医療機関における院内感染対策マニュアル 作成のための手引き（案）
Contents
1. IIIB 81 O157 IVA 8 2 8 3 O0157 IVA DiazGranados CA Jernigan JA Impact of vancomycin resistance on mortality among patients with neutropenia and en terococcal bloodstream infection J Infect Dis 2005 Feb 15 191 4 52. 1996 CDC 1 1 Ul VA 1 2 U IVA 2
3. 9 IVA 1 4 1 091 IVA 1 5 3 9 TVB 1 6 _ ICT 5 AVB 2 1ICT 2 1 0l IIIA 2 2 19 IIIA 2 3 IIA 2 4
4. 7 AIB 3 5 2 80 10 0 025 250ppm 30 C 5 Ul IVA 3 5 3 V CVA 3 5 3 1 60 70 10 0 025 250ppm 3 5 3 2 60 5 2 3 4 1 3 5 3 3 OE AKAUSBUK 80 C 10 0 025 250ppm
5. 7 IA 2 9 979 CIA 2 10 errs 057 TA 3 1 l OIA 3 2 5 14 1 IIA 3 3 CRIMI CRU 31 IIIA 3 4 CRM CRW JIIA 3 5
6. IIIA 5 1 3 IIA 5 1 4 IIIB 5 1 5 IIIA 5 1 6 3 CUB 5 2 1 AIA 5 2 2 5 2 2 1 IIIA 5 2 2 2
7. FER cl e 1 3 7 i me eta BAI 14 17 20 WOR ERIE OD EE aui EM 22 v WP Cc EET EE E Rm 28 Ui 30 tk 32 E UD DU PIE 36 WERENT 7 VEEL PRT uestes 39 BUS RID E 45 kk 48 i 51 LAFILA A m ER 56
8. IIIA 9 3 IIIA 10 10 1 31 IB 11 x 1 Edwards LD The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients a four year study of 40 923 operations at Rush Presbyterian St Luke s Hospital Chicago Ann Surg 1976 Dec 184 6 758 66 2 Simchen E Rozin R Wax Y The Israeli Study of Surgical Infection of drains and the risk of wound infection in opera tions for hernia Surg Gynecol Obstet 1990 Apr 170 4 331 7 3 Furnary AP Zerr KJ Grunkemeier GL Starr A Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients aft
9. AVA 6 3 IVA 6 4 IVA 6 5 IVA 7 1 P gt IVA 7 2 IIIA 8 1
10. CIA 65 0 02 200ppm 0 19 1 000ppm 0 029 6 200ppm B21 IA 71 IIA 7 2 CIA 73
11. IVA 51 VA 2 5 TUNIS IVA 2 6 MDR TB XDR TB IVA 2 7 IVA 3 1 P979 IA 3 2
12. e 2 3 ICU NICU 1 1 1
13. JIIB 9 91 Hz A 92 pH P23 mp 9 3 H gt P41 IA 10 10 1 30 45 Pl 1A 10 2 US IB 11 11 1 IIA 12 12 1 AIA x 1 10 11 12 13 14 15 16 17 18 19 20 21 Conly JM Hill S Ross J Lertzman J Louie TJ Handwashing practices in an intensive care unit the ef
14. 3 Id 1 3 1 4 VRE 1 1 1 VRE 1 CIB 1 1 2 VRE 071 IIB 1 1 3 0 IB 1 1 4 VRE ICU UL CIA 11 5 3 VRE 9 TB
15. IIA 1 23 1 4 IA 1 23 2 1 23 2 1 P81 TTA c 1 23 22 P IB 1 23 3 1 23 3 1 28 AIA 1 23 3 2 IIIA 1 24 1 24 1 1 24 1 1 AIA 1 24 1 2 JIIA 1 24 1 3
16. b IVA 7 6 P IVA 7 7 P vB 7 8 9947 TVA 7 9 BI TVA 7 10 999 TVA B 17 2 1 0201004 Suzuki A Namba Y Matsuura M Horisawa A Bacterial contamination of floors and other surfaces in operating rooms a five year survey J Hyg Lond 1984 Dec 93 3 559 66 Bartzokas CA Holley MP Sharp
17. PA ITA 6 2 IIIB 6 3 Ul IIIA 6 4 IIIA 6 5 CEDAR RR SC UM 6 6 B IB 6 7 IIIB 6 8 9 IA Joe 6 9 CVA x 2 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 17 2 1 0201004 Mortimer EA jr Lipsitz PJ Wolinsky E
18. AIA 2 2 JIIA 2 5 Pl IA 2 4 AIA 2 5 IIIA 2 6 HIA P OD iB LE N LA LAOS CREATA 6 IA 3 3 1 1 TA 3 2 B TA 4 4 1 Pl IA 42
19. IIIA 5 6 5 IIA 6 6 1 0229 ITA 62 P31 IIIA 63 8 IIB 6 4 P9301 qu 6 5 AIA 6 6 AIB 6 7 02 531 CIA 6 8 TPN 28 IIIA 6 9
20. 1 Qn 2 2 4 P9791 IIB 3 3 1 IED 5 DREGE CHEE A DIELS m Mao BHD SRE STD BW 091 IIIB 3 2 fee CU REMKO Vc LAKES SAA Rv 447 IB 3 3 LICK oTi fulictE SRUETER AS Zee C d fc z P5594 TITR a x 1 10 11 17 14 15 16 17 18 19 21 22 25 26 3 4 31 TIO Baskin WN Acute complications associated with bedside placement of feeding tubes Nutr Clin Pract 2006 Feb 21 1 40 55 Lai PB Pang PC Chan SK Lau WY Necrosis of the nasal ala after improper taping of a nasogastric tube Int J Clin Pract 2001 Mar 55 2 145 PEG In ed PEG AD Ree 2004 Bankier AA Wiesmayr MN Henk C Turetschek K Winkelbauer F Mallek R et al Radiographic detection of intra bronchial malposition
21. Ul IB 1 2 FERIA RIREZE SRM Uc REL ID IT ARO RERKS S rewic pees Pl IIA 2 2 1 IIIA 2 2 WAS NCOSBM BAST SAA B POZRECUIKS 1TUCv Sc cli UL BH S IIIA 2 2 1 M IA 2 2 2 IIIA 2 2 M IA 3 3 1 0 55 2 3 5 0 3 IIIA 32 IIIB
22. Eyidence basewd Medicine EBM 1 I RCT meta analysis II RCT CEB LEBER RUE SN TOG RCT I IV RCT Randomized Controlled Trial 2 A B C d
23. CRUATS 9 IIA 3 6 CMA CRY IIIA 3 7 7 VA 3 8 lI IIIA 4 1 120 IIIA 4 2 IIIA SAUL en aud di 5 1 ee ee OTD 52 QIIIA 6 1
24. 27341 TITA 6 9 1 9L qu 7 7 1 05 401 IVA 25 X 1 2 7 2 99 IVA 7 3 P IVA 7 3 1 UL IVA 7 3 2 99 TVA 7 8 8 Ul IVA 74 P21 IVA 7 5
25. Z 070828ver 5 18 H18 11 A Ai HAICS
26. VRSA VRE RS A C PRSP MRSA MDRP
27. 97 IA 1 7 1 7 1 9 CIA 1 8 1 8 1 0 5 10 I A 1 9 1 9 1 0 5 10 P74 CIA 1 10 1 10 1 PA A 1 11 1 11 1 P IIA 1 11 2 P IIB 1 12 1 12 1
28. evidence based clinical practice guideline 18 a b
29. IIIA gt 70 A P IVA 1 4 1 21 IIA 1 4 2 IIIA 1 4 3 IIIB 1 4 4 IIIB 1 4 5 IIIA 1 4 6 IIIA 1 4 7
30. 19 IA 2 2 7 IA 2 3 1591918 TTA 24 171 IIIA 2 4 1 4 IIA 3 3 1 _ 8 amp 13 16 17 9 201 TTA 3 1 1 IIA 3 1 2 2 1 IIIA 3 2 4 ITA 3 3 amp 8 16171 IB 3 4
31. H5ND 3 9 3 1 VA 3 1 1 IVA 3 1 2 IVA 4 P12 4 1 VO 42 IVA 43 IVA 5 18 7574 Jl 5 2
32. P IVA 18 1 Lr oc OW N 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Updated U S Public Health Service Guidelines for the Management of Occupational Exposures to HBV HCV and HIV and Recommendations for Postexposure Prophylaxis MMWR Recomm Rep 2001 Jun 29 50 RR 11 1 52 6 10 1 D 11 2 1 19 3 30 0330010 5 PT 10 HIV 1999 1 8 Occupational exposure to bloodborne pathogens OSHA Final rule Fed Regist 1991 Dec 6 56 235 64004 182 Poland GA Jacobson RM Clinical practice prevention of hepatitis B with the hepatitis B vaccine N Engl J Med 2004 Dec 30 351 27 2832 8 Puro V Cicalini S De Carli G Soldani F Ippolito G Towards a standard HIV post exposure prophylaxis for healthcare workers in Europe Euro Surveill 2004 Jun 9 6 40 3 Beasley RP Hwang LY Lee GC Lan CC Roan CH Huang FY et al Prevention of perinatally transmitted hepatitis B virus infecti
33. 13 2 22 125 Hoque SN Graham J Kaufmann ME Tabaqchali S Chryseobacterium Flavobacterium meningosepticum outbreak as sociated with colonization of water taps in a neonatal intensive care unit J Hosp Infect 2001 Mar 47 3 188 92 Cordes LG Wiesenthal AM Gorman GW Phair JP Sommers HM Brown A et al Isolation of Legionella pneumophila from hospital shower heads Ann Intern Med 1981 Feb 94 2 195 7 26 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 Hambraeus A Malmborg AS Disinfection or cleaning of hospital toilets an evaluation of different routines J Hosp Infect 1980 Jun 1 2 159 63 Bhalla A Pultz NJ Gries DM Ray AJ Eckstein EC Aron DC et al Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients Infect Control Hosp Epidemiol 2004 Feb 25 2 164 7 17 1 10 0110001 OD Kaatz GW Gitlin SD Schaberg DR Wilson KH Kauffman CA Seo SM et al Acquisition of Clostridium difficile from the hospital environment Am J Epidemiol 1988
34. 9 IB 2 5 ICT IIIB 2 6 ICT 19 Ig 2 7 ICT IIIA 3 3 1 ICT L121 IIB 4 4 1 ICT 2 TVA 42
35. LA IVA 1 2 1 2 1 IA 1 2 0 AIA 2 2 1 P IIIA 3 3 1 3 IVA 3 2
36. I 61 M Da 1
37. Step8 Step 9 Step 10 2 2 1 Pls IA 2 2 30 1 1691 IA 2 3 1 2 3 59 CA 2 4 24 9 A 3 3 1 IIB 3 2 IIIB 3 3
38. 1 000 mm v P8 IA 3 3 1 Ul IVA 3 2 IIIA 3 3 IIIA 3 4 NI IVA 3 5 IIA 3 5 1
39. 5917 IB 3 5 A 3 5 1 1 gt 691615221 IA 3 5 2 70 S 6 816 18 221 TTA 3 6 SaS 16201 A 3 6 1 IIIA 3 6 2 3 2 9 20 IIIA 3 6 3 7 16 235 IIIA 3 7 1 1
40. 1 IIIA 3 6 Pl IIIA 3 7 IIA 3 8 AIA 30 x 11 12 1 3 9 A IA 3 10 IITB 41 AIA 5 1 Bl ITA 52 Pl CIITA 5 3 3 14 IA 6 1 9 IIO B Garibaldi RA Burke JP Dickman ML Smith CB Factors predisposing to bacteriuria during indwelling urethral cath eterization N Engl
41. IIIA 4 4 1 Pl CTIA 4 2 Pl IIIA 20 1 Dellit TH Owens RC McGowan JE Jr Gerding DN Weinstein RA Burke JP et al Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship Clin Infect Dis 2007 Jan 15 44 2 159 77 Siegel JD Rhinehart E Jackson M Chiarello L The Healthcare Infection Control Practices Advisory Committee Man agement of Multidrug Resistant Organisms In Healthcare Settings 2006 cited Available from http www cdc gov ncidod dhqp pdf ar mdroGuideline2006 pdf Campaign to Prevent Antimicrobial Resistance in Healthcare Settings cited Available from http www cdc gov dru gresistance healthcare Brinsley K Srinivasan A Sinkowitz Cochran R Lawton R McIntyre R Kravitz G et al Implementation of the Cam paign to Prevent Antimicrobial Resistance in Healthcare Settings 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults experiences from 3 institu
42. IIIA 1 4 RAY Be SS IIIA 1 5 IIIA 2 2 1 2 1 1 IIA 2 1 2 CIA 2 1 3 IIA 2 1 4 3 IIIA 2 1 4 1 2 1 4 1 1 1
43. IIIA 2 2 4 P IIIB 2 2 5 9 IIB 2 3 2 3 1 7 IIIB 2 3 2 _ B19 CIB 2 3 3 d s tg DI IIA 2 4 2 4 1 IITB 3 1 P IA 32 Bl IIIA 3 3 H ITA 3 4 CAIA 3 5
44. 1 1 LSP VA WR AOE CHART SD BW B 5 3 3 0 1 1 000ppm U 19 IVA 5 4 1 AIA 5 4 2 IIIA 5 4 3 1 1 JIIA 5 4 4 1 1 CIB 5 4 5 IIIB 5 4 6 0 1 0 1 0 05 500ppm 94 2 9 5 6
45. 5 IIIA 6 4 JIIA 6 5 IIIA 36 6 6 IIIA 6 7 HEPA IA 6 8 CIA 7 FTO BR c Sth 7 1 IIIA 7 2 PIMA VP FEA ISHED BOLTS CIA 8 81 AIA 82 PO IA 8 3 P31 CIC 9 91 P41 IA 92
46. 24 23 B 4 4l 1617 rA 41 1 CIA 4 1 2 IIIB 42 0971615265 TTA 49 w N 1 10 11 12 13 14 15 16 17 18 19 21 22 23 24 25 26 20 Alvarado CJ Reichelderfer M APIC guideline for infection prevention and control in flexible endoscopy Association for Professionals in Infection Control Am J Infect Control 2000 Apr 28 2 138 55 17 2 1 0201004 1 D 11 2 1 19 3 30 0330010 5 American Society for Testing and Materials Standard Practice for Cleaning and Disin
47. l IIIA 5 4 7 IIIA 5 4 8 IIIB 5 5 1 JIIA 5 5 2 AIA 5 5 3 1 1 EE Pa 5 5 4 cu MuR ER c PD IIIA 5 6 1 IIIA 5 6 2 QIIA 5 6 2 1 5 6 2 2 5 6 3 1 IIA 5 6 4
48. IB 2 1 4 1 2 AIA 2 1 4 1 2 1 IIIA 2 1 4 1 2 2 CIA 2 1 4 1 2 3 CIB 2 1 4 1 2 4 80C 10 IIIB 2 1 4 1 2 5 AIA 2 1 4 1 2 6 IIIB 2 1 4 2 CIA 2 1 4 2 1 AIA 2 1 4 3 22 P ana 2 1 4 3 1 x32 IVA 2 2
49. 049 IIIA 9 IIA IIIA JIIA 6 10 6 12 IA 7 7 1 7 2 WS BIER IIIA CRUS C RW IIIB 8 8 1 8 2 8 3 8 4 8 5 l TB U IB 4 Pl CIB 20 30 cmH2O IIB
50. 2 1 P GIA 2 2 P IA 2 3 X35 IA 2 4 IIIA 2 5 57 IIIA 2 6 IIA 2 7 Pl IA 2 8
51. MRSA 1 2 1 MRSA MRSA MRSA 7 ITB 1 2 2 MRSA 8 PI IA MDRP 1 3 1 ICU P924 ITA 1 3 2 e ITA 1 4 1 26 271 IIB 2 2 1 22 2 3 2 4 BORER ERER ET EAD SEDTUS ICH DRE N95 JIIA CIA
52. AIA 4 3 SARS ANB 5 5 1 80C 10 PV IA 5 2 UU CA 5 3 l TA 5 4 CIB 5 5 AIB 991 6 6 1 0 2 0 3 6 4 6 5 6 6 6 7 6 8 6 9 IIIA IIIB 1 CIA 3 O JIIA
53. AIB 4 1 RB IKI TY TIVE SARS TVA 42 IIIA 4 3 IVA 4 4 SARS IVA 51 IIIA 5 2 QA 20 0 2 0 4mg L ppm 60C
54. ICT 59 IVA 7 4 ICT IIIA 7 5 ICT P24 CA 7 6 1ICT MRSA 62221 IIA 8 x 1 2 iss 16 17 18 8 1 ICT 9939 IA 8 2 ICT 3 IVA 8 3
55. 1 1 P31 IVA 6 4 ICT wee 9 IVA 6 5 ICT 1 1 1 IVA 6 6 ICT 181 B 7 1 1ICT 9 IVA 7 2 AVB 7 3
56. ICT 3 IVA 9 1 6 IVA 9 2 B 3 1951 IA 9 5 PP A 9 4 IVA 9 5 IIIA B
57. IIIA 4 2 HIV HIV 8 AHA 43 HIV 1 HIV US AIA 4A 1 3 6 1 9 IIB 5 1 JA 52 P97 IA 5 3 B ON IIA 77 6 1 IVA 6 2
58. 9 IIIA 1 3 1 3 1 Pl IIB 1 8 0 IB 2 2 1 2 1 1 RTH Ready To Hang IIB 2 1 2 HSS zd efie RSAC SAB CIB 2 1 3 IIIB 2 1 4 8 9 IIIB 2 2 2 2 1 8 RTH 24 0720 TIA 2 2 2 GluK amp L lt ERAS FU 7 A PL2 MIB 2 2 3
59. 4 IIIA 1 01 4 P CIA 1 2 1 5 CIA 1 3 1 3 1 N95 N95 P IA 1 3 2 N95 IIA 1 4 1 4 1 IIIA 1 4 2 IIA 1 4 3 IIA 2 1
60. PO PU PA P x oo N OW un wu rb N N N N OU WN CO OO N W 12 1 69 1 1 6 10 1 11 2 1 17 2 H 1 0201004 24 1 25 1 29 1 3 1
61. Medline PubMed Cochrane Library Best Evidence Evidence Based Medicine ACP Journal Club 2 c Sackett Chest 1989 95 2 Suppl 2S 4S I lt IV 1 IV 2 RCT IC RCT IIIA
62. 10 IA 3 3 IIIA 41 GIIAD 42 IA 43 4 TB 5 1 5 IIIA 5 2 A US CNA 6 1 e171 IVA 6 2 1 15 3 067191 TTA 6 3 HEPA
63. IVA 5 1 1 5 1 2 1 xd el 5 1 3 1 1 5 1 3 1 5 1 3 2 5 1 4 ie TUCU S Vestes Ae MLO a CVA 6 IVA 6 1 6 2 6 3 6 4 6 5 6 6 6 7 6 8 6 9
64. 5 TVA 1 1 1 1 1 1 1 JA 1 1 1 3 1 1 1 4 1 1 1 5 1 1 1 0 1 1 3 7 7 1 1 2 IVA 1 2 IVA 1 5 50 Pl 2
65. 30 3 Ul IVA 3 5 4 120 20 IVA 3 6 IIIB 3 7 9 IIIB 4 41 Uo 10 TVA 4 2 4 3 4 4 4 5 1 6 4m2 I IVA Im IIIA IIIB 1 Rw CIB 4 5 1 JIIB 4 5 2 IIIA 5 1 5 2 5 3 5 4
66. 6 3 4 2 53 RO 2 19 1 1 1 71 GIA 1 2 2002 CDC Campaign to Prevent Antimicrobial Resistance in Healthcare Settings 9 lk 12 4 12 6 Ge IA 12 Step5 Step6 Step7
67. CIA l IIIA 1 5 1 4 TVA 1 5 2 1 939 VA IIA 1 6 1 CIB 1 6 2 IIIA TVA 48 2 2 1
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69. IIIA 1 24 1 4 91 IIIA EE rei 1 24 2 1 IIB 1 24 2 2 MH IB 135 1 25 1 1 25 1 1 42 43 CIB 1 25 1 2 ICU 4 ITB 2 2 1 2 1 1 IB 2 2 2 2 1 H1 IIIB 2 3 REHAR 7 7 VOR EH FE 2 3 1 HHRROU AZ ZR S 7 5 AJ T 7 vii 96 v Ul IIB 2 4 2 4 1
70. CIB 1 13 1 13 1 3 26 CLA 39 1 14 1 14 1 1 2 P71 IIIA 1 15 1 15 1 P9 IIIB 1 16 1 16 1 1 IIA 1 17 1 17 1 ICU 991 5 A 1 17 2 CIA 1 18 1 18 1 B31 IIA 1 18 2 1 2 09 IB 1 19 1 19 1 24 3 IIIA 1 2
71. ICT 09519 VA 4 3 ICT 9 174 TVA 5 1 ICT C S CUB 6 1 ICT 1 1 P1 IVA 6 20 ICT JIB 6 3 ICT
72. 55C 0951 IVA 53 G O AIA 61 ER IIA 62 BI NAP1 027 IB 52 X 1 6 9 HG TA RAEN ES b BH Old RAPD BI NAP1 027 ARV CIB 64
73. A IIIA 22 2 2 1 _ AI IIIA 2 2 2 4 IIIA 2 2 3 Im IIIA 4a x 2 3 1 2 3 2 3 1 1m UI IIIA 2 4 2 4 1 CIA 2 4 2 IA 2 4 3 IIIA 3 1 IIIA 32 3 2 1 Ml CIA 3 2 2 M IIIA
74. 5 1 1 IIIA 5 1 2 IB 5 1 3 CIB 5 1 4 ITB 5 1 5 IITB 5 1 6 IIIB 5 1 7 1 1 CIB 5 2 1 1 1 IIIA 5 2 2 JIIA 5 2 3 U7 IIIA 5 3 1 1 1 D1 ITA 5 3 2
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77. IIIA 4 4 1 JIIA 4 1 1 IIIA 4 1 2 IIIB 413 CIA 4 1 4 3 IIIB 56 5 2 1 5 2 5 3 6 6 1 6 2 5 1 1 IIIA 5 1 1 1 IIIA 5 1 2
78. id 5 IIIA RID 5 2 2 3 19 IB 5 3 1 2 3 AHIO 5 32 AIA AIA 6 2 1 9 IIIA 6 2 2
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81. 3 2 3 1m IIIA 3 3 3 3 1 Ol TA 34 3 4 1 IIB 3 4 2 IIIA 3 5 3 5 1 JIIA 3 52 IIIA 3 5 3 IIIA 3 5 4 IA 3 6 3 6 1 IIA 3 6 2
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86. Di IC HRS e dz GS RE BKC BRK CHES H IB Vti o Vc BEES TTE EP DIC BARA RAY A do vitse PRESE 9 IVA QIIA 4 IVA EPINet P IIIB B 2 1 B 1 2 97 CIA 2 2 HBs HBs 159 IA 2 3 ERRAT B HBs HBs HBs B 1 919 IA 2 4 B 1 HBs HBs B
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