函数符号S1infection control and hospital epidemiology october 2008,vol.29,supplement 1手拉手地球村歌曲
s u p p l e m e n t a r t i c l e :e d i t o r i a l
Primum Non Nocere
Nalini Singh,MD,MPH;Patrick J.Brennan,MD;Michael Bell,MD
“First,do no harm.”The edict reminds physicians that they must consider the possible harm that might be caud by any intervention.Since as early as 1860,this phra among phy-sicians has been an expression of hope,intention,humility,and recognition that acts with good intentions may have un-wanted conquences.The vast majority of patients who have access to medical rvices today are healed.There are some,however,who suffer unintended conquences of care,such as healthcare-associated infections (HAIs).Since the 1860s,when Joph Lister,a pioneer of infection control,developed antipsis to prevent wound infections,health care has be-come increasingly complex and sophisticated,prenting op-portunities to save the lives of patients who would not have survived 3decades ago—for example,very-low-birth-weight infants and critically ill adults in highly specialized intensive care units.To ensure that such life-saving care does not result in HAI,modern health care has developed an extensive system for infection prevention.Indeed,as we rely increasingly
车定位怎么定位on cost-efficient ambulatory delivery of surgical procedures,en-doscopy,infusion care,and other invasive procedures,we must now address the need for appropriate oversight and maintenance of infection prevention practices in the new ttings,as well.Likewi,attention to infection prevention for populations that have not been the focus of traditional infection control rearch—for example,pediatric and be-havioral medicine patients—is increasingly needed.
Prevention of HAI is at the heart of patient safety.This issue is receiving welcome attention at regional and national levels and from consumers,payers,legislators,and the media,in addition to experts in the field.The Society for Healthcare Epidemiology of America/Infectious Dias Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals,”published in this supplement to Infection Control and Hospital Epidemi-ology,is a means of giving healthcare professionals access to prevention recommendations in a succinct format,promoting the application of current recommendations to clinical practice.
Success stories,including the prevention of central line–associated bloodstream infections and the u of antimicro-bial prophylaxis to prevent lected surgical site infections,have demonstrated that prevention of HAI is possible and can be sustained by u of “best practices”and bundled ap-proaches to intervention,which are quality improvement ef-forts that benefit from the inclusion of both
outcome mea-sures,such as rates of bloodstream infection or surgical site infection,and process measures,such as rates of adherence to recommended practices.Some facilities have implemented a top-down strategy that assigns accountability for imple-mentation to the facilities’chief executives and nior man-agers.Others have applied “positive deviance”programs in a bottom-up approach that engages frontline staff,including environmental rvices and transport personnel,in addition to clinical staff,to shift cultural norms.Regardless of the approaches taken,healthcare facilities must strive for 100%adherence to recommended infection control practices.Challenges to prevention include measurement of out-comes that may be complicated by diagnostic limitations—for example,diagnosis of ventilator-associated pneumonia.In contrast to the diagnosis of central line–associated blood-stream infection,diagnosis of ventilator-associated pneu-monia is less objective and frequently relies on clinical judg-ment.In addition to the complexity of combining clinical criteria,laboratory evidence,and radiographic evidence,un-derlying lung and cardiac dia in premature infants and in adults receiving intensive care further complicates the di-agnosis of ventilator-associated pneumonia.Nevertheless,process are implemented to reduce the incidence of ven-tilator-associated pneumonia in critical care ttings,and ad-herence to tho process can and should be measured,de-spite the diagnostic challenges.The microbial ecology of colonization might not be entirely within our control;how-ever,interventions for the prevention of transmission can
be implemented.Administrative strategies,such as standing or-ders or nur-driven protocols for patient testing,admittance-bad alert systems to notify infection control and clinical personnel about readmitted or transferred patients with a history of infection or colonization,and routine asssment of education and training among healthcare personnel,can improve infection prevention at the facility level.New chal-踩刹车要踩离合吗
S2infection control and hospital epidemiology october2008,vol.29,supplement1
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波兰人英语>粟裕之子lenges,such as community-associated methicillin-resistant Staphylococcus aureus soft tissue infections among adults and late-ont dia in neonates,continue to test the boundaries of infection prevention and healthcare epidemiology and will drive the need for ongoing tailoring of prevention recom-mendations to protect new locations and populations.Since the early1990s,infection prevention guidelines have been prepared by the Centers for Dia Control and Prevention and the Healthcare Infection Control Practices Advisory Committee.The main challenge to prevention has been not a lack of guidelines but,rather,a dearth of methods for ef-ficient and consistent implementation of recommended practices.
Guidelines are produced to guide practices;however, guidelines also drive policies and mandates.It is,therefore, esntial that the guideline development process be rigorous and transparent.Infection prevention recommendations are generally supported by high-quality evidence;however,some may rely on indirect evidence.The latter is particularly true for recommendations related to implementation strategies, which,nevertheless,are esntial components of infection prevention.In either ca,there must be careful evaluation of the relevance and quality of supporting evidence.There-fore,to ensure that recommendations are evaluated as con-sistently as possible,Centers for Dia Control and Pre-vention guidelines are produced by means of extensive systematic asssment of the quality and weight of evidence to support each recommendation while also allowing public scrutiny and comment.The Society for Healthcare Epide-miology of America/Infectious Dias Society of America compendium has the advantage of being bad on a more nimble approach that relies on the judgment of individual reviewers,which allows rapid production and efficient con-nsus.Although there is potential for variability among re-viewers in their asssment of recommendation strength or evidence quality,this compendium reprents an important tool that facilitates implementation of practices and proce-dures to prevent HAI,complementing official Centers for Dia Control and Prevention guidelines.The Society for Healthcare Epidemiology of America/Infectious Dias So-ciety of America compendium includes
metrics and indicators of success that can be applied to implementation and also includes assignment of accountability for facilities to ensure that implementation occurs.In addition,the compendium delivers updated guidance in areas where official guidelines have revisions ,surgical site infection prevention and urinary tract infection prevention guidelines currently in preparation).The compendium published here is a conci, easily applied distillation of current guidelines for the pre-vention of HAI that brings together recommendations from respected sources in a format suited to implementation in the clinical tting.As the Centers for Dia Control and Prevention continues to produce official guidelines in col-laboration with professional societies and academic partners, implementation tools such as this compendium will rve as a means to ensure that the best practices for infection pre-vention are successfully brought to the bedside.Its publica-tion could not be better timed to make the most of current heightened interest in safe health care.
Address reprint requests to the Reprints Coordinator,University of Chi-cago Press,1427E.60th St.,Chicago,IL60637(***********************.edu) or contact the journal office(*******************.edu).
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