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Disinfection for prevention and control of infections on the threshold of the 21st century for the critically ill patient

机译：预防和控制21世纪危重病人感染的消毒方法

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In infectious diseases we can discern a cause and effect chain, which in particular offers the practicable perspectives of prophylaxis and treatment. However, to date we have not been able to control them. Apart from new epidemics, such as those caused by HIV and SARS, long-forgotten scourges like TB are enjoying a comeback. Furthermore, the advances made in clinical medicine mean that induced immunosuppression, for instance as a result of major surgery or organ transplantation, has become a serious problem in intensive care units. The body’s natural barriers are breached through medical interventions while, on the other hand, immunocompromising therapeutic agents such as cytostacis and glucocorticoids ensure that invading microorganisms will be able to multiply. Drugs administered as stress ulcus prophylaxis give rise to a shift in the bacterial flora of the throat, thus laying the foundation for a lower respiratory tract infection. With regard to bacterial resistance, antibiotic therapy, especially when used as prophylaxis, results in the bacteria becoming less sensitive to the drugs, while reinforcing selective pressures. The hands of personnel as well as the therapeutic devices ranging from the respirator to the catheter are the chief sources of infection in intensive care units. Disinfection, antibiotic therapy and, possibly, extracorporeal elimination methods can be contemplated to selectively prevent the establishment and multiplication of microorganisms. However, only disinfectants are able to unleash their full destructive might against microbes, especially when used for medical devices that are not amenable to sterilization, even if their subsequent removal and, possibly, the issue of staff hand protection, can be a problem. While it is not easy to furnish proof of a direct link between efficient control and prevention methods and the incidence of infection, there is by now a consensus on the role of hand hygiene and of disinfection of the human body and of surfaces. In an age when medicine, in particular intensive care medicine, is at risk of becoming impaled on its own sword, disinfection could serve as a bulwark against rising infection rates.
机译：在传染病中，我们可以辨别因果关系，尤其是提供预防和治疗的实用观点。但是，到目前为止，我们还无法控制它们。除了新的流行病（例如由HIV和SARS引起的流行病）外，长期以来被人们遗忘的灾难（如结核病）也正在卷土重来。此外，临床医学的进步意味着，例如由于大手术或器官移植而引起的免疫抑制已成为重症监护病房中的严重问题。人体的自然屏障通过医学干预得以突破，另一方面，免疫抑制性治疗剂（例如细胞固定剂和糖皮质激素）可确保入侵的微生物能够繁殖。预防应激性溃疡所用的药物引起咽喉细菌菌群的转移，从而为下呼吸道感染奠定了基础。关于细菌耐药性，抗生素疗法，特别是当用作预防时，导致细菌对药物的敏感性降低，同时增强了选择性压力。人员的手以及从呼吸器到导管的治疗设备都是重症监护病房的主要感染源。可以考虑采用消毒，抗生素治疗以及可能的体外消除方法来选择性地防止微生物的建立和繁殖。但是，只有消毒剂才能释放出对微生物的全部破坏力，尤其是当用于不适合灭菌的医疗设备时，即使随后将其去除以及可能出现人员手部保护问题也是如此。尽管要提供有效控制和预防方法与感染发生率之间直接联系的证据并不容易，但目前在手卫生以及对人体和表面进行消毒的作用方面已达成共识。在当今时代，药物，尤其是重症监护药物有可能被自己的剑刺穿，消毒可能成为抵制感染率上升的堡垒。

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