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color=SeaGreen]这两天做了一些小工作，希望对大家的工作有帮助，也算是我对咱们论坛的小小贡献，希望以后多交流
GUIDELINES FOR PREVENTING HEALTH-CARE-ASSOCIATED PNEUMONIA, 2003 （预防医疗机构相关肺炎感染指南）
III. Prevention of Transmission of Microorganisms 阻止微生物组织的传播
A.Sterilization or Disinfection and Maintenance of Equipment and Devices 器材、设备的维护、消毒和灭菌
1.General measures 一般测定
a. Thoroughly clean all equipment and devices to be sterilized or
disinfected 彻底清洁所有器械、设备使之达到消毒或灭菌水平。
b. Whenever possible, use steam sterilization (by autoclaving) or high- level disinfection by wet heat pasteurization at >158oF (>70oC) for 30 minutes for reprocessing semicritical equipment or devices (i.e., items that come into direct or indirect contact with mucous membranes of the lower respiratory tract) that are not sensitive to heat and moisture (see examples in Appendix). 在任何可能的条件下，用蒸汽灭菌或高水平灭菌通过湿热巴氏消毒法(>70oC),30分钟，处理重复使用的器械（比如直接或间接接触下呼吸道黏膜的物品），湿热条件不会损坏这些器械。
Use low-temperature sterilization methods (as approved by the Office of Device Evaluation, Center for Devices and Radiologic Health, FDA) for equipment or devices that 57are heat- or moisture-sensitive. 一些易损坏的器械用低温消毒灭菌技术消毒灭菌。
After disinfection, proceed with appropriate rinsing, drying, and packaging, taking care not to contaminate the disinfected items in the process .器械消毒以后还要经过清洗、干燥、打包的过程，在此过程中不要污染这些器械。
c. Preferentially use sterile water for rinsing reusable semi-critical respiratory equipment and devices when rinsing is needed after they have been chemically disinfected.在用化学试剂消毒以后，应优先使用无菌水给中度危险的呼吸设备冲洗。
If this is not feasible, rinse the device with filtered water (i.e., water that has been through a 0.2: filter) or tap water, and then rinse with isopropyl alcohol and dry with forced air or in a drying cabinet. 如果不行，应该用经过过滤的水进行冲洗或是自来水，然后用异丙醇冲洗，最后要用烘干设备强力干燥。
d. Adhere to provisions in the FDA’s enforcement document for single- use devices that are reprocessed by third parties. CATEGORY IC 一次性设备要按着FDA文件的要求处理。
2. Mechanical ventilators Do not routinely sterilize or disinfect the internal machinery of mechanical ventilators. CATEGORY II
呼吸机的内部管道不能常规消毒、灭菌。
3. Breathing circuits, humidifiers, and HMEs 呼吸回路、湿化设备和湿热交换器
a. Breathing circuits with humidifiers 湿化设备的呼吸回路
(1) Do not change routinely on the basis of duration of use the
breathing circuit (i.e., ventilator tubing and exhalation valve and the attached humidifier) that is in use on an individual patient. Change the circuit when it is visibly soiled or mechanically malfunctioning (327-332). 在使用期间不要常规更换呼吸回路（比如，呼吸机管道系统、呼吸阀和附属的湿化设备）
CATEGORY IA
(2) Breathing-circuit-tubing condensate 呼吸机回路管道冷凝液
(a) Periodically drain and discard any condensate that collects in the tubing of a mechanical ventilator, taking precautions not to allow condensate to drain toward the patient (324). CATEGORY IB 定期排空和丢弃聚集在管道中的冷凝液，防止冷凝液流向患者。
(b) Wear gloves to perform the above procedure or handle the fluid (269;279). CATEGORY IB 戴手套执行以上程序、处理液体。
(c) Decontaminate hands with soap and water (if hands are visibly soiled) or with an alcohol-based hand rub, after performing the procedure or handling the fluid (269;278). CATEGORY IA 如果有明显的污渍操作后要用清水和肥皂洗手，不然用含有酒精的手消液搓手。
(3) No Recommendation can be made for placing a filter or trap
at the distal end of the expiratory-phase tubing of the breathing circuit to collect condensate. 在呼吸回路呼气相末端聚集的冷凝液不推荐放置过滤器或圈套 UNRESOLVED ISSUE未解决的问题
(4) Humidifier fluids 湿化液
(a) Use sterile (not distilled, nonsterile) water to fill bubbling humidifiers (146;291;298;299;324).CATEGORY II 使用无菌水（不是蒸馏水）灌冒泡加湿器。
(b) No recommendation can be made for the preferential use of a closed, continuous-feed humidification system. 优先使用封闭的、持续灌注的、加湿系统不被推荐 UNRESOLVED ISSUE未解决的问题
b. Ventilator breathing circuits with HMEs 有湿热交换器的呼吸机回路
(1) No recommendation can be made for the preferential use of
either HMEs or heated humidifiers to prevent pneumonia in patients receiving mechanically assisted ventilation (341;343- 346;1016). 优先使用有湿热交换器和（或）热加湿器的机械扶助通气仪器不是预防患者发生肺炎的最理想推荐UNRESOLVED ISSUE未解决的问题
(2) Changing HMEs 更换湿热交换器
(a) Change an HME that is in use on a patient when it malfunctions mechanically or becomes visibly soiled. CATEGORY II 有机械故障或明显污渍的时候需要更换患者使用的湿热交换器。
(b) Do not routinely change more frequently than every 48 hours an HME that is in use on a patient (1017- 1019). CATEGORY II 每48小时不用常规频繁更换湿热交换器。
(3) Do not change routinely (in the absence of gross contamination or malfunction) the breathing circuit attached to an HME while it is in use on a patient (1020). CATEGORY II 当病人正在使用有隶属于呼吸管路的湿热交换器的呼吸机时，不建议常规更换(除非它在总污染或故障的情况下缺乏)
4. Oxygen humidifiers 氧气湿化计
a. Follow manufacturers' instructions for use of oxygen humidifiers (1015;1021-1023).CATEGORIES II and IC 按机械说明书使用
b. Change the humidifier-tubing (including any nasal prongs or mask) that is in use on one patient when it malfunctions or becomes visibly contaminated. CATEGORY II 当湿化管路有故障或变得有明显的污染时要更换（包括任何鼻导管或者面罩）
5. Small-volume medication nebulizers: in-line and hand-held nebulizers 小容量雾化吸入器：管道内的和手持的
a. Between treatments on the same patient: clean, disinfect; rinse with sterile water (if rinsing is needed), and dry small-volume in-line or hand-held medication nebulizers (292;306;1024). (See recommendation III-A-1-c if rinsing with sterile water is not feasible.) CATEGORY IB 当治疗同一个患者的时候用无菌水清洁、消毒、冲洗（如果有必要冲洗）和干燥小容量药用雾化吸入器：管道内的和手持的。
b. Use only sterile fluid for nebulization, and dispense the fluid into the nebulizer aseptically (289;291;298;299;306;316;350). CATEGORY IA 无菌液体做雾化，保持清洁地将液体导入雾化器。
c. Whenever possible, use aerosolized medications in single-dose vials. 在任何可能的时候，单次给药小瓶用于雾化吸入的药物治疗。If multidose medication vials are used, follow manufacturers’ instructions for handling, storing, and dispensing the medications (289;350-354;1025). 如果使用多次给药小瓶，遵照产品说明书使用、储存和分配药物。
CATEGORY IB
6. Mist-tents 雾帐篷（什么东西）
a. Between uses on different patients, replace mist tents and their nebulizers, reservoirs, and tubings with those that have been subjected to sterilization or high-level disinfection (1026). CATEGORY II 多个病人使用时，要严格灭菌、高水平消毒它的雾化器、储水器、和管路
b. No Recommendation can be made about the frequency of routinely changing mist-tent nebulizers, reservoirs, and tubings while in use on one patient. UNRESOLVED ISSUE 当一个患者使用时不建议频繁常规更换它的雾化器、储水器、和管路。
c. Subject mist-tent nebulizers, reservoirs and tubings that are used on the same patient to daily low-level disinfection (e.g., with 2% acetic acid) or pasteurization followed by air-drying (1027). CATEGORY II 隶属于同一病人的雾帐篷的雾化器、储水器、和管路每日要低水平消毒(如用2％的乙酸)或者巴氏消毒风干。
7. Other devices used in association with respiratory therapy 与呼吸治疗相关的其他设备
a. Respirometers and ventilator thermometers. 呼吸器和呼吸机温度计。Between their uses on different patients, sterilize or subject to high- level disinfection portable respirometers, and ventilator thermometers (294;295;305;364;365). CATEGORY IB 不同的病人使用要高水平消毒和灭菌便携式呼吸器和呼吸机温度计。
b. Resuscitation bags 复苏袋
(1) Between their uses on different patients, sterilize or subject to high-level disinfection reusable hand-powered resuscitation bags (359-363). CATEGORY IB 不同病人使用可重复使用的手摇复苏带，要灭菌或高水平消毒。
(2) No Recommendation can be made about the frequency of changing hydrophobic filters placed on the connection port of resuscitation bags. UNRESOLVED ISSUE 不推荐频繁更换链接复苏袋的疏水性过滤器
8. Anesthesia machines and breathing systems or patient circuits 麻醉机和呼吸系统或患者回路
a. Do not routinely sterilize or disinfect the internal machinery of anesthesia equipment (368). CATEGORY IB 不要常规消毒、灭菌麻醉仪器内部。
b. Between uses on different patients, clean reusable components of the breathing system or patient circuit (e.g., tracheal tube or face mask; inspiratory and expiratory breathing tubing; y-piece; reservoir bag; humidifier; and tubing) and then sterilize or subject them to high-level liquid chemical disinfection or pasteurization in accordance with the device manufacturers' instructions for their reprocessing (310;314). CATEGORY IB 如果不同患者使用，要清洁呼吸系统和病人回路的使用部分，（如气管套管或面罩；呼吸管路的吸气和吐气部分；Y形件；储存袋；湿化器和管路）然后杀菌或使用高水平化学液体消毒或按照仪器说明书对他们的在利用进行巴氏消毒。
c. No recommendation can be made about the frequency of routinely cleaning and disinfecting unidirectional valves and carbon dioxide absorber chambers (371). UNRESOLVED ISSUE 不推荐常规清洁和消毒单项阀和二氧化碳吸收器分庭。未解决的问题。
d. Follow published guidelines and manufacturers' instructions about in- use maintenance, cleaning, and disinfection or sterilization of other components or attachments of the breathing system or patient circuit of anesthesia equipment (369;370).
CATEGORY IB 按照以出的指南和生产说明书对其他组成部分或麻醉设备的呼吸系统的附件进行使用中维护、清洁、消毒和灭菌。
e. No recommendation can be made for placing a bacterial filter in the breathing system or patient circuit of anesthesia equipment (3;372- 378). UNRESOLVED ISSUE 不推荐在呼吸系统和病人的麻醉设备里放置细菌过滤器。未解决的问题。
9. Pulmonary-function testing equipment 肺功能测试仪器
a. Do not routinely sterilize or disinfect the internal machinery of pulmonary-function testing machines between uses on different patients (379;380). CATEGORY II 当给不同病人使用肺功能测试仪器时不要常规消毒、灭菌。
b. Change the mouthpiece of a peak flow meter or the mouthpiece and filter of a spirometer between uses on different patients (379;384). CATEGORY II
10. Room-air “humidifiers” and faucet aerators 室内空气加湿器和水龙头曝气设备
a. Do not use large-volume room-air humidifiers that create aerosols (e.g., by venturi principle, ultrasound, or spinning disk, and thus actually are nebulizers) unless they can be sterilized or subjected to high-level disinfection at least daily and filled only with sterile water (145;288;291).CATEGORY II 不要用大容量的产生气溶胶的室内空气加湿器，除非能每天杀菌或高水平消毒并灌注无菌水。
b. Faucet aerators 水龙头曝气设备
(1) No recommendation can be made about the removal of faucet aerators from areas for immunocompetent patients (see also section on Legionnaires Disease, Part II, Section I-C-1-d). UNRESOLVED ISSUE 对于有免疫系统疾病的患者，不建议移除水龙头曝气设备。未解决的问题。
(2) If Legionella spp. are detected in the water of a transplant unit and until Legionella spp. are no longer detected by culture, remove faucet aerators in the unit (see also section on Legionnaires Disease, Part II, Section I-C-1-d) (506). CATEGORY II 如果在移植病房的水中检测到军团菌，要在不能被检测以后在移除此设备。
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发表于 2012-6-8 08:59:00
