呼吸道传染病的感染管制卫福部疾病管制署中区传染病防治-tmatw.PPT

基本防護觀念在平時就應該落實 微生物千變萬化，但是傳播方式卻只有寥寥幾種，日常之醫療行為若能稍加改變就可免去一場災難 處理每個病人都應遵守標準防護措施 處理呼吸道症狀的病人要外加呼吸道防護 處理不明皮疹的病人要外加接觸防護 處理皮膚膿瘍的病人要外加接觸防護 個人防護 個人防護的使用原則 任務導向，MOPP (mission oriented personal protection)，而非職務導向 症候群導向，而非診斷導向 醫院有責任訂定任務導向及症候群導向之個人防護使用原則之明文規定，並有強制落實之機制存在 醫院防疫物資之存量必須視可能疫情的持續時間、國內物資之供給性、及國內運輸狀況而定 A key controversy regarding H1N1 prevention Surgical mask or N95 ? SHEA recommendations “At the start of the 2009 outbreak, there was uncertainty regarding the transmission dynamics of the novel H1N1 virus. While seasonal influenza is spread by large respiratory droplets, a concern at the onset of any potential influenza pandemic is whether the pathogen will have a different dynamics or methods of spread.” 13th May – CDC recommends N95 to be used in all situations SHEA: Society of Healthcare Epidemiology of America “available data and clinical experiences suggest that H1N1 transmission occurs like seasonal influenza via droplets spread”. “SHEA endorses implementing the same practices recommended to prevent the transmission of seasonal influenza for the novel H1N1”. SHEA recommendations (10th June 2009) Mode of transmission “Negative pressure rooms are not needed for the routine care of such patients.” “The N95 is not recommended as part of standard precautions”. This applies even for “preventing seasonal influenza transmission.” Isolation Measures: Enhance respiratory protection including the N95 is recommended for such procedures. The procedures should include “open suctioning of airway secretions, resuscitation involving emergency incubation or cardiac pulmonary resuscitation and endotracheal intubation”. However the following should not be included: “collection of nasopharyngeal specimens, close suctioning of airway secretions and administration of nebulized medications”. High risk aerosol-generating procedures HICPIC advisory committee 23rd July to vote on the latest recommendation “endorse the use of surgical masks for