世卫组织关于在家中护理疑似新型冠状病毒感染患者的指南

原文链接:https://www.who.int/docs/default-source/coronaviruse/20200120-ncov-home-care-infected-patients.pdf

WHO只提供了英文版本,我参考google翻译,整理了中文译本,如下,供参考。

翻译有误之处,或其他任何建议或意见,欢迎留言或PR

Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts Interim guidance
轻度症状的疑似新型冠状病毒(nCoV)感染患者的家庭护理以及接触者管理的临时指导

20 January 2020
WHO/nCov/IPC_HomeCare/2020.1

Preamble 序言

WHO has developed this rapid advice note to meet the need for recommendations on the safe home care for patients with suspected novel coronavirus (2019-nCoV) infection presenting with mild symptoms and public health measures related to management of asymptomatic contacts.

世卫组织发布此快速建议说明,旨在满足对轻度症状的疑似新型冠状病毒(2019-nCoV)感染患者的安全家庭护理和和无症状接触者管理相关的公共卫生措施提出建议的需求。

The document is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care: WHO interim guidance (1), and based on the current information available regarding the 2019-nCoV infection.

该文件以世卫组织发布的循证指南为依据,包括预防感染和控制易流行和大流行的急性呼吸道疾病:WHO临时指南(1),并基于当前已知的有关2019-nCoV感染的信息。

This document is adapted from the original version addressing MERS-CoV, which was published in June 2018.

本文档改编自MERS-CoV的原始版本,该版本于2018年6月发布。

This rapid advice is intended for public health and infection prevention and control (IPC) professionals, health care managers, and health care workers. WHO continues to monitor the situation closely for any new data that may warrant revision of the contents of this rapid advice note.

此快速建议适用于公共卫生和感染预防与控制(IPC)专业人员,医护管理者和工作者。 世卫组织继续密切监测局势,寻找可能需要修改本快速咨询意见内容的任何新数据。

Please refer to the following document for 2019-nCoV case definition.: https://www.who.int/publications-detail/surveillance-case-definitions-for-human-infection-with-novel-coronavirus-(ncov)

有关2019-nCoV定义,请参考以下文档:https://www.who.int/publications-detail/surveillance-case-definitions-for-human-infection-with-novel-coronavirus-(ncov)

Home care for patients with suspected 2019-nCoV infection presenting with mild symptoms 轻度症状的疑似2019-nCoV感染患者的家庭护理

In view of the currently limited knowledge of the disease caused by 2019-nCoV infection and its transmission patterns, WHO recommends that suspected cases of 2019-nCoV infection be isolated and monitored in a hospital setting. This would ensure both safety and quality of health care (in case patients’ symptoms worsen) and public health security.

鉴于目前对由2019-nCoV感染引起的疾病及其传播方式的了解有限,世卫组织建议在医院内隔离和监测2019-nCoV感染的可疑病例。 这将确保医疗的安全性和质量(以防患者症状恶化)和公共卫生安全。

However, for several possible reasons, including situations when inpatient care is unavailable or unsafe (i.e. limited capacity and resources unable to meet demand for health care services), or in a case of informed refusal of hospitalization, alternative settings(1) for health care provision may need to be considered.

但是,由于多种可能的原因,包括无法提供住院治疗或住院环境不安全的情况(如,能力和资源有限,无法满足医护需求),又或者在被拒绝住院,那就可能需要考虑医疗护理的替代措施(1) 。

If such a reason exists, patients with mild symptoms(2) and without underlying chronic conditions such as lung or heart disease, renal failure, or immunocompromising conditions that place him/her at increased risk of developing complications may be cared for in the home environment. The same principle of care in the home environment applies to symptomatic patients no longer requiring hospitalization. This decision requires careful clinical judgment and should be informed by assessing the safety of the patient’s home environment(3).

如果存在这种情况,症状轻微的患者(2)并且没有潜在的慢性疾病,例如肺或心脏病,肾衰竭或免疫功能低下等可能使他/她出现并发症的风险增加的疾病,则可以在家庭环境中护理。 家庭环境中的相同护理原则适用于不再需要住院治疗的有症状患者。 该决定需要仔细的临床判断,并应通过评估患者家庭环境的安全性来确定(3)。

A communication link with a health care provider should be established for the full duration of the home care period until the patient fully recovers. Health care personnel should be involved in reviewing the current health status for the progression of symptoms (3) of contacts by phone and, ideally and if feasible, by face-to-face visits on a regular (e.g. daily) basis, performing specific diagnostic tests as necessary.

在整个家庭护理期间,应与医疗机构的保持通信,直到患者完全康复为止。 医护人员应通过电话了解症状进展及当前健康状况(3),理想情况下(如果可行)定期(例如每天)面对面拜访,进行特定的诊断、根据需要进行测试。

In addition, the patients and the household members should be educated on personal hygiene, basic infection prevention and control measures, on how to care for the suspected infected member of the family as safely as possible, and to prevent spread of infection to household contacts. The patient and family should be provided with ongoing support, education and monitoring. They should adhere to the following recommendations.

此外,应该对患者和家庭成员提供如下教育,包括有关个人卫生,基本感染预防和控制措施,以及如何尽可能安全地照顾疑似患者家庭成员,并防止感染传播到家庭接触者。 应为患者及其家人提供持续的支持,教育和监控。 他们应遵守以下建议。

• Place the patient in a well-ventilated single room.
•将患者安置在通风良好的独立房间。

• Limit the number of caretakers of the patient, ideally assign one person who is in a good health without risk conditions. No visitors.
•限制患者的看护人数,理想情况下分配一名身体健康且无风险的人。 拒绝访客。

• Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 m from the ill person (e.g. sleep in a separate bed)(4) .
•家庭成员应留在不同的房间,或者,如果不可能,请与患病者保持至少1 m的距离(例如,在单独的床上睡觉)(4)。

• Limit the movement of the patient and minimize shared space. Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (e.g. keep windows open).
•限制患者的活动并最小化共享空间。 确保共享空间(例如厨房,浴室)通风良好(例如保持窗户打开)。

• The caregiver should wear a medical mask fitted tightly to the face when in the same room with the ill person. Masks should not be touched or handled during use. If the mask gets wet or dirty with secretions, it must be changed immediately. Discard the mask after use and perform hand hygiene after removal of the mask.
•与患病者在同一房间时,看护者应佩戴紧贴面部的医用口罩。 使用过程中请勿触摸或操作口罩。 如果口罩被分泌物弄湿或弄脏,必须立即更换。 使用后请丢弃口罩,并在取下口罩后进行手部卫生。

• Perform hand hygiene (2) following all contact with ill persons or their immediate environment. Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. If hands are not visibly soiled, alcohol-based hand rub can be used. Perform hand hygiene using soap and water when hands are visibly soiled. Address safety concerns (e.g. accidental ingestion and fire hazards) before recommending alcohol-based hand rubs for household use.
•与患病者或其周围环境接触后,要进行手部卫生(2)。 在准备食物前后,饭前便后以及手脏时也应进行手卫生。 如果没有明显弄脏手,则可以使用酒精基的手霜。 明显弄脏手时,用肥皂和水进行手部清洁。 在建议家庭使用酒精基擦手液之前,请解决安全隐患(例如意外摄入和火灾隐患)。

• When using soap and water, disposable paper towels to dry hands is desirable. If not available, use dedicated cloth towels and replace them when they become wet.
•使用肥皂和水时,最好用一次性纸巾擦干手。 如果没有,请使用专用的毛巾擦干,并在变湿时进行更换。

• Respiratory hygiene should be practiced by all, especially ill persons, at all times. Respiratory hygiene refers to covering the mouth and nose during coughing or sneezing using medical masks, cloth masks, tissues or flexed elbow, followed by hand hygiene.
•所有人,尤其是患病者,应始终保持呼吸卫生。 呼吸卫生是指在咳嗽或打喷嚏时使用医用口罩,布口罩,或弯曲肘部遮住口鼻,然后进行手部卫生。

• Discard materials used to cover the mouth or nose or clean them appropriately after use (e.g. wash handkerchiefs using regular soap or detergent and water).
•丢弃用于遮盖口或鼻的材料,或在使用后适当清洁它们(例如,使用常规肥皂或清洁剂和水清洗手帕)。

• Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves to provide oral or respiratory care and when handling stool, urine and waste. Perform hand hygiene before and after removing gloves.
•避免直接接触体液,尤其是口腔或呼吸道分泌物和粪便。 处理粪便,尿液和废物时,请使用一次性手套保护口腔或呼吸系统。 脱下手套前后,都要进行手卫生。

• Gloves, tissues, masks and other waste generated by ill persons or in the care of ill persons should be placed in a lined container in the ill person’s room before disposal with other household waste.(4)
•在与其他家庭垃圾一起处置之前,患者产生或在患者护理下产生的手套,薄纸,口罩和其他废物应放在带衬里的容器中,并放在患者房间内。(4)

• Avoid other types of possible exposure to ill persons or contaminated items in their immediate environment (e.g. avoid sharing toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen). Eating utensils and dishes should be cleaned with either soap or detergent and water after use and may be re-used instead of being discarded.
•避免接触周围环境中其他类型的可能的暴露给病人或受污染的物品(例如,避免与他人共用牙刷,香烟,饮食用具,餐具,饮料,毛巾,浴巾或床单)。 饮食用具和餐具使用后应用肥皂或清洁剂和水清洗,并可以重复使用而不是丢弃。

• Clean and disinfect frequently touched surfaces such as bedside tables, bedframes, and other bedroom furniture daily with regular household disinfectant containing a diluted bleach(5) solution (1-part bleach to 99 parts water).
•每天使用含有稀释的漂白剂(5)溶液(1份漂白剂至99份水)的常规家用消毒剂清洁和消毒经常触摸的表面,例如床头柜,床架和其他卧室家具。

• Clean and disinfect bathroom and toilet surfaces at least once daily with regular household disinfectant containing a diluted bleach(6) solution (1-part bleach to 99 parts water).
•每天至少使用含稀释的漂白剂(6)溶液(1份漂白剂至99份水)的常规家用消毒剂清洁和消毒浴室和卫生间的表面。

• Clean clothes, bedclothes, bath and hand towels, etc. of ill persons using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid direct contact of the skin and clothes with the contaminated materials.
•使用常规的洗衣皂和水或在60–90°C下用普通的家用洗涤剂机洗,清洁病人的衣服,床单,浴室和毛巾等,并彻底干燥。 将受污染的内衣裤放入洗衣袋中。 请勿摇动脏污的衣物,并避免皮肤和衣服直接与被污染的材料接触。

• Use disposable gloves and protective clothing (e.g. plastic aprons) when cleaning or handling surfaces, clothing or linen soiled with body fluids. Perform hand hygiene before and after removing gloves.
•清洁或处理被体液弄脏的表面,衣服或内衣时,请使用一次性手套和防护服(例如塑料围裙)。 脱下手套前后,都要进行手卫生。

• Persons with symptoms should remain at home until their symptoms are resolved based on either clinical and/or laboratory findings (two negative RT-PCR tests at least 24 hours apart).
•有症状的人应待在家里,直到根据临床和/或实验室检查结果消除症状为止(两次间隔至少24小时的RT-PCR阴性)。

• All household members should be considered contacts and their health should be monitored as described below.
•应将所有家庭成员视为接触者,并应按照以下说明对其健康进行监控。

• If a household member develops symptoms of acute respiratory infection, including fever, cough, sore throat and difficult breathing, follow public health recommendations below.
•如果家庭成员出现急性呼吸道感染症状,包括发烧,咳嗽,喉咙痛和呼吸困难,请遵循以下公共卫生建议。

Healthcare workers providing home care should do risk assessment to select the appropriate PPE.
提供家庭护理的医护人员应进行风险评估,以选择合适的个人防护装备。

Management of contacts 接触者管理

In view of the limited evidence of human-to-human transmission of 2019-nCoV, persons (including health care workers) who may have been exposed to individuals with suspected 2019-nCoV infection should be advised to monitor their health for 14 days from the last day of possible contact and seek immediate medical attention if they develop any symptoms, particularly fever, respiratory symptoms such as coughing or shortness of breath, or diarrhoea.
鉴于2019-nCoV人际传播的证据有限,应建议可能接触2019-nCoV感染者的人(包括医护人员)自最后可能感染之日起14天监测其健康状况。 如果有任何症状,尤其是发烧,呼吸道症状,如咳嗽或呼吸急促或腹泻,请寻求医疗帮助。

A communication link with a health care provider should be established for the duration of the observation period. Health care personnel should be involved in reviewing the current health status of the contacts by phone and, ideally and if feasible, by face-to-face visits on a regular (e.g. daily) basis, performing specific diagnostic tests as necessary.
在观察期内应与医疗机构保持通信联系。 医护人员应电话复查接触者当前健康状况,理想情况下(如果可行)应定期(例如每天)面对面拜访,必要时进行特定的诊断测试。

The healthcare provider should give advance instructions on where to seek care when a contact becomes ill, what should be the most appropriate mode of transportation, when and where to enter the designated health care facility, and what infection control precautions should be followed.
医疗机构应预先提供以下指示:接触者生病时应在何处寻求医疗服务;最合适的运输方式;何时何地应进入指定的医疗保健机构;应遵循哪些感染控制预防措施。

• Notify the receiving medical facility that a symptomatic contact will be coming to their facility.
•通知接收医疗机构有症状接触者将来到他们的机构。

• While traveling to seek care, the ill person should wear a medical mask.
•在寻求护理途中,病人应戴好医用口罩。

• Avoid public transportation to the health care facility, if possible; call an ambulance or transport the ill person with a private vehicle and open the windows of the vehicle if possible.
•尽可能避免乘坐公共交通工具前往医疗机构; 叫救护车或用私家车运送病人,并尽可能打开车窗。

• The ill contact should be advised to always perform respiratory hygiene and hand hygiene; stand or sit as far away from others as possible (at least 1 m), when in transit and when in the health care facility.
•应建议病者始终保持呼吸系统卫生和手部卫生; 在运输途中或在医疗机构中时,应站立或坐在尽可能远的地方(至少1 m)。

• Appropriate hand hygiene should be employed by the ill contact and caregivers.
•病患接触者和护理人员应采取适当的手部卫生措施。

• Any surfaces that become soiled with respiratory secretions or body fluids during transport should be cleaned and disinfected with regular household containing a diluted bleach solution(6) (1-part bleach to 99 parts water).
•在运输过程中被呼吸道分泌物或体液弄脏的任何表面,应使用含有稀释漂白剂溶液(6)(1份漂白剂至99份水)的普通家庭清洁剂进行清洁和消毒。

Acknowledgements 致谢

This rapid guidance is based on the MERS-CoV document which was developed in consultation with the WHO Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in the development and updates of IPC documents for MERS-CoV.
该快速指南基于与世界卫生组织全球感染预防和控制网络及其他国际专家协商制定的MERS-CoV文件。 世卫组织感谢那些参与为MERS-CoV编写和更新IPC文件的人们。

References

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  2. WHO guidelines on hand hygiene in health care. Geneva: World Health Organization; 2009 (WHO/IER/PSP/2009/01; http://apps.who.int/iris/handle/10665/44102, accessed 13 June 2018).

Further References

Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/15.2 Rev.1; http://www.who.int/csr/disease/coronavirus_infections/management_of_asymptomatic_patients/en/, accessed 13 June 2018).

Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance. Geneva: World Health Organization; 2015 (WHO/MERS/Clinical/15.1; http://www.who.int/csr/disease/coronavirus_infections/case-management-ipc/en/, accessed 14 June 2018).

Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance: Geneva: World Health Organization; 2015 (WHO/MERS/IPC/15.1; http://apps.who.int/iris/handle/10665/174652, accessed 14 June 2018).

Infection prevention and control of epidemic- and pandemic- prone acute respiratory infections in health care: WHO guidelines. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/handle/10665/112656, accessed 14 June 2018).

Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 14 June 2018).

Laboratory testing for Middle East respiratory syndrome coronavirus: interim guidance (revised). Geneva: World Health Organization; 2018 (WHO/MERS/LAB/15.1/Rev1/2018; http://www.who.int/csr/disease/coronavirus_infections/mers-laboratory-testing/en/, accessed 14 June 2018).

Investigation of cases of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance. Geneva: World Health Organization; 2015 (WHO/MERS/SUR/15.2; http://www.who.int/csr/disease/coronavirus_infections/mers-investigation-cases/en/, accessed 14 June 2018).

Surveillance for human infection with Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance. Geneva: World Health Organization; 2015 (WHO/MERS/SUR/15.1; http://www.who.int/csr/disease/coronavirus_infections/surveillance-human-infection-mers/en/, accessed 14 June 2018).

Memish ZA, Zumla AI, Al-Hakeem RF, Al-Rabeeah AA, Stephens GM. Family cluster of Middle East respiratory syndrome coronavirus infections. N Engl J Med. 2013;368(26):2487–94. doi: 10.1056/NEJMoa1303729. (http://www.ncbi.nlm.nih.gov/pubmed/23718156).

Mailles A, Blanckaert K, Chaud P, van der Werf S, Lina B, Caro V et al. First cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in France, investigations and implications for the prevention of human-to-human transmission, France, May 2013. Euro Surveill. 2013;18(24):ii(http://www.ncbi.nlm.nih.gov/pubmed/23787161, accessed 13 June 2018).

Hijawi B, Abdallat M, Sayaydeh A et al. Novel coronavirus infections in Jordan, April 2012: epidemiological findings from a retrospective investigation. East Mediterr Health J. 2013;19(Suppl 1):S12–8 (http://applications.emro.who.int/emhj/v19/Supp1/EMHJ_2013_19_Supp1_S12_S18.pdf, accessed 13 June 2018).

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Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Diseases. 2013;17(9):e668-72. https://doi.org/10.1016/j.ijid.2013.07.001.

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1 These includes home settings.

2 Low-grade fever, cough, malaise, rhinorrhoea, sore throat without any warning signs, such as shortness of breath or difficulty in breathing, increased respiratory (i.e. sputum or haemoptysis), gastro-intestinal symptoms such as nausea, vomiting, and/or diarrhoea and without changes in mental status (i.e. confusion, lethargy).

3 A sample checklist is available on page 53 of Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care: (1).

4 An exception may be considered for a breastfeeding mother. Considering the benefits of breastfeeding and insignificant role of the breast milk in transmission of other respiratory viruses, the mother could continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform careful hand hygiene before close contact with the baby. She would need also to apply the other hygienic measures described in this document.

4 Countries may consider measures to ensure that the waste is disposed at a sanitary landfill, and not at an unmonitored open dump, wherever possible. Additional measures may be needed to prevent unhygienic reuse of gloves, masks, syringes and other items, and other hazards occurring from scavenging at waste disposal sites.

5 Most household bleach solutions contain 5% sodium hypochlorite.
5 大多数家用漂白剂溶液都含有5%的次氯酸钠。