活动性肺结核患者居家治疗感染控制的意见和建议

Suggestions on infection control of active pulmonary tuberculosis patients treated at home

活动性肺结核患者在没有进行抗结核药物治疗前具有传染性,住院治疗是患者及其家庭的理想选择。《北京市朝阳区涂阳肺结核患者住院隔离治疗的影响因素研究》显示,76.83%的涂阳肺结核患者没有选择住院治疗,对其共同居住和生活的密切接触者造成健康威胁。近年来,我国在结核感染控制方面做了一些工作,开展了一系列培训和调查研究,但是针对居家治疗的肺结核患者如何进行感染控制,目前无论国外还是国内尚无系统性的指南或文件。2018年受北京市科学技术委员会委托资助,本课题组组织国家和地方肺结核预防控制、临床、管理、护理等领域专家撰写《活动性肺结核患者居家治疗感染控制的意见和建议》,经过三轮会议专家咨询、一轮电子邮件专家咨询形成此文。作者简要介绍了活动性肺结核患者及其密切接触者居家治疗管理感染控制的要求和建议,包括患者居家治疗的隔离、咳嗽礼仪、口罩的佩戴、外出感染控制、洗手、居所设置与通风、日常消毒等;对本建议不足之处进行了说明,对未来发展前景进行了展望。

Active pulmonary tuberculosis (APTB) patients are highly infectious before anti-TB drugs are administered, and hospitalization is ideal for patients and their families. They are the main source of TB infection. However, the article “Factors affecting the hospitalization treatment of smear positive pulmonary tuberculosis patients in Chaoyang District, Beijing” shows that 76.83% of smear-positive tuberculosis patients do not choose hospitalization, which poses a health threat to their close contacts living together. In recent years, China has done some work in tuberculosis infection control, and carried out a series of training and research. However, there are no systematic guidelines or documents on how to carry out infection control for tuberculosis patients treated at home in China or abroad. Therefore, authorized by Beijing Science and Technology Commission in 2018, we organized national and local experts in tuberculosis prevention and control, clinical, management, nursing and other fields to draft “Suggestions on infection control of active pulmonary tuberculosis patients treated at home”, which were formed through three rounds of expert consultation and one round of email expert consultation. This article briefly introduces the infection control requirements and suggestions of home treatment management for active pulmonary tuberculosis patients and their close contacts, including isolation of patients, cough etiquette, wearing of masks, infection control of patients going out, hand washing, home setting and ventilation, daily disinfection, etc. At the end of the article, the limitations of this proposal are explained, and the future development are also prospected.