【Cochrane简语概要】穿戴手套、长袍或口罩后，接触带有对普通抗生素有抗药性的金黄色葡萄球菌的住院患者的影响

什么是MRSA，为什么这是医院中的问题？

MRSA代表“耐甲氧苯青霉素-（或耐甲氧西林-）金黄色葡萄球菌”。这是一种常见的细菌（金黄色葡萄球菌），它不再被甲氧苯青霉素（也称为“甲氧西林”，一种抗生素）或其他常用于治疗感染的抗生素杀灭。MRSA可以生活在人体内，而不会使人生病，并且不表现出任何症状，但是当它感染患者时就危险了。

在医院里，MRSA很容易从一个患者身上转移到另一个患者身上，并且导致严重的感染，甚至可能导致死亡。这种传播主要通过卫生保健工作者，通过医护人员的手、衣服或设备在MRSA患者的日常护理中被MRSA污染以传播。受污染的手、衣服或设备与其他患者的后续接触，会令MRSA在医院内传播。

（图片来源于网络）

为什么使用手套、长袍或口罩有助于防止院内患者之间传播MRSA？

戴一次性手套，穿或不穿一次性或可清洗的防护服，都有可能阻止MRSA的传播，因为它们可以保护医护人员的手和衣服不被MRSA污染。在一个患者得到护理后，手套和长袍将被丢弃，而干净的手套和长袍则用来诊断下一个患者。戴口罩也可以防止MRSA在空气中传播。

目前尚不清楚，在单独穿戴手套、长袍或口罩时，是否会减少MRSA的传播，将这三种方法中的两种或全部结合使用是否会产生更好的效果。

这项研究的目的和研究人员的发现

研究人员旨在查明，医院内任何接触被发现有MRSA的患者的人（例如医生），都穿戴手套、长袍或口罩，是否可以防止MRSA从该患者传染给医院中的其他人。

研究人员对截至2015年6月的医学文献进行了广泛的检索，但没有发现任何针对这一主题的严谨研究。

目前，没有科学证据表明，与MRSA患者接触的人穿戴手套、长袍或口罩会减少MRSA在医院向其他人传播。但是，这不能被解释为表明手套、长袍或口罩无效；这意味着，测量效果所需的研究（如果有的话）尚未完成。

结论: 

我们没有发现任何研究来评价，与MRSA住院患者接触或在其直接环境中的人，穿戴手套、长袍或口罩，对MRSA向患者、医院工作人员、患者护理人员或访客传播的影响。这种证据的缺乏不应被解释为这些干预措施没有效果的证据。在这种情况下，手套、长袍和口罩的影响还有待严格的试验研究来确定，例如涉及多个病房或医院的整群随机试验，或中断时间序列研究。

译者：朱思佳，审校：刘雪寒、鲁春丽；编辑排版：张晓雯、刘美迪，北京中医药大学循证中心

相关文章链接

减少感染与疫苗预防——

急症治疗——

其他呼吸道疾病的诊疗——

【Cochrane Plain Language Summary】Use of gloves, a gown or a mask for contact with hospitalised patients with Staphylococcus aureus resistant to a common antibiotic (MRSA)

What is MRSA, and why is it a problem in hospitals?

MRSA stands for 'meticillin‐ (or methicillin‐) resistant Staphylococcus aureus'. This is a common type of bacterium (Staphylococcus aureus) that is no longer killed by meticillin (also known as 'methicillin', an antibiotic) or other antibiotics that are frequently used to treat infections. MRSA can live on people without making them ill, and without them showing any symptoms, but is dangerous when it infects people who are unwell. 

MRSA is easily transferred from one patient to another in hospitals, where it causes severe infections and can cause death. This transmission occurs mainly through healthcare workers when their hands, clothes, or equipment become contaminated with MRSA during routine care of patients who have MRSA. Later contact of the contaminated hands, clothes or equipment with other patients allows MRSA to spread within the hospital.

Why might use of gloves, gowns or masks help prevent transmission of MRSA between patients in hospitals?

It is possible that the use of disposable gloves with or without the use of disposable or washable gowns could prevent transmission of MRSA, as they would protect the healthcare workers' hands and clothes from becoming contaminated with MRSA. The gloves and gowns would be discarded after one patient had been cared for, and clean ones used to visit the next patient. The use of masks might also prevent spread of MRSA through the air. 

It is not known whether use of gloves, gowns or masks reduces the spread of MRSA when they are used individually, or whether combining two of the three, or all three, produces better results.

The aim of this research and what the researchers found

The researchers aimed to find out whether the use of gloves, a gown or a mask by any person in the hospital (for example, a doctor) getting close to a patient found to have MRSA prevents the transmission of MRSA from this patient to other people in the hospital. 

The researchers made a wide search of the medical literature, up to June 2015, but did not find any rigorous studies that addressed this topic. 

At present there is no scientific evidence that the wearing of gloves, a gown, or a mask by people getting close to patients with MRSA reduces the transmission of MRSA to other people in the hospital. However, this should not be interpreted as demonstrating that gloves, gowns or masks are not effective; it means that the research that would be required to measure an effect ‐ if there is one ‐ has not been done yet.

Authors' conclusions:

We found no studies assessing the effects of wearing gloves, gowns or masks for contact with MRSA hospitalised patients or with their immediate environment on the transmission of MRSA. Thus, we cannot conclude on the impact of these interventions in hospitalised patients (in terms of healthcare‐associated MRSA colonisations, infections, bacteraemias, or pneumonias, or mortality attributable to MRSA), or in hospital staff, patients' caregivers or visitors (in terms of healthcare‐associated MRSA colonisations or prevalence of carriers of MRSA). 

This absence of evidence of an effect for these interventions should not be interpreted as the evidence of no effect; it means that research that would have been eligible for inclusion in this review has not been conducted.

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