The evidence speaks: Reducing HCAI through improved patient isolation

證據(jù)表明：對感染病人進行隔離可減少醫(yī)療相關(guān)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離病房對感染的病人進行隔離可以降低醫(yī)療相關(guān)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)

伽瑪快速隔離病房，介于隔離單間和多人間之間的產(chǎn)品，既有隔離單間的優(yōu)點，如更好保護病人隱私，更高的手衛(wèi)生依從性，更好的清潔與消毒；也有多人間的優(yōu)點，如更方便觀察病人，更節(jié)約人力資源。

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.

伽瑪快速隔離病房，提供了一種非常便捷的隔離方案。醫(yī)院可根據(jù)需求，快速搭建出隔離單間，以平衡臨床和病人的需求，主要可用于飛沫隔離和接觸隔離，并且可以為有需求的特殊病人騰出為數(shù)不多的常規(guī)隔離單間病房。

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.

英國衛(wèi)生部，2008年

《2008年衛(wèi)生和社會福利法》預防和控制感染行為守則及相關(guān)指導：《衛(wèi)生守則》的其中一項標準是，醫(yī)療服務提供者應提供足夠的隔離設施，以盡量減少感染的傳播。許多NHS醫(yī)院缺乏足夠數(shù)量用于隔離病人的房間。

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年國家審計署

減少英國醫(yī)療相關(guān)的感染,這份國家審計署的報告發(fā)現(xiàn)，23%的NHS信托機構(gòu)確認，用于隔離病人的設施不足是導致發(fā)生醫(yī)療相關(guān)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.

衛(wèi)生保健感染控制實踐咨詢委員會(HICPAC)，2007年

2007年隔離預防指南:在衛(wèi)生保健機構(gòu)中防止傳染病傳播 該指南概述了針對美國醫(yī)療保健機構(gòu)的患者隔離要求。本指南建議在單人房間內(nèi)進行接觸隔離、飛沫隔離和空氣隔離。

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.

蘇格蘭健康保護，2015年

基于傳播的預防措施文獻綜述:病人安置(隔離/分組) 本指南建議，已知或疑似感染了通過接觸或飛沫途徑傳播的微生物的患者，有條件時應在隔離單間護理。

Research Studies 研究報告

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.

從感染控制的角度評估一個臨時隔離病房:討論稿

本研究考慮了傳染病預防和控制的特點及其可能帶來的好處。Rediroom被安裝在一個模擬的臨床環(huán)境中，從感染預防和控制(IPC)的角度，根據(jù)標準或指南對其功能進行評估，并根據(jù)熒光標記的去除情況對其組裝和拆卸以及清潔能力進行評估。研究發(fā)現(xiàn)Rediroom完全符合19項相關(guān)指南或標準中的17項，部分符合另外兩項。被評為部分符合的兩項準則是個人防護裝備的儲存和使用，以及提供額外的儲存能力。另一個限制是房間內(nèi)缺乏洗手水池，但在Rediroom內(nèi)外都有提供酒精手消毒凝膠。對Rediroom的組裝和拆除的審查確定了有限的感染控制風險。令人印象深刻的是，Rediroom不到5分鐘就安裝好了!最后，清潔評估發(fā)現(xiàn)，在標記的24個表面中，有23個(96%)的紫外熒光標記被完全去除，而另一個表面的部分標記被去除。雖然在臨床實踐中沒有進行這種清潔評估，但它表明，從原則上講，Rediroom并不構(gòu)成清潔的障礙。

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.

在交叉干預研究中錄像、訪談和客觀的溫度和濕度測量，得出結(jié)論:在開放的平面區(qū)域中，Rediroom具有類似的病人護理功能。在本研究中，我們在一個模擬的臨床病房環(huán)境中評估了Rediroom。參與者在Rediroom或?qū)φ諈^(qū)域進行了一系列的臨床護理活動，包括轉(zhuǎn)送病人、給藥、測量觀察結(jié)果、執(zhí)行無菌操作、對病人進行床上沐浴和心肺復蘇。本研究以員工在室內(nèi)活動的網(wǎng)絡分析，以及員工通過訪談和問卷的反饋來評估Rediroom與對照區(qū)域的功能。測量Rediroom和對照區(qū)域的溫度和濕度。在Rediroom和對照區(qū)域，完成臨床護理活動所需的時間和活動次數(shù)大致相同。對涉及個體運動最多的兩種活動的網(wǎng)絡分析表明，在Rediroom和對照區(qū)域的運動模式非常相似。與工作人員的訪談中反復出現(xiàn)的關(guān)注的問題是空間舒適感、溫度和危重病人的管理。但是，重要的是要注意，Rediroom不是與其他單間進行比較，而是與一個開放的平面區(qū)域進行比較。如果將Rediroom與隔離單間相比，空間舒適感和溫度這兩方面的差異可能會不那么突出。

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.

英國衛(wèi)生部發(fā)起的一項倡議引發(fā)了臨時病房的發(fā)展，并在臨床環(huán)境中對臨時病房進行了評估。臨時病房是半永久性的裝置，可擴展的墻壁設計適合大多數(shù)病房空間。調(diào)查問卷發(fā)放給工作人員、病人和訪客;收集環(huán)境采樣樣本以及手部衛(wèi)生審計。53例患者被隔離，結(jié)果發(fā)現(xiàn)，與沒有安裝臨時病房相比，安裝了臨時病房造成了較少的床阻塞。病人和工作人員都擔心空間不夠大和影響交流。在臨時病房里，手部衛(wèi)生依從性有明顯改善。雖然環(huán)境表面污染程度很低，但沒有證據(jù)表明環(huán)境污染減少了。

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.

在兒科重癥病房使用半永久性隔離艙，減少隔離天數(shù)。

在一個兒科ICU中使用三個半永久性隔離艙，以提高單人病房隔離的可用性。這個措施將錯誤的隔離天數(shù)從58%減少到14%，從而降低了傳播風險。這些臨時隔離室由一家公司安裝，并且是“半永久性”的，因此在病人住宿方面提供了一些靈活性。

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