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

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

崇敬的编排:

医院感染已变为华夏崛起的公物健康问题,其促成的直白经济损失已抵达每年15~23亿美元(100~150亿人民币)。随着医疗技术的迈入,新型诊断和治疗技能的广泛应用以及更加多的侵入性操作,院内感染的传染源、传播途径和易感人群都暴发了极大的变更。而多重耐药菌的出现导致难治性感染病例的充实,使得感染控制面临着伟大的挑战。近期中华已经增长立法控制医院感染,此举获得了来自社会和工学各界的大规模援助,特别是在中国政坛应对中东呼吸道综合征疫情的时候展示得更为显明。

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.

二〇一三年五月,东港市社会保险医疗诊所接受静脉曲张治疗的120名患儿中,有99名被确诊出感染了丙型病毒性结石性胆囊炎。据调研声明,该院丙肝病毒的传入是出于医院内不同患者重复使用注射器造成的。二零一一年九月,大同市尧都区某口腔科医院15名斜视手术患者均感染了眼内炎。经调研,患者罹患绿脓杆菌感染性眼内炎是因为该院手术器械贫乏且手术器械未通过正规的杀菌便投动手术使用。二零零六年五月,吉达蓟县一家妇幼保健服务主题被曝出该诊所小儿病房6名宝宝中有5名过世。通过调查发现,导致该院新生儿高死亡率的原故是该核心医务人士未严俊执行感染控制和防护标准。

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.

这一雨后春笋严重的事件反映了卫生院感染管理专业的缺失。

第一,我们正面临医疗资源不足和诊所间发展不平衡这多个日益严酷的挑衅。每年由于各类疾病或外伤,13亿神州人中有贴近50万人需住院治疗。然则中国看病序列由于资金紧张,导致其发展缓慢、医疗设备短缺。同时我国尚未建立多层次医疗卫生系列。因而,大多数病人选拔在大、中型医院就诊,医院病房成为了病原微生物的温床,使得感染风险增添。

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.

社会保险,其次,卫生行政人士提议,在医疗卫生机构绩效考核中,存在院感案例和全职感控人士数量漏报的情状。医院的院领导一再忽视了感染控制管理人士的职位规范化培训和继续教育,使得其不可以出席医院感染和生意卫生培训。大多数医院尚未执行医院感染的目的性监测,为卫生院感染高发区域埋下了隐患。

双重,医院紧缺感染管理专业知识及人力资源。高层管理人员对感控人士的身价认证并未考虑。一些医疗机构甚至聘用退休护士以填补职位空缺,从而达成感染管理单位要求的感控人士数量。

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.

最终,抗生素的滥用爆发的耐药菌也是挑起院感的根本因素。流行病学探讨阐明,我国一些地点的医院,患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挑起院感的其它因素。未严俊执行手卫生专业、接触有感染病灶患者后未洗手、缺少专业总体的手术器械消毒、不按照手术正式、未将氧气加湿器作为下呼吸道感染重要来源以及不恰当的消毒隔离措施等,都是扩展院感的人为因素。

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.

近来,我国已提出革新院感管理的化解方案。《预防和决定医院感染行动计划(2012-2015年)》以增强院感预防和决定工作为主干,坚定不移“没错防控、规范管理、非凡重点、强化落实”的原则。该计划意在增强有关技术标准,完善并贯彻感染防控措施、提升专业技能与能力和药质量料安全。

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.

作者指出使用以下办法以应对院感挑衅:

•各级政府应加大投入以改良医院条件。在国家医疗服务体系中,公立医院应转变为非营利性社团。

•宣传院感知识。政党和卫生工作人士应向公众普及感染预防和决定的新技巧和拓展。

•为改善环境整洁。鉴于目前恶劣的医治条件,应创立国家卫生系统以为群众提供保健形式。

•为强调合理医院布局,科学统筹的诊所基础设备对保证可不止照护、发展以及院感管理不可或缺。政党及医院领导应重视病房和诊所布局的客观规划并平衡院感预防的血本和收益。

•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.

•医院音信体系(HIS)通过调试医院当前治疗、行政、财务、法律问题及连锁服务等各地点来进行感控工作。该系统能为医院提供必需的条件和底蕴设备信息备份。通过运用该系统,可补充院感相关音讯资源,进步医护人士的感控知识精通能力。并且该系统造福院感管理团队、保存官方文书,并能确保数据的安全性。

•循证经济学(EBM)的意在,通过精心设计的查证研讨以强调应用证据,从而优化农学决策。按照循证教育学的争辨,基于荟萃分析和系统评价等最强劲的证据,举办随机对照试验,得出强烈提出。循证医学结合流行病学调查和分析得到的数码,可以为改善院感管理提供有效的政策。然则在中原,院感管理方面循证经济学的诊疗应用较少,这一题目迫切

•对于医疗保险无法覆盖的院感项目,政坛和医疗保险机构应严俊执行免费政策。这一方针将会加强人们使用感染防控措施的的意识,从而降低院感爆发率。

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.

医院感染管理已变成衡量医院管理水平及治疗质地的第一标志之一。2002年,严重急性支气管综合征(非典)疫情爆发的最初,医务人士由于对该疾病认识不足,其院感发生指点先了10%。但诸如此类的浸染速度并不能够表示所有的数码,因为里面仍有几家诊所医生达到了零感染率。这种差距与各医院对待感控采用两样态度有关。总而言之,神州和全球的院感管理工作任重道远


上述文章是选自《U.S.感染控制杂志》一篇读者来信

核心为中国医院感染,并对及时严刻的院感现状指出了指出对策。

原文下载网址:http://dx.doi.org/10.1016/j.ajic.2016.01.039

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