泣く子も黙る感染対策

出版社: 中外医学社
著者:
発行日: 2023-08-20
分野: 臨床医学:内科  >  感染症/AIDS
ISBN: 9784498021464
電子書籍版: 2023-08-20 (1版1刷)
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2020年以降の新型コロナ対応の豊富な経験も踏まえ,聖路加国際病院感染対策室マネジャーである熟練の著者がエキスパートならではの視点から考察,詳述.現状を冷静に見つめ,具体例やエビデンスも豊かにICTが目指すべき理想とそこに向かう道筋を指し示し泣く子も黙る“鉄壁”を目指す.感染対策にかかわるすべての医療者が今読んでおきたい,具体的な指針が詰まった一冊!

目次

  • 【1】感染対策がうまくいく病院の5つの特徴
      特徴1 安全性を脅かしかねない些細な兆候を見逃さない
      特徴2 周囲の状況や過去の経験を単純化しない
      特徴3 期待されるパフォーマンスから日常業務が逸脱している状況に敏感である
      特徴4 エラーが起きても大事に至らない回復力(レジリエンスresilience)を大事にしている
      特徴5 年齢や序列にとらわれない専門家の重用

    【2】薬剤耐性(AMR)対策アクションプラン
       ―病院における薬剤耐性菌伝播防止のための基本戦略―
      基本戦略(1) 手指衛生
      基本戦略(2) 接触予防策の賢い使い方
      基本戦略(3) サーベイランスなくして戦略なし
      基本戦略(4) AMR対策における情報活用
      基本戦略(5) 感染対策の事前評価

    【3】針刺し・切創・粘膜/創傷汚染の予防と対応
    [1]職業曝露の予防
      1 針刺し・切創・粘膜/創傷汚染とは何か
      2 職業曝露に伴う血液媒介病原体の感染リスク
      3 予防のためにできること
    [2]職業曝露後対応
      1 職業曝露発生直後の対応
      2 B型肝炎ウイルスへの曝露後対応
      3 C型肝炎ウイルスへの曝露後対応
      4 ヒト免疫不全ウイルスへの曝露後対応
      5 ヒトT細胞白血病ウイルス1型への対応

    【4】医療関連感染予防のための水質管理
      1 レジオネラ対策
      2 加湿器の管理
      3 製氷機の管理
      4 生花の取り扱い
      5 ウォーターサーバーの使用

    【5】感染対策における管理図の活用
      1 管理図とは
      2 管理図のフォーマット
      3 管理図の種類
      4 X—R管理図の活用
      5 p管理図の活用
      6 u管理図の活用
      7 管理状態の確認と管理線の改訂

    【6】微生物検査室におけるバイオセーフティ
      1 検査室関連感染とは
      2 バイオハザードとバイオセーフティ
      3 リスク評価
      4 基本的な感染対策
      5 追加的な感染対策

    【7】医療施設の建築・改築・解体工事における感染対策
      1 工事に伴う医療関連感染リスク
      2 リスク評価と対策
      3 PCRAの運用例
      4 ICRA(infection control risk assessment)マトリックス

    【8】感染源になりうる病院環境
      1 高頻度接触環境表面
      2 シンク
      3 プライバシーカーテン
      4 床
      5 天井

    【9】清掃と医療関連感染
      1 清掃の質をどのように評価するか
      2 清潔さを追求する対策

    【10】超音波プローブの消毒
      1 医療器具のリスク分類と再生処理工程
      2 経腟・経直腸プローブに求められる消毒法
      3 経腟・経直腸プローブの医療関連感染リスク
      4 超音波検査用ゼリーを介した感染リスク
      5 今できることは何か

    【11】手指衛生
    [1]基礎知識
      1 そもそも手指衛生は感染予防に有効なのか
      2 手洗いと手指消毒のどちらを優先すべきか
      3 手指衛生の手順の違いは効果に影響するか
      4 手指衛生は何秒間実施すればよいか
      5 ノンアルコール製剤は有用か
      6 アルコールは皮膚から吸収されるか
    [2]手指衛生のタイミング
        手指衛生はいつ行うのがベストなのか
    [3]手指衛生のモニタリング
      1 モニタリング法
      2 モニタリングデータの活用
    [4]手指衛生について考える
      1 手指衛生を多面的に捉える
      2 リーダーシップ
      3 環境改善と体制整備
      4 教育と気づき
      5 患者の関与
      6 継続的モニタリング
      7 チャンピオンとロールモデル
      8 手指衛生は病院事業である

    【12】カテーテル関連尿路感染の予防
      領域1 必要な患者に限り使用する
      領域2 早期に抜去する
      領域3 清潔に挿入・管理する

    コラム 感染症業界ここがアカンやろ!
       プロアクティブかつコスパ重視の中長期戦略がない!

    【13】医療現場におけるマスクの使い方
      1 サージカルマスク
      2 N95マスク
      3 電気ファン付き呼吸用保護具(PAPR)
      4 サージカルマスクか,N95マスクか

    【14】新興感染症のパンデミックにおける職業感染予防
      1 職業感染予防における医療機関と職員の責務,権利,役割
      2 実効性のある職業感染予防の体制
      3 制御のヒエラルキーに基づく職業感染予防の考え方

    【15】日常と非日常をつなぐ医療関連感染予防・制御の体制
      1 パンデミックがもたらす非日常のインパクト
      2 推奨される日常のIPC体制とは

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参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

1 感染対策がうまくいく病院の5つの特徴

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2 薬剤耐性 ( AMR ) 対策アクションプラン - 病院における薬剤耐性菌伝播防止のための基本戦略 -

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3 針刺し・切創・粘膜 / 創傷汚染の予防と対応

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4 医療関連感染予防のための水質管理

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16) 公益社団法人日本臨床工学技士会 透析液等安全委員会. 透析液清浄化ガイドラインVer2.01. 2014. http://www.ja-ces.or.jp/ce/?p=2921

5 感染対策における管理図の活用

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6 微生物検査室におけるバイオセーフティ

P.91 掲載の参考文献
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10) 日本結核病学会・日本臨床微生物学会・日本臨床衛生検査技師会. 結核菌検査に関するバイオセーフティマニュアル 第二版(2005). https://www.kekkaku.gr.jp/manual/manual.html

7 医療施設の建築・改築・解体工事における感染対策

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7) 日本医療福祉設備協会. 病院設備設計ガイドライン (空調設備編) HEAS-02-2022.
8) American Society for Healthcare Engineering. Infection control risk assessment matrix of precautions for construction & renovation. http://www.ashe.org/advocacy/organizations/CDC/pdfs/assessment_icra.pdf

8 感染源になりうる病院環境

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5) Hota S, Hirji Z, Stockton K, et al. Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infect Control Hosp Epidemiol. 2009;30:25-33.
6) Kotay S, Chai W, Guilford W, et al. Spread from the sink to the patient:In situ study using green fluorescent protein (GFP)-expressing Escherichia coli to model bacterial dispersion from hand-washing sink-trap reservoirs. Appl Environ Microbiol. 2017;83:e03327-16.
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8) Shaw E, Gavalda L, Camara J, et al. Control of endemic multidrug-resistant Gram-negative bacteria after removal of sinks and implementing a new water-safe policy in an intensive care unit. J Hosp Infect. 2018;98:275-81.
9) Trillis F 3rd, Eckstein EC, Budavich R, et al. Contamination of hospital curtains with healthcare-associated pathogens. Infect Control Hosp Epidemiol. 2008;29:1074-6.
10) Shek K, Patidar R, Kohja Z, et al. Rate of contamination of hospital privacy curtains on a burns and plastic surgery ward:a cross-sectional study. J Hosp Infect. 2017;96:54-8.
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12) Ohl M, Schweizer M, Graham M, et al. Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. Am J Infect Control. 2012;40:904-6.
13) Shek K, Patidar R, Kohja Z, et al. Rate of contamination of hospital privacy curtains in a burns/plastic ward:a longitudinal study. Am J Infect Control. 2018;46:1019-21.
14) Larocque M, Carver S, Bertrand A, et al. Acquisition of bacteria on health care workers' hands after contact with patient privacy curtains. Am J Infect Control. 2016;44:1385-6.
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19) 平成17年2月1日付. 医政指発第0201004号. 厚生労働省医政局指導課長通知. 医療施設における院内感染の防止について. https://www.mhlw.go.jp/shingi/2006/09/dl/s0906-3d.pdf
21) Rashid T, VonVille HM, Hasan I, et al. Shoe soles as a potential vector for pathogen transmission:a systematic review. J Appl Microbiol. 2016;121:1223-31.
23) Janezic S, Mlakar S, Rupnik M. Dissemination of Clostridium difficile spores between environment and households:dog paws and shoes. Zoonoses Public Health. 2018;65:669-74.
24) Rashid T, Vonville H, Hasan I, et al. Mechanisms for floor surfaces or environmental ground contamination to cause human infection:a systematic review. Epidemiol Infect. 2017;145:347-57.
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32) FEMA. Dealing with mold & mildew in your flood damaged home. https://www.fema.gov/pdf/rebuild/recover/fema_mold_brochure_english.pdf

9 清掃と医療関連感染

P.117 掲載の参考文献
1) Han JH, Sullivan N, Leas BF, et al. Cleaning hospital room surfaces to prevent health care-associated infections:a technical brief. Ann Intern Med. 2015;163:598-607.
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4) CDC. Options for evaluating environmental cleaning. https://www.cdc.gov/hai/toolkits/appendices-evaluating-environ-cleaning.html
7) Marra AR, Schweizer ML, Edmond MB. No-touch disinfection methods to decrease multidrug-resistant organism infections:a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2018;39:20-31.
8) Anderson DJ, Moehring RW, Weber DJ, et al. Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile:a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection). Lancet Infect Dis. 2018;18:845-53.

10 超音波プローブの消毒

P.124 掲載の参考文献
1) CDC. Guideline for disinfection and sterilization in healthcare facilities, 2008. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf
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4) Nyhsen CM, Humphreys H, Koerner RJ, et al. Infection prevention and control in ultrasound-best practice recommendations from the European Society of Radiology Ultrasound Working Group. Insights Imaging. 2017;8:523-35.
5) American Institute of Ultrasound in Medicine. Guidelines for cleaning and preparing external-and internal-use ultrasound transducers between patients, safe handling, and use of ultrasound coupling gel. https://www.aium.org/accreditation/Guidelines_Cleaning_Preparing.pdf
6) Rutala WA, Weber DJ. New developments in reprocessing semicritical items. Am J Infect Control. 2013;41:S60-6.
7) 厚生労働省労働基準局. 医療機関におけるグルタルアルデヒドによる労働者の健康障害防止について(基発第0224007号). 2005.
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9) Leroy S. Infectious risk of endovaginal and transrectal ultrasonography:systematic review and meta-analysis. J Hosp Infect. 2013;83:99-106.
10) Lucet JC, Heard I, Roueli A, et al. Transvaginal ultrasound probes are HPV-free following low-level disinfection:a cross-sectional multicentre survey of 676 observations. Ultrasound Obstet Gynecol. 2019;54:688-95.
11) Gaillot O, Maruejouls C, Abachin E, et al. Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extended-spectrum beta-lactamase, originating from a contaminated ultrasonography coupling gel. J Clin Microbiol. 1998;36:1357-60.
12) Yamunadevi VR, Ramasubramanian V, Senthur Nambi P, et al. Outbreak of Burkholderia cepacia bacteraemia in a tertiary care centre due to contaminated ultrasound probe gel. J Hosp Infect. 2018;100:e257-8.
13) Cheng A, Sheng WH, Huang YC, et al. Prolonged postprocedural outbreak of Mycobacterium massiliense infections associated with ultrasound transmission gel. Clin Microbiol Infect. 2016;22:382. e1-382. e11.
14) Chittick P, Russo V, Sims M, et al. An outbreak of Pseudomonas aeruginosa respiratory tract infections associated with intrinsically contaminated ultrasound transmission gel. Infect Control Hosp Epidemiol. 2013;34:850-3.
15) Shaban RZ, Maloney S, Gerrard J, et al. Outbreak of health care-associated Burkholderia cenocepacia bacteremia and infection attributed to contaminated sterile gel used for central line insertion under ultrasound guidance and other procedures. Am J Infect Control. 2017;45:954-8.

11 手指衛生

P.145 掲載の参考文献
1) Sakihama T, Kayauchi N, Kamiya T, et al. Assessing sustainability of hand hygiene adherence 5 years after a contest-based intervention in 3 Japanese hospitals. Am J Infect Control. 2020;48:77-87.
2) WHO. Evidence of hand hygiene to reduce transmission and infections by multidrug resistant organisms in health-care settings. https://www.who.int/gpsc/5may/MDRO_literature-review.pdf?ua=1
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4) Centers for Disease Control and Prevention. Handwashing:Clean hands save lives. Show me the science-Why wash your hands? https://www.cdc.gov/handwashing/why-handwashing.html
5) SHEA/IDSA/APIC Practice Recommendation. Strategies to prevent healthcare-associated infections through hand hygiene:2022 Update. Infect Control Hosp Epidemiol. 2022;44:355-76.
6) WHO. Hand hygiene posters. https://www.who.int/gpsc/5may/resources/posters/en/
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12) WHO. My 5 moments for hand hygiene. https://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/
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15) WHO. A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. https://www.who.int/gpsc/5may/Guide_to_Implementation.pdf
16) CDC. Guideline for hand hygiene in health-care settings. https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
17) Stewardson A, Sax H, Longet-Di Pietro S, et al. Impact of observation and analysis methodology when reporting hand hygiene data. J Hosp Infect. 2011;77:358-9.
18) Yin J, Reisinger HS, Vander Weg M, et al. Establishing evidence-based criteria for directly observed hand hygiene compliance monitoring programs:a prospective, multicenter cohort study. Infect Control Hosp Epidemiol. 2014;35:1163-8.
19) Boyce JM. Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. Am J Infect Control. 2017;45:528-35.
20) Benudis A, Stone S, Sait AS, et al. Pitfalls and unexpected benefits of an electronic hand hygiene monitoring system. Am J Infect Control. 2019;47:1102-6.
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23) Zingg W, Holmes A, Dettenkofer M, et al. Hospital organisation, management, and structure for prevention of health-care-associated infection:a systematic review and expert consensus. Lancet Infect Dis. 2015;15:212-24.
24) World Health Organization. WHO guidelines on hand hygiene in health care:first global patient safety challenge clean care is safe care. Geneva, Switzerland:World Health Organization, 2009. http://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf; sequence=1
25) Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for hand hygiene in all health care settings. 4th ed. Toronto, ON:Queen's Printer for Ontario;2014. https://www.publichealthontario.ca/-/media/documents/B/2014/bp-hand-hygiene.pdf?la=en
26) Bischoff WE, Reynolds TM, Sessler CN, et al. Handwashing compliance by health care workers:the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med. 2000;160:1017-21.
27) McCormick RD, Buchman TL, Maki DG. Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers. Am J Infect Control. 2000;28:302-10.
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29) Storr J, Twyman A, Zingg W, et al. Core components for effective infection prevention and control programmes:new WHO evidence-based recommendations. Antimicrob Resist Infect Control. 2017;6:6.

12 カテーテル関連尿路感染の予防

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1) European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Stockholm:ECDC;2013.
2) Magill SS, O'Leary E, Janelle SJ, et al;Emerging Infections Program Hospital Prevalence Survey Team. Changes in prevalence of health care-associated infections in U. S. hospitals. N Engl J Med. 2018;379:1732-44.
3) Garibaldi RA, Mooney BR, Epstein BJ, et al. An evaluation of daily bacteriologic monitoring to identify preventable episodes of catheter-associated urinary tract infection. Infect Control. 1982;3:466-70.
4) Saint S, Lipsky BA, Goold SD. Indwelling urinary catheters:a one-point restraint? Ann Intern Med. 2002;137:125-7.
5) Warren JW, Tenney JH, Hoopes JM, et al. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis. 1982;146:719-23.
6) Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic:a prospective study of 1,497 catheterized patients. Arch Intern Med. 2000;160:678.
7) Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000;28:68.
8) Leuck AM, Wright D, Ellingson L, et al. Complications of Foley catheters-is infection the greatest risk? J Urol. 2012;187:1662-6.
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11) Meddings J, Saint S, Fowler KE, et al. The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients:results obtained by using the RAND/UCLA appropriateness method. Ann Intern Med. 2015;162(9 Suppl):S1-34.
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13) Jain P, Parada JP, David A, et al. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med. 1995;155:1425-9.
14) Saint S, Wiese J, Amory JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med. 2000;109:476-80.
15) American Nurses Association. ANA CAUTI Prevention Tool. https://www.nursingworld.org/practice-policy/work-environment/health-safety/infection-prevention/ana-cauti-prevention-tool/

コラム 感染症業界ここがアカンやろ !

P.157 掲載の参考文献
1) Murphy DM, Hanchett M, Olmsted RN, et al. Competency in infection prevention:a conceptual approach to guide current and future practice. Am J Infect Control. 2012;40:296-303.
2) European Centre for Disease Prevention and Control. Core competencies for infection control and hospital hygiene professionals in the European Union. https://www.ecdc.europa.eu/en/publications-data/core-competencies-infection-control-and-hospital-hygieneprofessionals-european

13 医療現場におけるマスクの使い方

P.166 掲載の参考文献
1) FDA. N95 respirators, surgical masks, face masks, and barrier face coverings. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings
2) JHPIA/JSA. JIS T 9001:2021. 医療用マスク及び一般用マスクの性能要件及び試験方法.
3) ASTM International. ASTM Standards & COVID-19. https://www.astm.org/COVID-19/
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5) 一般社団法人 職業感染制御研究会. 不良品マスクを見分ける方法について. http://jrgoicp.umin.ac.jp/index_ppewg_respirator_defective.html
6) 電動ファン付き呼吸用保護具の規格(平成26年11月28日 厚生労働省告示第455号). https://www.mhlw.go.jp/file/06-Seisakujouhou-11200000-Roudoukijunkyoku/0000068302.pdf
7) Radonovich LJ, Simberkoff MS, Bessesen MT, et al. N95 respirators vs medical masks for preventing influenza among health care personnel:a randomized clinical trial. JAMA. 2019;322:824-33.
8) Long Y, Hu T, Liu L, et al. Effectiveness of N95 respirators versus surgical masks against influenza:a systematic review and meta-analysis. J Evid Based Med. 2020;13:93-101.
9) Andrejko KL, Pry JM, Myers JF, et al. Effectiveness of face mask or respirator use in indoor public settings for prevention of SARS-CoV-2 infection-California, February-December 2021. MMWR Morb Mortal Wkly Rep. 2022;71:212-6.
10) Collins AP, Service BC, Gupta S, et al. N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting:a systematic review and meta-analysis. J Am Coll Emerg Physicians Open. 2021;2:e12582.
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12) Loeb M, Bartholomew A, Hashmi M, et al. Medical masks versus N95 respirators for preventing COVID-19 among health care workers. Ann Intern Med. 2022;175:1629-38.
13) WHO. Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed. Interim guidance, 12 July 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC-2021.1
14) CDC. Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic, Updated Sept. 23, 2022. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
15) CDC. Isolation precautions. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

14 新興感染症のパンデミックにおける職業感染予防

P.175 掲載の参考文献
1) WHO. Occupational health and safety for health workers in the context of COVID-19. https://openwho.org/courses/COVID-19-occupational-health-and-safety
2) WHO. Coronavirus disease (COVID-19) outbreak:rights, roles and responsibilities of health workers, including key considerations for occupational safety and health. https://www.who.int/publications/i/item/coronavirus-disease-(covid-19)-outbreak-rights-roles-and-responsibilities-of-health-workers-including-key-considerations-for-occupationalsafety-and-health
3) OSHA. Guidance on preparing workplaces for COVID-19. https://www.osha.gov/Publications/OSHA3990.pdf
4) NIOSH. Hierarchy of controls. https://www.cdc.gov/niosh/topics/hierarchy/default.htm

15 日常と非日常をつなぐ医療関連感染予防・制御の体制

P.185 掲載の参考文献
1) WHO. Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. https://www.who.int/publications/i/item/9789241549929
2) WHO. Minimum requirements for infection prevention and control programmes. https://www.who.int/publications/i/item/9789241516945
4) CDC. Guideline for isolation precautions:preventing transmission of infectious agents in healthcare settings (2007). https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/standard-precautions.html
5) ニザム・ダマーニ, 著. 岩田健太郎, 監修. 感染予防, そしてコントロールのマニュアル第2版. メディカル・サイエンス・インターナショナル;2020.
6) Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best Practices for Hand Hygiene in All Health Care Settings. 4th ed. Toronto, ON:Queen's Printer for Ontario;2014.
7) WHO. WHO multimodal improvement strategy. https://www.who.int/infection-prevention/publications/ipc-cc-mis.pdf

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