手衛(wèi)生與職業(yè)安全GXD(NXPowerLite)

1、手衛(wèi)生與職業(yè)安全手衛(wèi)生與職業(yè)安全復(fù)旦大學(xué)中山醫(yī)院復(fù)旦大學(xué)中山醫(yī)院上海市院內(nèi)感染質(zhì)控中心上海市院內(nèi)感染質(zhì)控中心高曉東高曉東日本發(fā)生歷史最大的一次瘟疫日本發(fā)生歷史最大的一次瘟疫- -諾瓦克諾瓦克(norovirus)(norovirus)病毒病毒v 秋田市政府職員食用了一飯館在秋田市政府職員食用了一飯館在1111日至日至1313日加工的外賣盒飯后，從日加工的外賣盒飯后，從1212日起陸日起陸續(xù)有續(xù)有5252名職員出現(xiàn)嘔吐和腹瀉的中毒癥狀。在名職員出現(xiàn)嘔吐和腹瀉的中毒癥狀。在1414日夜，當(dāng)?shù)匦l(wèi)生防疫部門檢日夜，當(dāng)?shù)匦l(wèi)生防疫部門檢測出了諾瓦克病毒。測出了諾瓦克病毒。v 大館市日本大館市也傳出了當(dāng)?shù)卮?/p>

2、館市日本大館市也傳出了當(dāng)?shù)? 8所中小學(xué)校內(nèi)發(fā)生了集體食物中毒事件，共所中小學(xué)校內(nèi)發(fā)生了集體食物中毒事件，共有有340340多名師生出現(xiàn)了中毒癥狀。大館市衛(wèi)生防疫部門也在多名師生出現(xiàn)了中毒癥狀。大館市衛(wèi)生防疫部門也在1616日從日從1414名中毒人名中毒人員的排瀉物中檢測出了諾瓦克病毒。員的排瀉物中檢測出了諾瓦克病毒。v 北海道上川町也發(fā)生了北海道上川町也發(fā)生了167167名住宿在層云峽觀光旅館的觀光客集體食物中毒的名住宿在層云峽觀光旅館的觀光客集體食物中毒的情況情況 。v 日本國立傳染病研究所表示，根據(jù)全國約日本國立傳染病研究所表示，根據(jù)全國約30003000個醫(yī)療機(jī)構(gòu)上報的數(shù)據(jù)統(tǒng)計(jì)，個醫(yī)療

3、機(jī)構(gòu)上報的數(shù)據(jù)統(tǒng)計(jì)，截止到截止到1212月月3 3日，全國共有日，全國共有6563865638人感染疫情，平均每個醫(yī)療機(jī)構(gòu)收治人感染疫情，平均每個醫(yī)療機(jī)構(gòu)收治21.7721.77名名患者。根據(jù)各地的人口和病毒流行情況可推算出，以兒童為主的日本各地的患者。根據(jù)各地的人口和病毒流行情況可推算出，以兒童為主的日本各地的患者至少已經(jīng)達(dá)到患者至少已經(jīng)達(dá)到303303萬萬9 9千人千人 . .流行病學(xué)流行病學(xué)v 1996-20001996-2000年，美國年，美國CDCCDC報告了報告了348348起起集體性諾沃克病毒性胃腸炎暴發(fā)集體性諾沃克病毒性胃腸炎暴發(fā)疫情，其中疫情，其中136136起（起（39%3

4、9%）發(fā)生在飯店，）發(fā)生在飯店，101101起（起（29%29%）發(fā)生在療養(yǎng)院或）發(fā)生在療養(yǎng)院或醫(yī)院，醫(yī)院，4242起（起（12%12%）發(fā)生在學(xué)校和托幼機(jī)構(gòu)，還有）發(fā)生在學(xué)校和托幼機(jī)構(gòu)，還有10%10%發(fā)生在度假場所發(fā)生在度假場所和游船上。和游船上。v 近年來，集體性諾沃克病毒性胃腸炎暴發(fā)疫情在歐洲、亞洲、澳洲等近年來，集體性諾沃克病毒性胃腸炎暴發(fā)疫情在歐洲、亞洲、澳洲等地也頻頻出現(xiàn)。地也頻頻出現(xiàn)。v 20042004年年1111月月-2005-2005年年1 1月，日本報告月，日本報告236236起起集體性感染胃腸炎疫情，發(fā)集體性感染胃腸炎疫情，發(fā)病病78217821人，其中查出感染諾沃克

5、病毒者人，其中查出感染諾沃克病毒者53715371人，死亡人，死亡1212人。人。 對付對付“諾瓦克諾瓦克”的絕招的絕招洗手再洗手洗手再洗手 After petting a dog or catBefore handling or eating foodAfter coughing or sneezingAfter using the bathroom in your homeAfter changing a diaperAfter handling moneyAfter using a public restroomHand Washing HabitsHand Washing Habits

6、How Frequently Do Americans Say They Are Washing Their Hands?How Frequently Do Americans Say They Are Washing Their Hands?Always wash my hands(Usually wash my hands) Total Sample Q: I am going to read you a list of activities and Id like you to tell me how often you make it a practice of washing you

7、r hands. How often do you wash your hands after200542%(16%)200577%(14%)200532%(23%)200583%(10%)200573%(4%)200591%(6%)200521%(18%) In 1846, Ignaz Semmelweis observed that women whose babies were delivered by students and physicians in the First Clinic at the General Hospital of Vienna consistently ha

8、d a higher mortality rate than those whose babies were delivered by midwives in the Second Clinic. Perhaps because of the known deodorizing effect of chlorine compounds, as of May 1847, he insisted that students and physicians clean their hands with a chlorine solution between each patient in the cl

9、inic. The maternal mortality rate in the First Clinic subsequently dropped dramatically and remained low for years. 我院某科室醫(yī)院感染爆發(fā)我院某科室醫(yī)院感染爆發(fā)換能器內(nèi)液體換能器內(nèi)液體醫(yī)院感染中醫(yī)院感染中MRSAMRSA的檢出率的檢出率: 1975 - 1997: 1975 - 1997YearMRSA % 2022-2-813第第3434屆美國醫(yī)院感染年會屆美國醫(yī)院感染年會APICAPIC（2007.6.2528, San Jose2007.6.2528, San Jose）會

10、議主題：會議主題：蓄勢勃發(fā)，革新感染預(yù)防蓄勢勃發(fā)，革新感染預(yù)防Get Plugged In to Innovation in Infection PreventionGet Plugged In to Innovation in Infection Prevention 三種導(dǎo)管相關(guān)感染的預(yù)防三種導(dǎo)管相關(guān)感染的預(yù)防v盡早更換或拔除盡早更換或拔除v做好日常導(dǎo)管護(hù)理工作做好日常導(dǎo)管護(hù)理工作v手部衛(wèi)生手部衛(wèi)生 洗手和無菌隔離技術(shù)洗手和無菌隔離技術(shù)v觸摸、插入、更換或包扎血管內(nèi)導(dǎo)管的前、觸摸、插入、更換或包扎血管內(nèi)導(dǎo)管的前、后，均要洗手（后，均要洗手（IAIA）v插管或更換導(dǎo)管的覆蓋物，均要戴手套插管

11、或更換導(dǎo)管的覆蓋物，均要戴手套（IBIB）v單純更換敷料，不建議使用無菌手套（單純更換敷料，不建議使用無菌手套（IIIIII）Hand Hygiene: Not a New ConceptHand Hygiene: Not a New ConceptSemmelweis Hand Hygiene Intervention Hand antisepsis reduces the frequency of patient infections Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.洗手洗手 控制感染最有效、最方

12、便、最經(jīng)濟(jì)的方法控制感染最有效、最方便、最經(jīng)濟(jì)的方法 但要能夠經(jīng)常和適時的洗手但要能夠經(jīng)常和適時的洗手 什么時間洗手什么時間洗手? ? 直接接觸病人前后；直接接觸病人前后； 摘手套后（戴手套不能代替洗手）；摘手套后（戴手套不能代替洗手）； 不論是否戴手套，進(jìn)行侵襲性操作前；不論是否戴手套，進(jìn)行侵襲性操作前； 接觸體液或排泄物、粘膜、非完整皮膚或傷口敷料后；接觸體液或排泄物、粘膜、非完整皮膚或傷口敷料后； 護(hù)理病人從污染部位移到清潔部位時；護(hù)理病人從污染部位移到清潔部位時； 接觸緊鄰病人的物品后（包括醫(yī)療設(shè)備）；接觸緊鄰病人的物品后（包括醫(yī)療設(shè)備）；In 5 Years, the CDCs Di

13、vision of Healthcare Quality Promotion (DHQP) plans on accomplishing these seven challengesv Reduce catheter-associated adverse events by 50% among patients Reduce catheter-associated adverse events by 50% among patients in healthcare settings in healthcare settings v Reduce targeted surgical advers

14、e events by 50%Reduce targeted surgical adverse events by 50%v Reduce hospitalizations and mortality from respiratory tract Reduce hospitalizations and mortality from respiratory tract infections among long-term care patients by 50%infections among long-term care patients by 50%v Reduce targeted ant

15、imicrobial-resistant bacterial infections by Reduce targeted antimicrobial-resistant bacterial infections by 50% by:50% by: preventing infections preventing infections diagnosing and treating infections appropriately diagnosing and treating infections appropriately optimizing antimicrobial use, and

16、optimizing antimicrobial use, and preventing transmission in healthcare settings preventing transmission in healthcare settingsv Eliminate laboratory errors leading to adverse patient outcomesEliminate laboratory errors leading to adverse patient outcomesv Eliminate occupational needlestick injuries

17、 among healthcare Eliminate occupational needlestick injuries among healthcare personnelpersonnelv Achieve 100% adherence to ACIP (Advisory Committee on Achieve 100% adherence to ACIP (Advisory Committee on Immunization Practices) guidelines for immunization of Immunization Practices) guidelines for

18、 immunization of healthcare personnelhealthcare personnelSimple measures save livesThe focus is on preventing infectionassociated with health /patientsafety/events Hand HygieneHand HygieneClean Hands are Safer HandsGuidelines on Hand Hygiene in Health CareWHO GUIDELINES ON HAND HYGIEN

19、E IN HEALTH CARE(ADVANCED DRAFT): A SUMMARYObjective of the Guidelines:To provide health-care workers, administrators and health authorities with: a thorough review of hand hygiene in-depth information to help them overcome obstacles to improvementWHOWHO關(guān)于手衛(wèi)生（洗手或手消毒）的六關(guān)于手衛(wèi)生（洗手或手消毒）的六個指征包括：個指征包括：1 1、

20、接觸病人前后、接觸病人前后2 2、摘除手套后、摘除手套后3 3、進(jìn)行侵入性操作前、進(jìn)行侵入性操作前4 4、接觸病人體液、排泄物、粘膜、破損的皮、接觸病人體液、排泄物、粘膜、破損的皮膚或者傷口敷料后膚或者傷口敷料后5 5、從病人臟的身體部位到干凈的身體部位、從病人臟的身體部位到干凈的身體部位6 6、直接接觸接近病人的無生物物體（包括醫(yī)、直接接觸接近病人的無生物物體（包括醫(yī)療器械）后療器械）后Contamination of Contamination of Hands and EnvironmentHands and EnvironmentFirst cleaning, then disinfe

21、ction (if appropriate) 控制醫(yī)院感染控制醫(yī)院感染最簡單最簡單, , 最有效最有效, , 最方便最方便, , 最經(jīng)濟(jì)方法最經(jīng)濟(jì)方法 第一步第一步掌心相對，手指并攏相互摩擦掌心相對，手指并攏相互摩擦 第二步第二步手心對手背沿指縫相互搓擦手心對手背沿指縫相互搓擦 第三步第三步掌心相對，雙手交叉沿指縫相互摩擦掌心相對，雙手交叉沿指縫相互摩擦 第四步第四步雙手指交鎖，指背在對側(cè)掌心雙手指交鎖，指背在對側(cè)掌心第五步第五步一手握另一手大拇指旋轉(zhuǎn)搓擦，一手握另一手大拇指旋轉(zhuǎn)搓擦，交換進(jìn)行交換進(jìn)行 第六步第六步 指尖在對側(cè)掌心前后擦洗指尖在對側(cè)掌心前后擦洗洗手步驟Hand Hygiene

22、Technique酒精9 9方面方面1616項(xiàng)項(xiàng)v醫(yī)院感染管理委員會會議制度醫(yī)院感染管理委員會會議制度v醫(yī)院感染管理專職人員配備醫(yī)院感染管理專職人員配備v醫(yī)院感染及防控知識培訓(xùn)醫(yī)院感染及防控知識培訓(xùn)v醫(yī)院感染和病原菌監(jiān)測醫(yī)院感染和病原菌監(jiān)測v抗生素應(yīng)用管理抗生素應(yīng)用管理v醫(yī)院感染監(jiān)測管理和數(shù)據(jù)反饋醫(yī)院感染監(jiān)測管理和數(shù)據(jù)反饋v病區(qū)洗手設(shè)備病區(qū)洗手設(shè)備v消毒監(jiān)測（紫外線燈管強(qiáng)度和消毒劑濃度）消毒監(jiān)測（紫外線燈管強(qiáng)度和消毒劑濃度）v醫(yī)院感染知識的考核醫(yī)院感染知識的考核醫(yī)院感染管理規(guī)范醫(yī)院感染管理規(guī)范實(shí)施情況督查實(shí)施情況督查6363所受檢醫(yī)院肥皂污染情況所受檢醫(yī)院肥皂污染情況污染程度污染程度細(xì)菌數(shù)細(xì)菌

23、數(shù)/ /克肥皂克肥皂醫(yī)院數(shù)醫(yī)院數(shù)構(gòu)成比構(gòu)成比極嚴(yán)重極嚴(yán)重100100萬萬343454.054.0嚴(yán)重嚴(yán)重11-10011-100萬萬9 914.314.3中度中度1.11.11010萬萬4 46.36.3輕微輕微 1 1萬萬161625.425.4合計(jì)合計(jì)6363100.0100.0改善醫(yī)務(wù)人員手衛(wèi)生設(shè)施，提高依從性改善醫(yī)務(wù)人員手衛(wèi)生設(shè)施，提高依從性v20062006年：年：幾乎所有醫(yī)院取消了手動式水龍頭開關(guān)、固幾乎所有醫(yī)院取消了手動式水龍頭開關(guān)、固體肥皂，但體肥皂，但I(xiàn)CUICU床旁、治療車、抽血處等重要部門雖然床旁、治療車、抽血處等重要部門雖然大多配置了快速手消毒劑，但存在產(chǎn)品過期或均未開

24、大多配置了快速手消毒劑，但存在產(chǎn)品過期或均未開封等問題。僅封等問題。僅4 4所醫(yī)院所醫(yī)院所有醫(yī)院均能提供全院及具體科所有醫(yī)院均能提供全院及具體科室室20062006年全年的洗手液和快速手消毒液的用量。年全年的洗手液和快速手消毒液的用量。v20072007年：年：仍有仍有8 8所所醫(yī)院存在手動水龍頭，醫(yī)院存在手動水龍頭，3 3所所醫(yī)院未完醫(yī)院未完全取消固體肥皂，近半數(shù)醫(yī)院手衛(wèi)生依從性存在問題。全取消固體肥皂，近半數(shù)醫(yī)院手衛(wèi)生依從性存在問題。Alcohol-Based Hand Rub Consumption and Incidence Rates of Alcohol-Based Hand Ru

25、b Consumption and Incidence Rates of Nosocomial Infection in Intensive Care Units (ICU) in Lyon Nosocomial Infection in Intensive Care Units (ICU) in Lyon (France), 20012005 (France), 20012005 Treny-Juhen1. Treny-Juhen1. Lyon, FranceLyon, France6th Int. Conf. of the Hospital Infection Society, 1518

26、October 2006,Amsterdam, The Netherlands部長令：部長令：醫(yī)院感染管理辦法醫(yī)院感染管理辦法v配套的技術(shù)性規(guī)范文件配套的技術(shù)性規(guī)范文件內(nèi)窺鏡消毒技術(shù)規(guī)范內(nèi)窺鏡消毒技術(shù)規(guī)范口腔科器械消毒技術(shù)規(guī)范口腔科器械消毒技術(shù)規(guī)范醫(yī)療廢物處置醫(yī)療廢物處置抗菌藥物臨床應(yīng)用指導(dǎo)原則抗菌藥物臨床應(yīng)用指導(dǎo)原則醫(yī)療機(jī)構(gòu)手衛(wèi)生指南醫(yī)療機(jī)構(gòu)手衛(wèi)生指南醫(yī)院感染監(jiān)測指南醫(yī)院感染監(jiān)測指南醫(yī)療機(jī)構(gòu)空氣消毒凈化技術(shù)指南醫(yī)療機(jī)構(gòu)空氣消毒凈化技術(shù)指南醫(yī)療機(jī)構(gòu)隔離技術(shù)指南醫(yī)療機(jī)構(gòu)隔離技術(shù)指南 2006年手衛(wèi)生依從性差的原因手衛(wèi)生依從性差的原因v Physician status (rather than

27、a nurse)Physician status (rather than a nurse)v Nursing assistant status (rather than a nurse)Nursing assistant status (rather than a nurse)v Male sexMale sexv Working in an intensive-care unitWorking in an intensive-care unitv Working during the week (versus the weekendWorking during the week (vers

28、us the weekend) )v Wearing gowns/glovesWearing gowns/glovesv Automated sinkAutomated sinkv Activities with high risk of cross-transmissionActivities with high risk of cross-transmissionv High number of opportunities for hand hygiene High number of opportunities for hand hygiene per hour of patient c

29、areper hour of patient care自述手衛(wèi)生依從性差的原因自述手衛(wèi)生依從性差的原因v Handwashing agents cause irritation and dryness Handwashing agents cause irritation and drynessv Sinks are inconveniently located/shortage of sinks Sinks are inconveniently located/shortage of sinksv Lack of soap and paper towels Lack of soap and

30、paper towelsv Often too busy/insufficient time Often too busy/insufficient timev Understaffing/overcrowding Understaffing/overcrowdingv Patient needs take priority Patient needs take priorityv Hand hygiene interferes with health-care worker relationships Hand hygiene interferes with health-care work

31、er relationships with patientswith patientsv Low risk of acquiring infection from patients Low risk of acquiring infection from patientsv Wearing of gloves/beliefs that glove use obviates the need for Wearing of gloves/beliefs that glove use obviates the need for hand hygienehand hygienev Lack of kn

32、owledge of guidelines/protocols Lack of knowledge of guidelines/protocolsv Not thinking about it/forgetfulness Not thinking about it/forgetfulnessv No role model from colleagues or superiors No role model from colleagues or superiorsv Skepticism regarding the value of hand hygiene Skepticism regardi

33、ng the value of hand hygienev Disagreement with the recommendations Disagreement with the recommendationsv Lack of scientific information of definitive impact of Lack of scientific information of definitive impact of improved hand hygiene on health-careassociated infection improved hand hygiene on h

34、ealth-careassociated infection ratesrates. . . . v 乳膠乳膠, , 腈類腈類 & & 乙烯類等材料乙烯類等材料v 手套不能重復(fù)使用手套不能重復(fù)使用, ,更換要及時更換要及時. . 如果手套的防如果手套的防護(hù)效果沒有改變可以消毒后重復(fù)使用護(hù)效果沒有改變可以消毒后重復(fù)使用v 需要有一定彈性，必須蓋住袖口需要有一定彈性，必須蓋住袖口v 不要在公共場所戴手套不要在公共場所戴手套v 摘除手套后必須要洗手摘除手套后必須要洗手v 手套不能代替洗手手套不能代替洗手Stategies for successful promotion of han

35、d hygiene in hospitalsv EducationEducationv Routine observation and feedbackRoutine observation and feedbackv Engineering controlEngineering controlv Make hand hygiene possible, easy, and convenientMake hand hygiene possible, easy, and convenientv Make alcohol-based hand rub availableMake alcohol-ba

36、sed hand rub availablev (at least in high-demand situations)(at least in high-demand situations)v Patient educationPatient educationv Reminders in the workplaceReminders in the workplacev Administrative sanction/rewardingAdministrative sanction/rewardingv Change in hand-hygiene agentChange in hand-h

37、ygiene agentv Promote/facilitate skin care for health-careworkers Promote/facilitate skin care for health-careworkers handshandsv Obtain active participation at individual and Obtain active participation at individual and institutional levelinstitutional levelv Improve institutional safety climateIm

38、prove institutional safety climatev Enhance individual and institutitional self-efficacyEnhance individual and institutitional self-efficacyv Avoid overcrowding, understaffing, and excessive Avoid overcrowding, understaffing, and excessive workloadworkloadv Combine several of above strategiesCombine

39、 several of above strategies醫(yī)務(wù)人員職業(yè)危害風(fēng)險因素醫(yī)務(wù)人員職業(yè)危害風(fēng)險因素銳銳 器器 損損 傷傷刺刺傷傷相相關(guān)關(guān)因因素素n刺傷深度刺傷深度 深度刺傷引起感染深度刺傷引起感染 幾率大于淺度刺傷幾率大于淺度刺傷n不同器械和被污染液體的量不同器械和被污染液體的量 中空針頭沾染的血量大引中空針頭沾染的血量大引 起感染幾率大于縫針和刀起感染幾率大于縫針和刀n接觸路徑接觸路徑 針刺感染大于粘膜接觸針刺感染大于粘膜接觸n時間長短時間長短 被與病人剛接觸后的銳器刺被與病人剛接觸后的銳器刺 傷引起的感染幾率大于放置傷引起的感染幾率大于放置 數(shù)小時后銳器數(shù)小時后銳器v健康狀態(tài)健康狀態(tài)

40、 醫(yī)務(wù)人員健康狀態(tài)決定醫(yī)務(wù)人員健康狀態(tài)決定 接觸后造成感染的幾率接觸后造成感染的幾率v接觸的頻率接觸的頻率 接觸頻率高的人感染幾率大接觸頻率高的人感染幾率大v安全措施安全措施 采用安全措施和正確方式采用安全措施和正確方式v自我保護(hù)自我保護(hù) 接觸感染后的快速自我保護(hù)接觸感染后的快速自我保護(hù)措施實(shí)施措施實(shí)施醫(yī)醫(yī)務(wù)務(wù)人人員員相相關(guān)關(guān)因因素素Sharps Injuries among Massachusetts Hospital Sharps Injuries among Massachusetts Hospital Workers, 2002-2004 Workers, 2002-2004 top

41、4 occupationstop 4 occupations# of injuries醫(yī)療技術(shù)操作銳器傷構(gòu)成醫(yī)療技術(shù)操作銳器傷構(gòu)成將輸液導(dǎo)管與無將輸液導(dǎo)管與無針系統(tǒng)連接針系統(tǒng)連接醫(yī)務(wù)人員避免意外事故方法醫(yī)務(wù)人員避免意外事故方法整個過程中應(yīng)從容不迫整個過程中應(yīng)從容不迫使用真空采血系統(tǒng)使用真空采血系統(tǒng)如患者抵抗或慌如患者抵抗或慌張，可尋求幫助張，可尋求幫助洗手、帶手套洗手、帶手套在手術(shù)室中，使用消毒盤在手術(shù)室中，使用消毒盤傳遞器械傳遞器械 - - 不要直接傳遞不要直接傳遞禁止將針頭放置在禁止將針頭放置在床邊、小車頂部床邊、小車頂部醫(yī)務(wù)人員避免意外事故方法醫(yī)務(wù)人員避免意外事故方法使用后，應(yīng)立即丟使用

42、后，應(yīng)立即丟入尖銳物收集箱入尖銳物收集箱應(yīng)用重新蓋帽裝置應(yīng)用重新蓋帽裝置尖銳物收集箱尖銳物收集箱應(yīng)放在使用處應(yīng)放在使用處禁止雙手重新蓋帽禁止雙手重新蓋帽禁止用手移禁止用手移去注射器針頭去注射器針頭醫(yī)院感染控制 銳器刺傷處理及報告程序立即擠出傷口部位的血，用流動水沖洗，安爾碘立即擠出傷口部位的血，用流動水沖洗，安爾碘或酒精或碘酒消毒傷口或酒精或碘酒消毒傷口 急急 診診 治治 療：療： 傷口處理傷口處理 測感染者測感染者HBVHBV五項(xiàng)、五項(xiàng)、HIVHIV 報告主管部門：填寫刺傷報告表報告主管部門：填寫刺傷報告表 測感染源測感染源HBsAgHBsAg、GHIVGHIV 感染控制人員：提出改善意見感

43、染控制人員：提出改善意見 防刺傷教育防刺傷教育 感染者給予預(yù)防性治療感染者給予預(yù)防性治療 處置流程和報告表格見醫(yī)院內(nèi)部網(wǎng)處置流程和報告表格見醫(yī)院內(nèi)部網(wǎng)標(biāo)準(zhǔn)預(yù)防標(biāo)準(zhǔn)預(yù)防（Standard PrecautionsStandard Precautions）v在在 2 02 0世紀(jì)世紀(jì) 9090年代中期年代中期 , ,美國疾病控制中心提美國疾病控制中心提出了出了“標(biāo)準(zhǔn)預(yù)防標(biāo)準(zhǔn)預(yù)防”v它將普遍預(yù)防和體內(nèi)物質(zhì)隔離法的許多特點(diǎn)進(jìn)行它將普遍預(yù)防和體內(nèi)物質(zhì)隔離法的許多特點(diǎn)進(jìn)行綜合綜合 v是針對所有醫(yī)院中接受治療的病人而采取的預(yù)防是針對所有醫(yī)院中接受治療的病人而采取的預(yù)防措施措施 ( (不必考慮其診斷不必考慮其診斷 ) )v目的在于盡最大可能來降低醫(yī)務(wù)人員與病人之間、目的在于盡最大可能來降低醫(yī)務(wù)人員與病人之間、病人與病人之間微生物傳播的危險性病人與病人之間微生物傳播的危險性 , ,起到了雙起到了雙向防護(hù)的作用向防護(hù)的作用標(biāo)準(zhǔn)預(yù)防標(biāo)準(zhǔn)預(yù)防（Standard PrecautionsStandard Precautions）v血液血液v體液、分泌物、排泄物體液、分泌物、排泄物 v非完整性皮膚非完整性皮膚v粘膜粘