PDF(Pubmed)
Abstract：
Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28-34 billion annually in the United States alone. There is little understanding as to if current environmental surface disinfection practices reduce pathogen load, and subsequently HAIs, in critical care settings. This evidence map includes a systematic review on the efficacy of disinfecting environmental surfaces in healthcare facilities. We screened 17,064 abstracts, 635 full texts, and included 181 articles for data extraction and study quality assessment. We reviewed ten disinfectant types and compared disinfectants with respect to study design, outcome organism, and fourteen indictors of study quality. We found important areas for improvement and gaps in the research related to study design, implementation, and analysis. Implementation of disinfection, a determinant of disinfection outcomes, was not measured in most studies and few studies assessed fungi or viruses. Assessing and comparing disinfection efficacy was impeded by study heterogeneity; however, we catalogued the outcomes and results for each disinfection type. We concluded that guidelines for disinfectant use are primarily based on laboratory data rather than a systematic review of in situ disinfection efficacy. It is critically important for practitioners and researchers to consider system-level efficacy and not just the efficacy of the disinfectant.
摘要：
医疗保健相关感染（HAIs）导致患者发病率和死亡率，仅在美国，每年估计有170万例感染和99,000例死亡，成本为28-340亿美元。对于当前的环境表面消毒实践是否可以减少病原体负荷，随后HAIs，在重症监护环境中。此证据图包括对医疗机构环境表面消毒效果的系统评价。我们筛选了17064份摘要，635全文，共纳入181篇文章，用于数据提取和研究质量评估。我们回顾了十种消毒剂类型，并比较了研究设计方面的消毒剂，结果有机体，和十四个研究质量指标。我们在与研究设计相关的研究中发现了需要改进的重要领域和差距，实施，和分析。实施消毒，消毒结果的决定因素，在大多数研究中没有测量，很少有研究评估真菌或病毒。评估和比较消毒效果受到研究异质性的阻碍；然而，我们对每种消毒类型的结果和结果进行了分类。我们得出的结论是，消毒剂使用指南主要基于实验室数据，而不是对原位消毒效果的系统回顾。对于从业者和研究人员来说，考虑系统级功效而不仅仅是消毒剂的功效至关重要。
