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🛡️ 安全与感染预防 · 第1课，共6课 · 7 min

接触、飞沫、空气：选对那扇门

Contact, Droplet, Airborne: Pick the Right Door

😷 患者离开后，麻疹病毒可以在病房的空气中悬浮两小时。流感病毒会在几英尺内落到地面。C. diff 根本不怕洗手液。三种疾病，三个完全不同的病房。

😷 Measles can hang in the air of a room for two hours after the client leaves. Influenza falls to the floor within a few feet. C. diff laughs at hand sanitizer. Three diseases, three completely different rooms.

💡 核心要点

接触：隔离衣和手套。飞沫：进入病房时戴外科口罩。空气：N95和负压病房。C. diff：用肥皂和水，绝不能只用洗手液。

Contact: gown and gloves. Droplet: surgical mask on entering the room. Airborne: N95 and a negative-pressure room. C. diff: soap and water, never sanitizer alone.

🧠 为什么重要

标准预防措施适用于所有人：手卫生、接触体液时戴手套，以及锐器安全。接触预防措施在此基础上增加隔离衣和手套，并安排单人病房或同病种集中安置：MRSA、VRE、Clostridioides difficile、疥疮、RSV、轮状病毒和引流伤口。对于C. diff，要用肥皂和水洗手，因为酒精杀不死芽孢，清洁时要使用漂白剂。飞沫预防措施增加外科口罩，进入病房时戴上：流感、百日咳、腮腺炎、风疹、脑膜炎球菌性脑膜炎、咽白喉和支原体肺炎；转运时患者要戴外科口罩。空气预防措施要求负压病房并关好房门，还要佩戴与你本人密合测试合格的N95呼吸器：结核病、麻疹（rubeola）、水痘和播散性带状疱疹。空气传播疾病的记忆口诀是My Chicken Hez TB（我的鸡得了结核），对应麻疹、水痘、播散性带状疱疹和结核病。水痘和播散性带状疱疹需要空气预防措施加接触预防措施。

STANDARD precautions apply to everyone: hand hygiene, gloves for body fluids, and sharps safety. CONTACT precautions add a gown and gloves and a private room or cohorting: MRSA, VRE, Clostridioides difficile, scabies, RSV, rotavirus and draining wounds. For C. diff, wash with SOAP AND WATER because alcohol does not kill spores, and use bleach for cleaning. DROPLET precautions add a surgical mask, put on when entering the room: influenza, pertussis, mumps, rubella, meningococcal meningitis, pharyngeal diphtheria and mycoplasma pneumonia; the client wears a surgical mask when transported. AIRBORNE precautions require a negative-pressure room with the door closed and an N95 respirator fit-tested to you: tuberculosis, measles (rubeola), varicella and disseminated herpes zoster. A memory aid for airborne: My Chicken Hez TB, for measles, chickenpox, disseminated herpes zoster, tuberculosis. Varicella and disseminated zoster need airborne plus contact precautions.

🏥 真实场景

🚪 一名新护士把疑似结核病的患者安置在普通单人病房，房门开着，自己戴着外科口罩。这两个选择都错了：结核飞沫核非常微小且能悬浮空中，只有密合的N95才能过滤它们，也只有负压才能阻止它们飘进走廊。考试会用一个看似合理却错误的口罩选项，设下正是这个陷阱。

🚪 A new nurse puts a client with suspected tuberculosis in a regular private room with the door open and wears a surgical mask. Both choices fail: TB droplet nuclei are tiny and float; only a fitted N95 filters them, and only negative pressure keeps them out of the hallway. The exam will set exactly this trap with a plausible but wrong mask.

📌 要点总结

  • 接触：MRSA、VRE、C. diff（肥皂和水）、疥疮、RSVContact: MRSA, VRE, C. diff (soap and water), scabies, RSV
  • 飞沫：流感、百日咳、腮腺炎、风疹、脑膜炎球菌性脑膜炎Droplet: flu, pertussis, mumps, rubella, meningococcal meningitis
  • 空气：TB、麻疹、水痘、播散性带状疱疹：N95加负压Airborne: TB, measles, varicella, disseminated zoster: N95 plus negative pressure

📖 本课术语

标准预防措施 (Standard precautions): 对每位患者都采用的手卫生、与预期暴露相匹配的防护用品，以及安全的锐器和注射做法，不论诊断如何。

接触预防措施 (Contact precautions): 针对通过接触传播的病原体（如MRSA、VRE、C. difficile和疥疮）穿隔离衣并戴手套。

飞沫预防措施 (Droplet precautions): 进入患有流感、百日咳、腮腺炎、风疹或脑膜炎球菌性脑膜炎的患者房间时佩戴外科口罩。

空气传播预防措施 (Airborne precautions): 针对结核病、麻疹、水痘和播散性带状疱疹，佩戴N95呼吸器并使用负压病房。

负压病房 (Negative-pressure room): 一种将空气向内吸入并排到室外的房间，使空气传播的病原体无法逸出到走廊。

SPIDERMAN（飞沫预防措施） (SPIDERMAN (droplet precautions)): 需要在进入房间时佩戴外科口罩的疾病：脑膜炎球菌性脓毒症（meningococcal Sepsis）、猩红热（Scarlet fever）、链球菌性咽喉炎（Strep throat）、细小病毒感染（Parvovirus）、肺炎（Pneumonia，某些类型）、百日咳（Pertussis）、流感（Influenza）、白喉（Diphtheria）、会厌炎（Epiglottitis）、风疹（Rubella）、腮腺炎（Mumps）、脑膜炎球菌性脑膜炎（meningococcal Meningitis）、支原体感染（Mycoplasma）、腺病毒感染（Adenovirus）。

MRS. WEE（接触预防措施） (MRS. WEE (contact precautions)): 需要穿隔离衣并戴手套的疾病：多重耐药菌（Multidrug-resistant organisms）、呼吸道合胞病毒（Respiratory syncytial virus）、皮肤感染（Skin infections，如疥疮、脓疱疮、单纯疱疹）、伤口感染（Wound infections，引流中）、肠道感染（Enteric infections，如C. difficile）、眼部感染（Eye infections，病毒性结膜炎）。

✅ 自我测试

哪位患者需要在负压病房接受空气预防措施？Which client requires airborne precautions in a negative-pressure room?
  1. 患活动性肺结核的患者A client with active pulmonary tuberculosis
  2. 患百日咳且有阵发性咳嗽的患者A client with pertussis and a paroxysmal cough
  3. 患流感且频繁咳嗽的患者A client with influenza who is coughing frequently
  4. 引流性手术伤口感染MRSA的患者A client with MRSA in a draining surgical wound

答案: A · 患活动性肺结核的患者

结核病通过微小的空气飞沫核传播。流感和百日咳属于飞沫传播；MRSA伤口感染属于接触传播。

Tuberculosis spreads by tiny airborne droplet nuclei. Influenza and pertussis are droplet; MRSA wound infection is contact.

护理患Clostridioides difficile的患者后，正确的手卫生方式是什么？After caring for a client with Clostridioides difficile, which hand hygiene is correct?
  1. 用含酒精手消毒剂揉搓20秒Alcohol-based hand rub for 20 seconds
  2. 只戴手套就足够了Gloves alone are sufficient
  3. 用氯己定湿巾擦拭手套Chlorhexidine wipes on the gloves
  4. 肥皂和水Soap and water

答案: D · 肥皂和水

C. diff芽孢能在酒精下存活。用肥皂和水机械性清洗可将其去除。

C. diff spores survive alcohol. Mechanical washing with soap and water removes them.

患细菌性（脑膜炎球菌性）脑膜炎的患者必须去做CT，转运期间正确的预防措施是什么？A client with bacterial (meningococcal) meningitis must go to CT. Which precaution is correct during transport?
  1. 给患者戴上外科口罩Place a surgical mask on the client
  2. 离开病房后无需特殊预防措施No special precautions once outside the room
  3. 工作人员戴N95呼吸器，患者什么都不戴Staff wear N95 respirators and the client wears nothing
  4. 取消检查，直到隔离结束Cancel the test until isolation ends

答案: A · 给患者戴上外科口罩

脑膜炎球菌性脑膜炎属于飞沫传播；转运期间患者戴外科口罩以阻隔飞沫。N95呼吸器用于结核病等空气传播疾病，而不戴口罩的患者仍会沿转运路线传播飞沫。

Meningococcal meningitis is droplet; the client wears a surgical mask to contain droplets during transport. N95 respirators are for airborne diseases such as tuberculosis, and an unmasked client would still spread droplets along the transport route.

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