隔离病房循证相关

The evidence speaks: Reducing HCAI through improved patient isolation

证据表明:对感染病人进行隔离可减少医疗相关感染。

A series of studies have shown that increasing the proportion of single room accommodation for patients reduces the rate of HCAI.

一系列的研究表明增加隔离病房对感染的病人进行隔离可以降低医疗相关感染。

The Rediroom has been designed to offer the middle ground between single rooms and multi-occupancy bays – providing many of the benefits of single rooms (more privacy,improved hand hygiene, and better containment of pathogens) and multi-occupancy bays (patient visibility, and reduced cost in terms of staffing)

 

伽玛快速隔离病房,介于隔离单间和多人间之间的产品,既有隔离单间的优点,如更好保护病人隐私,更高的手卫生依从性,更好的清洁与消毒;也有多人间的优点,如更方便观察病人,更节约人力资源。

The Rediroom offers flexible patient isolation, allowing hospitals to rapidly flex isolation capacity to meet demand, balancing changing clinical and patient priorities, has been designed to deliver droplet and contact precautions, and frees up existing hard-walled permanent isolation rooms for other priority patients.

 

伽玛快速隔离病房,提供了一种非常便捷的隔离方案。医院可根据需求,快速搭建出隔离单间,以平衡临床和病人的需求,主要可用于飞沫隔离和接触隔离,并且可以为有需求的特殊病人腾出为数不多的常规隔离单间病房。

 

Guidelines 指南

Department of Health,2008

The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance

One of the criteria of the ‘Hygiene Code’ is that healthcare providers should provide adequate isolation facilities, which are sufficient to minimise the spread of infection. Many NHS hospitals lack an adequate number of rooms suitable for isolating patients in order to minimise the spread of infection.

 

英国卫生部,2008年

《2008年卫生和社会福利法》预防和控制感染行为守则及相关指导:《卫生守则》的其中一项标准是,医疗服务提供者应提供足够的隔离设施,以尽量减少感染的传播。许多NHS医院缺乏足够数量用于隔离病人的房间。

National Audit Office,2009

Reducing Healthcare Associated Infections in Hospitals in England

This National Audit Office report found that 23% of NHS Trusts identified insufficient facilities to isolate patients as driver of healthcare-associated infection.

 

2009年国家审计署

减少英国医疗相关的感染,这份国家审计署的报告发现,23%的NHS信托机构确认,用于隔离病人的设施不足是导致发生医疗相关感染的原因。

Healthcare Infection Control Practices Advisory Committee (HICPAC),2007

2007 Guideline for isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

This guideline outlines the requirements for patient isolation, aimed at healthcare facilities in the US. This guideline recommends that contact,droplet and airborne isolation is performed in single rooms.

 

卫生保健感染控制实践咨询委员会(HICPAC),2007年

2007年隔离预防指南:在卫生保健机构中防止传染病传播 该指南概述了针对美国医疗保健机构的患者隔离要求。本指南建议在单人房间内进行接触隔离、飞沫隔离和空气隔离。

Health Protection Scotland, 2015

Transmission Based Precautions Literature Review: Patient Placement (Isolation/Cohorting)

This guideline recommends that patients who are known or suspected to be infected with microorganism spread by the contact or droplet route should be cared for in single rooms when available.

 

苏格兰健康保护,2015年

基于传播的预防措施文献综述:病人安置(隔离/分组) 本指南建议,已知或疑似感染了通过接触或飞沫途径传播的微生物的患者,有条件时应在隔离单间护理。

Research Studies 研究报告

Mitchell BG, Williams A, Wong Z, O’Connor J. Infection, Disease & Health 2017;22;129-35.

Assessing a temporary isolation room from an infection control perspective: A discussion paper

A study considered the infection prevention and control characteristics and potential benefits of the Rediroom. The Rediroom was installed in a simulated clinical environment, and its function from an Infection Prevention and Control (IPC) viewpoint was assessed against standards or guidelines, for assembly and dismantling, and for cleanability, as judged by the removal of fluorescent markers. Rediroom was found to be fully compliant with 17 of 19 relevant guidelines or standards, and partially compliant with the other two. The two guidelines rated as partially compliant were storage and use of personal protective equipment, and provision of additional storage capacity. Another limitation was the lack of a sink for hand hygiene inside the room, but there is provision for alcohol gel to be situated both inside and outside the Rediroom. The review of assembly and dismantling of the Rediroom identified limited infection control risk. Impressively, the Rediroom was installed in less than 5 minutes! Finally, the cleaning assessment found that the UV fluorescent markers were fully removed from 23 (96%) of the 24 surfaces marked, and partially removed from the other surface. Whilst this cleaning assessment was not performed in clinical practice, it demonstrates that the Rediroom does not present a barrier to cleaning in principle.

 

从感染控制的角度评估一个临时隔离病房:讨论稿

本研究考虑了传染病预防和控制的特点及其可能带来的好处。Rediroom被安装在一个模拟的临床环境中,从感染预防和控制(IPC)的角度,根据标准或指南对其功能进行评估,并根据荧光标记的去除情况对其组装和拆卸以及清洁能力进行评估。研究发现Rediroom完全符合19项相关指南或标准中的17项,部分符合另外两项。被评为部分符合的两项准则是个人防护装备的储存和使用,以及提供额外的储存能力。另一个限制是房间内缺乏洗手水池,但在Rediroom内外都有提供酒精手消毒凝胶。对Rediroom的组装和拆除的审查确定了有限的感染控制风险。令人印象深刻的是,Rediroom不到5分钟就安装好了!最后,清洁评估发现,在标记的24个表面中,有23个(96%)的紫外荧光标记被完全去除,而另一个表面的部分标记被去除。虽然在临床实践中没有进行这种清洁评估,但它表明,从原则上讲,Rediroom并不构成清洁的障碍。

Mitchell BG, Williams A, Wong Z. Am J Infect Control 2017;45;1231-7..

Assessing the functionality of temporary isolation rooms.

An Australian study evaluated various functional characteristics of the Rediroom using a mixed methods approach involved video recording, interviews, and objective temperature and humidity measurements within a crossover intervention study, concluding that the Rediroom had similar functional performance to performing patient care in an open plan area. In this study, a Rediroom was evaluated in a simulated clinical ward environment. Participants undertook a range of clinical nursing activities in a Rediroom or in a control area, including transferring patients, administration of medications, measurement of observations, performing an aseptic technique, bed bathing a patient, and cardiopulmonary resuscitation. A network analysis of staff movements in the room, and staff feedback via interviews and a questionnaire were used to evaluate the functionality of the Rediroom vs. control area. Temperature and humidity was measured in the Rediroom and control area. The time taken and the number of movements required to complete clinical nursing activities was broadly similar in the Rediroom and control area. A network analysis of the two activities that involved the most individual movements showed that there was close similarity in the pattern of movements in the Rediroom and control area. Recurring themes from interviews with staff were a sense of restriction, temperature, and management of critically ill patients. However, it is important to note that the Rediroom was not compared against another single room, but against an open plan area. It is likely that the sense of restriction and temperature themes would be less prominent if the Rediroom was compared to an isolation room.

 

在交叉干预研究中录像、访谈和客观的温度和湿度测量,得出结论:在开放的平面区域中,Rediroom具有类似的病人护理功能。在本研究中,我们在一个模拟的临床病房环境中评估了Rediroom。参与者在Rediroom或对照区域进行了一系列的临床护理活动,包括转送病人、给药、测量观察结果、执行无菌操作、对病人进行床上沐浴和心肺复苏。本研究以员工在室内活动的网络分析,以及员工通过访谈和问卷的反馈来评估Rediroom与对照区域的功能。测量Rediroom和对照区域的温度和湿度。在Rediroom和对照区域,完成临床护理活动所需的时间和活动次数大致相同。对涉及个体运动最多的两种活动的网络分析表明,在Rediroom和对照区域的运动模式非常相似。与工作人员的访谈中反复出现的关注的问题是空间舒适感、温度和危重病人的管理。但是,重要的是要注意,Rediroom不是与其他单间进行比较,而是与一个开放的平面区域进行比较。如果将Rediroom与隔离单间相比,空间舒适感和温度这两方面的差异可能会不那么突出。

Moore G, Ali S, FitzGerald G et al. J Hosp Infect 2010;  76; 103-7

Ward assessment of Smartideas Project: Bringing source isolation to the patient

A UK Department of Health led initiative led to the development of a Temporary Side Room, which was evaluated in a clinical setting. The Temporary Side Room was a semi-permanent installation, with expandable walls designed to fit over most bed spaces. Questionnaires were issued to staff, patients, and visitors; environmental samples were collected; and hand hygiene audits performed. 53 patients were isolated, which resulted in less bed blocking than would have occurred if the Temporary Side Room was not installed. Patients and staff were concerned about limited space and communication. Hand hygiene compliance was significantly improved in the Temporary Side Room. There was no evidence of reduced environmental contamination, although the levels identified were low.

 

英国卫生部发起的一项倡议引发了临时病房的发展,并在临床环境中对临时病房进行了评估。临时病房是半永久性的装置,可扩展的墙壁设计适合大多数病房空间。调查问卷发放给工作人员、病人和访客;收集环境采样样本以及手部卫生审计。53例患者被隔离,结果发现,与没有安装临时病房相比,安装了临时病房造成了较少的床阻塞。病人和工作人员都担心空间不够大和影响交流。在临时病房里,手部卫生依从性有明显改善。虽然环境表面污染程度很低,但没有证据表明环境污染减少了。

Keward J, Bradshaw P, Otter JA. Infect Prev 2017;18:67-71.

Reducing the number of missed isolation days in a paediatric high-dependency unit using semi-permanent pods.

Three semi-permanent pods were implemented in a paediatric ICU to improve the availability of single rooms for isolation. This reduced the number of ‘missed’ isolation days from 58% to 14%, thus reducing the risks of transmission. These temporary isolation rooms had to be installed by a company and were ‘semi-permanent’, so provided limited flexibility in patient accommodation.

 

在儿科重症病房使用半永久性隔离舱,减少隔离天数。

在一个儿科ICU中使用三个半永久性隔离舱,以提高单人病房隔离的可用性。这个措施将错误的隔离天数从58%减少到14%,从而降低了传播风险。这些临时隔离室由一家公司安装,并且是“半永久性”的,因此在病人住宿方面提供了一些灵活性。

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