「英中对照」安全协同：通过医疗设施环境清洁消毒实现兼顾患者与工作人员安全的感染预防

For environmental services managers, the central message is that cleaning and disinfection should be governed through an integrated systems approach.对环境服务经理而言，核心信息是：清洁与消毒应通过综合系统方法进行管理。

By J. Darrel Hicks, Contributing Writer 作者：特约撰稿人 J. Darrel Hicks

Key Takeaways:关键要点：

• Effective healthcare disinfection depends on more than product selection; contact time, surface compatibility, staff training, and consistent auditing also matter.有效的医疗机构消毒不仅取决于产品选择；接触时间、表面相容性、员工培训和持续审核同样重要。
• Involve infection prevention, environmental services, occupational health, and frontline staff in evaluating cleaning products and procedures.让感染预防、环境服务、职业健康和一线员工参与清洁产品与操作规程的评估。
• Use the hierarchy of controls and monitor both cleaning outcomes and worker health to build a safer, more sustainable program.运用控制层级，并同时监测清洁效果和工作人员健康，以建立更安全、更可持续的项目。

A 2015 article from the National Center for Biotechnical Information made a clear and convincing argument: Environmental cleaning in hospitals and other healthcare facilities must be managed as both an infection prevention intervention and an occupational health responsibility. Surfaces in these facilities can contribute to transmission of pathogens such as Clostridioides difficile, MRSA, vancomycin-resistant enterococci, norovirus and multidrug-resistant gram-negative organisms. 2015年，National Center for Biotechnical Information 的一篇文章提出了明确且有说服力的论点：医院和其他医疗机构的环境清洁必须同时作为感染预防干预措施和职业健康责任来管理。这些机构中的物体表面可能会促进艰难梭菌（Clostridioides difficile）、MRSA、耐万古霉素肠球菌、诺如病毒和多重耐药革兰氏阴性菌等病原体的传播。 

At the same time, the chemicals and work practices used to control these organisms can expose environmental services (EVS) workers, nurses and other staff to respiratory irritation, asthma, skin disease and other health risks. The authors of the article, Cleaning and disinfecting environmental surfaces in healthcare: Toward an integrated framework for infection and occupational illness prevention, called for a more coordinated framework that protects patients and workers simultaneously. 同时，用于控制这些微生物的化学品和作业方式可能使环境服务（EVS）人员、护士和其他工作人员暴露于呼吸道刺激、哮喘、皮肤病和其他健康风险。该文章作者在医疗机构环境表面清洁与消毒：迈向感染与职业病预防综合框架中呼吁建立更协调的框架，同时保护患者和工作人员。 

For infection preventionists, the article reinforced that surface cleaning and disinfection are not merely housekeeping tasks. They are core elements of healthcare-associated infection (HAI) prevention. High-touch surfaces, shared equipment and rooms occupied by patients on transmission-based precautions require reliable, evidence-based cleaning and disinfection. But effectiveness depends on more than selecting a disinfectant with the right kill claims. Contact time, surface compatibility, soil removal, staff training, workflow, auditing and feedback all influence outcomes. 对感染预防人员而言，该文章重申表面清洁与消毒并不仅仅是保洁工作，而是医疗相关感染（HAI）预防的核心要素。高频接触表面、共享设备以及采取基于传播途径预防措施的患者所住病房，都需要可靠、循证的清洁与消毒。但其有效性不仅仅取决于选择具有正确杀灭宣称的消毒剂。接触时间、表面相容性、污物去除、员工培训、工作流程、审核和反馈都会影响最终效果。 

For EVS managers, the article highlighted the need to recognize EVS workers as essential members of the infection prevention team. These workers often have the highest exposure to disinfectants, but they might have the least control over product selection, staffing, room turnover expectations and training resources. 对EVS经理而言，该文章强调必须认识到EVS人员是感染预防团队的重要成员。这些人员通常接触消毒剂最多，但对产品选择、人员配置、病房周转预期和培训资源的控制力却可能最弱。 

Disinfectants such as bleach, quaternary ammonium compounds, hydrogen peroxide products and peracetic acid can be effective, but they can also cause eye, skin and respiratory symptoms if used improperly or without adequate controls. Safer use requires clear instructions, appropriate dilution systems, ventilation, personal protective equipment, realistic workload expectations and reporting systems for symptoms or incidents. 漂白剂、季铵盐化合物、过氧化氢产品和过氧乙酸等消毒剂可能有效，但如果使用不当或缺乏充分控制，也可能引发眼部、皮肤和呼吸道症状。更安全地使用这些产品需要明确的说明、适当的稀释系统、通风、个人防护装备、切合实际的工作量预期，以及症状或事件报告系统。 

HFT Recommends: Respecting EVS Workers: 19 Minutes Is Not EnoughHFT推荐：尊重EVS人员：19分钟并不够

For EVS managers, the central message is that cleaning and disinfection should be governed through an integrated systems approach. Infection prevention, occupational health, EVS, safety, purchasing, facilities and frontline staff should jointly evaluate products and processes. Decisions should take into account antimicrobial efficacy, occupational exposure, surface damage, ease of use, cost, training needs and environmental impact. 对于EVS经理而言，核心信息是清洁与消毒应通过综合系统方法进行管理。感染预防、职业健康、EVS、安全、采购、设施和一线员工应共同评估产品和流程。决策应考虑抗微生物效力、职业暴露、表面损伤、易用性、成本、培训需求及环境影响。 

The article encouraged applying the hierarchy of controls: Eliminate unnecessary chemical use where possible, substitute safer products when appropriate, use engineering controls such as closed dilution systems and ventilation, implement administrative controls such as standardized protocols and competency training, and provide personal protection equipment as the last line of defense. 文章鼓励采用控制层级：尽可能消除不必要的化学品使用，在适当情况下替代以更安全的产品，使用封闭式稀释系统和通风等工程控制，实施标准化规程和胜任力培训等管理控制，并将提供个人防护装备作为最后防线。 

The authors also emphasized measurement. Healthcare organizations should monitor cleaning thoroughness, disinfectant use, staff injuries and symptoms, compliance with protocols and infection outcomes. Feedback should be nonpunitive, and managers should use it for improvement. New technologies such as ultraviolet disinfection and hydrogen peroxide vapor might be useful adjuncts, but they do not replace manual cleaning and must be assessed for worker safety. 作者还强调了衡量工作。医疗机构应监测清洁彻底性、消毒剂使用情况、员工受伤与症状、规程依从性以及感染结局。反馈应是非惩罚性的，管理者应利用反馈加以改进。紫外线消毒和过氧化氢蒸气等新技术可能是有用的辅助手段，但不能替代人工清洁，并且必须评估其对工作人员的安全性。 

The practical takeaway is clear: Patient safety and worker safety are interconnected. A disinfection program that prevents infections but harms staff is not sustainable, and a program that is safer for workers but ineffective against pathogens is unacceptable. The goal is a balanced, evidence-based program that uses the right product in the right way for the right surface and risk level. 实际启示很明确：患者安全与工作人员安全相互关联。一项能够预防感染却伤害员工的消毒计划不可持续，而一项对工作人员更安全但对抗病原体无效的计划则不可接受。目标是建立平衡、循证的计划，针对合适的表面和风险等级，以合适的方式使用合适的产品。 

Infection preventionists, EVS professionals and managers should build shared accountability for clean, safe healthcare environments. By integrating infection prevention science with occupational health principles, managers and their organizations can reduce pathogen transmission, protect the workforce and strengthen the culture of safety. 感染预防专业人员、EVS专业人员和管理者应为清洁、安全的医疗环境建立共同问责制。通过将感染预防科学与职业健康原则相结合，管理者及其机构能够减少病原体传播、保护员工队伍并强化安全文化。 

J. Darrel Hicks, BA, MESRE, CHESP, Certificate of Mastery in Infection Prevention, is the past president of the Healthcare Surfaces Institute. Hicks is nationally recognized as a subject matter expert in infection prevention and control as it relates to cleaning. He is the owner and principal of Safe, Clean and Disinfected. His enterprise specializes in B2B consulting, webinar presentations, seminars and facility consulting services related to cleaning and disinfection. He can be reached at darrel@darrelhicks.com, or learn more at www.darrelhicks.com. J. Darrel Hicks拥有BA、MESRE、CHESP和感染预防精通证书，是Healthcare Surfaces Institute的前任主席。Hicks在与清洁相关的感染预防和控制领域是全国公认的主题专家。他是Safe, Clean and Disinfected的所有者兼负责人。其企业专注于与清洁和消毒相关的B2B咨询、网络研讨会演讲、研讨会及设施咨询服务。可通过darrel@darrelhicks.com与他联系，或访问www.darrelhicks.com了解更多。