?? ??S????????? ?????????? OS ??G? ????O??S

1
?? ??S????????? ?????????? OS ??G? ????O??S
T???O???????? ?F?????? ??, MSc , MHP,
DiplEd ??s??e?t??a ?p?t???s?? ???µ??e?? G.?.
?at??? ? ????? ??d??a?
2
????S
3

• ?????? ??????S?S ??S????O?

• ???S?
• ?µes? epaf?
• ??t??e?s? sta????d???

• ????S?
• ?e???e???
• ??a µ?s?? e??? ?????? a?????
• ??a µ?s?? e??? "?µ?????" d?aß?ßast?.

4
??t??e?s? sta????d??? ap? ft????sµa!!!
???? Jennison, 1942
5
?e???e??? µet?d?s?
??asp???

• ?etaf??? a?????µe??? s?µat?d??? f??t?sµ?v?? µe
  ???µ??????? pa?????te?
• st? a?ap?e?st??? s?st?µa
• e??? ep?de?t???? at?µ??

6
??????µe?a s?µat?d?a

• p????e? - sta????d?a (droplet-nuclei)
• µ????s??p??? ?at????pa p?? p????pt???
• ?ta? e?atµ?st??? ta ???? s?stat???
• t?? sta????d??? t?? ?µes?? µet?d?s??
• "s????" (dust)
• ? d??µet??? t??? p??????e? (0,1-10mm.) ?a?
  ep??e??e? ap?fas?st??? t? ßa?µ? d?e?sd?s?? ?a?
  ?ata???t?s?? t??? st? a?ap?e?st??? d??d??

7

• ? ????? t?? a??a st? µet?d?s? t?? µ??????a??sµ??
  se e??atast?se?? ??e????µ???? pe???a????

8
????G??OS ????????????S ????O???S

• S?ßa?? ??? ??ap?e?st??? S??d??µ? (SARS)
• F?µat??s?
• ??a??
• ??eµ?ß????? ??p?? ??st??a?
• ???µ??e?? ap? Gram ?et????? µ???????a??sµ???
• ( p.?. Staphylococcus aureus , Streptococcus
  pyogenes)
• ??s?? t?? ?e?e??a????
• ????t?a??? ???µ??e??

9
?spe??????s?

• e????t?? e??a?
• ???s??atasta?µ???? as?e?e??
• ?????a ?eo???

• d?aspe??eta?
• ?at? t?? d????e?a ????d?µ???? ?atas?e???
• ?p? ap????µµata pe??ste???? se ae?a??????
• ?p? µ???sµ??a p????t??a ?????
• ?p? ??p? ????

10
?spe??????s?

• Se as?e?e?? µe ?e??a?µ?a ? ?a????? µe de?te???e??
  d?????s? aspe??????s?? pa?at??????e
• 26 µ??e? pe??ss?te?? st? ??s???µe??
• 115,262 a???s? ??st???
• 4 times the mortality rate se s?????s? µe t???
  ?d???? ????? aspergillosis

Dasbach EJ, Davies GM, Teutsch SM. Clin Infect
Dis 2000 31 1524-1528.
11
??a??

• ? ??? t?? ??a???, a? ?a? µetad?deta? ?at? ?a???a
  ?µesa µe sta????d?a, µp??e? ?a ep?ß???e? st??
  a??a ??a s?et??? µe???? ??????? d??st?µa, ?a? ?a
  p???a?e? ?ts? µe???e? ep?d?µ?e?

12
Meschede Hospital ?e???e??? µet?d?s? ???????
Fenner, 1988
13
F?µat??s?

• Me???a sta????d?a

1. ??sp????ta?
2. ??ft??? st? ?daf??
??atµ????ta?
14
???????

• ??t?a e??????
• ?p?µ???s? as?e???
• ?pe???d? a?t???ß???a
• ??d??? f??t?a a??a p?? pa??de???? airborne
  bacteria
• ??s?e?

15
?e???e??? µet?d?s? ap? t??? e??a??µ?????
??e????µ???? pe???a???? st??? as?e?e??

• ?a??????
• Bordetella pertussis ep?d?µ?e? se tµ?µata p??
  ??s??e???ta? pa?d?at????? as?e?e??
• Streptococcus pyogenes
• as?pt?µat???? f???a???a??e???t??? µet?d?s?
• Staphylococcus aureus
• (cloud healthcare provider)

16
(No Transcript)
17
Group A Streptococcus pyogenes (GAS)

• ???µ??e?? ?e?????????? ??s??
• 5 ?p?d?µ?e? GAS p?? s??d???ta? µe t???
  e??a??µ????? ??e????µ???? pe???a????
• ?? pe?????? t?? ap????s?? GAS ????, t?? ???p?,
  ?a? t? d??µa.
• ? µ??a??sµ?? ap? t?? ?p??? t? GAS µetaf??eta?
  ae???e??? de? e??a? e? ????????? saf?? ?a? ?a
  µp????se ?a pe????ße? t?? a??a??µe??
  d?ast????t?ta (14), t?? t??ß? µe t?? ?µat?sµ?
• ?p?d?µ?e? µp????? ?a p???a??s??? a??µ? ?a? t?
  ???at?.

18
Table 2. Hospital group A streptococcal outbreaks
suggesting airborne transmission by asymptomatic
health-care workers Reference Health-care
worker Source of GASa,bPatient population
Infected patients (no.) McKee (14,15) Attendant
Rectum Gynecologic
11 Schaffner
(16)Anesthesiologist Rectum Surgical 20 Berk
elman (17)OR nurse Vagina Surgical 10 Mastro
(18) OR technician ScalpSurgical 20 aGAS air
cultures were all positivebGAS Group A
Streptococcus, OR operating room   
19
????? ???????S
20
1. S?st?µata e?ae??sµ??

• ?e???d???? ??e???? ?a? µ?t??s? t?? p???t?ta? t??
  a??a
• S??t???s? ???µat?sµ?? (a??a?? f??t??? ?.?.p.)
• ?e??sµ?? ?????? ????? , µe?a??te??? ap? 6 a??a???
  a?? ??a s?µpe???aµßa??µe??? µ?a µe µe??µa f??s???
  a??a
• S?st?µata ?a?a??sµ?? f??t??? HEPA (high
  effeciency particulate air)
• Ultraviolet germicidal irradiation ??a t??
  ap?te?esµat??? ap???µa?s? ap? ta pe??ßa????t???
  ae??µetafe??µe?a pa?????a st? ??s???µe??

21
????????S ???????S!!!
22
???G????????? ????

• t? de??µa ep??e??eta? ap?
• ?????t?ta a??a , p?? p?????e? ap? ???aµ? se
  ???aµ? a??? ?a? t?? d??f??e? ??e? t?? ?µ??a?
• ?a ?e?µata a??a p?? ep???at??? se ???e ???aµ?
  ?at? t?? d????e?a t?? de??µat?????a?
• ?????e?a ?a? s????t?ta de??µat?????a?
• ???? ap? t? ?p??a ???eta? a?t?

23
2. ?atas?e???- a?a?a???se?? st??? ?????? pa?????
??e?a?

• ??ep?st?µ????? s??e??as?a
• ??t?µ?s? ???d???? p??? t?? ??a??? t?? e??as???
• ???te????? ?atas?e???
• ?s?te????? ?atas?e???
• F?a?µ??
• ?p?t???s? ?a? de??µat?????a a??a

24

• ????t??? p?es? µ?sa st? ???? e??as?a?
• F??t?a ???? st??? ae?a??????
• ?????f???a e??at?? ?a? ??????.
• Sf????sµa ???? t?? pa?a?????- ????? st?? pe?????
  t?? e??as???
• F?a?µ?? s????? ap? t? p?t?µa µ???? t?? ???f?
• ???? sf???????sµa ? t?? s???pa µe f??t?? a??a

25

3. ?e???e?e?? p??f????e??
26
?O??? ?ST??O?

• T??aµ?? ????t???? ??es??
• ?d?a?te?? ??µ?t?? ??s??e?a? (ap?µ???s?) µe WC
  ?a? D/S, µe p?????aµ?, µe a?e???t?t? s?st?µa
  ae??sµ?? ?a? e?ae??sµ?? (µe f??t?a HEPA ?a? µe 6
  12 e?a??a??? a??a t?? ??a) ?a? µe p??ta ??e?st?
• ??s??e?a µe ?????? as?e?e?? p?? p?s???? ap? t?
  ?d?? ??s?µa se d?µ?t?? µe WC ?a? D/S, µe
  p?????aµ?, µe a?e???t?t? s?st?µa ae??sµ?? ?a?
  e?ae??sµ?? (µe f??t?a HEPA ?a? µe 6 12
  e?a??a??? a??a t?? ??a) ?a? µe p??ta ??e?st?

???? CDC, 1994
27
??s?a ?????? a?ap?e?st???? p??stas?a?
28
???s? p??state?t???? e??p??sµ??

• S?ßa?? ??? ??ap?e?st??? S??d??µ? (SARS)
• ??eµ?ß????? - ??p?? ??st??a? (se
  a??s??atesta?µ?????)
• ??µ???a????? p??et??, p.?. Ebola ?.?.p.

29
S?S ??????S?O!