Environmental interventions to control nosocomial infections.
Environmental interventions to control nosocomial infections.
复制标题
控制医院感染的环境干预措施。
DOI：
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发表时间：
1995
影响因子：
4.5
通讯作者：
D. Weber
中科院分区：
文献类型：
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作者：
W. Rutala;D. Weber
许多医院感染的流行病源于无生命的医院环境中的病原体储存库。1然而，环境对地方性医院感染的获得和传播的贡献被认为是微不足道的。Cooney提供了关于铜基涂料减少表面污染的功效的实验数据。4重金属作为杀微生物剂用于临床医学已有100多年的历史。含重金属化合物的使用包括局部用硝酸银预防结膜炎，局部用磺胺嘧啶银治疗烧伤，以及用8-羟基喹啉铜减少假天花板上方的真菌生长。最近，重金属如银被结合到Foley和静脉内导管上，试图降低尿路感染或血管内管路相关菌血症的发生率。可能限制重金属使用增加的因素包括对毒性和微生物对重金属产生抗性的能力的担忧;这种抗性可能转移到质粒上。5在采取干预措施控制油漆表面（如墙壁）的环境污染之前，应满足几项标准。首先，环境表面是否已被证明是医院病原体的储存库？第二，这个水库是否与地方性或流行性医院感染有关？第三，环境操作是否能减少或消除该水库上的医院病原体？第四，消库能否科学显示，减少地方性或流行性感染？最后，假设以上所有都已得到证实，消除环境源或库的最有效方法是什么？对军团菌和曲霉菌的科学研究已经满足了上述证明环境储库的标准，并制定了控制环境源的指南。6关于维护医院通风系统和遏制与医院装修相关的灰尘的指南已成功预防免疫功能低下患者的曲霉菌感染。同样，对军团菌蓄水池的阐明导致了在流行病学上与医院获得性感染有关时消除军团菌蓄水池的方法指南。本研究在实验室环境中比较了几种铜和非铜涂料的杀菌活性。当将铜涂料应用于盖玻片时，似乎能够在24小时内实现测试生物体的5-log至7-log减少。数据还表明，具有杀微生物添加剂的标准乳胶内墙涂料在24小时内实现了5个对数的测试生物的平均减少，并且在48小时内实现了大于6个对数的测试生物的平均减少。如何评估和应用库尼提供的数据？几个科学问题关系到是否应该将铜基涂料纳入常规感染控制实践。首先，对文献的回顾未能证明墙
Many epidemics of nosocomial infections have stemmed from reservoirs of pathogens in the inanimate hospital environment.1 However, the contribution of the environment to the acquisition and spread of endemic nosocomial infections has been thought to be insignificant.2,3 In this issue, Timothy E. Cooney provides experimental data on the efficacy of copper-based paints to reduce surface contamination.4 Heavy metals have been used in clinical medicine for more than 100 years as microbicides. The use of heavy-metal-containing compounds has included topical silver nitrate to prevent ophthalmia neonatorum, topical silver sulfadiazine to treat burn wounds, and copper-8-quinolinolate to reduce fungal growth above false ceilings. More recently, heavy metals such as silver have been bonded to Foley and intravenous catheters in an attempt to reduce the incidence of urinary tract infections or intravascular line-associated bacteremia. Factors that may limit increasing use of heavy metals include concerns about toxicity and the ability of microorganisms to develop resistance to heavy metals; such resistance may be transferred on plasmids.5 Several criteria should be met prior to instituting an intervention to control environmental contamination of painted surfaces such as walls. First, has the environmental surface been shown to be a reservoir of nosocomial pathogens? Second, has this reservoir been linked to endemic or epidemic nosocomial infections? Third, can environmental manipulation reduce or eliminate nosocomial pathogens on this reservoir? Fourth, can the elimination of the reservoir be shown scientifically to reduce endemic or epidemic infections? Finally, assuming all of the above have been demonstrated, what is the most efficient method of eliminating the environmental source or reservoir? Scientific studies of Legionella and Aspergillus have fulfilled the above criteria for demonstrating an environmental reservoir and have led to guidelines for control of the environmental source.6 Guidelines regarding the maintenance of the hospital ventilation system and containment of dust associated with hospital renovations have been successful in preventing Aspergillus infections in immunocompromised patients. Similarly, the elucidation of the water reservoirs of Legionella has led to guidelines on methods to eliminate Legionella reservoirs when epidemiologically linked to hospital-acquired infections. The present study compares the bactericidal activity of several copper and noncopper paints in a laboratory setting. It appears that copper paints, when applied to glass coverslips, were able to achieve a 5-log to 7-log reduction of test organisms within 24 hours. The data also demonstrated that a standard latex interior paint with a microbicidal additive achieved mean reductions in test organisms of 5 logs in 24 hours and greater than 6 logs in 48 hours. How should the data provided by Cooney be evaluated and applied? Several scientific issues bear on whether copper-based paints should be incorporated into routine infection control practices. First, a review of the literature fails to demonstrate that walls