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译|比赛-Nosocomial infection in China: Management status and solutions

2019年1月24日 - 微生物

Letters to the editor

Nosocomial infection in China:Management status and solutions

To the Editor:

In China, nosocomial infection is aprominent public health concern and
is associated with an annual direct economic burden of $1.5-$2.3
billion (¥10-¥15 billion). Advancesin medical technology, extensive
application of novel diagnosticand therapeutic techniques, and
increased adoption of traumatic and invasiveinterventions have
drastically altered the source, transmission route, andsusceptible
population of nosocomial infection. Emergence of
multidrug-resistantbacteria has increased the proportion of refractory
infections and thechallenges of infection control. China has
reinforced legislation to controlnosocomial infection, drawing
extensive support from society and medicalcommunity. This transition
is reflected in the Chinese governmental response tothe epidemic of
Middle East respiratory syndrome.

读者来信——中国医院感染及对策

崇敬的编制:

诊所感染已变成中华非凡的公家健康问题,其造成的直白经济损失已抵达每年15~23亿美元(100~150亿人民币)。随着医疗技术的腾飞,新型诊断和医疗技能的广泛应用以及进一步多的侵入性操作,院内感染的传染源、传播路线和易感人群都发出了高大的改变。而多重耐药菌的出现造成难治性感染病例的扩充,使得感染控制面临着英雄的挑衅。方今中国现已加强立法控制医院感染,此举得到了来自社会和艺术学各界的宽广襄助,尤其是在中国政府回应中东呼吸道综合征疫情的时候显示得更为引人侧目。

In January 2013, 99 out of 120 patientsreceiving treatments for
varicosity at Donggang Social Insurance Medical Clinicwere infected
with hepatitis C virus. Investigations indicated that this
aggressive,multisource, and nosocomial hepatitis C virus infection
resulted from repeatedsyringe use among different patients. In July
2011, 15 cataract patientsundergoing surgical treatment at an
Ophthalmic Hospital in the Raodu district,Linfen, suffered from
endophthalmitis. Investigation showed that patients wereinfected with
Pseudomonas aeruginosa endophthalmitis, which resulted from a shortage
of surgical equipment andnonstandard disinfection of the surgical
instruments. In March 2009, incidenceof neonatal nosocomial infection
was reported in a maternal and child careservice center in the Ji
County of Tianjin. In a neonatal ward, 5 of the total6 newborns were
dead. Investigations revealed a severe nosocomial infectionresulting
in deaths attributed to negligence by staff with poor infection
prevention andcontrol standards.

二〇一三年九月,东港市社会保证医疗诊所接受静脉曲张治疗的120名伤者中,有99名被确诊出感染了丙型病毒性胆总管结石。据检察讲明,该院丙肝病毒的传播是出于医院内差异患者重复使用注射器造成的。二零一一年三月,临汾市尧都区某男科医院15名沙眼手术伤者均感染了眼内炎。经查证,患者罹患绿脓杆菌感染性眼内炎是因为该院手术器械缺少且手术器械未通过专业的杀菌便投出手术使用。二零零六年十二月,曼彻斯特蓟县一家妇幼保健服务中央被曝出该医院新生儿病房6名婴孩中有5名过世。通过调研发现,导致该院新生儿高谢世率的原因是该主旨医务人士未严厉执行感染控制和防备标准。

The ongoing incidence of such seriousevents reflects poor standards of
nosocomial infection management.

First, inadequate medical sources and imbalancein hospital development
are increasingly serious challenges. Nearly 50 millionof the total 1.3
billion people in China require hospitalization annually because of
diseases or trauma. However, theChinese health care system is riddled
with long wait lists, shortages, and poorequipment because of funding
constraints. The national medical system is not hierarchical in
structure. As aresult, most patients are traditionally segregated in
large- and medium-sizedhospitals, and hospital wards have become
breeding grounds for microbialpathogens, with increased risk of
infection.

这一层层严重的事件反映了医院感染管理规范的缺失。

率先,大家正面临医疗资源枯竭和卫生院间发展不平衡那八个日益严厉的挑衅。每年由于各类疾病或外伤,13亿神州人中有接近50万人需住院治疗。但是中国治病系统由于资金紧张,导致其发展缓慢、医疗装备短缺。同时我国没有建立多层次医疗卫生连串。由此,一大半病员选用在大、中型医院就医,医院病房成为了病原微生物的温床,使得感染风险扩张。

Second, the under-reporting of nosocomialinfection and the number of
full-time staff experienced in infection controlhave been highlighted
by health administrators during the performance appraisalof health
care institutions. In some hospitals, hospital leaders neglect
poststandardization training and continuing education of the managers
involved incontrolling infection. Full-time professional staff members
fail to undergotraining in nosocomial infection and occupational
health. In most hospitals,target and prospective monitoring are rare,
which results in delayed discoveryof high-risk areas.

Third, hospitals lack expertise and humanresources skilled in
infection management. Senior managers fail to considerqualified
personnel. A few health care institutions simply fill
availablevacancies with retired nurses to ensure the number of
required personnel in thedepartment of nosocomial infection.

其次,卫生行政人士提出,在医疗卫生机构绩效考核中,存在院感案例和专职感控人士数量漏报的景况。医院的院领导一再忽视了感染控制管理人士的职责规范化培训和继续教育,使得其不可以参加医院感染和工作卫生培训。半数以上医务室尚未执行医院感染的目的性监测,为医院感染高发区域埋下了隐患。

重复,医院缺少感染管理专业知识及人力资源。高层管理人士对感控人员的身价评释并未考虑。一些医疗机构甚至聘用退休医护人员以填补职位空缺,从而达到感染管理部门需要的感控人士数量。

Forth, drug-resistant bacteria as a resultof antibiotic abuse and
unreasonable use are still important factors leading tonosocomial
infection. Epidemiology studies suggest that the usage rate
ofantibiotics in hospitalized patients in some regions and hospitals
is still >60%,reaching a rate of 74.67%, or even exceeding 90% in
the neonatal ward.Inadequate catheterization and subsequent care along
with poor concept ofasepsis are other factors. Failure to comply with
standard regulations of handhygiene or even handwashing after
examining patients with infections, lack ofstandardized or complete
disinfection of surgical instruments, failure to implementsurgical
standards, failure to consider oxygen humidifiers as an important
sourceof lower respiratory infection, and inappropriate measures of
disinfection andisolation are some of the factors that artificially
increase nosocomial infection.

终极,抗生素的滥用爆发的耐药菌也是滋生院感的重大元素。流行病学切磋注脚,我国部分所在的卫生院,伤者抗生素使用率高于60%达74.67%,在婴幼儿病房甚至超过了90%。导尿术操作不当以及术后不够无菌观念护理也是引起院感的其余因素。未严酷执行手卫生规范、接触有感染病灶患者后未洗手、紧缺专业总体的手术器械消毒、不根据手术正式、未将氧气加湿器作为下呼吸道感染主要来源以及不相宜的消毒隔离措施等,都是增添院感的人为因素。

A solution for improved nosocomial infection management in China has
been proposed. The overall goal of the Chinese Action Plan on
Prevention and Control of Nosocomial Infection (2012-2015) includes
enhanced prevention and control of nosocomial infection, insisting
on“scientific prevention and control, standard management,
highlighting the key points, and enforcing the implementation.”The
solutions are designed to improve the related technicalcriteria,
upgrade and implement prevention and control measures, raise the
professionalskills and capacities, and increase the quality and safety
of medicines.

眼前,我国已指出改进院感管理的缓解方案。《预防和控制医院感染行动安插(2012-二〇一五年)》以加强院感预防和控制工作为主题,锲而不舍“正确防控、规范管理、卓绝重点、强化落到实处”的条件。该安排目的在于增强有关技术标准,完善并完成感染防控措施、提升专业技能与力量和药物质料安全。

The following additional steps arerecommended to address the
challenges of nosocomial infection:

•Governmentsat all levels must invest increasingly to improve hospital
conditions. Publichospitals should be transformed into not-for-profit
organizations in thenational health care system.

•Todisseminate the knowledge of nosocomial infection, the government
and healthworkers should popularize and publicize new techniques and
know-hows forinfection prevention and control.

•To improveenvironmental hygiene, a national system of sanitation
should be created toprovide population access to adequate sanitation
measures given the currentunsanitary conditions in hospitals.

•To emphasizeappropriate hospital layout, a well-developed,
scientifically planned hospitalinfrastructure is essential to ensure
sustainable care and development andnosocomial infection management.
The government and the director of thehospital should emphasize the
role of rational design of the wards and hospitallayout and balance
the costs and benefits in prevention of infection.

小编指出使用以下方法以应对院感挑衅:

•各级政党应加大投入以精雕细刻医院条件。在国家医疗服务系统中,公立医院应转变为非营利性组织。

•宣传院感知识。政坛和卫生工作人士应向公众普及感染预防和操纵的新技巧和进展。

•为核对环境净化。鉴于方今恶劣的诊疗条件,应创立国家卫生系统以为群众提供保健措施。

•为强调合理医院布局,科学统筹的诊所基础设备对确保可不止照护、发展以及院感管理不可或缺。政坛及医院老总应爱抚病房和卫生院布局的合理性设计并平衡院感预防的资金和收入。

•The hospitalinformation system (HIS) enables the control of infection
by regulating all ofthe operational aspects, such as medical,
administrative, financial, and legalissues and the corresponding
services. The HIS is the essential technologicbackup of the
environment and infrastructure in a modernized hospital
system.Information sources related to nosocomial infection may be
enriched using theHIS and enhance the ability of health care
professionals. The HIS facilitatesorganizations in nosocomial
infection management, official documentation, andensures data
security.

•Evidence-basedmedicine (EBM) is intended to optimize decision-making
by emphasizing the useof evidence from welldesigned research studies.
According to the theory of EBM,the strongest evidence based on
meta-analyses, systematic reviews, andrandomized controlled trials
yields strong recommendations. Combined with thedata of epidemiologic
survey and analysis, EBM may provide useful strategies toimprove
nosocomial infection management. However, the inadequacy of clinical
application of EBM in nosocomial infectionmanagement in China needs to
be addressed.

•A no-paypolicy by the government and medical insurance organizations
must beimplemented rigorously for items of nosocomial infection that
are not coveredby medical insurance. This policy will encourage
awareness of prevention and controlmeasures that reduce the incidence
of hospital infection.

•医院信息连串(HIS)通过调节医院当前治病、行政、财务、法律问题及有关服务等各地点来执行感控工作。该系统能为医院提供必需的条件和底蕴设备音信备份。通过使用该系统,可补充院感相关信息资源,进步医护人士的感控知识了解能力。并且该系统造福院感管理协会、保存官方文书,并能确保数据的安全性。

•循证农学(EBM)的意在,通过精心设计的调研商量以强调应用证据,从而优化历史学决策。按照循证文学的申辩,基于荟萃分析和系统评价等最强劲的凭据,进行随机对照试验,得出强烈提出。循证管理学结合流行病学调查和分析得到的数目,可以为鼎新院感管理提供可行的政策。然则在中华,院感管理方面循证工学的医治应用较少,这一题材急于

•对于医疗有限支撑不可以覆盖的院感项目,政党和医疗保障机构应严厉执行免费政策。这一政策将会拉长人们使用感染防控措施的的意识,从而下降院感爆发率。

The quality of infection control is animportant indicator balancing
quality of management and medical administration.During the early
period of the severe acute respiratory syndrome epidemic in2002, the
nosocomial infection rate of medical staff reportedly exceeded
10%because of inadequate disease knowledge. However, this rate does
not representall the data because there were several hospitals or
wards with a zeroinfection rate among the medical staff during the
outbreak. The discrepancy isassociated with different attitudes toward
infection. Overall, nosocomial infectionmanagement in China and
worldwide has a long way to go.

医院感染管理已改成衡量医院管理水平及治疗质地的要紧标志之一。2002年,严重急性支气管综合征(非典)疫情爆发的初期,医务人士由于对该疾病认识不足,其院感暴发率超越了10%。但这样的感染速度并不能够代表享有的数码,因为中间仍有几家医院医务卫生人员达到了零感染率。那种差别与各卫生院对待感控拔取两样态度有关。总而言之,华夏和天底下的院感管理工作任重(英文名:)道远


上述文章是选自《美利坚合营国感染控制杂志》一篇读者来信

宗旨为中国医院感染,并对即刻严苛的院感现状提议了指出对策。

初稿下载网址:http://dx.doi.org/10.1016/j.ajic.2016.01.039

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