"Guidelines for Environmental Infection Control in Health-Care Facilities"とは、医療施設における環境の感染管理のためのガイドラインと訳すことができると思います。
Guidelines for Environmental Infection Control in Health-Care Facilities
Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)
Lynne Sehulster, Ph.D. Division of Healthcare Quality Promotion National Center for Infectious Diseases
Raymond Y.W. Chinn, M.D. HICPAC member Sharp Memorial Hospital San Diego, California
The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Director; and the Division of Healthcare Quality Promotion, Steven L. Solomon, M.D., Acting Director.
このレポートは国立感染症センターJames M. Hughes局長（医師）とヘルスケア品質推進課Steven L. Solomon部長代理（医師）が発案したものです。
The health-care facility environment is rarely implicated in disease transmission,except among patients who are immunocompromised. Nonetheless, inadvertentexposures to environmental pathogens (e.g., Aspergillus spp. and Legionellaspp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zostervirus) can result in adverse patient outcomes and cause illness among health-careworkers. Environmental infection-control strategies and engineering controlscan effectively prevent these infections. The incidence of health-care--associatedinfections and pseudo-outbreaks can be minimized by 1) appropriate useof cleaners and disinfectants; 2) appropriate maintenance of medical equipment(e.g., automated endoscope reprocessors or hydrotherapy equipment); 3)adherence to water-quality standards for hemodialysis, and to ventilationstandards for specialized care environments (e.g., airborne infection isolationrooms, protective environments, or operating rooms); and 4) prompt managementof water intrusion into the facility. Routine environmental sampling isnot usually advised, except for water quality determinations in hemodialysissettings and other situations where sampling is directed by epidemiologicprinciples, and results can be applied directly to infection-control decisions.
This report reviews previous guidelines and strategies for preventing environment-associatedinfections in health-care facilities and offers recommendations. Theseinclude 1) evidence-based recommendations supported by studies; 2) requirementsof federal agencies (e.g., Food and Drug Administration, U.S. EnvironmentalProtection Agency, U.S. Department of Labor, Occupational Safety and HealthAdministration, and U.S. Department of Justice); 3) guidelines and standardsfrom building and equipment professional organizations (e.g., AmericanInstitute of Architects, Association for the Advancement of Medical Instrumentation,and American Society of Heating, Refrigeration, and Air-Conditioning Engineers);4) recommendations derived from scientific theory or rationale; and 5)experienced opinions based upon infection-control and engineering practices.The report also suggests a series of performance measurements as a meansto evaluate infection-control efforts.
Maintain continuous negative air pressure (2.5 Pa [0.01 inch water gauge])in relation to the air pressure in the corridor; monitor air pressure periodically,preferably daily, with audible manometers or smoke tubes at the door (forexisting AII rooms), or with a permanently installed visual monitoringmechanism. Document the results of monitoring (1,100,101). Category IC (AIA: 7.2.C7, Table 7.2)
1.廊下の空気圧に対して、継続的な陰圧(2.5 Pa [ 0.01インチ水柱])を維持します。ドアにある差圧計または煙管(既存の空気感染隔離室の場合)、または常設された視覚的監視装置を使用して、定期的に、できれば毎日、気圧を監視し、モニタリング結果を文書化します(1,100,101)。 カテゴリIC (AIA：7.2.C7、表7.2)
Ensure that rooms are well-sealed by properly constructing windows,doors, and air-intake and exhaust ports; when monitoring indicates airleakage, locate the leak and make necessary repairs (1,99,100). Category IB, IC (AIA: 7.2.C3)
Direct exhaust air to the outside, away from air-intake and populatedareas. If this is not practical, air from the room can be recirculatedafter passing through a HEPA filter (1,34). Category IC (AIA: Table 7.2)
※.AIAとはAmerican Institute of Architects、アメリカ建築家協会 ※.ACHとはair changes per hour、1時間あたりの空気入替(換気)回数
B. Where supplemental engineering controls for air cleaning are indicatedfrom a risk assessment of the AII area, install UVGI units in the exhaustair ducts of the HVAC system to supplement HEPA filtration or install UVGIfixtures on or near the ceiling to irradiate upper room air (34). Category II
※.HVACとはheating, ventilation, air conditioning、暖房・換気・エアコンの総称 ※.UVGIとはultraviolet germicidal irradiation、紫外線殺菌照射
C. Implement environmental infection-control measures for persons withdiagnosed or suspected airborne infectious diseases.
Use AII rooms for patients with or suspected of having an airborne infectionwho also require cough-inducing procedures, or use an enclosed booth thatis engineered to provide 1) >12 ACH; 2) air supply and exhaust ratesufficient to maintain a 2.5 Pa (0.01-inch water gauge) negative pressuredifference with respect to all surrounding spaces with an exhaust rateof >50 ft3/min; and 3) air exhausted directly outside away from airintakes and traffic or exhausted after HEPA filtration before recirculation(1,34,105--107). Category IB, IC (AIA: 7.15.E, 7.31.D23, 9.10, Table 7.2)
Although airborne spread of viral hemorrhagic fever (VHF) has not been documented in a health-care setting, prudence dictates placing a VHF patient in an AII room, preferably with an anteroom, to reduce the risk of occupational exposure to aerosolized infectious material in blood, vomitus, liquid stool, and respiratory secretions present in large amounts during the end stage of a patient's illness (108--110). Category II 2.ウイルス性出血熱(VHF)の空中拡散は医療現場で文書化されていませんが、患者の病気のエンドステージに大量に存在する血液、嘔吐物、液体便、呼吸分泌物中のエアロゾル化された感染性物質への職業的曝露のリスクを減らすために、VHF患者を空気感染隔離室に、望ましくは前室を配置することを指示します(108-110)。 カテゴリII
a. If an anteroom is not available, use portable, industrial-grade HEPAfilters in the patient's room to provide additional ACH equivalents forremoving airborne particulates.
Maintain backup ventilation equipment (e.g., portable units for fans orfilters) for emergency provision of ventilation requirements for AII rooms,and take immediate steps to restore the fixed ventilation system (1,34,47). Category IC (AIA: 5.1)
Note: Stacked black boxes represent patient's bed. Long open box with cross-hatch represents supply air. Open boxes with single, diagonal slashes represent air exhaust registers. Arrows indicate direction of airflow. Possible uses include treatment or procedure rooms, bronchoscopy rooms,and autopsy.
Negative-pressure room engineering features include
○negative pressure (greater exhaust than supply air volume) ○pressure differential of 2.5 Pa (0.01-in. water gauge) ○airflow differential > 125-cfm suply versus exhaust ○sealed room, approximately 0.5-sq. ft. leakage ○clean to dirty airflow ○monitoring ○>12 air exchanges/hr (ACH) new or renovation, 6 ACH existing; and ○exhaust to outside or HEPA-filtered if recirculated.
Required by state or federal regulation, or representing an establishedassociation standard. (Note: Abbreviations for governing agencies and regulatorycitations are listed where appropriate. Recommendations from regulationsadopted at state levels are also noted. Recommendations from AIA guidelinescite the appropriate sections of the standards.)