: bacterial contaimination, ef 1. ficacy and compatibility of disinfectants". ICHE-2005-161.
2. Neely AN, Sittig DF. "Basic microbiologic and infection control information to reduce the potential transmission of pathogens to patients via computer hardware". J Am Med Inform Assoc.2002 Sep- Oct;9(5):500-8.
3. Coia JE, Masterton RG. "Computer keyboards as a risk for nosocomial infection". Am J Infec Control.2001 Oct;29(5):345.
4. Schultz M, et al. "Bacterial contamination of computer keyboards in a teaching hospital". Infect Control Hosp Epidemiol.2003 Apr;24(4):302-3.
5. Bures S, et al. "Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit". Am J Infec Control. 2000 Dec;28(6):465-471.
6. Neely AN, et al, "Dealing with contaminated computer keyboards and microbial survival". Am J Infec Control,2001, Apr;29(2):131-132.
7. Hartman B, et al "Computer keyboard and mouse as a reservoir of pathogens in an intensive care unit. J Clin Monit Comput.2004 Feb;18(1):7-12.
8. Singh D, et al, "Bacterial contamination of hospital pagers". Infect Control Hosp Epidemiol.2002 May;23(5):274-6.
9. Devine J, et al. "Is methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals a surrogate marker for nosocomial MRSA transmission and handwashing compliance?" J Hosp Infect.2001 May;48(1):72-5.
10. Denton M, et al. "Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit". J Hosp Infect.2004 Feb;56(2):106-10.
11. Boyce JM, et al. "Environmental contamination due to methicillinresistant Staphylococcus aureus; possible infection control implications". Infect Control Hosp Epidemiol.1997 Sep:18(9):622-7.
12. Neely AN, "Computer equipment used in patient care within a multi-hospital system: Recommendations for cleaning and disinfection". Am J Infec Control,2005 May;33(4)233-7.
13. Ivey JC, et al. "Fungal contamination related to personal computer devices installed in a hospital intensive care unit". Am Soc Microbiol Abstras2001:L-I:469.
14. Hassoun A, et al. "Colonization of personal digital assistants carried by health care professionals". Infect Control Hosp Epidemiol2003:24:302-3.
15. Man GS, et al. "Bacterial contamination of ward-based computer terminals". J Hosp Infect2002;24:302-3





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