药学热点话题：ASHP优势：小型与乡村医院如何遵循USP第797章

欢迎收听ASHP Advantage播客，与ASHP官方专家对话，聚焦药学与医疗保健领域的最新议题，对话顶尖从业者。

Welcome to the ASHP Advantage podcast, engaging the experts on ASHP official, featuring conversations with top level practitioners about the latest issues in pharmacy and health care.

感谢您参与本期药学热点话题讨论，我们将与内容专家深入交流，探讨当前药学领域最受关注的问题。

Thanks for joining us in this episode of pharmacy hot topics, where we sit down with content matter experts and discuss what is currently top of mind in the world of pharmacy.

我是迈克·加尼欧。

My name is Mike Gagneux.

我担任ASHP药学实践与质量高级总监，今天与我同台的还有卡地纳健康集团认证与用药安全总监帕蒂·基恩利，以及马萨诸塞州橡树崖镇玛莎葡萄园医院无菌复合指定人员、临床肿瘤药剂师奥克特·莫托哈里。

I'm senior director of pharmacy practice and quality with ASHP, and I'm joined by Patty Keanely, director of accreditation and medication safety at Cardinal Health, and Orkut Motohari, who's a sterile compounding designated person and clinical oncology pharmacist at Martha's Vineyard Hospital in Oak Bluffs, Massachusetts.

本期节目属于ASHP Advantage播客系列《专家对话》的一部分，该系列致力于与顶尖从业者进行深度访谈。

Today's episode is part of the ASHP Advantage podcast series, Engaging the Experts, featuring conversations with top level practitioners.

本节目由美国辉瑞公司赞助，内容仅供信息参考，不提供继续教育学分认证。

This episode is supported by Pfizer Incorporated USA and is for informational purposes and not approved for continuing education credit.

感谢各位今天的参与。

Thanks for joining us today.

让我们开始讨论今天的主题：小型及乡村医院如何遵守USP第797章标准。

Let's get started talking about today's topic, compliance with USP Chapter seven ninety seven in Small and Rural Hospitals.

奥克特、帕蒂，欢迎二位。

Orchid, Patty, welcome.

谢谢。

Thank you.

谢谢。

Thank you.

那么在全面采用新797章标准的过程中，哪些方面对小型和乡村医院构成了挑战？

So what areas pose a challenge to small and rural hospitals on their way to fully adopt the new seven ninety seven standards?

谢谢你，迈克。

Thank you, Mike.

毫无疑问，乡村医院是美国数千个小社区的生命线，但不幸的是，这些机构日益严重的财政困难已是众所周知的事实，也是建设和运营一个完全合规的无菌配药设施的重大障碍。

There is no doubt that rural hospitals are the lifeline for thousands of small communities in America, but, unfortunately, increasing financial difficulties of these institutions are a known fact and a significant barrier to building and having a fully compliant sterile compounding facility.

空间有限和基础设施老化是另一个挑战。

Limited space and aging infrastructure is another challenge.

建造或扩建无菌配药设施通常需要对现有过时的结构和工程进行彻底改造。

Building or expanding a sterile compounding facility often requires making extreme makeovers to existing outdated structures and engineering.

此外，仅由一人运营的小型医院药房并不罕见。

Also, small hospital pharmacies that operate with only one person are not uncommon.

即便不是单人运营，他们也只有一小群接受过跨领域培训的员工，需要时能迅速转换工作角色。

If not, they have a small group of staff that are cross trained in multiple areas and expected to switch gears quickly when needed.

为因生病或未能通过能力评估而无法配药的员工寻找替补，意味着要从全院药物分发或订单审核工作中抽调人手，这种多米诺效应有时最终会导致药房主任亲自顶岗。

Finding coverage for staff member who cannot compound due to sickness or failing competency evaluation means, pulling another from hospital wide medication distribution or order verification activities with a domino effect sometimes ends ending with pharmacy director stepping in.

这类医院通常没有受过专业培训的内部专家来支持无菌配药操作，特别是在感染控制、技术和工程方面。

These types of hospitals often do not have in house experts who are trained and specialized in supporting sterile compounding operations, especially in terms of infection control, technology, and engineering.

因此，这些服务有时会外包，但高昂的成本以及对服务质量和监管合规性的担忧，又带来了额外的财务和监管压力。

As a result, these services are sometimes outsourced, but the high cost and concerns over quality control and regulatory compliance of these services are an add on financial and regulatory pressure.

最后，这些医院主要位于偏远地区，有时甚至难以到达。

Lastly, these hospitals are primarily located in remote and sometimes hard to access areas.

以玛莎葡萄园岛为例，这个岛屿只能通过飞机或渡船抵达，天气问题可能导致通行延误，严重影响外部供应商执行的时间敏感性任务。

In the case of Martha's Vineyard, an island only accessible by air or ferry, Weather issues can cause access delays that significantly impact time sensitive tasks performed by outside vendors.

对于偏远地区的乡村医院来说，无菌配药操作因意外事件或机械故障而停摆，通常意味着35英里甚至更大半径范围内唯一的无菌配药设施将无法使用。

For rural hospitals in remote areas, the sterile compounding operations shutdown due to excursions or mechanical failure often means the only sterile compounding facility within a 35 miles radius or greater is out of commission.

我们这里有一些有趣的观点，我认为许多听众可能不会考虑到，除非他们身处类似的情况。

We have some interesting points there that I think many of our listeners probably don't consider unless they're in a similar situation.

你知道吗，我发现一件有趣的事，如果你熟悉ASHP全国医院药学实践调查，我们的调查会对全国医院进行抽样。

You know, one thing I have found interesting, if you're familiar with the ASHP National Survey of Hospital Pharmacy Practice, we do a sampling of of hospitals across the country for our survey.

其中一个显著的统计数据是，美国约半数非联邦医院的床位数在50张或更少。

And one of the remarkable statistics is that about half of the hospitals in The US, non federal hospitals, are 50 bed or smaller.

因此我认为很多人低估了这些地区医疗服务规模之小和乡村化程度之高。

And so I think it's probably underappreciated just how small and rural most of our health care delivery is in a lot of these areas.

帕蒂，对此有什么看法吗？

Patty, any thoughts there?

是的，我在小型医院发现的其他特点是，特别是在门诊方面，许多小型乡村医院的输液中心规模堪比中等城市的中型医院。

Yeah, I mean, some of the other things that I've found with small hospitals is, especially on the ambulatory side, it's there are plenty of small and rural hospitals that have as large infusion centers as a medium sized hospital in a good sized city.

所以我们没有意识到每个人都应该遵循相同的标准，对吧？

So we don't realize the fact that everybody needs to be practicing from the same standards, right?

因此我们不能认为这些小型医院的人没有开展工作，因为他们确实在做。

So we can't expect that people aren't doing things in these smaller hospitals because they are.

我的意思是，这是相当重要的事情。

I mean, it's a pretty significant thing.

所以需要平衡这一点与即时使用制剂的需求，因为很多地方并非24/7都有人值班。

So balancing that with the need for more immediate use preparations, for example, because a lot of places aren't staffed 20 fourseven.

他们可能每周七天都有人值班，但小型医院很少会在夜间安排专人驻守。

They may be staffed seven days a week, but very rarely will a small hospital have somebody physically on staff there at night.

因此我们也需要将所有这些其他从业人员纳入797标准中。

So we need to include all of those other practitioners in the seven ninety seven standards as well.

不仅仅是护理工作。

And it's not just nursing.

例如，还包括影像学和麻醉学等部门，任何可能需要调配无菌制剂的学科都必须纳入其中。

It's people like imaging and anesthesia, for example, and any of those other disciplines that may be mixing sterile preparations have to be included in this.

是的，说得很对，佩蒂。

Yeah, very good points, Patty.

那么，奥琪德，面对你描述的所有这些挑战，你们医院是如何为章节修订做准备的？

So Orchid, given all of those challenges that you described, how did your hospital prepare for the chapter revisions?

简而言之，我们建造了一个洁净室。

The short answer is that we built a clean room.

早在2019年动工新建洁净室之前，我们多年来都各自拥有独立的配药区。

And we each had a segregated compounding area for years before breaking ground for a new clean room in 2019.

从最初设计到迁入新空间，洁净室建设项目历时约三年，其中包括2020年的暂停期。

From initial design to moving into our new space, the clean room construction project lasted about three years, including a pause in 2020.

在过渡到新洁净室的三年间，我们制定了USP797要求的政策和流程，并安排员工作为洁净室培训和教学的一部分进行学习。

During the three years before transitioning to our new clean room, we developed the required USP seven nine seven policies and procedures and assigned them to staff to study as part of their clean room training and didactics.

我们对CSP进行了全面审查，准备了MBH，并开发了最终整合到洁净室远程药师验证系统中的配方手册。

We performed a comprehensive review of CSPs, prepared an MBH, and developed the recipe book that was eventually incorporated into our, clean room remote pharmacist verification system.

更新了每个配方的BUD以符合USP修订版，并将SCA标准改为ISO分级洁净室。

BUDs for each recipe were updated to reflect USP revisions and changed from SCA to ISO classified clean rooms.

在施工的最后阶段，员工们在新设施中模拟工作流程，演练不同的无菌配制场景，如物料和人员流动、更衣、清洁等。

During the final phases of construction, staff toward the new facility, practice the workflow, stimulated different sterile compounding scenarios such as, material and people movement, garbing, cleaning.

在完成初始清洁和认证后，我们还在新洁净室进行了一轮员工能力评估。

And after the initial cleaning and certification, we also performed a round of staff competency evaluation in the new clean room.

我们目前正通过与护理管理部门和教育工作者密切合作，推进年度护理能力评估工作。

We are currently in the process of rolling out our annual nursing competencies by working closely with nursing management and nursing educators.

遗憾的是，在准备修订过程中也遇到了一些挑战。

Unfortunately, there were also challenges in preparing for the revisions.

回想起来，我们应该在洁净室信息通信技术的安装和部署上投入更多时间。

In retrospect, more time should have been dedicated to the installation and rollout of information and communication technology in our clean room.

另一个问题是药房与暖通团队之间的沟通不足，这对于建立和维护洁净室环境因素的微妙平衡至关重要。

Another issue was shortcomings in communication between pharmacy and HVAC teams, which is, crucial in creating and maintaining the delicate balance of environmental factors in a clean room.

嗯。

Yeah.

有些我觉得可以称之为创新解决方案的有趣点子。

Some interesting I I would call them innovative solutions there.

比如在完成洁净室时对人员和物料流动进行模拟，这确实是个好主意，对其他开设新空间的人可能也很有帮助。

Like, the the simulation of movement and and materials as you're finishing the clean room is that's actually a really good idea and probably helpful for others who are opening up a new space.

帕蒂，你有什么想法吗？

Patty, any thoughts?

是的。

Yeah.

你知道，就是遇到些类似的情况。

You know, just some of the same kind of situations.

奥基德，你一开始提到了一些老化设施的问题。

Orkid, you mentioned at the beginning about some of the aging facilities.

我经常看到的情况是，人们没有意识到我们对某些设备（比如空气处理系统）所需的技术复杂度。

And that's something I see pretty frequently is that people don't realize the sophistication that we need for some of these things air handling, for example.

正如你提到的Orkut往事，我认为让人们了解那些障碍和绊脚石非常重要，这样他们才能提前做好规划。

So often, those things that you mentioned, Orkut, that you look back on, I think that's really important for people to know what those barriers were and what those stumbling blocks were so that they can plan ahead for that.

而你很幸运地具备了前瞻性思维，并为此做了规划。

And you, fortunately, were very, you know, forward looking and planning this.

现在很多人还在努力追赶这种思维。

And a lot of people now are just kind of catching up to that.

所以那些出问题的经验对其他人非常有用。

So the things that went wrong is very useful to other people.

是的。

Yeah.

这个观点非常好。

That's a very good point.

而且Orkut，你一开始提到资源有限，但你依然取得了很大成就。

And, know, Orkut, you've mentioned in the beginning some of the limited resources you're working with, but you've you've managed to accomplish a lot.

你愿意聊聊是怎么做到的吗？

You care to talk about, you know, how you how you did that?

谢谢Mike。

Thank you, Mike.

我认为对小型乡村医院来说，在资源有限情况下最重要的成就是确保员工在无菌配药操作中的专业能力。

I think for small rural hospitals, the most important mile and that can be achieved with limited resources is ensuring staff competency when it comes to sterile compounding practices.

手部卫生、个人防护装备和环境清洁是无菌配药与感染控制的核心要素。

Hand hygiene, PPE, environmental cleaning are core values of the sterile compounding and infection control.

无论我们的无菌配药设施工程设计多么先进都无关紧要。

It does not matter how sophisticated our sterile compounding facility engineering and design is.

如果无菌配药人员在标准预防措施的知识和实践上存在不足，那么复合无菌制剂(CSPs)的质量以及洁净室或SCA的控制状态将会受到影响。

If there are gaps in the sterile compounding personnel's knowledge and practice of standard precautions, the quality of CSPs, and the state of control in our clean room or SCA will be compromised.

因此在继续之前，应重点关注人员手部卫生、着装、戴手套、无菌技术及清洁流程。

So before going any further, focus should be placed on personnel hand hygiene, garbing, gloving, aseptic technique, cleaning routines.

接下来是为药房和护理部门设计教学与能力评估方案。

Next is designing a didactics and competency evaluation program for both pharmacy and nursing.

在护理能力方面，与护理管理部门及护士教育者合作设计符合机构需求和偏好的方案，可以加速流程推进，这非常有益。

In the case of nursing competencies, working with nursing management and nurse educators in designing a program that meets your institution's needs and preferences can expedite the process, and it's extremely helpful.

此外，制定易于遵循的标准操作规程或让员工能便捷获取的政策文件，对小型机构而言是重大里程碑。

Also, developing policies, easy to follow standard operating procedures or that are readily available to your staff is a huge milestone for your small institutions.

这有助于确保设施运作和员工持续符合USP最低实践标准。

This helps you ensure that facility operation and staff consistently meet minimum USP practice standards.

下一步是基于稳定性、无菌性和无菌配药类别设定BUD（使用截止日期），并确保药师能获取USB法规副本及权威的定期更新文献数据库，以协助确定适当的BUD和储存条件。

Next is BUD assignments based on stability, sterility, sterile compounding categories, and make sure a copy of USB regulations and reputable and frequently updated literature and databases are available to pharmacists to help them assign proper BUDs and storage conditions.

我还建议编制详细记录配药流程、储存条件和BUD的配方手册。

I also recommend developing a recipe book that details the compounding process, storage conditions, and BUDs.

最后我想说，避免陷入过度焦虑，评估机构内无菌配药的现状，利用现有资源量力而行，同时积极争取欠缺的资源支持。

Finally, I would say avoid becoming overwhelmed, evaluate the state of sterile compounding in your institution, see what you can do with resources on hand, and at the same time advocate for resources you don't have.

不要让自己不堪重负。

Avoid becoming overwhelmed.

我认为很多同行无论所在医院的规模或地理位置如何，都可能面临这种挑战。

I think a lot of folks are probably challenged with that regardless of the size or location of their hospital.

帕蒂，你去过许多不同的医院，其中有些资源有限。

Patty, you're in a lot of different hospitals and some have limited resources.

还有其他要补充的吗？

Any other anything to add?

嗯，关于这件事，你知道的，关键是不能被压垮，我在几个地方都听到他们在说，你知道吗？

Well, one of the things, you know, about that, you know, don't become overwhelmed piece, I I have run into a few places where they're saying, you know what?

我就是应付不了这个。

I just can't handle this.

我打算把这些都推回给护理部。

I'm gonna turf it all back to nursing.

出于几个原因，这种做法并不合适。

And that is not an appropriate approach for a couple of reasons.

首先，这是我们的责任。

First of all, it's our responsibility to do that.

我也意识到，这话由我来说比那些实际执行的人要轻松得多。

And I realize that's a whole lot easier for me to say than than, you know, people who have the boots on the ground to be able to do that.

但从认证角度来看，比如联合委员会——我知道不是所有机构都通过他们的认证——但联合委员会引用CMS参与条件明确指出，药房有责任做这件事。

But from an accreditation perspective too, Joint Commission, for example and I realize not everyone is accredited by Joint Commission, but Joint Commission has said and references the CMS conditions of participation that said pharmacy has a responsibility to do this.

所以这确实需要权衡。

So it's really a balance.

比如奥奇德，你所在的机构还设有肿瘤科服务。

Like, Orchid, you're at a place where that has an oncology service too.

所以你看，这是问题的一个极端。

So, you know, there's that's one end of the spectrum.

我认为一些小型乡村机构中，有些地方静脉注射做得非常少。

I think some of the small and rural places, there are some that do very few IVs.

所以你需要平衡整个局面，但我非常确信我们有责任确保不放弃药房实践，那些我们必须完成的基本药学工作。

So you have to kind of balance that whole situation, but I'm very I really think that it's our responsibility to make sure that we're not giving away the pharmacy practice, the basic pharmacy practice things that we need to do.

因此你处理这个问题的方式非常全面，从斯沃斯莫尔乡村的角度来看，确实是令人钦佩的应对方法。

So your approach to this has been very comprehensive and really, you know, an admirable way of handling this from a Swarthmore rural perspective.

奥卡，你刚才稍微提到了在准备启用洁净室或即将启用时进行的模拟演练。

And Orka, you talked a little bit about that simulation that you went through as you opened up the clean room or you were preparing to open.

在正式运营前，你们还做了哪些准备度评估工作？

What else did you do to assess readiness before going live?

谢谢，迈克。

Thank you, Mike.

我们一路上频繁进行差距分析以识别问题区域。

We performed frequent gap analysis along the way to identify the problem areas.

ASHP有一张名为'USP797关键变更'的对比图表，详细列出了法规修订内容，并提供了新旧条款的并列摘要。

ASHP has a comparison chart titled USB seven nine seven key changes, which itemizes the revisions made to the regulations and provides a summary of the old and new language side by side.

这份文件对我们的准备度评估帮助极大。

This document was extremely helpful in assessing our readiness.

我现在仍会经常查阅它来获取指导或刷新记忆。

I I still find myself going back to it for guidance or just to refresh my memory.

其他对我们有帮助的工具还包括USP797常见问题文档，以及ASHP和BPS的继续教育课程。

Other tools we benefited from were the USP seven nine seven frequently asked questions document in addition to ASHP and BPS continuing education courses.

请记住，准备度在纸面上可能看起来不错，但在实践中你可能会发现还需要更多工作，这就是为什么必须通过员工观察、基于科学数据的设施巡查以及领域专家协助来评估准备度。

Please keep in mind that readiness might look good on paper, but in practice, you might find out that more work is needed to be done, and that is why it is crucial to assess readiness, through staff observation, touring the facility based on scientific data, and with the help from experts in the field.

例如，我们通过能力测试、每天数小时的实操观察，以及直接与员工进行一对一谈话来评估人员准备度。

For example, we assess the staff readiness through competency testing, numerous hours of daily observation of their practices, and simply by just holding one on one conversations with the staff.

我们通过研究认证报告、全天候监测温湿度压力以及进行环境测试来评估设施的准备工作，这些测试在测试频率和采样点数量上都超出了最低要求。

The facility's readiness was evaluated by studying the certification reports and monitoring temperature, humidity pressure around the clock, also by performing environmental testing, which exceeded the minimum requirements in both frequency of testing and number of sample locations.

最后，我们审查了整个无菌配制政策和程序系列，确保它们符合最新的USB规定。

Lastly, we reviewed the entire series of sterile compounding policies and procedures and made sure they reflected the latest USB regulations.

很好。

Great.

还有，帕蒂，你帮我们审查了那份797关键变更文件，我们对此表示感谢。

And, Patty, you helped us review that that seven nine seven key changes document, document, and we appreciate that.

那是凯文·汉森和他当时的一名学生共同开发的。

That was Kevin Hansen and one of his students at the time who developed that.

很高兴听到这份文件成为了有用的资源。

Good good to hear that that's been a useful resource.

是的。

Yeah.

我是说，这些在复方药物资源中心和ASHP网站上的信息非常棒。

I mean, that's great information that's on the Compounding Resource Center and on the ASHP site.

所以别忘了关注这些内容。

So don't lose, you know, track of that.

所有这些信息都很有价值。

All of that information is good.

那里有很多非常好的文件。

There's a lot of really good documents there.

或者你能提一下USP的常见问题吗？

Or could you mention the the FAQs from USP?

这些信息也会不时变化，确实会引发更多当下存在的问题。

That information changes from time to time too, and it really brings up con more contemporary issues that are there.

我认为进行差距分析对此至关重要。

I think doing a gap analysis is critical for this.

需要记住的一点是，这些信息不应在你们组织内部成为隐秘信息。

And one thing to keep in mind is this is this should not be stealth information in your your organization.

不要仅仅将其局限在药房部门。

Don't just keep it in pharmacy.

要确保质量部门知晓存在的差距，你们必须采取相应措施。

Make sure that, you know, the quality department knows if there's gaps in there that you have to do that.

你的直属上级也需要知情。

Your direct report knows.

这从质量角度涉及认证标准，也关系到州药房委员会的检查。

And that comes up from a quality perspective in accreditation standards as well as inspections from your state board of pharmacy.

因此务必清楚这些差距所在，并让组织中能支持风险管理等相关工作的其他人员也了解需要完成的事项。

So make sure you know what those gaps are and that others in your organization who can support you in that risk management, for example, are also aware of any things that need to get done.

说到不同的资源和教育项目，兰花，对于小型医院、乡村医院，在团队教育项目方面有什么不同安排吗？

And speaking of different resources and educational programs, is there anything different, Orchid, for small hospitals, rural hospitals as far as educational programs for your your team?

谢谢，迈克。

Thank you, Mike.

对于资源有限、缺乏实地专家的小型乡村医院，我认为有针对性的教育项目至关重要。这些项目为小型乡村医院提供寻求指导的机会（甚至可匿名咨询），有时是这些小型机构唯一能获得的意见渠道。由于各机构在类型、规模、可用资源、提供服务等方面的独特性，不同无菌复合设施对USP797标准的遵守程度存在很大差异。

In the case of small rural hospitals with limited resources and a shortage of experts with boots on the ground, I think targeted educational programs that provide an opportunity for small rural hospitals to come forward and ask for guidance even anonymously are crucial and sometimes really the only sounding board available to these small institutions due to differences in types, size, available resources, services provided, and other characteristics unique to each facility, there is great degree of variation in the rate and extent of USB seven nine seven compliance from one sterile compounding facility to the other.

此外，修订后的USP797标准将某些决策权下放给各机构自主决定，这可能导致整体上更大程度的差异性。

In addition, the revised USB seven nine seven leaves certain decisions off to individual institutions to make based on their preferences, which could cause an even greater degree of variability across the board.

因此，针对不同类别历史复合机构的特定情况和需求量身定制的教育计划和讨论小组，有助于提高其合规的速率和程度。

As a result, educational programs and discussion panels tailored to the specific situation and needs of different categories of histo compounding institutions can help increase, the rate and extent of their regulatory compliance.

帕蒂，再说一次，你经常出入许多医院。

And Patty, again, you're in a lot of hospitals.

就不同规模或可用资源的教育需求而言，你看到了什么？

What do you see as far as educational needs for various sizes or resources available?

我认为人们依赖ASHP（美国卫生系统药师协会），举个例子。

I think people are depending on ASHP, for example.

也许他们的采购集团提供了一些现有的资源。

Perhaps their buying group has some offerings that are there.

有很多继续教育（CE）内容，甚至非CE相关的优质内容也是可获取的。

There's there's a lot of CE and even, you know, non CE related good content that's available.

重申一下，ASHP网站上有很多资源。

Again, ASHP has a lot of resources on the site.

ASHP Connect平台让人们可以提问，并真正获得来自相似或不同组织的回应，这些组织可能提供非常有价值的信息。

ASHP Connect, where people can ask questions and really get responses from those in similar organizations or dissimilar organizations that maybe be able to provide some really valuable information.

所以从虚拟角度来看，确实有很多资源可供人们依赖。

So there there's a lot of resources out there from a virtual perspective that people can depend on.

我同意，虽然我不想特意推荐ASHP资源，但USP（美国药典）常见问题文档很可能已经有人在你之前提出过相同问题，并且答案已经存在于某处。

And I agree with the, you know, I'm not gonna plug ASHP resources, but the the the USP FAQ documents are more than likely, someone has followed the question before you and, you know, it's been answered somewhere.

如果没有的话，我也认同存在向外寻求帮助的机会。

And if not, you know, I agree there's opportunity to reach out.

我要说的是，就那个Connect社区而言，特别是复合药物专项社区，我们大约一年前建立它，它可能是我们迄今为止最活跃的ASHP Connect社区之一。

And I will say, you know, as far as that connect community, the the compounding one specifically, we stood that up about a year ago, and it has been probably one of the most active ASHP connect communities that we've ever had.

我认为小型乡村医院可能难以满足的其他一些要求包括，你知道的，加强环境监测、表面采样等方面的监管。

So some of the other requirements that I think small rural hospitals might struggle with are, you know, the the increased surveillance for environmental monitoring, surface sampling, etcetera.

有些医院甚至可能没有自己的实验室。

Some hospitals may not even have their own lab.

这意味着你要自动送检微生物样本吗？

What does that mean you're automatically sending out microbiologic samples?

或者这类监测在小型医院是如何进行的？

Or how is this kind of surveillance happening in smaller hospitals?

嗯，有趣的是在没有实验室的情况下，或者可能只有一两个医疗技术人员在做一些处理，但从微生物学的角度来看，通常会把样本送到其他实验室。

Well, it's kind of interesting where there is no lab or there's perhaps one or two med techs who may be doing some processing, but often from a microbiological standpoint is sending that out to another lab.

你必须把自己当作实验室来思考。

You have to kind of think of yourself as the lab.

因此有一些你需要了解的要求。

So there's requirements that you need to be aware of.

例如培养条件。

Incubation, for example.

很多人只是把东西放在室温下，比如架子上，但现在这样已经不够了。

This isn't something many people have just stored things at room temp, like on a shelf, and that's not adequate anymore.

必须放在培养箱里。

It has to be in an incubator.

所以这些设备是必需的。

So there's a need for those.

因此你可能需要一个实体培养箱。

So you've got a physical incubator that you may need.

有人会说，那我该怎么办呢？

Some people will say, well, what do I do?

如果我遇到问题需要咨询微生物学家，但医院里没有这样的人。

I need a microbiologist to consult if I have some issues, and I don't have one here at the hospital.

但想想你的认证机构是做什么的？

But think in terms of what does your certifier do?

如果你的认证机构为你发送环境样本，他们会送到实验室。

If your certifier is sending out environmental samples for you, they're sending it to a lab.

所以至少会有微生物学家看过那些样本。

So there's a microbiologist who has at least taken a look at that.

这对你来说可能是个机会。

So that may be an opportunity for you.

如果你在关键接入医院，总会有个转诊医院在那里。

You probably well, if you're in critical access hospital anyway, you have a referral hospital that's there.

也许那个转诊医院的微生物学家可以帮忙。

So maybe the microbiologist in that referral hospital can be there.

别忘了你们医院也有一位感染控制医师。

And don't lose track of the of the of the point that you have an infection control practitioner at your hospital as well.

他们可以成为很好的盟友，提供某些资源或至少告诉你哪些地方可以送检样本，你可以利用医院现有资源或你尚未意识到的资源来解决这些问题。

So they can be a really good ally and provide some of those resources or at least some some places where you may be able to send things to, and you may be able to work that out either at your hospital site or with some resources that you already have and may not be aware of.

是的，这些都是需要牢记的重要事项。

Yeah, those are some important things to keep in mind.

奥尔金，关于你们的监测工作，你有什么要补充的智慧之言吗？

And Orkin, do you have any words of wisdom to add to that as far as your surveillance?

不，迈克。

No, Mike.

正如我所说，我认为关键点在于你也提到的——不要被压垮，一步步来，确保有监督机制，无论资源如何，无论现在或未来能否完成某事，只需确保你需要有监督。

I just as I said, I think it's the main point is just as you also talked about it, it's just not being overwhelmed and take it one at a time and make sure to have oversight regardless of your resources, regardless of being able to accomplish something now or in the future, just make sure you need to have oversight.

是的。

Yeah.

我认为这非常关键，是个很好的观点。

That's I think that's that's critical, a very good point.

我喜欢你分解章节的方式，让每个部分都得到分配或处理。

And I like how you, you know, you broke down the chapter and and had each each part, you know, assigned or taken care of.

这确实能有效防止人们感到不堪重负。

That really, I think that would really prevent people from feeling overwhelmed.

就像你说的，一次处理一个部分。

You know, like you said, take it one part at a time.

非常感谢你们两位，奥琪德、帕蒂，今天能来参加。

Well, I really want to thank you both, Orchid, Patty, for joining me today.

我们的时间到此结束。

That is all the time we have.

这次讨论非常精彩。

This was a really good discussion.

我们即将举办与帕蒂和奥琪德的前线对话，届时你们可以现场提问，由我们的专家团队解答。

We have an upcoming frontline conversations with both Patty and Orchid, where you can bring your questions live for our faculty experts to address.

所以你们还有机会听到专家们的见解。

So you'll have another opportunity to hear from our experts.

希望您喜欢今天的对话。

And we hope you enjoyed today's conversation.

请务必通过您喜爱的播客平台订阅ASHP播客。

Be sure to subscribe to ASHP podcasts through your favorite podcast provider.

帕蒂、奥琪德，再次感谢你们。

Patty, Orchid, thank you again.

谢谢你，迈克。

Thanks, Mike.

感谢您收听ASHP优势播客《专家对话》。

Thanks for joining us for the ASHP advantage podcast, engaging the experts.

请访问ashp.org/podcast发现更多精彩内容，查看节目笔记并下载文字稿。

Be sure to visit a shp.org/podcast to discover more great episodes, access show notes, and download the episode transcript.

如果您喜欢本期节目并想收听更多，请务必订阅、评分或留下评论。

If you loved the episode and wanna hear more, be sure to subscribe, rate, or leave a review.

下次节目我们将继续为您带来ASHP官方的专家观点。

Join us next time for more expert perspectives on ASHP official.