ﺍﻫﻤﻴﺖ ﻋﻔﻮﻧﺖ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ
ﺍﻫﻤﻴﺖ ﻋﻔﻮﻧﺖ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ
ﺍﻫﻤﻴﺖ ﻋﻔﻮﻧﺖ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ
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ﻊﻣﺎﺟ ﺏﺎﺘﻛ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ<br />
ﻲﻤﻬﻓﺍﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ / ٧ ﺭﺎﺘﻔﮔ / ٤ ﻞﺼﻓ<br />
ﺎﻫ ﻥﺁ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﻩﺍﺭ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ<br />
ﺐﻟﺎﻄﻣ ﺖﺳﺮﻬﻓ<br />
٣٥٥........................<br />
................................ ................................ ................................ ﺱﺭﺩ ﻑﺍﺪﻫﺍ<br />
٣٥٥...........................<br />
................................ ................................ ................................ ﻪﻠﺌﺴﻣ ﻥﺎﻴﺑ<br />
٣٥٧...............................<br />
................................ ................................ ................................ ﻒﻳﺭﺎﻌﺗ<br />
٣٦٠.......<br />
................................ ................................ ................................ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﻴﻤﻫﺍ<br />
٣٦١.............<br />
................................ ................................ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻝﺎﻘﺘﻧﺍ ﻱﺎﻫ ﻩﺍﺭ<br />
٣٦٢....<br />
................................ ................................ ﻝﺎﻘﺘﻧﺍ ﻩﺍﺭ ﺱﺎﺳﺍﺮﺑ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻪﻠﻘﺘﻨﻣ ﻱﺎﻫ ﻥﮊﻮﺗﺎﭘ<br />
٣٦٤....<br />
................................ ................................ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ<br />
ﺖﻧﻮﻔﻋ ﺐﺒﺴﻣ ﻱﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
٣٦٥..........................<br />
................................ ................................ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﺵﻭﺭ<br />
٣٦٦...........................<br />
................................ ................................ ................................ ﺵﺯﻮﻣﺁ<br />
٣٦٦...........................<br />
................................ ................................ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ<br />
ﻡﺎﻈﻧ<br />
٣٦٦...................<br />
................................ ................................ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻑﺍﺪﻫﺍ<br />
٣٦٧..<br />
................................ ................................ ................................ ﻲﻜﺷﺰﭘ ﻥﺎﻨﻛﺭﺎﻛ ﺯﺍ ﺖﺒﻗﺍﺮﻣ<br />
٣٦٨...................<br />
................................ ................................ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻞﻏﺎﺷ ﻥﺎﻨﻛﺭﺎﻛ ﻱﺯﺎﺴﻨﻤﻳﺍ<br />
٣٦٨..........<br />
................................ ................................ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ﻱﺯﺎﺳﺍﺪﺟ ﺎﻳ ﻥﻮﻴﺳﻻﻭﺰﻳﺍ<br />
٣٦٨..............<br />
................................ ................................ ................................ ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ<br />
٣٧٣........<br />
................................ ................................ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻪﻟﺎﺑﺯ ﻝﺮﺘﻨﻛﻭ ﻱﺯﺎﺳ ﻥَﻭﺮ ﹶﺘِﺳ ،ﻲﻳﺍﺩﺯﺪﻨﮔ<br />
٣٧٥..........................<br />
................................ ................................ ................................ ﺕﺍﺩﺎﻬﻨﺸﻴﭘ<br />
٣٧٦................................<br />
................................ ................................ ................................ ﻪﺻﻼﺧ<br />
٣٧٧..<br />
................................ ................................ ................................ ................................ ﻊﺑﺎﻨﻣ
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﺎﻫ ﻥﺁ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﻩﺍﺭ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٥٥<br />
ﻲﻤﻬﻓﺍ ﻦﻳﺮﻴﺷﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣ ﻪﺑﻮﺒﺤﻣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳ ﻞﺻﺍ ﻦﻴﺴﺣﺮﺘﻛﺩ<br />
ﻥﺍﺮﻬﺗ ﻲﻧﺎﻣﺭﺩ ﻲﺘﺷﺍﺪﻬﺑ ﺕﺎﻣﺪﺧ<br />
ﻭ ﻲﻜﺷﺰﭘ ﻡﻮﻠﻋ ﻩﺎﮕﺸﻧﺍﺩ<br />
ﺱﺭﺩ ﻑﺍﺪﻫﺍ<br />
: ﺩﻮﺑ ﺪﻫﺍﻮﺧ ﺭﺩﺎﻗ ﻩﺪﻧﺮﻴﮔﺍﺮﻓ ،ﺚﺤﺒﻣ ﻦﻳﺍ ﻱﺮﻴﮔﺩﺎﻳ ﺯﺍ ﺲﭘ<br />
ﺪﻨﻛ ﻥﺎﻴﺑ ﺮﺼﺘﺨﻣ ﺭﻮﻃ ﻪﺑ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻪﭽﺨﻳﺭﺎﺗ<br />
ﺪﻳﺎﻤﻧ ﻒﻳﺮﻌﺗ ﺍﺭ ﻥﺁ ﻊﻳﺎﺷ ﻉﺍﻮﻧﺍ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ<br />
ﺪﻫﺩ ﺡﺮﺷ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺐﻗﺍﻮﻋ ﻭ ﺖﻴﻤﻫﺍ<br />
ﺪﻫﺩ ﺢﻴﺿﻮﺗ ﺍﺭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻝﺎﻘﺘﻧﺍ ﻱﺎﻫ ﻩﺍﺭ<br />
ﺩﺭﺎﻤﺷ ﺮﺑ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻪﺑ ﻩﺪﻨﻨﻛ ﺪﻌﺘﺴﻣ ﻞﻣﺍﻮﻋ<br />
ﺩﺮﺒﺑ ﻡﺎﻧ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺐﺒﺴﻣ ﻱﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
ﺪﻨﻛ ﺺﺨﺸﻣ ﺍﺭ ﺎﻫ ﻥﺁ ﻒﻳﺎﻇﻭ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﻪﺘﻴﻤﻛ ﺭﺎﺘﺧﺎﺳ<br />
ﺪﻫﺩ ﺢﻴﺿﻮﺗ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻑﺍﺪﻫﺍ<br />
،ﻥﺎﻨﻛﺭﺎﻛ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ،ﺖﺳﺩ ﻦﺘﺴﺷ ،ﻥﻮﻴﺳﻻﻭﺰﻳﺍ ﺪﻨﻧﺎﻣ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﻱﺎﻫ ﺵﻭﺭ<br />
ﻉﺍﻮﻧﺍ<br />
ﺪﻨﻛ ﻥﺎﻴﺑ ﺮﺼﺘﺨﻣ ﺭﻮﻃ ﻪﺑ ﺍﺭ ﻲﺑﻭﺮﻜﻴﻣ ﺖﻣﻭﺎﻘﻣ ﺩﺎﺠﻳﺍﺯﺍ ﻱﺮﻴﮔﻮﻠﺟ ﻭ ﻪﻟﺎﺑﺯ ﻊﻓﺩ ،ﻲﻳﺍﺩﺯﺪﻨﮔ<br />
ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ ،ﻥﻮﻴﺳﻻﻭﺰﻳﺍ ،ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ،ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﺘﻴﻤﻛ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ<br />
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ﻱﺪﻴﻠﻛ ﻱﺎﻫ ﻩﮊﺍﻭ<br />
ﺕﺎﻣﺪﺧ ﻉﺍﻮﻧﺍ ﻪﻛ ﺪﻧﺍ ﻩﺪﺷ ﻪﺘﺧﺎﺳ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻡﺎﻧ ﻪﺑ ﺰﻬﺠﻣ ﻭ ﺪﻳﺪﺟ ﻱﺎﻫ ﻥﺎﻤﺘﺧﺎﺳ ﺮﻴﺧﺍ ﻱﺎﻫ ﻝﺎﺳ ﺭﺩ<br />
ﻪﻠﺌﺴﻣ ﻥﺎﻴﺑ
٣٥٦/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﺐﺴﻛ ﻪﺑ ﺮﻳﺬﭘﺎﻧ ﺏﺎﻨﺘﺟﺍ ﺭﻮﻃ ﻪﺑ ﺕﺎﻣﺍﺪﻗﺍ ﻦﻳﺍ ﻲﻫﺎﮔ ﻲﻟﻭ ﺪﻨﻳﺎﻤﻧ ﻲﻣ ﻪﺋﺍﺭﺍ ﻥﺍﺭﺎﻤﻴﺑ ﻪﺑ ﺍﺭ ﻲﻧﺎﻣﺭﺩ ﻭ ﻲﺼﻴﺨﺸﺗ<br />
. ﺪﻣﺎﺠﻧﺎﻴﺑ ﺰﻴﻧ ﻥﺍﺭﺎﻤﻴﺑ ﺕﻮﻓ ﻪﺑ ﻲﺘﺣ ﺖﺳﺍ ﻦﻜﻤﻣ ﻪﻛ ﺩﺩﺮﮔ ﻲﻣ ﺮﺠﻨﻣ ﻥﺍﺭﺎﻤﻴﺑ ﻂﺳﻮﺗ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ<br />
ﻥﺎﻧﺯ ،ﻱﺩﻼﻴﻣ ﻢﻫﺩﺯﻮﻧ ﻭ ﻢﻫﺪﺠﻴﻫ ﻥﺮﻗﺭﺩ . ﺩﺩﺮﮔ ﻲﻣ ﺮﺑ ﻞﺒﻗ ﺎﻫ ﻝﺎﺳ ﻪﺑ ( ١)<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻪﭽﺨﻳﺭﺎﺗ<br />
ﺭﺩ ﻪﻛ ﺩﻮﺑ ﺩﺎﻳﺯ ﻱﺪﺣ ﻪﺑ ﺰﻛﺍﺮﻣ ﻦﻳﺍ ﺭﺩ ﺮﻴﻣ ﻭ ﮒﺮﻣ ﻥﺍﺰﻴﻣ ﻲﻟﻭ ﺪﻧﺩﻮﻤﻧ ﻲﻣ ﻪﻌﺟﺍﺮﻣ ﺎﻫ ﻩﺎﮕﺸﻳﺍﺯ ﻪﺑ ﻥﺎﻤﻳﺍﺯ ﺖﻬﺟ ﺮﻴﻘﻓ<br />
ﺎﻫ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ"<br />
: ﺖﺷﻮﻧ ﻥﺪﻨﻟ ﻲﻜﺷﺰﭘ ﻪﻠﺠﻣ ﺭﺩ ( Thomas lightfoot)<br />
ﺕﻮﻓ ﺖﻳﻻ ﺱﺎﻣﻮﺗ ،ﻱﺩﻼﻴﻣ ١٨٥٠ ﻝﺎﺳ<br />
. " ﺪﻨﺘﺴﻫ ﮒﺮﻣ ﻱﻮﺳ ﻪﺑ ﻥﺎﻧﺯ ﻩﺪﻨﻨﻛ ﺖﻳﺍﺪﻫ ﻱﺎﻫ ﻩﺯﺍﻭﺭﺩ<br />
ﺐﺗ ﺖﻳﺍﺮﺳ ﺖﻴﻠﺑﺎﻗ ﺩﺭﻮﻣ ﺭﺩ ﻱﺍ ﻪﻟﺎﻘﻣ ( Oliver Wendell Holmes)<br />
ﺰﻤﻟﻮﻫ ﻝﺪﻧﻭ ﺭﻮﻴﻟﻭﺍ ،١٨٤٣<br />
ﻝﺎﺳ ﺭﺩ<br />
ﺎﺑ . ﺩﻮﻤﻧ ﻩﺭﺎﺷﺍ ﺪﻴﻧﺎﺳﺭ ﻞﻗﺍﺪﺣ ﻪﺑ ﺍﺭ ﻱﺭﺎﻤﻴﺑ ﺭﺎﺸﺘﻧﺍ<br />
ﻥﺍﻮﺘﺑ ﺎﻫ ﻥﺁ ﻪﻠﻴﺳﻭ ﻪﺑ ﻪﻛ ﻲﻳﺎﻫ ﺵﻭﺭ ﻪﺑ ﻭ ﺩﺮﻛ ﺮﺸﺘﻨﻣ ﻥﺎﻤﻳﺍﺯ ﺯﺍ ﺪﻌﺑ<br />
ﺩﻮﺧ ﺕﺍﺪﻫﺎﺸﻣ ﺱﺎﺳﺍﺮﺑ ( Semmelweis)<br />
ﺰﻳﺍﻮﻠﻤﺳ ﻪﻜﻨﻳﺍ ﺎﺗ ﺪﻳﺩﺮﮕﻧ ﻞﺻﺎﺣ ﻪﻨﻴﻣﺯ ﻦﻳﺍ ﺭﺩ ﻲﻧﺍﺪﻨﭼ ﺕﺍﺮﻴﻴﻐﺗ ﻝﺎﺣ ﻦﻳﺍ<br />
ﻩﺯﻭﺮﻜﻧ ﺩﺍﻮﻣ ﻪﺑ ﻩﺩﻮﻟﺁ ﻱﺎﻫ ﺖﺳﺩ ﻖﻳﺮﻃ ﺯﺍ ﺎﻫ ﺎﻣﺎﻣ ﻭ ﻥﺎﻜﺷﺰﭘ ﻂﺳﻮﺗ ﻥﺎﻤﻳﺍﺯ ﺯﺍ ﺪﻌﺑ ﺐﺗ ﺖﻳﺍﺮﺳ ﺖﻴﻠﺑﺎﻗ ﻪﻴﺿﺮﻓ ،ﻦﻳﻭ ﺭﺩ<br />
ﻭ ﺖﻧﻮﻔﻋ ﻦﻳﺍ ﺯﺍ ﻥﺍﻮﺗ ﻲﻣ ( ﻚﻫﺁ ﺏﺁ)<br />
ﺭﺍﺩﺮﻠﻛ ﺩﺍﻮﻣ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﻖﻴﻗﺩ ﻱﻮﺸﺘﺴﺷ ﺎﺑ ﻪﻛ ﺩﺍﺩ ﻥﺎﺸﻧ ﻭ ﺖﺧﺎﺳ<br />
ﺡﺮﻄﻣ ﺍﺭ<br />
( William farr)<br />
ﺭﺎﻓ ﻡﺎﻴﻠﻳﻭ ﻭ ( Florence Nightingale)<br />
ﻞﮕﻨﻴﺘﻳﺎﻧ ﺲﻧﺍﺭﻮﻠﻓ . ﺩﺮﻛ ﻱﺮﻴﮔﻮﻠﺟ ﻥﺍﺭﺩﺎﻣ ﮒﺮﻣﺰﻴﻧ<br />
ﻲﺸﺗﺭﺍ ﻱﺎﻫﻭﺮﻴﻧ ﻥﺍﻭﺍﺮﻓ ﺮﻴﻣ ﻭ ﮒﺮﻣ ﻪﻛ ﺪﻧﺩﺍﺩ ﻥﺎﺸﻧ ﻱﺭﺎﻜﻤﻫ ﻝﺎﺳ ٢٠ ﻲﻃ ،١٨٥٦<br />
ﻝﺎﺳ ﺭﺩ ﺮﮕﻳﺪﻜﻳ ﺎﺑ ﻲﻳﺎﻨﺷﺁ ﺯﺍ ﺲﭘ<br />
ﻲﺘﺷﺍﺪﻬﺑ ﺕﺎﻣﺍﺪﻗﺍ ﺩﻮﺒﻬﺑ ﻪﺑ ﺎﻫ ﻥﺁ ﺕﺍﺪﻫﺎﺸﻣ . ﺖﺳﺍ ﻥﺍﺭﺎﻤﻴﺑ ﻡﺎﺣﺩﺯﺍ ﻭ ﻱﺮﺴﻣ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﺩﻮﺟﻭ ﺯﺍ ﻲﺷﺎﻧ ﻥﺎﺘﺳﺭﺎﻤﻴﺑﺭﺩ<br />
. ﺪﻳﺩﺮﮔ ﺮﺠﻨﻣ ﻲﻣﺎﻈﻧ ﻥﺍﺭﺎﻤﻴﺑ ﺮﻴﻣ ﻭ ﮒﺮﻣ ﻲﻫﺩ ﺵﺭﺍﺰﮔ ﻢﺘﺴﻴﺳ ﻥﺩﺮﻛ ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻭ<br />
ﻭ ﮒﺮﻣ ﺩﺭﺍﻮﻣ ﺵﺭﺍﺰﮔ)<br />
ﻞﻏﺎﺷ ﻥﺍﺭﺎﺘﺳﺮﭘ<br />
ﻂﺳﻮﺗ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﺭﺎﺑ ﻦﻴﻟﻭﺍ ﻱﺍﺮﺑ ﺲﻧﺍﺭﻮﻠﻓ<br />
ﺮﻴﮔﺍﻭ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﺯﺍ ﻲﺷﺎﻧ ﺮﻴﻣ ﻭ ﮒﺮﻣ ﺮﺘﺸﻴﺑ ﻉﻮﻴﺷ ﻦﻴﻨﭽﻤﻫ ﺭﺎﻓ ﻡﺎﻴﻠﻳﻭ . ﺩﻮﻤﻧ ﻊﺿﻭ ﺍﺭ ( ﻥﺍﺭﺎﺘﺳﺮﭘ ﻂﺳﻮﺗ ﻥﺍﺭﺎﻤﻴﺑﺮﻴﻣ<br />
. ﺩﺍﺩ ﻥﺎﺸﻧ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻥﺎﻨﻛﺭﺎﻛﺮﻳﺎﺳ ﻭ ﻥﺍﺭﺎﺘﺳﺮﭘ ﻦﻴﺑ ﺭﺩ ﺍﺭ<br />
ﺭﺩ ﻥﻮﻴﺳﺎﺗﻮﭙﻣﺁ ﻝﺎﺒﻧﺪﺑ ﺮﻴﻣ ﻭ ﮒﺮﻣ ( Dr. James Simpson)<br />
،ﻥﻮﺴﭙﻤﻴﺳ ﺰﻤﻴﺟ ﺮﺘﻛﺩ ،١٨٦٠<br />
ﻝﺎﺳ ﺭﺩ<br />
ﻭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻕﺎﺗﺍ ﺮﻫ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ﺮﺘﻤﻛ ﻱﺮﺘﺴﺑ ﺩﺍﺪﻌﺗ ﻭ ﻥﺍﺭﺎﻤﻴﺑ ﻥﻮﻴﺳﻻﻭﺰﻳﺍ ﺮﺑ ﻭ ﺩﺮﻛ ﺡﺮﻄﻣ ﺍﺭ ﮒﺭﺰﺑ ﻱﺎﻫ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻱﺎﻫ ﻲﺳﺭﺮﺑ ﺞﻳﺎﺘﻧ ١٨٦٧ ﻝﺎﺳ ﺭﺩ ( Lister)<br />
ﺮﺘﺴﻴﻟ . ﺩﻮﻤﻧ ﺪﻴﻛﺎﺗ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖﻧﻮﻔﻋ ﺭﺎﺸﺘﻧﺍ ﻝﺎﻤﺘﺣﺍ ﺶﻫﺎﻛ ﻪﺠﻴﺘﻧ ﺭﺩ<br />
ﻞﻤﻋ ﻊﺿﻮﻣ ﻥﺩﺮﻛ ﺰﻴﻤﺗ ﻭ ﻩﺪﻨﻨﻛ ﻲﻧﻮﻔﻋ ﺪﺿ ﻩﺩﺎﻣ ﺭﺩ ﺖﺳﺩ ﻥﺎﺘﺸﮕﻧﺍ ﻥﺩﺮﺑ ﻭﺮﻓ ﺎﺑ ﻪﻛ ﺩﺍﺩ ﻥﺎﺸﻧ ﻭ ﻩﺩﺮﻛ ﺮﺸﺘﻨﻣ ﺍﺭ ﺩﻮﺧ<br />
ﻭ ﺪﻨﺘﻓﺮﻳﺬﭘ ﺖﻋﺮﺳ ﻪﺑ ﺍﺭ ﺮﺘﺴﻴﻟ ﻱﺎﻫ ﺵﻭﺭ ،ﻲﻧﺎﻤﻟﺁ ﻥﺎﺣﺍﺮﺟ . ﺩﻮﻤﻧ ﻱﺮﻴﮔﻮﻠﺟ ﻢﺧﺯ ﺖﻧﻮﻔﻋ ﺯﺍ ﻥﺍﻮﺗ ﻲﻣ ،ﻲﺣﺍﺮﺟ ﺯﺍ ﻞﺒﻗ<br />
ﻪﺑ ﻲﻫﺎﮕﺸﻧﺍﺩ<br />
ﮒﺭﺰﺑ ﻱﺎﻫ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻞﻳﺮﺘﺳﺍ ﻱﺎﻫ ﺶﻜﺘﺳﺩ ﻭ ﻚﺳﺎﻣ ،ﻥﺎﮔ ،ﻲﺣﺍﺮﺟ ﻞﻳﺎﺳﻭ ،ﻱﺩﻼﻴﻣ ١٩١٠ ﻝﺎﺳ ﺎﺗ<br />
. ﺖﻓﺮﮔ ﺭﺍﺮﻗ ﻩﺩﺎﻔﺘﺳﺍ ﺩﺭﻮﻣ ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﺕﺭﻮﺻ<br />
ﻭ ﺡﺍﺮﺟ ،(<br />
Meleney)<br />
ﻲﻨﻠﻣ . ﺩﺭﻭﺁ ﺭﺩ ﻝﺮﺘﻨﻛ ﺖﺤﺗ ﺍﺭ ﻲﺣﺍﺮﺟ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ،ﻲﻧﻮﻔﻋﺪﺿ ﺵﻭﺭ ﻱﺮﻴﮔﺭﺎﻜﺑ<br />
ﺕﺭﻮﺻ ﻪﺑ ﻢﺧﺯ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ ﻭ ﻲﺣﺍﺮﺟ ﺖﻧﻮﻔﻋ ﺩﺭﺍﻮﻣ ﺖﺒﺛ ﺮﺑ ﻙﺭﻮﻳﻮﻴﻧ ﺭﺩ ،ﺖﺴﻳﮊﻮﻟﻮﻳﺮﺘﻛﺎﺑ<br />
. ﺪﻳﺯﺭﻭ ﺪﻴﻛﺎﺗ ﻝﺎﻌﻓ<br />
ﺖﻧﻮﻔﻋ ﺯﻭﺮﺑ ،ﻱﺭﺍﺭﺩﺍ ﻦﻜﻤﺘﻣ ﺮﺘﺗﺎﻛﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﻝﺎﺒﻧﺪﺑ ﻪﻛ ﺪﺷ ﻪﺟﻮﺘﻣ ( Dukes)<br />
ﺰﻛﻭﺩ<br />
،١٩٢٩<br />
ﻝﺎﺳ ﺭﺩ<br />
ﺺﻴﺨﺸﺗ ﺖﻬﺟ ﻲﻫﺎﮕﺸﻳﺎﻣﺯﺁ ﻲّﻤﻛ ﻭ ﻥﺎﺳﺁ ﺵﻭﺭ ﻚﻳ ﻪﺑ ﻱﺍ ﻪﻟﺎﻘﻣ ﺭﺩ ﻱﻭ . ﺖﺳﺍ ﺮﻳﺬﭘﺎﻧ ﺏﺎﻨﺘﺟﺍ ﻱﺭﺍﺭﺩﺍ ﻩﺎﮕﺘﺳﺩ<br />
. ﺩﺮﻛ ﻩﺭﺎﺷﺍ ﻱﺭﺍﺭﺩﺍ ﺖﻧﻮﻔﻋ<br />
ﺭﺩ<br />
. ﺪﻳﺩﺮﮔ ﺡﺮﻄﻣ ﻲﺴﻛﻼﻴﻓﻭﺮﭘ<br />
ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﻪﻴﺿﺮﻓ ،ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻒﺸﻛ ﺎﺑ ﻭ ١٩٣٥ ﻝﺎﺳ ﺯﺍ ﺲﭘ
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٥٧<br />
ﺭﺍﺰﮔﺮﺑ ﻲﻛﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺩﺭﻮﻣ ﺭﺩ ﺍﺭ ﻲﺴﻧﺍﺮﻔﻨﻛ ،(<br />
CDC)<br />
ﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﺰﻛﺮﻣ ١٩٥٨ ﻝﺎﺳ<br />
ﺭﻮﻣ ﺖﻳﺎﻬﻧ ﺭﺩ . ﺩﻮــﻤﻧ ﺮﺸﺘﻨﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎــﻫ ﺖﻧﻮﻔﻋﺩﺭﻮﻣ ﺭﺩ ﻲﺑﺎﺘﻛ ،١٩٦٠<br />
ﻝﺎﺳ ﺭﺩ ( Williams)<br />
ﺰﻣﺎﻴﻠﻳﻭ . ﺩﻮﻤﻧ<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﺖﻴﻟﺎﻌﻓ ﻪﻨﻴﻣﺯ ﺭﺩ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺭﺎﺘﺳﺮﭘ<br />
ﻲﺳﺎﺳﺍ ﺶﻘﻧ ﺮﺑ ﺶﻧﺍﺭﺎﻜﻤﻫ ﻭ ( Moore)<br />
١٩٦٠ ﻭ ١٩٥٠ ﻱﺎﻫ ﻪﻫﺩ ﺭﺩ ﺍﺭ ﺎﻜﻳﺮﻣﺁ ﺭﺩ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻭ ﺖﺴﻳﮊﻮﻟﻮﻴﻣﺪﻴﭘﺍ ﺭﺎﺘﺳﺮﭘ ﻒﻳﺎﻇﻭ ( Wise)<br />
ﺰﻳﺍﻭ ﻭ ﺪﻧﺩﺮﻛ ﺪﻴﻛﺎﺗ<br />
. ﺖﺳﺍ ﻱﺩﺪﻌﺘﻣ ﻦﻴﻘﻘﺤﻣ ﻪﻟﺎﺳ ١٥٠ ﺵﻼﺗ ﻞﺻﺎﺣ ،ﻢﻴﺘﺴﻫ ﺪﻫﺎﺷ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﻨﻴﻣﺯ ﺭﺩ ﺯﻭﺮﻣﺍ ﻪﭽﻧﺁ ﺍﺬﻟ . ﺩﺍﺩ ﺢﻴﺿﻮﺗ<br />
ﻒﻳﺭﺎﻌﺗ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ<br />
ﺖﻋﺎﺳ ٧٢ ﺎﻳ ٤٨)<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺭﺎﻤﻴﺑ ﺵﺮﻳﺬﭘ ﺯﺍ ﺲﭘ ﻪﻛ ﺩﻮﺷ ﻲﻣ ﻪﺘﻔﮔ ﻲﺘﻧﻮﻔﻋ ﻪﺑ ( ٢)<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ<br />
ﺯﺍ ﺲﭘ ،ﻲﺣﺍﺮﺟ ﻢﺧﺯ ﻱﺎﻫ ﺖﻧﻮﻔﻋ % ٥٠ ﺎﺗ ٢٥)<br />
ﺭﺎﻤﻴﺑ ﺺﻴﺧﺮﺗ ﺯﺍ ﺲﭘ ( ﺯﻭﺭ ٣٠ﺎﺗ<br />
١٠)<br />
ﺺﺨﺸﻣ ﻱﺍ ﻩﺭﻭﺩ ﻲﻃ ﺎﻳ ( ﺪﻌﺑ<br />
ﺭﺍﺮﻗ ﺪﻳﺎﺒﻧ ﺰﻴﻧ ﺩﻮﺧ ﻲﮕﺘﻔﻬﻧ ﻩﺭﻭﺩ ﺭﺩ ﻭ ﻪﺘﺷﺍﺪﻧ ﺩﻮﺟﻭ ﺭﺎﻤﻴﺑ ﺵﺮﻳﺬﭘ ﻥﺎﻣﺯ ﺭﺩ<br />
ﻭ ﺪﻫﺩ ﺥﺭ ( ﺪﻧﺩﺮﮔ ﻲﻣ ﺮﻫﺎﻇ ﺭﺎﻤﻴﺑ ﺺﻴﺧﺮﺗ<br />
،(<br />
Implant)<br />
ﺩﻮﺷ ﻪﺘﺷﺍﺬﮔ ﺭﺎﻛ ﻲﺟﺭﺎﺧ ﻢﺴﺟ ﻥﺍﺭﺎﻤﻴﺑ ﻥﺪﺑ ﺭﺩ ،ﻲﺣﺍﺮﺟ ﻝﺎﻤﻋﺍ ﻝﺎﺒﻧﺪﺑ ﻪﻛ ﻲﺗﺭﻮﺻ ﺭﺩ . ﺪﺷﺎﺑ ﻪﺘﺷﺍﺩ<br />
ﺪﻨﻧﺍﻮﺗ ﻲﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻱﺎﻫ ﺖﻧﻮﻔﻋ .( ٣)<br />
ﺩﺪﻧﻮﻴﭙﺑ ﻉﻮﻗﻭ ﻪﺑ ،ﻝﺎﻤﻋﺍ ﻪﻧﻮﮕﻨﻳﺍ ﺯﺍ ﺲﭘ ﻝﺎﺴﻜﻳ ﺎﺗ ﺪﻧﺍﻮﺗ ﻲﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ<br />
. ﺪﻧﺯﺎﺳ ﻼﺘﺒﻣ ﺰﻴﻧ ﺍﺭ ﻥﺎﮔﺪﻨﻨﻛ ﺕﺩﺎﻴﻋ ﻭ ﻥﺎﻨﻛﺭﺎﻛ ،ﻥﺍﺭﺎﻤﻴﺑ ﺮﺑ ﻩﻭﻼﻋ<br />
ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻉﺍﻮﻧﺍ ﻦﻴﺑ ﺭﺩ ﻲﻟﻭ ﺩﺩﺮﮔ ﺖﻧﻮﻔﻋ ﺭﺎﭼﺩ ،ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺪﻧﺍﻮﺗ ﻲﻣ ﻥﺎﺴﻧﺍ ﻥﺪﺑ ﻱﺎﻀﻋﺍ ﺯﺍ ﻚﻳ ﺮﻫ<br />
ﻩﺪﺷ ﻩﺭﺎﺷﺍ % ١١ ﺩﺪﻋ ﻪﺑ ﺮﮕﻳﺩ ﻪﻌﻟﺎﻄﻣ ﺭﺩ)<br />
ﻲﻧﺎﺘﺤﺗ ﻲﺴﻔﻨﺗ ﻩﺎﮕﺘﺳﺩ ﺖﻧﻮﻔﻋ ،(%<br />
٤٢)<br />
ﻱﺭﺍﺭﺩﺍ ﻩﺎﮕﺘﺳﺩ ﺖﻧﻮﻔﻋ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
،(%<br />
٥-١٠)<br />
ﻥﻮﺧ ﺵﺩﺮﮔ ﻩﺎﮕﺘﺳﺩ ﺖﻧﻮﻔﻋ ﻭ ،(%<br />
٢٤)<br />
ﻲﺣﺍﺮﺟ ﻢﺧﺯ ﺯﺍ ﻲﺷﺎﻧ ﺖﻧﻮﻔﻋ ،(%<br />
٢٠ ﺎﺗ % ١٥)<br />
ﻲﻧﻮﻣﻮﻨﭘ ﺎــﻳ ( ﺖﺳﺍ<br />
ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﺰﻛﺮﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻒﻳﺭﺎﻌﺗ ﺱﺎﺳﺍﺮﺑ ﻪﻛ ﺪﻧﺭﺍﺩﺭﻮﺧﺮﺑ ﻲﺻﺎﺧ ﺖﻴﻤﻫﺍ ﺯﺍ<br />
ﻭ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ،ﻱﺭﺍﺭﺩﺍ ﺖﻧﻮﻔﻋ ،ﻩﺪﺷ ﻡﺎﺠﻧﺍ ﻱﺎﻫ ﻲﺳﺭﺮﺑ ﻖﺒﻃ . ﺪﻧﺍ ﻩﺪﺷ ﻩﺩﺍﺩ ﺡﺮﺷ ١ ﻩﺭﺎﻤﺷ ﻝﻭﺪﺟ ﺭﺩ ( CDC)<br />
ﺎﻫ ﻱﺭﺎﻤﻴﺑ<br />
ﻩﺎﮕﺘﺳﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ،ﺰﻛﺍﺮﻣ ﺯﺍ ﻲﻀﻌﺑ ﺭﺩ ﻪﭼﺮﮔ<br />
. ﺪﺷﺎﺑ ﻲﻣ ﻥﺍﺭﺎﻤﻴﺑ ﮒﺮﻣ ﻲﻠﺻﺍ ﺖﻠﻋ ،ﻥﻮﺧ ﺵﺩﺮﮔ<br />
ﺪﻧﻮﺷ ﻲﻣ ﺏﻮﺴﺤﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻦﻳﺮﺗ ﻩﺪﻨﺸﻛ ﻲﻧﻮﻣﻮﻨﭘ<br />
ﺰﻛﺍﺮﻣ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﺱﺎﺳﺍﺮﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻉﺍﻮﻧﺍ ﻒﻳﺭﺎﻌﺗ ـ<br />
( Surgical site lnfection : SSI)<br />
١<br />
ﻝﻭﺪﺟ<br />
ﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ<br />
ﻲﺣﺍﺮﺟ ﻞﻤﻋ ﻞﺤﻣ ﺖﻧﻮﻔﻋ<br />
ﺖﻨﻠﭙﻤﻳﺍ ﻲﺣﺍﺮﺟ ﺯﺍ ﺲﭘ ﻝﺎﺴﻜﻳ ﻲﻃ ﺎﻳ ،ﻲﺣﺍﺮﺟ ﺯﺍ ﺲﭘ ﺯﻭﺭ ٣٠ ﻲﻃ ﻪﻛ ﻲﺣﺍﺮﺟ ﻞﻤﻋ ﺯﺍ ﻲﺷﺎﻧ ﺖﻧﻮﻔﻋ<br />
ﻞﻣﺎﺷ ﺍﺭ ﻞﻳﺫ ﺩﺭﺍﻮﻣ ﺯﺍ ﻲﻜﻳ ﻞﻗﺍﺪﺣﺪﻳﺎﺑ<br />
( Superficial incisional : SSI)<br />
ﺪﺘﻔﻴﺑ ﻕﺎﻔﺗﺍ ( ﻲﺟﺭﺎﺧ ﻢﺴﺟ ﻱﺭﺍﺬﮔﺭﺎﻛ)<br />
ﻲﺣﺍﺮﺟ ﺵﺮﺑ ﺯﺍ ﻲﺷﺎﻧ ﻲﺤﻄﺳ ﺖﻧﻮﻔﻋ
٣٥٨/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﺎﻴﺳﺎﻓ ﻪﻳﻻ ﻱﻻﺎﺑ ﺖﻤﺴﻗ ﻱﺪﻠﺟ ﺮﻳﺯ ﺖﻓﺎﺑ ﺖﺳﻮﭘ ﺯﺍ ﻲﻛﺮﭼ ﺢﺷﺮﺗ ﺝﻭﺮﺧ<br />
ﻩﺪﺷ ﻪﺘﺴﺑ ﺍﺪﺘﺑﺍ ﺭﺩ ﻪﻛ ﻲﺤﻄﺳ ﺵﺮﺑ ﺯﺍ ﻞﺻﺎﺣ ﺖﻓﺎﺑ ﺎﻳ ﻊﻳﺎﻣ ﺯﺍ ﻲﻧﻮﻔﻋﺮﻴﻏ ﺵﻭﺭ ﻪﺑ ﻢﺴﻴﻧﺎﮔﺭﺍ ﻥﺪﺷ ﺍﺪﺟ<br />
ﺪﺷﺎﺑ<br />
ﻲﻔﻨﻣ ﺖﺸﻛ ﻪﺠﻴﺘﻧ ﻪﻜﻧﺁ ﺮﮕﻣ ،ﺡﺍﺮﺟ ﻂﺳﻮﺗ ﻱﺪﻤﻋ ﺭﻮﻃ ﻪﺑ ﻲﺤﻄﺳ ﺵﺮﺑ ﻥﺩﺮﻛ ﺯﺎﺑ<br />
ﺩﻮﺑ<br />
ﻪﻃﻮﺑﺮﻣ ﻚﺷﺰﭘ ﺎﻳ ﺡﺍﺮﺟ ﻂﺳﻮﺗ ﻢﺧﺯ ﺖﻧﻮﻔﻋ ﺺﻴﺨﺸﺗ<br />
: ﺩﻮﺷ<br />
: ﺩﻮﺷ ﻞﻣﺎﺷ ﺍﺭ ﺮﻳﺯ ﺩﺭﺍﻮﻣ ﺯﺍ ﻲﻜﻳ ﻞﻗﺍﺪﺣ ﺪﻳﺎﺑ ﻲﺣﺍﺮﺟ ﺵﺮﺑ ﺯﺍ ﻲﺷﺎﻧ ﻲﻘﻤﻋ ﺖﻧﻮﻔﻋ<br />
ﺭﺎﻤﻴﺑ ﻪﻛ ﻲﻧﺎﻣﺯ ﺭﺩ ﺡﺍﺮﺟ ﻂﺳﻮﺗ ﻱﺪﻤﻋ ﺭﻮﻃ ﻪﺑ ﻥﺁ ﻥﺪﺷ ﺯﺎﺑ ﺎﻳ ( ﻢﺧﺯ)<br />
ﻪﻠﻀﻋ ﻭ ﺎﻴﺳﺎﻓ ﺪﻨﻧﺎﻣ ﻲﻘﻤﻋ ﺵﺮﺑ ﺯﺍ ﻲﻛﺮﭼ ﺢﺷﺮﺗ ﺝﻭﺮﺧ<br />
ﻲﻘﻤﻋ ﺵﺮﺑ ﺩﻮﺨﺑﺩﻮﺧ ﻥﺪﺷ ﺯﺎﺑ<br />
ﺪﺷﺎﺑ ﻲﻔﻨﻣ ﺖﺸﻛ ﻪﺠﻴﺘﻧ ﻪﻜﻨﻳﺍﺮﮕﻣ ،ﺩﺭﺍﺩ ﻲﻌﺿﻮﻣ ﺖﻴﺳﺎﺴﺣ ﺎﻳ ﺩﺭﺩ ﺎﻳ<br />
ﻭ ﺐﺗ<br />
ﻲﺳﺭﺮﺑ ﻂﺳﻮﺗ ﺎﻳ ،ﺩﺪﺠﻣ ﻲﺣﺍﺮﺟ ،ﻢﻴﻘﺘﺴﻣ ﻪﻨﻳﺎﻌﻣ ﻦﻴﺣ ﻪﻛ ﻲﻘﻤﻋ ﺵﺮﺑ ﺖﻧﻮﻔﻋ ﺪﻫﺍﻮﺷ ﺮﻳﺎﺳ ﺎﻳ ﻪﺴﺑﺁ<br />
ﺩﻮﺷ ﺖﻳﻭﺭ ﻱﮊﻮﻟﻮﻳﺩﺍﺭ ﺎﻳ ﻲﺘﻓﺎﺑ ﻲﺳﺎﻨﺷ ﺐﻴﺳﺁ<br />
. ﻪﻃﻮﺑﺮﻣ ﻚﺷﺰﭘ ﺎﻳ ﺡﺍﺮﺟ ﻂﺳﻮﺗ ﻢﺧﺯ ﺖﻧﻮﻔﻋ ﺺﻴﺨﺸﺗ<br />
ﺎﻀﻓ / ﻮﻀﻋ ﻲﺣﺍﺮﺟ ﻞﻤﻋ ﺖﻧﻮﻔﻋ<br />
ﻩﺪﺷ ﻱﺭﺎﻜﺘﺳﺩ ﺎﻳ ﺯﺎﺑ ،ﻲﺣﺍﺮﺟ ﻦﻴﺣ ﻭ ﻪﺘﻓﺮﮔ ﺭﺍﺮﻗ ﻲﺣﺍﺮﺟ ﺵﺮﺑ ﻞﺤﻣ ﺮﻳﺯ ﺭﺩ ﻪﻛ ﺎﻀﻓ / ﻮﻀﻋ ﺖﻧﻮﻔﻋ<br />
ﻩﺪﺷ ﻪﺘﺷﺍﺬﮔ ﺭﺎﻛ ﺎﻀﻓ / ﻮﻀﻋ ﺭﺩ ( Stab Wound)<br />
: ﺪﺷﺎﺑ ﺍﺭﺍﺩ ﺍﺭ ﺮﻳﺯ ﺩﺭﺍﻮﻣ ﺯﺍ ﻲﻜﻳ ﻞﻗﺍﺪﺣ ﻭ ﺖﺳﺍ<br />
ﻮﻗﺎﭼ ﻭ ﻲﺣﺍﺮﺟ ﻂﺳﻮﺗ ﻪﻛ ﻲﻧﺭﺩ ﺯﺍ ﻲﻛﺮﭼ ﺢﺷﺮﺗ ﺝﻭﺮﺧ<br />
. ﺖﺳﺍ<br />
ﺎﻀﻓ / ﻮﻀﻋ ﻥﺁ ﺖﻓﺎﺑ ﺎﻳ<br />
ﻊﻳﺎﻣ ﺖﺸﻛ ﺯﺍ ﻲﻧﻮﻔﻋﺮﻴﻏ ﺵﻭﺭ ﻪﺑ ﻢﺴﻴﻧﺎﮔﺭﺍ ﻥﺪﺷ ﺍﺪﺟ<br />
ﻲﺳﺭﺮﺑ ﺱﺎﺳﺍﺮﺑ ﺎﻳ ﺩﺪﺠﻣ ﻲﺣﺍﺮﺟ ﻦﻴﺣ ،ﻢﻴﻘﺘﺴﻣ ﻪﻨﻳﺎﻌﻣ ﻦﻴﺣ ﺎﻀﻓ / ﻮﻀﻋ ﺖﻧﻮﻔﻋ ﺪﻫﺍﻮﺷ ﺮﻳﺎﺳ ﺎﻳ ﻪﺴﺑﺁ<br />
( Bloodstream lnfection : BSI)<br />
ﺩﻮﺟﻭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺭﺎﻤﻴﺑ ﺵﺮﻳﺬﭘ ﻥﺎﻣﺯ ﺭﺩ ﻪﻛ ﻩﺎﮕﺸﻳﺎﻣﺯﺁ<br />
ﻱﮊﻮﻟﻮﻳﺩﺍﺭ ﺎﻳ ﻲﺘﻓﺎﺑ ﻲﺳﺎﻨﺷ ﺐﻴﺳﺁ<br />
ﻪﻃﻮﺑﺮﻣ ﻚﺷﺰﭘ ﺎﻳ ﺡﺍﺮﺟ ﻂﺳﻮﺗ ﺖﻧﻮﻔﻋ ﺺﻴﺨﺸﺗ<br />
ﻥﻮﺧ ﺵﺩﺮﮔ ﻩﺎﮕﺘﺳﺩ ﺖﻧﻮﻔﻋ<br />
ﻂﺳﻮﺗ ﻩﺪﺷ ﺪﻴﻳﺎﺗ ﻥﻮﺧ ﺵﺩﺮﮔ ﺖﻧﻮﻔﻋ<br />
ﺯﺍ ﻲﻜﻳ ﻭ ،ﺖﺳﺍ ﻩﺩﺍﺩ ﺥﺭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖﻣﺎﻗﺍ ﺯﺍ ﺪﻌﺑ ﺎﻳ ﻦﻴﺣ ﻭ ﻪﺘﺷﺍﺪﻧ ﺭﺍﺮﻗ ﺰﻴﻧ ﻥﺁ ﻲﮕﺘﻔﻬﻧ ﻩﺭﻭﺩ ﺭﺩ ﻭ ﻪﺘﺷﺍﺪﻧ<br />
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: ﺪﺷﺎﺑ ﻲﻣ ﺍﺭﺍﺩ ﺍﺭ ﺮﻳﺯﺩﺭﺍﻮﻣ<br />
ﺎﻳ ،ﺮﮕﻳﺩ ﻥﻮﻧﺎﻛ<br />
ﺭﺩ ﺖﻧﻮﻔﻋ ﺎﺑ ﻥﮊﻮﺗﺎﭘ ﻁﺎﺒﺗﺭﺍ ﻡﺪﻋ ﻭ ﻥﻮﺧ ﺖﺸﻛ ﺯﺍ ﻩﺪﺷ ﻪﺘﺧﺎﻨﺷ ﻱﺎﻫ ﻥﮊﻮﺗﺎﭘ ﻥﺪﺷ ﺍﺪﺟ<br />
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ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﺖﻧﻮﻔﻋ ﺎﺑ ﻂﺒﺗﺮﻣ ﺎﻳ<br />
( ﻥﻮﺧ ﺵﺩﺮﮔ ﻪﻴﻟّﻭﺍ ﺖﻧﻮﻔﻋ)<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٥٩<br />
ﻲﻗﻭﺮﻋ ﻞﺧﺍﺩ ﻪﻠﻴﺳﻭ ﺎﺑ ﻂﺒﺗﺮﻣ ﻥﮊﻮﺗﺎﭘ ﻥﺪﺷﺍﺪﺟ<br />
.( ﻥﻮﺧ ﺵﺩﺮﮔ ﻪﻳﻮﻧﺎﺛ ﺖﻧﻮﻔﻋ)<br />
ﺮﮕﻳﺩ ﻥﻮﻧﺎﻛﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻪﻧﻮﻤﻧ ﻭﺩ ﺯﺍ ﺪﻨﻛ ﻲﻣ ﻩﺩﻮﻟﺁ ﺍﺭ ﺖﺳﻮﭘ ﻊﻳﺎﺷ ﺭﻮﻃ ﻪﺑ ﻪﻛ ﻲﻤﺴﻴﻧﺎﮔﺭﺍ ﻥﺪﺷ ﺍﺪﺟ ﻭ ﻥﻮﺧ ﺭﺎﺸﻓ ﺖﻓﺍ ﺎﻳ ﺯﺮﻟ ،ﺐﺗ<br />
ﻚﺷﺰﭘ ﻪﻜﻧﺁ ﻁﺮﺷ ﻪﺑ ﺩﺭﺍﺩ ﻲﻗﻭﺮﻋ ﻞﺧﺍﺩ ﻪﻠﻴﺳﻭ ﻪﻛ ﻱﺭﺎﻤﻴﺑ ﺭﺩ ﻥﻮﺧ ﺖﺸﻛ ﻪﻧﻮﻤﻧ ﻚﻳ ﺯﺍ ﺎﻳ ،ﻥﻮﺧ ﺖﺸﻛ<br />
. ﻥﻮﺧ ﻪﻧﻮﻤﻧ ﻥﮊ ﻲﺘﻧﺁ ﻥﻮﻣﺯﺁ ﻥﺪﺷ ﺖﺒﺜﻣ ﺎﻳ ﺪﻨﻛ ﻉﻭﺮﺷ ﻱﻭ ﻱﺍﺮﺑ ﺍﺭ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﺎﺑ ﺐﺳﺎﻨﻣ ﻥﺎﻣﺭﺩ<br />
•<br />
ﻱﺭﺍﺭﺩﺍ ﻩﺎﮕﺘﺳﺩ ﺖﻧﻮﻔﻋ<br />
ﺭﺍﺩ ﺖﻣﻼﻋ ﻱﺭﺍﺭﺩﺍ ﺖﻧﻮﻔﻋ<br />
ﺍﺭ ﺮﻳﺯ ﺩﺭﺍﻮﻣ ﺯﺍ ﻲﻜﻳ ﻭ ﻩﺩﻮﺒﻧ ﺰﻴﻧ ﻲﮕﺘﻔﻬﻧ ﻩﺭﻭﺩ ﺭﺩ ﻭ ﻪﺘﺷﺍﺪﻧ ﺩﻮﺟﻭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺵﺮﻳﺬﭘ ﻥﺎﻣﺯ ﺭﺩ ﺖﻧﻮﻔﻋ<br />
ﻭ ﻚﻴﺑﻮﭘﺍﺮﭘﻮﺳ ﻪﻴﺣﺎﻧ ﺖﻴﺳﺎﺴﺣ ﺎﻳ ﺭﺍﺭﺩﺍ ﺵﺯﻮﺳ ﺎﻳ ﺭﺮﻜﺗ ،(<br />
Urgency)<br />
: ﺪﺷﺎﺑ ﺍﺭﺍﺩ<br />
ﻥﺩﺮﻛ ﺭﺍﺭﺩﺍ ﺭﺩ ﺖﻳﺭﻮﻓ ﺱﺎﺴﺣﺍ ،ﺐﺗ<br />
ﻥﺪﻣﺁ ﺖﺳﺪﺑ ﻭ ﺭﺍﺭﺩﺍ ﺮﺘﻴﻟ ﻲﻠﻴﻣ ﺮﻫ ﺭﺩ ١٠٠٠٠٠ ﺯﺍ ﺮﺘﺸﻴﺑ ﺎﻳ ﻱﻭﺎﺴﻣ ﻲﻧﻮﻠﻛ ﺵﺭﺎﻤﺷ ﺎﺑ ﺖﺒﺜﻣ ﺭﺍﺭﺩﺍ ﺖﺸﻛ<br />
. ﺭﺍﺭﺩﺍ<br />
ﻪﻧﻮﻤﻧ ﺯﺍ ﻢﺴﻴﻧﺎﮔﺭﺍ ﻉﻮﻧ ﻭﺩ ﺮﺜﻛﺍﺪﺣ<br />
ﻱﺰﻴﻣﺁ ﮓﻧﺭ ﺎﻳ ،ﺖﺒﺜﻣ ﺯﺍﺮﺘﺳﺍ ﺖﻴﺳﻮﻜﻟ ﺎﻳ ﺕﺍﺮﺘﻴﻧ ﻥﻮﻣﺯﺁ ﺎﻳ ،ﻱﺭﻮﻴﭘ ﺎﺑ ﻩﺍﺮﻤﻫ ،ﻕﻮﻓ ﻢﻳﻼﻋ ﺯﺍ ﺖﻣﻼﻋ ﻭﺩ ﺩﻮﺟﻭ<br />
ﺎﻳ ﻝﺩﺎﻌﻣ ﻲﻧﻮﻠﻛ ﺵﺭﺎﻤﺷ ﺎﺑ ﻪﻧﻮﻤﻧ ﻭﺩﺮﻫ ﺭﺩ ﻢﺴﻴﻧﺎﮔﺭﺍ ﻥﺪﺷ ﺍﺪﺟ ﻭ ﺭﺍﺭﺩﺍ ﺖﺸﻛ ﻪﻧﻮﻤﻧ ﻭﺩ ﻡﺎﺠﻧﺍ ﺎﻳ ،ﻡﺮﮔ ﺖﺒﺜﻣ<br />
ﺮﻫ ﺭﺩ ١٠٠٠٠٠ ﺯﺍ ﺮﺘﻤﻛ ﺎﻳ ﻝﺩﺎﻌﻣ ﻲﻧﻮﻠﻛﺎﺑ ﺭﺍﺭﺩﺍ ﺖﺸﻛ ﻚﻳ ﺎﻳ ،ﺭﺍﺭﺩﺍ ﺮﺘﻴﻟ ﻲﻠﻴﻣ ﺮﻫ ﺭﺩ ﺭﺍﺰﻫ ١٠٠ ﺯﺍ ﺮﺘﺸﻴﺑ<br />
ﺎﻳ ،ﺪﻨﻛ ﺯﺎﻏﺁ ﺭﺎﻤﻴﺑ ﻱﺍﺮﺑ ﺍﺭ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﺐﺳﺎﻨﻣ ﻥﺎﻣﺭﺩ ﺞﻟﺎﻌﻣ ﻚﺷﺰﭘ ﻪﻛ ﻲﻌﻗﺍﻮﻣ ﺭﺩ ﺭﺍﺭﺩﺍ ﺮﺘﻴﻟ ﻲﻠﻴﻣ<br />
. ﻚﺷﺰﭘ ﻂﺳﻮﺗ ﺖﻧﻮﻔﻋ ﺐﺳﺎﻨﻣ ﻥﺎﻣﺭﺩ ﺎﻳ ﺺﻴﺨﺸﺗ<br />
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ﺖﻣﻼﻋ ﻥﻭﺪﺑ ﻱﺭﻮﻳﺮﺘﻛﺎﺑ<br />
: ﻞﻳﺫ ﺩﺭﺍﻮﻣ ﺯﺍ ﻲﻜﻳ ﺩﻮﺟﻭ<br />
ﻉﻮﻧ ﻭﺩ ﺮﺜﻛﺍﺪﺣ ﻭ ﺭﺍﺭﺩﺍ ﺮﺘﻴﻟ ﻲﻠﻴﻣ ﺮﻫ ﺭﺩ ﻲﻧﻮﻠﻛ ١٠٠٠٠٠ ﺯﺍ ﺮﺘﺸﻴﺑ ﺎﻳ ﻝﺩﺎﻌﻣ ﺵﺭﺎﻤﺷ ﺎﺑ ﺭﺍﺭﺩﺍ ﺖﺸﻛ<br />
. ﺩﻮﺷ ﺍﺪﺟ ،ﺖﺳﺍ ﻲﻨﻴﻟﺎﺑ ﺖﻣﻼﻋ ﺪﻗﺎﻓ ﻲﻟﻭ ﻪﺘﺷﺍﺩ ﻱﺭﺍﺭﺩﺍ ﻦﻜﻤﺘﻣ ﺮﺘﺗﺎﻛ ﻪﻛ ﻱﺭﺎﻤﻴﺑ ﺭﺍﺭﺩﺍ ﻪﻧﻮﻤﻧ ﺯﺍ ﻢﺴﻴﻧﺎﮔﺭﺍ<br />
ﻥﺪﺷﺍﺪﺟ ﻭ ﺭﺍﺭﺩﺍ ﺮﺘﻴﻟ ﻲﻠﻴﻣ ﺮﻫ ﺭﺩ ١٠٠٠٠٠ ﺯﺍ ﺮﺘﺸﻴﺑ ﺎﻳ ﻝﺩﺎﻌﻣ ﻲﻧﻮﻠﻛ ﺵﺭﺎﻤﺷ ﺎﺑ ﺭﺍﺭﺩﺍ ﺖﺸﻛ ﻭﺩ ﺩﻮﺟﻭ<br />
ﻲﻨﻴﻟﺎﺑ ﺖﻣﻼﻋ ﺪﻗﺎﻓ ﻭ ﻪﺘﺷﺍﺪﻧ ﻱﺭﺍﺭﺩﺍ ﻦﻜﻤﺘﻣ ﺮﺘﺗﺎﻛ ﻪﺘﺷﺬﮔ ﺯﻭﺭ ٧ ﻲﻃ ﻪﻛ ﻱﺭﺎﻤﻴﺑ ﺭﺩ ﻢﺴﻴﻧﺎﮔﺭﺍ ﻥﺎﻤﻫ<br />
.<br />
ﺖﺳﺍ<br />
•<br />
•
٣٦٠/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﻲﻜﻳ ﻭ ،ﺖﺳﺍ ﻩﺩﻮﺒﻧ ﺰﻴﻧ ﺩﻮﺧ ﻲﮕﺘﻔﻬﻧ ﻩﺭﻭﺩ ﺭﺩ ﻭ ﻪﺘﺷﺍﺪﻧ ﺩﻮﺟﻭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺭﺎﻤﻴﺑ ﺵﺮﻳﺬﭘ ﻥﺎﻣﺯ ﺭﺩ ﺖﻧﻮﻔﻋ<br />
ﻲﻧﻮﻣﻮﻨﭘ<br />
: ﺩﻮﺷ ﻲﻣ ﻞﻣﺎﺷ ﺍﺭ ﻞﻳﺫ ﺩﺭﺍﻮﻣ ﺯﺍ<br />
ﺯﺍ ﻥﮊﻮﺗﺎﭘ ﻥﺪﺷ ﺍﺪﺟ ﺎﻳ ،ﺪﻳﺪﺟ ﻲﻛﺮﭼ ﻂﻠﺧ ﺶﻳﺍﺪﻴﭘ ﻭ ﻪﻨﻴﺳ ﻪﺴﻔﻗ ﻥﺩﺮﻛ ﻕﺩ ﻦﻴﺣ ﻪﺘﻴﺗﺎﻣ ﺎﻳ ﻝﺍﺭ ﺩﻮﺟﻭ<br />
. ﺶﻧﻭﺮﺑ ﻱﻮﺸﺘﺴﺷ ﺎﻳ ﻲﺴﭘﻮﻴﺑ ﻪﻧﻮﻤﻧ ،ﻝﺎﺌﻛﺍﺮﺗ ﺲﻧﺍﺮﺗ ﻪﻧﻮﻤﻧ ،ﻥﻮﺧ ﺖﺸﻛ<br />
ﻱﺎﻫ ﺺﺧﺎﺷ ﺯﺍ ﻲﻜﻳ ﺩﻮﺟﻭ ﻭ ﻪﻨﻴﺳ ﺲﻜﻋ ﺭﺩ ﺪﻳﺪﺟ ﺭﻮﻠﭘ ﻊﻳﺎﻣ ﺎﻳ ﻩﺮﻔﺣ ،ﻢﻛﺍﺮﺗ ،ﻱﻮﻳﺭ ﺡﺎﺸﺗﺭﺍ ﺶﻳﺍﺪﻴﭘ<br />
ﻲﺴﻔﻨﺗ ﻥﮊﻮﺗﺎﭘ<br />
ﺩﻮﺟﻭ ﻅﺎﺤﻟ ﺯﺍ ﺖﺒﺜﻣ ﻱﮊﻮﻟﻭﺮﺳ ﺎﻳ ﺖﺒﺜﻣ ﻢﻴﻘﺘﺴﻣ ﻲﺼﻴﺨﺸﺗ ﻥﻮﻣﺯﺁ ﺎﻳ ،ﻕﻮﻓ ﺭﺩ ﻩﺪﺷ ﻩﺭﺎﺷﺍ<br />
. ﻲﺘﻓﺎﺑ ﻲﺳﺎﻨﺷ ﺐﻴﺳﺁ ﺪﻫﺍﻮﺷ ﺱﺎﺳﺍﺮﺑ ﻲﻧﻮﻣﻮﻨﭘ ﺺﻴﺨﺸﺗ ﺎﻳ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﻴﻤﻫﺍ<br />
: ﺪﻨﺷﺎﺑ ﻲﻣ ﺖﻴﻤﻫﺍ ﺰﺋﺎﺣ ﻪﺒﻨﺟ ﺪﻨﭼ ﺯﺍ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ<br />
ﻥﺍﺭﺎﻤﻴﺑ ﻲﺷﻮﺧﺎﻧ ﻭ ﺮﻴﻣ ﻭ ﮒﺮﻣ •<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ﻱﺮﺘﺴﺑ ﺕﺪﻣ ﻝﻮﻃ ﺶﻳﺍﺰﻓﺍ •<br />
ﻲﻧﺎﻣﺭﺩ ﻭ ﻲﺼﻴﺨﺸﺗ ﺕﺎﻣﺍﺪﻗﺍ ،ﻥﺍﺭﺎﻤﻴﺑ<br />
ﺖﻣﺎﻗﺍ ﻥﺪﺷ ﻲﻧﻻﻮﻃ ﺯﺍ ﻲﺷﺎﻧ ﻱﺎﻫ ﻪﻨﻳﺰﻫ ﺶﻳﺍﺰﻓﺍ •<br />
ﺵﺮﻳﺬﭘ ﺩﺭﻮﻣ ١٠٠ ﺮﻫ ﻱﺍﺯﺍ ﻪﺑ ﺎﻜﻳﺮﻣﺁ ﺭﺩ ﻪﻛ ﺪﻧﺍ ﻩﺩﺍﺩ ﻥﺎﺸﻧ ﻱﺩﻼﻴﻣ ١٩٧٥ ﺎﺗ ١٩٧٠ ﻝﺎﺳ ﺯﺍ ﺎﻫ ﻲﺳﺭﺮﺑ<br />
ﻥﺁ ﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻥﻮﻴﻠﻴﻣ ٢/<br />
١ ﻞﻗﺍﺪﺣ ﻪﻧﺎﻴﻟﺎﺳ ﺍﺬﻟ ﻭ ﺪﻫﺩ ﻲﻣ ﺥﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺩﺭﻮﻣ ٥/<br />
٧ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﺖﻴﻤﻫﺍ ﺎﺑ ﻩﺯﺍﺪﻧﺍ ﻦﻴﻤﻫ ﻪﺑ ﻞﻗﺍﺪﺣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺩﺭﺍﻮﻣ ﺎﻴﻧﺩ ﻁﺎﻘﻧ ﻡﺎﻤﺗ ﺭﺩ ﺪﺳﺭ ﻲﻣ ﺮﻈﻧ ﻪﺑ ﻭ ﺪﺘﻓﺍ ﻲﻣ ﻕﺎﻔﺗﺍ ﺭﻮﺸﻛ<br />
. ﺪﺷﺎﺑ<br />
ﺎﻫ ﺶﺨﺑ ﺯﺍ ﻲﻀﻌﺑ ﺭﺩ ﻢﻗﺭ ﻦﻳﺍ ﻭ ﻩﺩﻮﺑ % ١٠ ﺎﺗ ٥ ،ﺎﭘﻭﺭﺍ ﻭ ﺎﻜﻳﺮﻣﺁ ﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻉﻮﻴﺷ ﻪﻛ ﺩﻮﺷ ﻲﻣ ﻪﺘﻔﮔ<br />
ﮒﺮﻣ ﻥﺍﺰﻴﻣ ،١٩٩٩<br />
ﻝﺎﺳ ﺭﺎﻣﺁ ﻖﺒﻃ)<br />
ﺎﻜﻳﺮﻣﺁ ﺭﺩ ﺕﺎﻌﻟﺎﻄﻣ . ﺪﺳﺭ ﻲﻣ ﺰﻴﻧ % ٥٠ ﻪﺑ ICU ﺎﻳ ﻩﮋﻳﻭ ﻱﺎﻫ ﺖﺒﻗﺍﺮﻣ ﺶﺨﺑ ﺪﻨﻧﺎﻣ<br />
ﻪﺑ ﻢﻴﻘﺘﺴﻣ ﺭﻮﻃ ﻪﺑ ﻪﻧﺎﻴﻟﺎﺳ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻪﻛ ﺪﻧﺍ ﻩﺩﺍﺩ ﻥﺎﺸﻧ ٠ ( ﺖﺳﺍ ﻩﺩﻮﺑ ﻝﺎﺳ ﺭﺩ ﺩﺭﻮﻣ ٩٠/<br />
٠٠٠ ﺮﺑ ﻎﻟﺎﺑ ﺮﻴﻣ ﻭ<br />
ﻪﺑ ﻼﺘﺑﺍ ﻝﺎﺒﻧﺩ ﻪﺑ ﺮﻴﻣ ﻭ ﮒﺮﻣ . ﺩﺩﺮﮔ ﻲﻣ ﺮﺠﻨﻣ ﻥﺎﺴﻧﺍ ٥٨/<br />
٠٠٠ ﮒﺮﻣ ﻪﺑ ﻢﻴﻘﺘﺴﻣﺮﻴﻏ ﺭﻮﻃ ﻪﺑ ﻭ ﺮﻔﻧ ١٩/<br />
٠٠٠ ﮒﺮﻣ<br />
ﺚﻋﺎﺑ ﻦﻴﻨﭽﻤﻫ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺎﻜﻳﺮﻣﺁ ﺭﺩ . ﺖﺳﺍ % ٢٧ ﺎﺗ ٧ ﻲﻧﻮﻣﻮﻨﭘ<br />
ﻝﺎﺒﻧﺩ ﻪﺑ ﻭ % ٥٠ ﺎﺗ ٢٥ ،ﻥﻮﺧ ﺵﺩﺮﮔ ﺖﻧﻮﻔﻋ<br />
ﺶﻳﺍﺰﻓﺍ ﺯﻭﺭ ٤ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺭﺎﻤﻴﺑ ﻱﺮﺘﺴﺑ ﺕﺪﻣ ﻝﻮﻃ ﻭ ﻩﺪﺷ ﻝﺎﺳ ﺭﺩ ﺭﻻﺩ ﻥﻮﻴﻠﻴﺑ ٤/<br />
٥ ﻝﺩﺎﻌﻣ ﻱﺍ ﻪﻨﻳﺰﻫ ﻑﻼﺗﺍ<br />
.( ٢ ﻩﺭﺎﻤﺷ ﻝﻭﺪﺟ)<br />
ﺪﺑﺎﻳ ﻲﻣ<br />
ﻪﺑ ﻲﻟﻭ ﺖﺴﻴﻧ ﺖﺳﺩ ﺭﺩ ﻪﻠﺻﺎﺣ ﻲﻟﺎﻣ ﻭ ﻲﻧﺎﺟ ﺽﺭﺍﻮﻋ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻉﻮﻴﺷ ﺩﺭﻮﻣ ﺭﺩ ﻲﻘﻴﻗﺩ ﺭﺎﻣﺁ ،ﻥﺍﺮﻳﺍ ﺭﺩ<br />
. ﺩﺩﺮﮔ ﻲﻣ ﻩﺭﺎﺷﺍ ،ﻩﺪﺷ ﻡﺎﺠﻧﺍ ﻪﻌﻟﺎﻄﻣ ﺪﻨﭼ<br />
ﻥﺍﻮﺗ ﻲﻣ ﺖﺳﺍ ﻩﺪﻣﺁ ﺖﺳﺪﺑ ﻥﺍﺮﻳﺍ ﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺯﻭﺮﺑ ﻭ ﻉﻮﻴﺷ ﻥﺍﺰﻴﻣ ﺹﻮﺼﺧ ﺭﺩ ﻪﻛ ﻲﺗﺎﻌﻟﺎﻄﻣ ﺱﺎﺳﺍﺮﺑ<br />
ﺭﺩ ﻦﻳﻭﺰﻗ ﺭﺩ ﻪﻛ ﻱﺍ ﻪﻌﻟﺎﻄﻣ ﺭﺩ .( ٤)<br />
ﺩﺭﺍﺩ ﺭﺍﺮﻗ ﻲﻳﻻﺎﺑ ﺪﺣ ﺭﺩ ﺎﻫ ﺖﻧﻮﻔﻋ ﻦﻳﺍ ﺯﻭﺮﺑ ﻥﺍﺰﻴﻣ ﻪﻛ ﺩﻮﻤﻧ ﻱﺮﻴﮔ ﻪﺠﻴﺘﻧ ﻦﻴﻨﭼ<br />
.<br />
ﺪﻳﺩﺮﮔ ﺵﺭﺍﺰﮔ % ٦/<br />
٨١ ﻲﺷﺯﻮﻣﺁ ﻱﺎﻫ ﻥﺎﺘﺳﺭﺎﻤﻴﺑﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻥﺍﺰﻴﻣ ،ﺖﻓﺮﮔ ﺕﺭﻮﺻ ١٣٧٨ ﻝﺎﺳ<br />
•<br />
•
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٦١<br />
ﺭﺩ ١٣٧٨ ﻝﺎﺳ ﺭﺩ ﻦﻴﻨﭽﻤﻫ . ﺩﻮﻤﻧ ﺩﺭﻭﺁﺮﺑ % ٣/<br />
٥٦ ﺍﺭ ﺎﻫ ﺖﻧﻮﻔﻋ ﻦﻳﺍ ﺯﻭﺮﺑ ،١٣٧٧<br />
ﻝﺎﺳ ﺭﺩ ﺯﺍﺮﻴﺷ ﺭﺩ ﻱﺮﮕﻳﺩ ﻪﻌﻟﺎﻄﻣ<br />
ﻦﻳﺍ ﺭﺩ . ﺪﺷ ﻩﺩﺍﺩ ﺡﺮﺷ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻚﻳ ﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺯﻭﺮﺑ ﻥﺍﺰﻴﻣ ،ﻥﺍﺭﺎﻤﻴﺑ ﺮﻄﺧ ﻞﻣﺍﻮﻋ ﺱﺎﺳﺍﺮﺑ ،ﺯﺍﺮﻴﺷ<br />
ﻭ ٦/<br />
٩ ﺎﺗ ﺮﻔﺻ ﺯﺍ ﻱﺭﺍﺭﺩﺍ ﺖﻧﻮﻔﻋ ،٤٠<br />
ﺎﺗ ٦/<br />
٣ ﺯﺍ ﻲﻧﻮﻣﻮﻨﭘ ،٤٠<br />
ﺎﺗ ١/<br />
٥ ﺯﺍ ﻲﺣﺍﺮﺟ ﻢﺧﺯ ﺖﻧﻮﻔﻋ ﺯﻭﺮﺑ ﻥﺍﺰﻴﻣ ،ﻪﻌﻟﺎﻄﻣ<br />
. ﺪﻳﺩﺮﮔ ﺵﺭﺍﺰﮔ % ٢ ﺎﺗ ﺮﻔﺻ ﺯﺍ ﻥﻮﺧ ﺵﺩﺮﮔ ﻩﺎﮕﺘﺳﺩ ﺖﻧﻮﻔﻋ<br />
ﻝﺎﺒﻧﺪﺑ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ﻱﺮﺘﺴﺑ ﺕﺪﻣ ﻝﻮﻃ ﺶﻳﺍﺰﻓﺍ ﻭ ،ﻪﻨﻳﺰﻫ ﻑﻼﺗﺍ ،ﺮﻴﻣ ﻭ ﮒﺮﻣ ﻥﺍﺰﻴﻣ ـ ٢ ﻝﻭﺪﺟ<br />
ﻢﻴﻘﺘﺴﻣﺮﻴﻏ ﮒﺮﻣ<br />
ﺮﻔﻧ ﺐﺴﺣ ﺮﺑ<br />
( ﻲﻠﻛ ﺭﻮﻃ ﻪﺑ)<br />
٩/<br />
٧٢٦<br />
٢٢/<br />
٩٨٣<br />
٨/<br />
٨٤٤<br />
٦/<br />
٥٠٣<br />
١٠/<br />
٠٣٦<br />
٥٨/<br />
٠٩٢<br />
ﻢــﻴﻘﺘﺴﻣ ﮒﺮﻣ<br />
( ﻲﻠﻛ ﺭﻮﻄﺑ)<br />
٣/<br />
٢٥١<br />
٧/<br />
٠٨٧<br />
٤/<br />
٤٩٦<br />
٩٤٧<br />
٣/<br />
٢٤٦<br />
١٩/<br />
٠٢٧<br />
( ١٩٩٢ ﻝﺎﺳ)<br />
ﺎﻜﻳﺮﻣﺁﺭﻮﺸﻛ ﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺏﺎﺴﺘﻛﺍ<br />
ﻲﻠﻛ ﻪﻨﻳﺰﻫ ﺶﻳﺍﺰﻓﺍ<br />
( ﺭﻻﺩ ﻥﻮﻴﻠﻴﻣ)<br />
١/<br />
٦٠٩<br />
١/<br />
٢٩٠<br />
٣٦٢<br />
٦١٥<br />
٦٥٦<br />
٤/<br />
٥٣٢<br />
ﺩﺍﺪــــﻌﺗ ﻂﺳﻮﺘﻣ<br />
ﻪﺑ ﻱﺮﺘﺴﺑ ﻱﺎﻫﺯﻭﺭ<br />
[١] ﺖﻧﻮﻔﻋ ﺮﻫ ﻱﺍﺯﺍ<br />
٧/<br />
٣<br />
٥/<br />
٩<br />
٧/<br />
٤<br />
١<br />
٤/<br />
٨<br />
٤<br />
ﺖﻧﻮﻔﻋ ﻉﻮﻧ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻢﺧﺯ ﺖﻧﻮﻔﻋ<br />
ﻲﺣﺍﺮﺟ<br />
ﻲﻧﻮﻣﻮﻨﭘ<br />
ﻲﻤﻳﺮﺘﻛﺎﺑ<br />
ﻱﺭﺍﺭﺩﺍ ﺖﻧﻮﻔﻋ<br />
ﺎﻫ ﺖﻤﺴﻗ ﺮﻳﺎﺳ<br />
ﻱﺍﺮﺑ ،ﺯﻭﺭ ٣٠ ﺎﺗ ٧ ﻲﻧﻮﻣﻮﻨﭘ ﻱﺍﺮﺑ ،ﺯﻭﺭ ٤ ﺎﺗ ١ ﻱﺭﺍﺭﺩﺍ ﺖﻧﻮﻔﻋ ﻱﺍﺯﺍ ﻪﺑ ﻱﺮﺘﺴﺑ ﻱﺎﻫﺯﻭﺭ ﺩﺍﺪﻌﺗ ﺶﻳﺍﺰﻓﺍ ﻩﺩﻭﺪﺤﻣ [١]<br />
ﻊﻤﺟ<br />
ﺪﺷﺎﺑ ﻲﻣ ﺯﻭﺭ ٨ ﺎﺗ ٧ ﻲﺣﺍﺮﺟ ﻢﺧﺯ ﺖﻧﻮﻔﻋ ﺖﻬﺟ ﻭ ﺯﻭﺭ ٢١ ﺎﺗ ٧ ﻲﻤﻳﺮﺘﻛﺎﺑ<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻝﺎﻘﺘﻧﺍ ﻱﺎﻫ ﻩﺍﺭ<br />
ﺏﻭﺮﻜﻴﻣ ﻚﻳ ﻲﻫﺎﮔ ﻭ ( ٥)<br />
ﺪﻧﺩﺮﮔ ﻞﻘﺘﻨﻣ ﻒﻠﺘﺨﻣ ﻕﺮﻃ ﻪﺑ ﺪﻨﻧﺍﻮﺗ ﻲﻣ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ<br />
: ﺯﺍ ﺪﻨﺗﺭﺎﺒﻋ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
ﻝﺎﻘﺘﻧﺍ ﻱﺎﻫ ﻩﺍﺭ . ﺩﻮﺷ ﻞﻘﺘﻨﻣ ﻖﻳﺮﻃ ﺪﻨﭼ ﺯﺍ ﺪﻧﺍﻮﺗ ﻲﻣ<br />
ﺭﺎﻤﺷ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻝﺎﻘﺘﻧﺍ ﻩﺍﺭ ﻦﻳﺮﺘﻤﻬﻣ ﻭ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ،ﺱﺎﻤﺗ : (Contact) ﺱﺎﻤﺗ ﻖﻳﺮﻃ ﺯﺍ ﻝﺎﻘﺘﻧﺍ ( ١<br />
: ﺩﻮﺷ ﻲﻣ ﻢﻴﺴﻘﺗ ﻩﻭﺮﮔ ﺮﻳﺯ ﻪﺳ ﻪﺑ ﻭ ﺪﻳﺁ ﻲﻣ<br />
ﺎﻳ ﺖﻧﻮﻔﻋ ﺭﺎﭼﺩ ﺩﺮﻓ<br />
ﻭ ﺱﺎﺴﺣ ﻥﺎﺑﺰﻴﻣ ﻦﻴﺑ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻲﻜﻳﺰﻴﻓ ﻝﺎﻘﺘﻧﺍ ﻭ ﻥﺪﺑ ﺡﻮﻄﺳ ﻢﻴﻘﺘﺴﻣ ﺱﺎﻤﺗ<br />
ﺏﻭﺮﻜﻴﻣ ﺎﺑ ﻩﺪﺷ ﻩﺰﻴﻧﻮﻠﻛ<br />
( ﻩﺩﻮﻟﺁ ﺶﻜﺘﺳﺩ ،ﻥﺎﻤﺴﻧﺎﭘ ،ﻥﺯﻮﺳ ،ﻞﻳﺎﺳﻭ)<br />
ﻩﺩﻮﻟﺁ ﻪﻄﺳﺍﻭ ﺀﻲﺷﺎﺑ ﺱﺎﺴﺣ ﻥﺎﺑﺰﻴﻣ ﻢﻴﻘﺘﺴﻣﺮﻴﻏ ﺱﺎﻤﺗ<br />
ﺎﻳ ﻥﺩﺮﻛ ﻦﺸﻛﺎﺳ ﻦﻴﺣ ،ﻥﺩﺮﻛ ﺖﺒﺤﺻ ﻭ ﻪﻓﺮﺳ ،ﻪﺴﻄﻋ ﻦﻴﺣ ﺩﺮﻓ ﻂﺳﻮﺗ ﻩﺪﺷ ﺪﻴﻟﻮﺗ<br />
( Droplet)<br />
ﻩﺮﻄﻗ<br />
•<br />
•<br />
•
٣٦٢/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﻥﺎﻫﺩﺎﻳ ﻲﻨﻴﺑ ﻁﺎﺨﻣ ،ﻪﻤﺤﺘﻠﻣ ﺎﺑ ﻪﻬﺟﺍﻮﻣ ﻭ ﻲﭘﻮﻜﺳﻮﻜﻧﻭﺮﺑ<br />
(Airborne) ﺍﻮﻫ ﻖﻳﺮﻃ ﺯﺍ ﻝﺎﻘﺘﻧﺍ<br />
( ٢<br />
ﻩﺩﻮﻟﺁ ﻞﻳﺎﺳﻭ ﻭ ﺕﺍﺰﻴﻬﺠﺗ ﻭ ﺎﻫﻭﺭﺍﺩ ،ﺏﺁ ،ﺍﺬﻏ ﺪﻨﻧﺎﻣ ﻩﺩﻮﻟﺁ ﻙﺮﺘﺸﻣ ﻪﻠﻴﺳﻭ ﻖﻳﺮﻃ ﺯﺍ ﻝﺎﻘﺘﻧﺍ ( ٣<br />
. ﺩﺭﺍﺪﻧ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻝﺎﻘﺘﻧﺍ ﺭﺩ ﻲﻧﺍﺪﻨﭼ ﺖﻴﻤﻫﺍ ﻪﻛ ﺵﻮﻣ ﻭ ﺲﮕﻣ ،ﻪﺸﭘ ﺪﻨﻧﺎﻣ ﻦﻴﻠﻗﺎﻧ ﻖﻳﺮﻃ ﺯﺍ ﻝﺎﻘﺘﻧﺍ ( ٤<br />
ﻝﺎﻘﺘﻧﺍ<br />
ﻩﺍﺭ ﺱﺎﺳﺍﺮﺑ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻪﻠﻘﺘﻨﻣ ﻱﺎﻫ ﻥﮊﻮﺗﺎﭘ<br />
ﺪﻨﻧﺎﻣ ﻲﺳﻭﺮﻳﻭ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ،ﻪﺳﺎﻳﺮﺘﻛﺎﺑﻭﺮﺘﻧﺍ ﻩﺩﺍﻮﻧﺎﺧ ﻱﺎﻫ ﻱﺮﺘﻛﺎﺑ ،ﻙﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ : ﻞﻳﺎﺳﻭ ﺎﻳ ﻥﺍﺭﺎﻤﻴﺑ ﺎﺑ ﺱﺎﻤﺗ •<br />
. ﺍﺪﻳﺪﻧﺎﻛ ﭺﺭﺎﻗ ﻭ ،ﺱﻭﺮﻳﻭﺎﺗﻭﺭ<br />
. ﺍﺰﻧﺍﻮﻠﻔﻧﺁ ﺱﻭﺮﻳﻭ ،ﺱﻭﺮﻳﻭﻮﻧﺩﺁ : ﻩﺮﻄﻗ ـ<br />
HIV , B ﺖﻴﺗﺎﭙﻫ : ﻥﺯﻮﺳ ـ<br />
ﻞﺳ ﻞﻴﺳﺎﺑ : ﺍﻮﻫ •<br />
: ﻙﺮﺘﺸﻣ ﻪﻠﻴﺳﻭ •<br />
. ﺎﻴﺷﺍﺮﺳ ،ﺮﺘﻛﺎﺑﻮﺘﻨﻴﺳﺁ : ﺏﺁ ،ﺍﺩﺯﺪﻨﮔ<br />
ﺩﺍﻮﻣ ،ﻱﺪﻳﺭﻭ ﺕﺎﻌﻳﺎﻣ ـ<br />
. ﺮﺘﻛﺎﺑﻮﺘﻨﻴﺳﺁ ،ﺎﻧﻮﻣﻭﺩﻮﺴﭘ : ﭖﻮﻜﺳﻭﺪﻧﺍ ـ<br />
ﺎﻧﻮﻣﻭﺩﻮﺴﭘ ،ﻼﻧﻮﻤﻟﺎﺳ : ﺍﺬﻏ ـ<br />
ﻲﻳﺎﺳﺭﺎﻧ ،ﻪﻳﺭ ﻱﺩﺍﺪﺴﻧﺍ ﻦﻣﺰﻣ ﻱﺭﺎﻤﻴﺑ<br />
،ﺱﻮﺘﻴﻠﻣ ﺖﺑﺎﻳﺩ ،ﻱﺪﺒﻛ ﺯﻭﺮﻴﺳ)<br />
ﺯﺍ ﺪﻨﺗﺭﺎﺒﻋ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻪﺑ ﻥﺍﺭﺎﻤﻴﺑ ﻩﺪﻨﻨﻛ ﺪﻌﺘﺴﻣ ﻞﻣﺍﻮﻋ<br />
.( ﻪﻳﺬﻐﺗ ﺀﻮﺳ ،ﻲﻨﻤﻳﺍ ﻩﺎﮕﺘﺳﺩ ﻩﺪﻨﻨﻛ ﺏﻮﻛﺮﺳ ﻱﺎﻫ ﻭﺭﺍﺩ ﺎﺑ ﻥﺎﻣﺭﺩ ،ﺯﺪﻳﺍ)<br />
( ﻦﺴﻣ ﺩﺍﺮﻓﺍ ،ﻥﺍﺩﺍﺯﻮﻧ)<br />
ﺭﺎﻤﻴﺑ ﻦﺳ<br />
ﻮﻀﻋ ﻲﻳﺎﺳﺭﺎﻧ ﺪﻨﻧﺎﻣ ﻱﺍ ﻪﻨﻴﻣﺯ ﻱﺭﺎﻤﻴﺑ<br />
ﻲﻨﭘﻭﺮﺗﻮﻧ ،ﻥﺎﻃﺮﺳ ،(<br />
ﻪﻴﻠﻛ<br />
ﻲﺑﺎﺴﺘﻛﺍ ﺎﻳ ﻱﺩﺍﺯﺭﺩﺎﻣ ﻲﻨﻤﻳﺍ ﺺﻘﻧ<br />
ﻲﺳﻭﺮﻳﻭ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻞﺑﺎﻘﻣ ﺭﺩ ﻱﺮﻳﺬﭘ ﺐﻴﺳﺁ<br />
،ﻦﻜﻤﺘﻣ ﻱﺎﻫﺮﺘﺗﺎﻛ<br />
،ﻲﭘﻮﻜﺳﻭﺪﻧﺍ ،ﻲﺣﺍﺮﺟ ،ﻲﮕﺘﺧﻮﺳ ،ﺎﻣﻭﺮﺗ ﻝﺎﺒﻧﺪﺑ ﻲﻃﺎﺨﻣ ﻱﺪﻠﺟ ﻲﻋﺎﻓﺩ ﺪﺳ ﺭﺩ ﻝﻼﺘﺧﺍ<br />
ﻲﻃﺎﺨﻣ ﻭ ﻲﺘﺳﻮﭘ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ<br />
. ﺩﺩﺮﮔ ﻲﻣ ﺮﺠﻨﻣ ﻱﻮﻳﺭ ﻪﻳﻮﻬﺗ ﺶﻫﺎﻛ ﺎﻳ ﻪﻓﺮﺳ ﺏﻮﻛﺮﺳ ﻪﺑ ﻪﻛ ( Sedation)<br />
ﻲﮔﺩﻮﻟﺁ ﺏﺍﻮﺧ ﺩﺎﺠﻳﺍ ،ﻲﺷﻮﻬﻴﺑ<br />
ﻲﻨﻳﺰﮕﻳﺎﺟ ﻞﺑﺎﻘﻣ ﺭﺩ ﺖﻣﻭﺎﻘﻣ ﺶﻫﺎﻛ ﻭ ﻥﺪﺑ ﻢﻴﻘﻣ ﺭﻮﻠﻓ ﺮﻴﻴﻐﺗ)<br />
ﺪﻴﺳﺍ ﻲﺘﻧﺁ ،ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻱﺎﻫﻭﺭﺍﺩ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ<br />
ﻩﻮﻘﻟﺎﺑ ﻉﺍﻮﻧﺍ ﻭ ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻪﺑ ﻡﻭﺎﻘﻣ ﻭ ﻪﺘﻓﺎﻳ ﺶﻬﺟ ﻱﺎﻫ ﭺﺭﺎﻗ ﻭ ﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺏﺎﺨﺘﻧﺍ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﻮﻠﻓ<br />
.( ﻡﻭﺎﻘﻣ<br />
. ﺐﻠﻃ ﺖﺻﺮﻓ ﻱﺎﻫ ﭺﺭﺎﻗ ﻭ ﺎﻫ ﻱﺮﺘﻛﺎﺑ ﻲﻠﻗﺎﻧ ﺖﻟﺎﺣ ﺯﻭﺮﺑ ﻪﺠﻴﺘﻧ ﺭﺩ ﻭ ﺭﻮﻠﻓ ﻥﺪﺷ ﻩﺰﻴﻧﻮﻠﻛ<br />
.<br />
ﻲﻨﻤﻳﺍ ﻩﺎﮕﺘﺳﺩ ﺏﻮﻛﺮﺳ ﻝﺎﺒﻧﺪﺑ ﺎﻫ ﻥﺁ ﺩﺪﺠﻣ ﺖﻴﻟﺎﻌﻓ ﻭ ﺵﻮﻣﺎﺧ ﻭ ﻪﺘﻔﻬﻧ ﻱﺎﻫ ﺖﻧﻮﻔﻋ<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٦٣<br />
ﻲﻠﺻﺍ ﻱﺎﻫ ﻥﻮﻧﺎﻛﺭﺩ ﺍﺯ ﻱﺭﺎﻤﻴﺑ ﻞﻣﺎﻋ ﺱﺎﺳﺍﺮﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻱﺪﺻﺭﺩ ﻊﻳﺯﻮﺗ ـ ١ ﺭﺍﺩﻮﻤﻧ<br />
NNISS<br />
ﻡ ١٩٩٤ ﺎﺗ ١٩٩٠ ﻝﺎﺳ ﺖﻧﻮﻔﻋ
٣٦٤/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺐﺒﺴﻣ ﻱﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
ﺪﻧﺩﺮﮔ ﻚﻴﻣﺪﻴﭘﺍ ﻭ ﻚﻴﻣﺪﻧﺍ ﺕﺭﻮﺻ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺯﻭﺮﺑ ﺚﻋﺎﺑ ﺪﻨﻧﺍﻮﺗ ﻲﻣ ﻲﺗﻭﺎﻔﺘﻣ ﻱﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
. ﺖﺳﺍ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻲﻠﺒﻗ ﻑﺮﺼﻣ ﻭ ﻲﻤﺟﺎﻬﺗ ﻞﻳﺎﺳﻭ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ،ﻱﺍ<br />
ﻪﻨﻴﻣﺯ ﻱﺭﺎﻤﻴﺑ ﺪﻨﻧﺎﻣ ﻲﻄﻳﺍﺮﺷ ﻊﺑﺎﺗ ﻪﻛ<br />
ﻡﺎﻈﻧ ﻲﻠﻣ ﻢﺘﺴﻴﺳ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻲﺑﻭﺮﻜﻴﻣ ﻱﻮﮕﻟﺍ ﺩﺭﻮﻣ ﺭﺩ ﺕﺎﻋﻼﻃﺍ ﺐﺴﻛ ﻊﺑﺎﻨﻣ ﻦﻳﺮﺘﻬﺑ ﺯﺍ ﻲﻜﻳ<br />
ﻦﻳﺍ ﻂﺳﻮﺗ ﻱﺩﻼﻴﻣ ١٩٩٤ ﺎﺗ ١٩٩٠ ﻝﺎﺳ ﺯﺍ ﻪﻛ ﻲﺳﺭﺮﺑ ﺭﺩ . ﺪﺷﺎﺑ ﻲﻣ ( NNISS ystem)<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ<br />
ﻱﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺩﺭﺍﻮﻣ % ٣ ﺭﺩ ،ﻱﺯﺍﻮﻫ ﻱﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺩﺭﺍﻮﻣ % ٨٧ ﺭﺩ ﻪﻛ ﺪﻳﺩﺮﮔ ﺺﺨﺸﻣ ،ﻪﺘﻓﺮﮔ<br />
ﺕﺭﻮﺻ ﻪﻋﻮﻤﺠﻣ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺩﺎﺠﻳﺍ ﺭﺩ ﺎﻫ ﻞﮕﻧﺍ ﻭ ﺎﻫ ﺱﻭﺮﻳﻭ ﻉﺍﻮﻧﺍ ﺮﻳﺎﺳ ﺩﺭﺍﻮﻣ % ١ ﺭﺩﻭ ﺎﻫ ﭺﺭﺎﻗ ﺩﺭﺍﻮﻣ % ٩ ﺭﺩ ،ﻱﺯﺍﻮﻫ ﻲﺑ<br />
ﻱﺭﺎﻤﻴﺑ ﻞﻣﺎﻋ ﻦﻳﺮﺗ ﻊﻳﺎﺷ E. ( Coli)<br />
ﻲﻟﻮﻛﺎﻴﺸﻳﺮﺷﺍ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻉﺍﻮﻧﺍ ﻦﻴﺑ ﺭﺩ ﻲﻠﻛ ﺭﻮﻃ ﻪﺑ . ﺪﻧﺍ ﻩﺩﻮﺑ ﻞﻴﺧﺩ<br />
.<br />
. ﺪﻧﺍ ﻩﺪﺷ ﻩﺩﺍﺩ ﻥﺎﺸﻧ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻉﻮﻧ ﺱﺎﺳﺍﺮﺑ ﺍﺰﻳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺏﻭﺮﻜﻴﻣ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ،١<br />
ﺭﺍﺩﻮﻤﻧ ﺭﺩ<br />
ﻙﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ ،ﻱﺭﺍﺭﺩﺍ ﻩﺎﮕﺘﺳﺩ<br />
ﺖﻧﻮﻔﻋ ﻞﻣﺎﻋ ﻦﻳﺮﺘﻌﻳﺎﺷ E. Coli ،ﺖﺳﺍ ﻩﺪﻳﺩﺮﮔ ﺺﺨﺸﻣ ﺭﺍﺩﻮﻤﻧ ﻦﻳﺍ ﺭﺩ ﻪﻛ ﻪﻧﻮﮕﻧﺎﻤﻫ<br />
ﻱﺎﻫ ﻱﺮﺘﻛﺎﺑ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ﺱﻮﺋﺭﺁ ﻙﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ ﻭ ﺍﺯﻮﻨﻳﮊﻭﺮﺋﺁ ﺎﻧﻮﻣﻭﺩﻮﺴﭘ ،ﻲﺣﺍﺮﺟ ﻢﺧﺯ ﺖﻧﻮﻔﻋ ﻞﻣﺎﻋ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ﺱﻮﺋﺭﺁ<br />
ﻪﻴﻟﻭﺍ ﻲﻤﻳﺮﺘﻛﺎﺑﺩﺎﺠﻳﺍ ﺭﺩ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ﺖﺒﺜﻣ ﻡﺮﮔ ﻱﺎﻫ ﻲﺴﻛﻮﻛ ﻭ ﻲﻧﺎﺘﺤﺗ ﻲﺴﻔﻨﺗ ﻩﺎﮕﺘﺳﺩ ﻱﺎﻫ ﺖﻧﻮﻔﻋ<br />
. ﺪﻧﺍ ﻩﺩﻮﺑ<br />
ﺖﺳﺍ ﻪﺘﺷﺍﺩ ﺭﺍﺮﻗ ﻡﻭﺩ ﻪﺒﺗﺮﻣ ﺭﺩ ﺱﻮﺋﺭﺁ ﻙﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ ﻥﺁ ﺯﺍ ﺲﭘﻭ ﻩﺩﻮﺑ ﺍﺯ<br />
ﻪﻫﺩ ﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﺰﻛﺮﻣ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻱﺮﻴﮔ ﻪﻤﻫ ﺐﺒﺴﻣ ﻱﺍﺰﻳﺭﺎﻤﻴﺑ<br />
ﻞﻣﺍﻮﻋ ـ ٢ ﺭﺍﺩﻮﻤﻧ<br />
١٩٨٠
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٦٥<br />
ﺭﺩ . ﺪﻧﺍ ﻩﺩﻮﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺐﺒﺴﻣ ﻱﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺰﻴﻧ ﺎﻫ ﻱﺮﻴﮔ ﻪﻤﻫ ﺭﺩ<br />
ﺩﺭﺍﻮﻣ % ٦٢ ﺭﺩ ،ﻪﺘﻓﺮﮔ ﺕﺭﻮﺻ ﻱﺩﻼﻴﻣ ١٩٩٠ ﺎﺗ ١٩٨٠ ﻪﻫﺩ ﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﻱﺮﻴﮔ ﻪﻤﻫ ﻉﻮﻗﻭ ﺩﺭﻮﻣ ﺭﺩ ﻪﻛ ﻲﺳﺭﺮﺑ<br />
. ﺪﻫﺩ ﻲﻣ ﻥﺎﺸﻧ ﺍﺭ ﺎﻫ ﻱﺮﻴﮔ ﻪﻤﻫ ﻦﻳﺍ ﺭﺩ ﺍﺰﻳﺭﺎﻤﻴﺑ ﻞﻣﺍﻮﻋ ،٢<br />
ﺭﺍﺩﻮﻤﻧ .( ٥)<br />
ﺪﻧﺍ ﻩﺪﺷ ﻪﺘﺧﺎﻨﺷ ﻱﺮﻴﮔ ﻪﻤﻫ ﻞﻣﺎﻋ ﺎﻫ ﻱﺮﺘﻛﺎﺑ<br />
١٩٨٤ ﻝﺎﺳ ﺯﺍ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻱﺎﻫ ﻱﺮﻴﮔ ﻪﻤﻫ ﺹﻮﺼﺧ ﺭﺩ ﻦﻳﻻﺪﻣ ﺭﺩ ﺩﻮﺟﻮﻣ ﻪﻟﺎﻘﻣ ٥٥٥ ﺮﺑ ﻱﺭﻭﺮﻣ ﻦﻴﻨﭽﻤﻫ<br />
ﺭﺩ ﻭ ،ﺎﻫ ﭺﺭﺎﻗ ﺩﺭﺍﻮﻣ % ٥ ﺭﺩ ،ﺎﻫ ﺱﻭﺮﻳﻭ ﺩﺭﺍﻮﻣ % ٢١ ﺭﺩ ،ﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺩﺭﺍﻮﻣ<br />
% ٧١ ﺭﺩ ﻪﻛ ﺖﺳﺍ ﻩﺩﺍﺩ ﻥﺎﺸﻧ ﻱﺩﻼﻴﻣ ١٩٩٥ ﺎﺗ<br />
ﻦﻴﺑ ﺭﺩ . ﺖﺳﺍ ﻩﺪﺸﻧ ﻲﻳﺎﺳﺎﻨﺷ ،ﺖﻧﻮﻔﻋ ﻞﻣﺎﻋ ﺩﺭﺍﻮﻣ % ٢ ﺭﺩ ﻭ ﺪﻧﺍ ﻩﺩﻮﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺮﻴﮔ ﻪﻤﻫ ﺚﻋﺎﺑ ﺎﻫ ﻞﮕﻧﺍ ﺩﺭﺍﻮﻣ % ٣<br />
،ﺮﺘﻛﺎﺑﻮﺘﻨﻴﺳﺁ<br />
،ﺎﻫ ﻥﺁ ﻦﻴﺑ ﺭﺩ ﻭ ﺪﻧﺍ ﻩﺩﻮﺑ ﺖﻧﻮﻔﻋ ﺖﻠﻋ ﻲﻔﻨﻣ ﻡﺮﮔ ﻱﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺩﺭﺍﻮﻣ ﺯﺍ ﻲﻤﻴﻧ ﺭﺩ ﺎﺒﻳﺮﻘﺗ ،ﺎﻫ ﻱﺮﺘﻛﺎﺑ<br />
،ﻢـﺴﻴﻧﺎﮔﺭﺍ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ،ﺖﺒﺜﻣ ﻡﺮﮔ ﻱﺎﻫ ﻱﺮﺘﻛﺎﺑ ﻦﻴﺑ ﺭﺩ ﺪﻧﺍ ﻩﺩﻮﺑ ﺮﺗ ﻊﻳﺎﺷ ﻼﻧﻮﻤﻟﺎﺳ ﻭ ،ﺎﻧﻮﻣﻭﺩﻮﺴﭘ ،ﺎﻴﺷﺍﺮﺳ<br />
. ﺖﺳﺍ ﻩﺩﻮﺑ ( % ٦٠)<br />
ﺱﻮﺋﺭﺁ ﻙﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﺵﻭﺭ<br />
ﺯﺍ<br />
ﺖﻈﻓﺎﺤﻣ ﻪﺠﻴﺘﻧ ﺭﺩ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺏﺎﺴﺘﻛﺍ ﺮﻄﺧ ﺶﻫﺎﻛ ،ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﻣﺎﻧﺮﺑ ﻲﻠﺻﺍ ﻑﺪﻫ<br />
ﺭﺩ ﻲﺗﻼﻴﻜﺸﺗ ،ﻑﺪﻫ ﻦﻳﺍ ﻪﺑ ﻥﺪﻴﺳﺭ ﺭﻮﻈﻨﻣ ﻪﺑ . ﺖﺳﺍ ﻥﺎﮔﺪﻨﻨﻛ ﺕﺩﺎﻴﻋ ﻭ ( ﻥﺎﻳﻮﺠﺸﻧﺍﺩ ﻭ)<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻥﺎﻨﻛﺭﺎﻛ ،ﻥﺍﺭﺎﻤﻴﺑ<br />
( lnfection Control Committee)<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﺘﻴﻤﻛ ﻥﺁ ﻪﺑ ﻪﻛ ﺖﺳﺍ ﻩﺪﻣﺁ ﺪﻳﺪﭘ ﺎﻫ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻝﺮﺘﻨﻛ ﻪﺑ ﻁﻮﺑﺮﻣ ﺭﻮﻣﺍ ﻪﻴﻠﻛ ﻲﺑﺎﻳﺯﺭﺍ ﻭ ﻱﺰﻳﺭ ﻪﻣﺎﻧﺮﺑ<br />
ﺖﻴﻟﻮﺌﺴﻣ ( ٧ ﻭ ٦)<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﺘﻴﻤﻛ . ﺪﻨﻳﻮﮔ<br />
: ﺯﺍ ﺪﻨﺗﺭﺎﺒﻋ ﻪﺘﻴﻤﻛ ﻦﻳﺍ ﻱﺎﻀﻋﺍ . ﺩﺭﺍﺩ ﻩﺪﻬﻋ ﺮﺑ ﺍﺭ ﺖﻧﻮﻔﻋ<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺲﻴﺋﺭ ﺎﻳ ﺮﻳﺪﻣ •<br />
ﺖﺴﻳﮊﻮﻟﻮﻴﻣﺪﻴﭘﺍ ﺎﻳ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻚﺷﺰﭘ •<br />
ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺭﺎﺘﺳﺮﭘ •<br />
ﻲﻫﺎﮕﺸﻳﺎﻣﺯﺁ ﻡﻮﻠﻋ ﺺﺼﺨﺘﻣ ﺎﻳ ﻲﻨﻴﻟﺎﺑ ﺖﺴﻳﮊﻮﻟﻮﻴﺑﻭﺮﻜﻴﻣ •<br />
ﻱﺭﺎﺘﺳﺮﭘ ﺮﻳﺪﻣ •<br />
. . . ﻭ ﺕﺎﻣﺪﺧ ،ﻪﻳﺬﻐﺗ ،ﻲﺘﺷﺍﺪﻬﺑ ﻱﺎﻫ ﺪﺣﺍﻭ ﻩﺪﻨﻳﺎﻤﻧ ،ﺡﺍﺮﺟ ،ﻲﻠﺧﺍﺩ ﺺﺼﺨﺘﻣ ﻚﺷﺰﭘ<br />
ﺪﻨﻧﺎﻣ ﺎﻀﻋﺍ ﺮﻳﺎﺳ •<br />
ﻭ ﺪﻨﻫﺩ ﻲﻣ ﻞﻴﻜﺸﺗ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻢﻴﺗ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﺴﻳﮊﻮﻟﻭﺮﻜﻴﻣ ﻭ ﺭﺎﺘﺳﺮﭘ ،ﻚﺷﺰﭘ<br />
. ﺪﻨﻳﺁ ﻲﻣ ﺭﺎﻤﺷ ﻪﺑ ﻪﺘﻴﻤﻛ ﻱﺎﻀﻋﺍ ﻦﻳﺮﺗ ﻝﺎﻌﻓ ﻭ ﻦﻳﺮﺘﻤﻬﻣ<br />
: ﺯﺍ ﺪﻨﺗﺭﺎﺒﻋ ﻥﺁ ﻒﻳﺎﻇﻭ ﻭ ﺪﻫﺩ ﻲﻣ ﻪﺴﻠﺟ ﻞﻴﻜﺸﺗ ﻝﺎﺳ ﺭﺩ ﺭﺎﺑ ١٢ ﺎﺗ ٣ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﺘﻴﻤﻛ<br />
( Surveillance)<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ •<br />
ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺖﻬﺟ ﺭﺩ ﻲﺷﺯﻮﻣﺁ ﻱﺎﻫ ﻪﻣﺎﻧﺮﺑ ﻦﻳﻭﺪﺗ •<br />
ﻥﺎﻨﻛﺭﺎﻛ ﺖﻣﻼﺳ ﻆﻔﺣ •<br />
ﺪﻳﺪﺟ ﺩﺍﻮﻣ ﻭ ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﺪﻨﻧﺎﻣ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺎﺑ ﻪﻄﺑﺍﺭ ﺭﺩ ﻲﺸﻣ ﻂﺧ ﻦﻴﻴﻌﺗ ﻭ ﻱﺰﻳﺭ ﻪﻣﺎﻧﺮﺑ<br />
ﻪﻟﺎﺑﺯ ﻊﻓﺩ ﻭ ﺍﺩﺯﺪﻨﮔ<br />
•
٣٦٦/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
. ﻪﺘﻴﻤﻛ ﻂﺳﻮﺗ ﻩﺪﺷ ﻊﺿﻭ ﺕﺍﺭﺮﻘﻣ ﻱﺍﺮﺟﺍ ﺮﺑ ﺕﺭﺎﻈﻧ ﻭ ﻲﺑﺎﻳﺯﺭﺍ<br />
•<br />
ﺵﺯﻮﻣﺁ<br />
ﻥﺎﻴﻣ ﻦﻳﺍ ﺭﺩ ﻭ ﺖﺳﺍ ﻲﺷﺯﻮﻣﺁ ﻱﺎﻫ ﻪﻣﺎﻧﺮﺑ ﻦﻳﻭﺪﺗ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﺘﻴﻤﻛ ﻲﻠﺻﺍ ﻒﻳﺎﻇﻭ ﺯﺍ ﻲﻜﻳ<br />
ﻪﻄﺑﺍﺭ ﺭﺩ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻥﺎﻨﻛﺭﺎﻛ ﺵﺯﻮﻣﺁ . ﺩﺭﺍﺩ ﻲﺷﺯﻮﻣﺁ ﻱﺎﻫ ﻪﻣﺎﻧﺮﺑ ﻱﺍﺮﺟﺍ ﺖﻬﺟ ﺭﺩ ﻲﺳﺎﺳﺍ ﺶﻘﻧ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺭﺎﺘﺳﺮﭘ<br />
ﺯﺍ ﺢﻴﺤﺻ ﻩﺩﺎﻔﺘﺳﺍ ،(<br />
Disinfection)<br />
ﻲﻳﺍﺩﺯﺪﻨﮔ ( Sterilization)<br />
،ﻱﺯﺎﺳ ﻥَﻭﺮﹶﺘِﺳ ،ﻱﺮﺴُﻣ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻝﺮﺘﻨﻛ ﺎﺑ<br />
ﻥﻮﺧ ﻩﺍﺭ ﺯﺍ ﻪﻠﻘﺘﻨﻣ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﺮﺑﺍﺮﺑ ﺭﺩ ﺖﻈﻓﺎﺤﻣ ﻭ ،ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ﻭ ﻲﺘﺷﺍﺪﻬﺑ ﻞﺋﺎﺴﻣ ﺖﻳﺎﻋﺭ ،ﺕﺍﺰﻴﻬﺠﺗ ﻭ ﻞﻳﺎﺳﻭ<br />
. ﺪﺷﺎﺑ ﻲﻣ . . . ﻭ ﺯﺪﻳﺍ ﻭ ﻲﺳﻭﺮﻳﻭ ﺖﻴﺗﺎﭙﻫ ﺪﻨﻧﺎﻣ<br />
( Surveillance)<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ<br />
ﺕﺭﻮﺻ ﻪﺑ ﻲﺘﺷﺍﺪﻬﺑ ﻱﺎﻫ ﻩﺩﺍﺩ ﻭ ﺕﺎﻋﻼﻃﺍ ﺮﻴﺴﻔﺗ ﻭ ﻞﻴﻠﺤﺗ ،ﻪﻳﺰﺠﺗ ،ﻱﺭﻭﺁ ﻊﻤﺟ ﺯﺍ ﺖﺳﺍ ﺕﺭﺎﺒﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ<br />
ﺖﺳﺪﺑ ﺕﺎﻋﻼﻃﺍ . ﻲﺘﺷﺍﺪﻬﺑ ﻪﻌﻗﺍﻭ ﻚﻳ ﻒﻴﺻﻮﺗ ﻭ ( Monitoring)<br />
ﺶﻳﺎﭘ ﺪﻨﻳﺁﺮﻓ ﻲﻃ ( ﻱﺭﺎﺟ)<br />
ﻝﺎﻌﻓ ﻭ ﻚﻴﺗﺎﻤﺘﺴﻴﺳ<br />
ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻭ ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻪﺑ ﻁﻮﺑﺮﻣ ﻱﺎﻫ ﻪﻣﺎﻧﺮﺑ<br />
ﻭ ﺕﻼﺧﺍﺪﻣ ﻲﺑﺎﻳﺯﺭﺍ ﻭ ﻱﺮﻴﮔﺭﺎﻜﺑ ،ﻲﺣﺍﺮﻃ ﺖﻬﺟ ﻩﺪﻣﺁ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻪﻨﻴﻣﺯ ﺭﺩ ﺎﻫ ﺖﻴﻟﺎﻌﻓ ﻪﺑ ﻁﻮﺑﺮﻣ ﻱﺎﻫ ﺯﺎﻴﻧ ،ﺕﺎﻋﻼﻃﺍ ﻦﻳﺍ . ﺪﻧﺮﻴﮔ ﻲﻣ ﺭﺍﺮﻗ ﻩﺩﺎﻔﺘﺳﺍ ﺩﺭﻮﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
.( ٨)<br />
ﺪﻨﻛ ﻲﻣ ﺺﺨﺸﻣ ﺍﺭ ﺎﻫ ﻪﻣﺎﻧﺮﺑ ﻲﺸﺨﺑ ﺮﺛﺍ ﻭ ﻲﻳﺁﺭﺎﻛ ﻭ ﻩﺩﻮﻤﻧ ﻦﻴﻴﻌﺗ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛﻭ<br />
ﻱﺮﻴﮔﻮﻠﺟ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺩﺭﺍﻮﻣ ﻡﻮﺳ ﻚﻳ ﺩﻭﺪﺣ ﺯﻭﺮﺑ ﺯﺍ ﻥﺍﻮﺗ ﻲﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ ﺎﺑ<br />
ﺶﻫﺎﻛ % ٥٠ ﺍﺭ ﺖﻧﻮﻔﻋ ﻉﻮﻧ ﻦﻳﺍ ﺩﺭﺍﻮﻣ ﻥﺍﻮﺗ ﻲﻣ ،ﻲﺣﺍﺮﺟ ﻢﺧﺯ ﺖﻧﻮﻔﻋ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ ﺎﺑ ﻝﺎﺜﻣ ﻥﺍﻮﻨﻋ ﻪﺑ ،ﺩﻮﻤﻧ<br />
ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻢﺘﺴﻴﺳ<br />
. ﺪﺷ ﺪﻫﺍﻮﺧ ﻱﺮﻴﮔﻮﻠﺟ ﺰﻴﻧ ﻲﻟﺎﻣ ﻊﺑﺎﻨﻣ ﻑﻼﺗﺍ ﺯﺍ ،ﺖﻧﻮﻔﻋ ﺩﺭﺍﻮﻣ ﺶﻫﺎﻛ ﺎﺑ ﺖﺳﺍ ﻲﻬﻳﺪﺑ . ﺩﺍﺩ<br />
ﺖﺒﻗﺍﺮﻣ ﻪﺑ ﻱﺍ ﻩﺭﻭﺩ ﺕﺭﻮﺻ ﻪﺑ ﻪﻜﻨﻳﺍ ﺎﻳ ﺪﻫﺩ ﺶﺷﻮﭘ ﺍﺭ ﻲﺻﺎﺧ ﻱﺎﻫ ﺶﺨﺑ ﺎﻳ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻡﺎﻤﺗ ﺪﻧﺍﻮﺗ ﻲﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻉﺍﻮﻧﺍ ﻭ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﻨﻴﻣﺯ ﺭﺩ ﺎﻫ ﺖّﻳﻮﻟﻭﺍ ﺱﺎﺳﺍﺮﺑ ﺪﻧﺍﻮﺗ ﻲﻣ ﺖﺒﻗﺍﺮﻣ ﻦﻴﻨﭽﻤﻫ . ﺪﻳﺎﻤﻧ ﻡﺍﺪﻗﺍ<br />
ﻢﺘﺴﻴﺳ ﺖﻴﺳﺎﺴﺣ ﻪﺑ ﻭ ﻩﺩﻮﺑ ﺭﺍﺩﺭﻮﺧﺮﺑ ﻲﺻﺎﺧ ﺖﻴﻤﻫﺍ ﺯﺍ ﺭﺎﻤﻴﺑ ﺺﻴﺧﺮﺗ<br />
ﺯﺍ ﺲﭘ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ . ﺩﺮﻴﮔ ﺕﺭﻮﺻ<br />
. ﺪﻳﺍﺰﻓﺍ ﻲﻣ ﺖﺒﻗﺍﺮﻣ<br />
ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﺖﻳﻮﻟﻭﺍ ﻦﻴﻴﻌﺗ ﻭ ( ﺮﻄﺧ ﻞﻣﺍﻮﻋ)<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻑﺍﺪﻫﺍ<br />
ﺮﻄﺧﺮﭘ ﻲﻤﺟﺎﻬﺗ ﺕﺎﻣﺍﺪﻗﺍ ﻭ ﻥﺍﺭﺎﻤﻴﺑ ﻲﻳﺎﺳﺎﻨﺷ<br />
ﻚﻴﻣﺪﻧﺍ<br />
ﺯﺍ ﺮﺗﻻﺎﺑ ﺪﺣ ﺭﺩ ﺖﻧﻮﻔﻋ ﺩﺭﺍﻮﻣ ﺶﻳﺍﺰﻓﺍ ﻭ ﺖﻧﻮﻔﻋ ﻚﻴﻣﺪﻧﺍ ﻥﺍﺰﻴﻣ ﻒﻳﺮﻌﺗ<br />
ﻥﺎﻣﺯ ﻝﻮﻃ ﺭﺩ ﻥﺁ ﻱﺎﻫﻮﮕﻟﺍ ﻭ ﺖﻧﻮﻔﻋ ﺯﻭﺮﺑ ﺪﻧﻭﺭ ﺶﻳﺎﭘ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻱﺎﻫ ﻱﺮﻴﮔ ﻪﻤﻫ ﻒﺸﻛ<br />
ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﻪﻨﻴﻣﺯ ﺭﺩ ﻩﺪﺷ ﻡﺎﺠﻧﺍ ﺕﻼﺧﺍﺪﻣ ﻲﻳﺍﺭﺎﻛ ﻥﺍﺰﻴﻣ ﻲﺑﺎﻳﺯﺭﺍ<br />
ﺖﻴﻔﻴﻛ ﻦﻴﻤﻀﺗ ﻱﺎﻫ ﻪﻣﺎﻧﺮﺑ ﻲﺑﺎﻳﺯﺭﺍ<br />
ﺖﻳﺮﻳﺪﻣ ﻭ ﻲﻜﺷﺰﭘ ﻥﺎﻨﻛﺭﺎﻛ ﺭﺩ ﻩﺰﻴﮕﻧﺍ ﺩﺎﺠﻳﺍ ﻭ ﺵﺯﻮﻣﺁ<br />
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ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٦٧<br />
ﻞﻳﺫ ﺩﺭﺍﻮﻣ ﻞﻣﺎﺷ ﺪﻧﺭﺍﺬﮔ ﻲﻣ ﺭﺎﻴﺘﺧﺍ ﺭﺩ ﺍﺭ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ ﻱﺍﺮﺑ ﺕﺎﻋﻼﻃﺍ ﻱﺭﻭﺁ ﻊﻤﺟ ﻥﺎﻜﻣﺍ<br />
ﻪﻛ ﻲﻌﺑﺎﻨﻣ<br />
: ﺪﻨﺷﺎﺑ ﻲﻣ<br />
ﻱﺪﻳﺭﻭ ﺮﺘﺗﺎﻛ ﻖﻳﺮﻃ ﺯﺍ ﻪﻳﺬﻐﺗ ،ﻱﺪﻳﺭﻭ ﻲﻧﺎﻣﺭﺩ ﻊﻳﺎﻣ ،ﻥﺎﻤﺴﻧﺎﭘ ﺾﻳﻮﻌﺗ ،ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ)<br />
ﻥﺍﺭﺎﻤﻴﺑ ﺲﻛﺩﺭﺎﻛ<br />
.( ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺩﺪﺠﻣ ﺵﺮﻳﺬﭘ ،ﻱﺭﺍﺭﺩﺍ ﺪﻧﻮﺳ ،ﻱﺰﻛﺮﻣ<br />
ﻱﮊﻮﻟﻮﻴﺑﻭﺮﻜﻴﻣ<br />
ﻱﺎﻫ ﺶﻳﺎﻣﺯﺁ ﺵﺭﺍﺰﮔ<br />
ﻥﺍﺭﺎﻤﻴﺑ ﺐﺗ ﺕﺭﺎﭼ<br />
ﻱﺭﺎﺘﺳﺮﭘ ﺵﺭﺍﺰﮔ<br />
ﺎﻫ ﺶﺨﺑ ﻝﻮﺌﺴﻣ ﻥﺍﺭﺎﺘﺳﺮﭘ ﺎﺑ ﻁﺎﺒﺗﺭﺍ<br />
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ﻲﻜﺷﺰﭘ ﻥﺎﻨﻛﺭﺎﻛ ﺯﺍ ﺖﺒﻗﺍﺮﻣ<br />
ﺪـﻨﺷﺎﺑ ﻲﻣ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖـﻳﺍﺮﺳ ﻞﺑﺎﻗ ﻱﺎــﻫ ﻱﺭﺎﻤﻴﺑ ﺎﺑ ﻪﻬﺟﺍﻮﻣ ﺮﻄﺧ ﺽﺮﻌﻣ ﺭﺩ ،ﻲﻜﺷﺰﭘ ﻱﺎﻫ ﻪﻓﺮﺣ ﻥﺎﻨﻛﺭﺎﻛ<br />
ﺀﺎﻀﻋﺍ ﻭ ﻥﺎﻨﻛﺭﺎﻛ ﺮﻳﺎﺳ ،ﻥﺍﺭﺎﻤﻴﺑ ﻪﺑ ﻥﺎﻨﻛﺭﺎﻛ ﺯﺍ ﺖﻧﻮﻔﻋ<br />
ﻝﺎﻘﺘﻧﺍ ﺮﻄﺧ ،ﻱﺭﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺑﺍ ﻝﺎﺒﻧﺪﺑ ﺖﺳﺍ ﻲﻬﻳﺪﺑ .( ١٠ ،٩)<br />
ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻞﺑﺎﻘﻣ ﺭﺩ ﻥﺎﻨﻛﺭﺎﻛ ﺯﺍ ﺖﻈﻓﺎﺤﻣ ،ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﻪﺘﻴﻤﻛ ﻒﻳﺎﻇﻭ ﺯﺍ ﻲﻜﻳ . ﺩﺭﺍﺩ ﺩﻮﺟﻭ ﺎﻫ ﻥﺁ ﻩﺩﺍﻮﻧﺎﺧ<br />
ﻥﻮﻴﺳﺎﻨﻴﺴﻛﺍﻭ ﻅﺎﺤﻟ ﻦﻳﺪﺑ . ﺪﺷﺎﺑ ﻲﻣ ﻩﺩﻮﻟﺁ ﻩﻮﻘﻟﺎﺑ ﺩﺍﻮﻣ ﻭ ﻥﻮﺧ ﺎﺑ ﻩﮋﻳﻮﺑ ﻲﻠﻐﺷ ﻪﻬﺟﺍﻮﻣ ﻞﺑﺎﻘﻣ ﺭﺩ ﺰﻴﻧ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﺰﻴﻧ ﻭ ﻥﺍﺭﺎﻤﻴﺑ ﻱﺯﺎﺳﺍﺪﺟ ﺎﻳ ﻥﻮﻴﺳﻻﻭﺰﻳﺍ ﻪﺑ ﻁﻮﺑﺮﻣ ﻦﻴﻧﺍﻮﻗ ﺮﻳﺎﺳ ﻭ ( ﺩﺭﺍﺪﻧﺎﺘﺳﺍ)<br />
ﻲﻣﻮﻤﻋ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ ﺖﻳﺎﻋﺭ<br />
،ﻥﺎﻨﻛﺭﺎﻛ<br />
ﻪﺠﻴﺘﻧ ﺭﺩ ﻭ ﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺑﺍ ﻭ ﻪﻬﺟﺍﻮﻣ ﺩﺭﺍﻮﻣ ﺶﻫﺎﻛ ﻪﺑ ،ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻞﻏﺎﺷ ﻥﺎﻨﻛﺭﺎﻛ ﻂﺳﻮﺗ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ<br />
. ﺩﺩﺮﮔ ﻲﻣ ﺮﺠﻨﻣ ﻪﻠﺻﺎﺣ ﺐﻗﺍﻮﻋ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺶﻫﺎﻛ<br />
ﺕﺎﻣﺍﺪﻗﺍ ﺩﻮﺷ ﻲﻣ ﻪﻴﺻﻮﺗ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻂﻴﺤﻣ ﺭﺩ ﺩﻮﺟﻮﻣ ﻱﺍﺯﺮﻄﺧ ﻞﻣﺍﻮﻋ ﺎﺑ ﻥﺎﻨﻛﺭﺎﻛ ﻪﻬﺟﺍﻮﻣ ﺶﻫﺎﻛ<br />
ﺭﻮﻈﻨﻣ ﻪﺑ<br />
: ﺩﺮﻴﮔ ﺕﺭﻮﺻ ﻞﻳﺫ<br />
ﻥﺎﻨﻛﺭﺎﻛ ﻡﺍﺪﺨﺘﺳﺍ ﺯﺍ ﻞﺒﻗ ﻲﻜﺷﺰﭘ ﺕﺎﻨﻳﺎﻌﻣ ﻡﺎﺠﻧﺍ •<br />
ﻥﺎﻨﻛﺭﺎﻛ ﻱﺍ ﻩﺭﻭﺩ ﻲﻜﺷﺰﭘ ﺕﺎﻨﻳﺎﻌﻣ ﻡﺎﺠﻧﺍ •<br />
ﺮﻴﮔﺍﻭ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻪﻴﻠﻋﺮﺑ ﻥﺎﻨﻛﺭﺎﻛ ﻱﺯﺎﺴﻨﻤﻳﺍ •<br />
ﻪﺑ ﻩﺩﻮﻟﺁ ﻥﺯﻮﺳ ﺎﺑ ﻪﻬﺟﺍﻮﻣ ﺪﻨﻧﺎﻣ)<br />
ﻲﻠﻐﺷ ﺙﺩﺍﻮﺣ ﻭ ﺐﻴﺳﺁ ﺯﻭﺮﺑ<br />
ﺕﺭﻮﺻ ﺭﺩ ﻥﺎﻨﻛﺭﺎﻛ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ •<br />
ﺭﺎﻛ ﻂﻴﺤﻣ ﺕﺍﺮﻃﺎﺨﻣ ﻭ ( HIV<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺍﺰﻳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﺎﺑ ﻪﻬﺟﺍﻮﻣ ﺯﺍ ﻱﺮﻴﮕﺸﻴﭘ ﺭﻮﻈﻨﻣ ﻪﺑ ﻲﺷﺯﻮﻣﺁ ﻱﺎﻫ ﻪﻣﺎﻧﺮﺑ ﻦﻳﻭﺪﺗ •<br />
ﻼﺘﺑﺍ ﻝﺎﺒﻧﺪﺑ<br />
ﻝﺰﻨﻣ ﺭﺩ ﺖﺣﺍﺮﺘﺳﺍ ﻭ ﻥﺎﻨﻛﺭﺎﻛ ﻦﻴﺑ ﺭﺩ ﻱﺮﻴﮔ ﻪﻤﻫ ﺯﻭﺮﺑ ﺩﺭﺍﻮﻣ ﺭﺩ ﻲﺸﻣ ﻂﺧ ﻦﻴﻴﻌﺗ ﻭ ﻱﺰﻳﺭ ﻪﻣﺎﻧﺮﺑ •<br />
. ﺍﺯ ﻱﺭﺎﻤﻴﺑ ﻞﻣﺍﻮﻋ ﺎﺑ ﻪﻬﺟﺍﻮﻣ ﺎﻳ<br />
: ﻪﺟﻮﺗ<br />
ﺪﺷﺎﺑ ﻲﻣ ﻥﺎﻨﻛﺭﺎﻛ ﺖﻬﺟ ﻲﻜﺷﺰﭘ ﻩﺪﻧﻭﺮﭘ ﻞﻴﻜﺸﺗ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺪﻨﻣﺩﻮﺳ ﺕﺎﻣﺍﺪﻗﺍ ﺯﺍ ﻲﻜﻳ
٣٦٨/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻞﻏﺎﺷ ﻥﺎﻨﻛﺭﺎﻛ ﻱﺯﺎﺴﻨﻤﻳﺍ<br />
ﻭ ﺩﺍﺮﻓﺍ ﻱﺯﺎﺴﻨﻤﻳﺍ ،ﺖﻳﺍﺮﺳ ﻞﺑﺎﻗ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺑﺍ ﺯﺍ ﻱﺮﻴﮕﺸﻴﭘ ﻱﺎﻫ ﺵﻭﺭ ﻦﻳﺮﺗ ﻪﻓﺮﺻ ﻪﺑ ﻥﻭﺮﻘﻣ ﺯﺍ ﻲﻜﻳ<br />
( ﻥﺎﻳﻮﺠﺸﻧﺍﺩ ﻞﻣﺎﺷ)<br />
ﻲﻜﺷﺰﭘ ﻞﻏﺎﺸﻣ ﻥﺎﻨﻛﺭﺎﻛ ﺩﻮﺷ ﻲﻣ ﻪﻴﺻﻮﺗ ﺱﺎﺳﺍ ﻦﻳﺍ ﺮﺑ . ﺖﺳﺍ ﻲﻜﺷﺰﭘ ﻱﺎﻫ ﻪﻓﺮﺣ ﻥﺎﻨﻛﺭﺎﻛ ﻩﮋﻳﻮﺑ<br />
. ﺪﺷﺎﺑ ﻥﺎﮕﻳﺍﺭ ﺕﺭﻮﺻ ﻪﺑ ﺪﻳﺎﺑ B ﺖﻴﺗﺎﭙﻫ ﻦﺴﻛﺍﻭ ﺎﺑ ﻥﺎﻨﻛﺭﺎﻛ ﻱﺯﺎﺴﻨﻤﻳﺍ . ﺪﻧﺩﺮﮔ ﻦﻤﻳﺍ B ﺖﻴﺗﺎﭙﻫ ﺱﻭﺮﻳﻭ ﻪﻴﻠﻋ ﺮﺑ<br />
ﻥﻮﻣﺯﺁ ،(<br />
ﻡﻮﺳ ﺖﺑﻮﻧ ﻖﻳﺭﺰﺗ ﺯﺍ ﺲﭘ)<br />
B ﺖﻴﺗﺎﭙﻫ ﻦﺴﻛﺍﻭ ﺯﻭﺩ ﻦﻳﺮﺧﺁ ﻖﻳﺭﺰﺗ ﺯﺍ ﺲﭘ ﻩﺎﻣ ﻭﺩ ﺎﺗ ﻚﻳ ﺩﻮﺷ ﻲﻣ ﻪﻴﺻﻮﺗ<br />
ﻪﻴﻠﻋ ﺮﺑ ﺎﻫ ﻥﺁ ﻲﻨﻤﻳﺍ ﺖﻴﻌﺿﻭ ﺯﺍ ﺎﺗ ﺩﺮﻴﮔ ﺕﺭﻮﺻ ﻥﺎﻜﺷﺰﭘ ﻭ ﻥﺍﺭﺎﺘﺳﺮﭘ ﺪﻨﻧﺎﻣ ﻲﻠﻐﺷ ﺮﻄﺧ ﺮﭘ ﻱﺎﻫ ﻩﻭﺮﮔ ﺭﺩ HBsAb<br />
. ﺩﻮﺷ ﻞﺻﺎﺣ ﻥﺎﻨﻴﻤﻃﺍ B ﺖﻴﺗﺎﭙﻫ ﺱﻭﺮﻳﻭ<br />
ﻲﺻﻮﺼﺧ ﺪﺣﺍﻭ ١٠٠ ﻱﻭﺭ ﺮﺑ ﻥﺍﺮﻬﺗ ﻲﻜﺷﺰﭘ ﻡﻮﻠﻋ ﻩﺎﮕﺸﻧﺍﺩ ﻱﻭﺭﺍﺩ ﻭ ﻥﺎﻣﺭﺩ ﺖﻧﻭﺎﻌﻣ ،١٣٧٧<br />
ﻝﺎﺳ ﺭﺩ<br />
ﻦﺴﻛﺍﻭ ﻥﺎﻜﺷﺰﭙﻧﺍﺪﻧﺩ % ٦٠ ﺎﻬﻨﺗ ،ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﻖﺒﻃ ﻭ ﺩﺍﺩ ﻡﺎﺠﻧﺍ ﺍﺭ ﻱﺍ ﻪﻌﻟﺎﻄﻣ ﻥﺍﺮﻬﺗ ﺮﻬﺷ ﺏﻮﻨﺟ ﺢﻄﺳ ﺭﺩ ﻲﻜﺷﺰﭙﻧﺍﺪﻧﺩ<br />
.( ١١)<br />
ﺪﻧﺩﻮﺑ ﻩﺩﺍﺩ ﻡﺎﺠﻧﺍ ﺍﺭ HBsAb ﻥﻮﻣﺯﺁ ﻦﺴﻛﺍﻭ ﻖﻳﺭﺰﺗ ﺯﺍ ﺲﭘ ﻥﺎﻧﺁ % ٢١ ﻂﻘﻓ ﻭ ﻩﺩﺮﻛ ﺖﻓﺎﻳﺭﺩ ﺍﺭ B ﺖﻴﺗﺎﭙﻫ<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ﻱﺯﺎﺳﺍﺪﺟ ﺎﻳ ﻥﻮﻴﺳﻻﻭﺰﻳﺍ<br />
ﺮﻳﺎﺳ ﻪﺑ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﺎﺑ ﻩﺰﻴﻧﻮﻠﻛ ﺎﻳ ﻲﻧﻮﻔﻋ ﺭﺎﻤﻴﺑ ﺯﺍ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
ﻝﺎﻘﺘﻧﺍ ﺯﺍ ﻱﺮﻴﮕﺸﻴﭘ ﺭﻮﻈﻨﻣ ﻪﺑ<br />
١٩٨٣ ﻝﺎﺳ ﺭﺩ .( ١٣ ،١٢)<br />
ﺖﺳﺍ ﻱﺭﻭﺮﺿ ﻲﻠﻤﻋ ﻱﺎﻫ ﻲﺸﻣ ﻂﺧ ﺫﺎﺨﺗﺍ ،ﻥﺎﮔﺪﻨﻨﻛ ﺕﺩﺎﻴﻋ ﻲﺘﺣ ﻭ ﻥﺎﻨﻛﺭﺎﻛ ،ﻥﺍﺭﺎﻤﻴﺑ<br />
ﻱﺯﺎﺳﺍﺪﺟ ﻞﻣﺎﺷ ﻪﻛ ﺩﻮﺑ ﻩﺩﺮﻛ ﻩﺩﺎﻴﭘ ﺍﺭ ﻱﺯﺎﺳﺍﺪﺟ ﻢﺘﺴﻴﺳ ﻭﺩ ( CDC)<br />
ﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﺰﻛﺮﻣ ،ﻱﺩﻼﻴﻣ<br />
ﺰﻴﻧ ١٩٨٥ ﻝﺎﺳ ﺭﺩ . ﺪﺷ ﻲﻣ ( Disease Specific I)<br />
ﻱﺭﺎﻤﻴﺑ ﻉﻮﻧ ﻭ ( Category Specific I)<br />
ﻱﺭﺎﻤﻴﺑ ﻩﻭﺮﮔ ﺱﺎﺳﺍﺮﺑ<br />
،(<br />
HIV)<br />
ﻲﺑﺎﺴﺘﻛﺍ ﻲﻨﻤﻳﺍ ﺺﻘﻧ ﺱﻭﺮﻳﻭ ﻭ B ﺖﻴﺗﺎﭙﻫ ﺪﻨﻧﺎﻣ ﻥﻮﺧ ﻩﺍﺭ ﺯﺍ ﻪﻠﻘﺘﻨﻣ ﻱﺎﻫ ﻥﮊﻮﺗﺎﭘ ﻝﺎﻘﺘﻧﺍﺯﺍ ﻱﺮﻴﮔﻮﻠﺟ ﺭﻮﻈﻨﻣ ﻪﺑ<br />
ﻞﻣﺍﻮﻋ ﻝﺎﻘﺘﻧﺍ ﻝﺎﻤﺘﺣﺍ ﻞﻴﻟﺪﺑ . ﺩﻮﻤﻧ ﻪﻴﺻﻮﺗ ﺍﺭ ( Universal precautions)<br />
ﻪﺒﻧﺎﺟ ﻪﻤﻫ ﺎﻳ ﻲﻣﻮﻤﻋ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ ﺖﻳﺎﻋﺭ<br />
ﺖﻳﺎﻋﺭ ١٩٩٦ ﻝﺎﺳ ﺭﺩ ،ﺕﺍﺮﻄﻗ ﺎﺑ ﺱﺎﻤﺗ ﺎﻳ ﻲﻳﺍﻮﻫ ﻩﺍﺭ ،ﻢﻴﻘﺘﺴﻣ ﺱﺎﻤﺗﺪﻨﻧﺎﻣ ،ﻥﻮﺧ ﺰﺟ ﻪﺑ ﺮﮕﻳﺩ ﻱﺎﻫ ﻩﺍﺭ ﺯﺍ ﺍﺯ ﻱﺭﺎﻤﻴﺑ<br />
ﺽﺮﻓ ( Transmission - Based P. ) ﺖﻧﻮﻔﻋ ﻝﺎﻘﺘﻧﺍ ﻩﺍﺭ ﺱﺎﺳﺍﺮﺑ ﻁﺎﻴﺘﺣﺍ ﻭ ( Standard P. ) ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ<br />
ﻥﺍﺭﺎﻤﻴﺑ ﻱﺯﺎﺳﺍﺪﺟ ﺕﺎﻣﺍﺪﻗﺍ ﺀﺰﺟ ﻦﻳﺮﺘﻤﻬﻣ ،ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ ﺖﻳﺎﻋﺭ ﻩﺯﻭﺮﻣﺍ . ﺪﺷ ﺪﻨﻫﺍﻮﺧ ﻩﺩﺍﺩ<br />
ﺡﺮﺷ ﻪﻛ ﺪﻳﺩﺮﮔ<br />
. ﺩﺩﺮﮔ ﻲﻣ ﺏﻮﺴﺤﻣ<br />
ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ<br />
،ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻪﺘﺧﺎﻨﺷﺎﻧ ﺎﻳ ﻩﺪﺷ ﻪﺘﺧﺎﻨﺷ ﻊﺑﺎﻨﻣ ﺯﺍ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻝﺎﻘﺘﻧﺍ ﺮﻄﺧ ﺶﻫﺎﻛ ﺭﻮﻈﻨﻣ ﻪﺑ<br />
ﻉﻮﻧ ﻪﻜﻧﺁ ﻥﻭﺪﺑ ،ﺖﺳﺍ ﻱﺭﻭﺮﺿ ﻥﺍﺭﺎﻤﻴﺑ ﻡﺎﻤﺗ ﻱﺍﺮﺑ ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫﻁﺎﻴﺘﺣﺍ<br />
ﺖﻳﺎﻋﺭ . ﺪﻧﻭﺭ ﻲﻣ ﺭﺎﻜﺑ ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ<br />
. ﺩﻮﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ ﺭﺩ ﺎﻫ ﻥﺁ ﻱﺭﺎﻤﻴﺑ<br />
: ﺪﻧﻮﺷ ﺖﻳﺎﻋﺭ ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ ﺪﻳﺎﺑ ﻞﻳﺫ ﺩﺭﺍﻮﻣ ﺯﺍ ﻚﻳ ﺮﻫ ﺎﺑ ﺱﺎﻤﺗ ﻭ ﻪﻬﺟﺍﻮﻣ ﻊﻗﺍﻮﻣ ﺭﺩ<br />
ﺭﺩ ﺖﻳﻭﺭ<br />
ﻞﺑﺎﻗ ﻥﻮﺧ ﺩﻮﺟﻭ ﻦﺘﻓﺮﮔﺮﻈﻧ ﺭﺩ ﻥﻭﺪﺑ ﻕﺮﻋ ﺰﺟ ﻪﺑ ﻥﺪﺑ ﻲﻌﻓﺩ ﺩﺍﻮﻣ ﻭ ،ﺕﺎﺤﺷﺮﺗ ،ﺕﺎﻌﻳﺎﻣ ﻡﺎﻤﺗ<br />
ﻥﻮﺧ<br />
•<br />
•
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٦٩<br />
. ﺎﻫ ﻥﺁ<br />
ﻩﺪﻳﺩ ﺐﻴﺳﺁ ﺖﺳﻮﭘ<br />
ﺕﺎﻃﺎﺨﻣ<br />
•<br />
•<br />
ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ ﻝﻮﺻﺍ ﺡﺮﺷ<br />
ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ـ<br />
،ﻩﺩﻮﻟﺁ ﻞﻳﺎﺳﻭ ﻭ ﻲﻌﻓﺩ ﺩﺍﻮﻣ ،ﺕﺎﺤﺷﺮﺗ ،ﻥﺪﺑ ﺕﺎﻌﻳﺎﻣ ،ﻥﻮﺧ ﻪﺑ ﻥﺩﺯ ﺖﺳﺩ ﺯﺍ ﺲﭘ ﻪﻠﺻﺎﻓﻼﺑ ﺪﻳﺎﺑ ﺎﻫ ﺖﺳﺩ<br />
ﺯﺍ ﺶﻜﺘﺳﺩ ﻥﺩﺭﻭﺁ ﺭﺩ ﺯﺍ ﺲﭘ . ﺪﻧﻮﺷ ﻪﺘﺴﺷ ،ﺮﻴﺧ ﺎﻳ ﺖﺳﺍ ﻩﺪﺷ ﻩﺩﺎﻔﺘﺳﺍ ﺶﻜﺘﺳﺩ ﺯﺍ ﻪﻛ ﻪﺘﻜﻧ ﻦﻳﺍ ﻦﺘﻓﺮﮔ ﺮﻈﻧ ﺭﺩ ﻥﻭﺪﺑ<br />
ﻪﺑ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻝﺎﻘﺘﻧﺍ ﺯﺍ ﺎﺗ ﺪﻧﻮﺷ ﻪﺘﺴﺷ ﺪﻳﺎﺑ ﺎﻫ ﺖﺳﺩ ،ﻡﺯﻻ ﺩﺭﺍﻮﻣ ﺮﻳﺎﺳ ﺭﺩ ﻭ ﻥﺍﺭﺎﻤﻴﺑ ﺎﺑ ﺱﺎﻤﺗ ﻞﺻﺍﻮﻓ ﺭﺩ ،ﺖﺳﺩ<br />
ﻒﻠﺘﺨﻣ ﻱﺎﻫﺭﺎﻛ ﺎﻳ ﻲﻤﺟﺎﻬﺗ ﺕﺎﻣﺍﺪﻗﺍ ﺭﺎﻤﻴﺑ ﻚﻳ ﻱﺍﺮﺑ ﺮﮔﺍ . ﺪﻳﺁ ﻞﻤﻋ ﻪﺑ ﻱﺮﻴﮔﻮﻠﺟ ﻂﻴﺤﻣ ﺎﻳ ﻥﺎﻨﻛﺭﺎﻛ ،ﻥﺍﺭﺎﻤﻴﺑ ﺮﻳﺎﺳ<br />
ﻥﺪﺑ ﻒﻠﺘﺨﻣ ﻱﺎﻫ ﺖﻤﺴﻗ ﻪﺑ ﻲﮔﺩﻮﻟﺁ ﻝﺎﻘﺘﻧﺍ ﺯﺍ ﺎﺗ ﺪﻧﻮﺷ ﻪﺘﺴﺷ ﺪﻳﺎﺑ ﺎﻫ ﺖﺳﺩ ﺭﻮﻣﺍ ﻦﻳﺍ ﻞﺻﺍﻮﻓ ﺭﺩ ،ﺩﺮﻴﮔ ﻲﻣ ﺕﺭﻮﺻ<br />
. ﺩﻮﺷ ﻱﺮﻴﮔﻮﻠﺟﺭﺎﻤﻴﺑ<br />
ﻭ ﻱﺮﻴﮕﻧﻮﺧ ﻥﺎﻣﺯ ﺭﺩ ﻭ ﻩﺩﻮﻟﺁ ﻞﻳﺎﺳﻭ ،ﺭﺎﻤﻴﺑ ﻥﺪﺑ ﻲﻌﻓﺩ ﺩﺍﻮﻣ ،ﺕﺎﺤﺷﺮﺗ ،ﺕﺎﻌﻳﺎﻣ ،ﻥﻮﺧ ﻪﺑ ﻥﺩﺯ ﺖﺳﺩ ﻡﺎﮕﻨﻫ<br />
. ﺪﻴﺷﻮﭘ ﺰﻴﻤﺗ ﺶﻜﺘﺳﺩ ﺪﻳﺎﺑ ﻲﻗﻭﺮﻋ ﻲﻤﺟﺎﻬﺗ ﺕﺎﻣﺍﺪﻗﺍ ﺮﻳﺎﺳ<br />
. ﺪﻴﺷﻮﭘ ﺰﻴﻤﺗ ﺶﻜﺘﺳﺩ ﺪﻳﺎﺑ ﻩﺪﻳﺩ ﺐﻴﺳﺁ ﺖﺳﻮﭘ ﻭ ﺎﻫ ﻁﺎﺨﻣ<br />
ﺎﺑ ﺱﺎﻤﺗ ﺯﺍ ﻞﺒﻗ<br />
ﻡﺎﺠﻧﺍ ﻞﺻﺍﻮﻓ ﺭﺩ ﺪﻳﺎﺑ ﺎﻫ ﺶﻜﺘﺳﺩ ﺩﺮﻴﮔ ﻲﻣ ﺕﺭﻮﺻ ﻲﻬﺟﺎﻬﺗ ﺕﺎﻣﺍﺪﻗﺍ ﻭ ﻒﻠﺘﺨﻣ ﻱﺎﻫﺭﺎﻛ ﺭﺎﻤﻴﺑ ﻚﻳ ﻱﺍﺮﺑ ﺮﮔﺍ<br />
ﺩﺎﻳﺯ ﺖﻈﻠﻏ ﻱﻭﺎﺣ ﺖﺳﺍ ﻦﻜﻤﻣ ﻪﻛ ﻱﺍ ﻩﺩﺎﻣ ﺎﺑ ﺱﺎﻤﺗ ﺯﺍ ﺪﻌﺑ ﻦﻴﻨﭽﻤﻫ . ﺪﻧﻮﺷ ﺾﻳﻮﻌﺗ ﺭﻮﻣﺍ ﻦﻳﺍ<br />
. ﺪﻧﺩﺮﮔ<br />
ﺾﻳﻮﻌﺗ ﺪﻳﺎﺑ ﺎﻫ ﺶﻜﺘﺳﺩ ،ﺪﺷﺎﺑ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
ﺎﺑ ﺱﺎﻤﺗ ﺯﺍ ﻞﺒﻗ ﻭ ﻩﺩﻮﻟﺁﺮﻴﻏ ﻞﻳﺎﺳﻭ ﻭ ﺡﻮﻄﺳ ﻪﺑ ﻥﺩﺯ ﺖﺳﺩ ﺯﺍ ﻞﺒﻗ ،ﺶﻜﺘﺳﺩ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﺯﺍ ﺲﭘ ﻪﻠﺻﺎﻓﻼﺑ<br />
. ﺩﻮﻤﻧ ﺝﺭﺎﺧ ﺎﻫ ﺖﺳﺩ ﺯﺍ ﺍﺭ ﺎﻫ ﺶﻜﺘﺳﺩ ﺪﻳﺎﺑ ،ﺮﮕﻳﺩ ﺭﺎﻤﻴﺑ<br />
ﺶﻜﺘﺳﺩ ـ<br />
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ﺕﺭﻮﺻ ﻆﻓﺎﺤﻣ ،ﻢﺸﭼ ﻆﻓﺎﺤﻣ ،ﻚﺳﺎﻣ ـ<br />
ﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻱﺎﻫ<br />
ﺖﻴﻟﺎﻌﻓ ﺎﻳ ﻲﻤﺟﺎﻬﺗ ﻱﺎﻫ ﺭﺎﻛ ﻡﺎﺠﻧﺍ ﻦﻴﺣ ﻥﺎﻫﺩ ﻭ ﻲﻨﻴﺑ ،ﻢﺸﭼ ﻁﺎﺨﻣ ﺖﻈﻓﺎﺤﻣ ﺭﻮﻈﻨﻣ ﻪﺑ<br />
ﺎﻳ ﺕﺭﻮﺻ ﻆﻓﺎﺤﻣ ﻭ ﻚﺳﺎﻣ ﺯﺍ ﺪﻳﺎﺑ ﺩﺭﺍﺩ ﺩﻮﺟﻭ ﻲﻌﻓﺩ ﺩﺍﻮﻣ ﻭ ﺕﺎﺤﺷﺮﺗ ،ﻥﺪﺑ ﺕﺎﻌﻳﺎﻣ ،ﻥﻮﺧ ﻥﺪﺷ ﻩﺪﻴﺷﺎﭘ ﻝﺎﻤﺘﺣﺍ ﻪﻛ<br />
. ﺩﻮﻤﻧ ﻩﺩﺎﻔﺘﺳﺍ ﻢﺸﭼ<br />
•<br />
ﻥﺎﮔ ـ<br />
،ﻥﺪﺑ ﺕﺎﻌﻳﺎﻣ ،ﻥﻮﺧ ﻥﺪﺷ ﻩﺪﻴﺷﺎﭘ ﻝﺎﻤﺘﺣﺍ ﻪﻛ ﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻱﺎﻫ ﺖﻴﻟﺎﻌﻓ ﺎﻳ ﻲﻤﺟﺎﻬﺗ ﻱﺎﻫ ﺭﺎﻛ ﻡﺎﺠﻧﺍ ﻦﻴﺣ<br />
ﻥﺎﮔ<br />
ﺪﻳﺎﺑ ﺱﺎﺒﻟ ﻥﺪﺷ ﻩﺩﻮﻟﺁ ﻭ ﻒﻴﺜﻛ ﺯﺍ ﻱﺮﻴﮔﻮﻠﺟ ﻭ ﺖﺳﻮﭘ ﺯﺍ ﺖﻈﻓﺎﺤﻣ ﺭﻮﻈﻨﻣ ﻪﺑ ،ﺩﺭﺍﺩ ﺩﻮﺟﻭ ﻲﻌﻓﺩ<br />
ﺩﺍﻮﻣ ﻭ ﺕﺎﺤﺷﺮﺗ<br />
I<br />
II<br />
III<br />
IV
٣٧٠/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
. ﺪﻴﺷﻮﭘ<br />
ﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻞﻳﺎﺳﻭ ﻭ ﺕﺍﺰﻴﻬﺠﺗ ـ<br />
ﻲﻌﻓﺩ ﺩﺍﻮﻣ ﺎﻳ ﻭ ﺕﺎﺤﺷﺮﺗ ،ﻥﺪﺑ ﺕﺎﻌﻳﺎﻣ ،ﻥﻮﺧ ﺎﺑ ﻪﻛ ﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻞﻳﺎﺳﻭ ﻭ ﺕﺍﺰﻴﻬﺠﺗ ﻝﺎﻘﺘﻧﺍ ﻭ ﻱﺭﻭﺁ ﻊﻤﺟ<br />
ﻝﺎﻘﺘﻧﺍ ﻭ ﺱﺎﺒﻟ ﻥﺪﺷ ﻩﺩﻮﻟﺁ ،ﺎﻫ ﻥﺁ ﺎﺑ ﺎﻫ ﻁﺎﺨﻣ ﻭ ﺖﺳﻮﭘ ﻪﻬﺟﺍﻮﻣ ﺯﺍ ﻪﻛ ﺪﺷﺎﺑ<br />
ﻱﺍ ﻪﻧﻮﮔ ﻪﺑ ﺪﻳﺎﺑ ،ﺪﻧﺍ ﻩﺪﺷ ﻩﺩﻮﻟﺁ<br />
. ﺪﻳﺁ ﻞﻤﻋ ﻪﺑ ﻱﺮﻴﮔﻮﻠﺟ ﻂﻴﺤﻣ ﻭ ﻥﺍﺭﺎﻤﻴﺑ ﺮﻳﺎﺳ ﻪﺑ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
ﺱﺎﻤﺗ ﺭﺩ ﺕﺎﻃﺎﺨﻣ ﺎﻳ ،ﻥﺪﺑ ﺕﺎﻌﻳﺎﻣ ،ﻥﻮﺧ ،ﻩﺪﻳﺩ ﺐﻴﺳﺁ ﺖﺳﻮﭘ ﺎﺑ ﻭ ﺪﻨﺘﺴﻫ ﺩﺪﺠﻣ ﻩﺩﺎﻔﺘﺳﺍ ﻞﺑﺎﻗ ﻪﻛ ﻲﻠﻳﺎﺳﻭ<br />
ﻞﺒﻗ . ﺪﻧﻮﺷ ﺰﻴﻤﺗ ﻭ ﻙﺎﭘ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺐﺳﺎﻨﻣ ﻱﺍﺩﺯﺪﻨﮔ ﻩﺩﺎﻣ ﺎﺑ ،ﺮﮕﻳﺩ<br />
ﺭﺎﻤﻴﺑ ﻱﺍﺮﺑ ﻩﺩﺎﻔﺘﺳﺍ ﺯﺍ ﻞﺒﻗ ﺪﻳﺎﺑ ،ﺪﻧﺍ ﻩﺩﻮﺑ<br />
. ﺩﺍﺩ ﺭﺍﺮﻗ ،ﺮﮕﻳﺩ ﺰﻴﻤﺗ ﻖﻃﺎﻨﻣ ﺎﻳ ﺮﮕﻳﺩ ﻥﺍﺭﺎﻤﻴﺑ ﻕﺎﺗﺍ ﺭﺩ ﺍﺭ ﺎﻫ ﻥﺁ ﺪﻳﺎﺒﻧ ،ﻞﻳﺎﺳﻭ ﻦﻳﺍ ﻞﻣﺎﻛ ﻥﺩﺮﻛ ﺰﻴﻤﺗ ﺯﺍ<br />
ﺪﻳﺎﺑ ،ﺖﺳﺍ ﻩﺪﺷ ﻩﺩﺎﺘﺳﺮﻓ ﺲﻳﻭﺮﺳ ﺎﻳ ﺮﻴﻤﻌﺗ ﺖﻬﺟ ﻒﻠﺘﺨﻣ ﻱﺎﻫ ﺶﺨﺑ ﺯﺍ ﻪﻛ ﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻪﻠﻴﺳﻭ ﻉﻮﻧ ﺮﻫ<br />
. ﺩﻮﺷ ﻙﺎﭘ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺐﺳﺎﻨﻣ ﻱﺍﺩﺯﺪﻨﮔ<br />
ﻩﺩﺎﻣ ﺎﺑ<br />
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ﻪﻔﺤﻠﻣ ـ<br />
ﺯﺍ ﻪﻛ ﺪﺷﺎﺑ ﻱﺍ ﻪﻧﻮﮔ ﻪﺑ ﺪﻳﺎﺑ ﻲﻌﻓﺩ ﺩﺍﻮﻣ ﺎﻳ ،ﺕﺎﺤﺷﺮﺗ ،ﻥﺪﺑ ﺕﺎﻌﻳﺎﻣ ،ﻥﻮﺧ ﻪﺑ ﻩﺩﻮﻟﺁ ﻪﻔﺤﻠﻣ ﻝﺎﻘﺘﻧﺍ ﻭ ﻱﺭﻭﺁ ﻊﻤﺟ<br />
ﻞﻤﻋ ﻪﺑ ﻱﺮﻴﮔﻮﻠﺟ ﻂﻴﺤﻣ ﻭ ﻥﺍﺭﺎﻤﻴﺑ ﺮﻳﺎﺳ ﻪﺑ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻝﺎﻘﺘﻧﺍ ﻭ ﺱﺎﺒﻟ ﻲﮔﺩﻮﻟﺁ ،ﻁﺎﺨﻣ ﺎﻳ ﺖﺳﻮﭘ ﺎﺑ ﻪﻬﺟﺍﻮﻣ<br />
. ﺩﺍﺩ ﺭﺍﺮﻗ ﺰﻴﻤﺗ ﺡﻮﻄﺳ ﺎﻳ ﻦﻴﻣﺯ ﻱﻭﺭ ﺍﺭ ﻒﻴﺜﻛ ﻪﻔﺤﻠﻣ ﺪﻳﺎﺒﻧ ﺰﮔﺮﻫ . ﺪﻳﺁ<br />
ﻥﻮﺧ ﻩﺍﺭ ﺯﺍ ﻪﻠﻘﺘﻨﻣ ﻱﺎﻫ ﻥﮊﻮﺗﺎﭘ ﻭ ﻲﻠﻐﺷ ﺖﻣﻼﺳ ـ<br />
ﺰﻴﺗ ﻙﻮﻧ ﻞﻳﺎﺳﻭ ﺮﻳﺎﺳ ﻭ ﻞﭙﻟﺎﻜﺳﺍ ،ﻥﺯﻮﺳ ﻝﺎﻘﺘﻧﺍ ﻭ ﻱﺭﻭﺁ ﻊﻤﺟ ﻦﻴﺣ ﻲﮔﺪﻳﺩ ﺐﻴﺳﺁ ﺯﺍ ﻱﺮﻴﮔﻮﻠﺟ ﺭﻮﻈﻨﻣ ﻪﺑ<br />
. ﺩﺍﺩ ﺭﺍﺮﻗ ﺰﻴﺗ ﻙﻮﻧ ﻱﺎﻴﺷﺍ ﺹﻮﺼﺨﻣ ﻑﻭﺮﻇ ﻞﺧﺍﺩ ﺭﺩ ﺍﺭ ﺎﻫ ﻥﺁ ﺍﺭﻮﻓ ﻭ ﺩﻮﻤﻧ ﻁﺎﻴﺘﺣﺍ ﺭﺎﻴﺴﺑ ﺪﻳﺎﺑ<br />
ﺚﻋﺎﺑ ﻪﻛ ﻲﺷﻭﺭ ﭻﻴﻫ ﺯﺍ ﺎﻳ ﺩﺍﺩ ﺭﺍﺮﻗ ﻩﺪﺷ ﻑﺮﺼﻣ ﻱﺎﻫ ﻥﺯﻮﺳ ﻱﻭﺭ ﺍﺩﺪﺠﻣ ﺍﺭ ﺎﻫ ﻥﺯﻮﺳ ﺵﻮﭘﺮﺳ ﺪﻳﺎﺒﻧ ﺰﮔﺮﻫ<br />
ﻦﺘﺷﺍﺬﮔ ،ﻲﻨﻴﻟﺎﺑ ﻂﻳﺍﺮﺷ ﺭﺩ ﺮﮔﺍ . ﺩﺮﻛ ﻩﺩﺎﻔﺘﺳﺍ ﺪﻳﺎﺒﻧ ﺩﺮﻴﮔ ﺭﺍﺮﻗ ﻥﺪﺑ ﻑﺮﻃ ﻪﺑ ﺰﻴﺗ ﻱﺎﻴﺷﺍ ﺎﻳ ﻥﺯﻮﺳ ﻙﻮﻧ ﺩﻮﺷ<br />
ﻲﻜﻴﻧﺎﻜﻣ ﻪﻠﻴﺳﻭ ﺎﻳ ﺹﻮﺼﺨﻣ ﺲﻨﭘ ﻚﻳ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﺎﺑ ﻭ ﺖﺳﺩ ﻚﻳ ﺎﺑ ،ﺩﺭﺍﺩ ﺕﺭﻭﺮﺿ ﻥﺯﻮﺳ ﻱﻭﺭ ﺵﻮﭘﺮﺳ<br />
. ﺩﻮﺷ ﻡﺎﺠﻧﺍ ﺭﺎﻛ ﻦﻳﺍ ﻥﺯﻮﺳ ﻑﻼﻏ ﻦﺘﺷﺍﺪﻬﮕﻧ ﻱﺍﺮﺑ<br />
. ﺩﻮﻤﻧ ﺍﺪﺟ ﻑﺮﺼﻣ ﺭﺎﺒﻜﻳ ﮓﻧﺮﺳ ﺯﺍ ﺍﺭ ﻩﺪﺷ ﻑﺮﺼﻣ ﻥﺯﻮﺳ ،ﺖﺳﺩ ﺎﺑ ﺪﻳﺎﺒﻧ<br />
ﺎﻫ ﻥﺯﻮﺳ ،ﺎﻫ ﮓﻧﺮﺳ . ﺩﻮﻤﻧ ﻱﺭﺎﻜﺘﺳﺩ ﺎﻳ ﺖﺴﻜﺷ ﺪﻳﺎﺒﻧ ﺍﺭ ﻥﺁ ،ﺩﺮﻛ ﻢﺧ ﺖﺳﺩ ﺎﺑ ﺪﻳﺎﺒﻧ ﺍﺭ ﻩﺪﺷ ﻑﺮﺼﻣ ﻥﺯﻮﺳ<br />
ﻱﻭﺭ ﻪﻛ ﻥﺪﺷ ﺥﺍﺭﻮﺳ ﻞﺑﺎﻘﻣ ﺭﺩ ﻡﻭﺎﻘﻣ ﻑﻭﺮﻇ ﻞﺧﺍﺩ ﺭﺩ ﺪﻳﺎﺑ ﺪﻨﺘﺴﻫ<br />
ﺩﺪﺠﻣ ﻩﺩﺎﻔﺘﺳﺍ ﻞﺑﺎﻗ ﻪﻛ ﺰﻴﺗ ﻞﻳﺎﺳﻭ ﺎﻳ<br />
ﺖﻬﺟ ﺐﺳﺎﻨﻣ ﻞﺤﻣ ﻪﺑ ﻭ ﻪﺘﻓﺮﮔ ﺭﺍﺮﻗ ﺪﺷﺎﺑ ﻪﺘﺷﺍﺩ ﺩﻮﺟﻭ ﻲﻄﻴﺤﻣ ﺖﺴﻳﺯ ﺕﺍﺮﻃﺎﺨﻣ ﻪﻧﺎﺸﻧ ﻭ ﺐﺴﭼ ﺮﺑ ﺎﻫ ﻥﺁ<br />
. ﺪﻧﺩﺮﮔ ﻞﻤﺣ ﺎﻫ ﻥﺁ ﻥﺩﻮﻤﻧ ﻲﻳﺍﺩﺯﺪﻨﮔ ﻭ ﺰﻴﻤﺗ<br />
ﺵﻭﺭ ﻦﻳﺰﮕﻳﺎﺟ<br />
ﻞﻳﺎﺳﻭ ﻥﺍﻮﻨﻋ ﻪﺑ ،ﻲﺴﻔﻨﺗ ﻞﻳﺎﺳﻭ ﺮﻳﺎﺳ ﺎﻳ Mouthpiece ،ﺀﺎﻴﺣﺍ ﻒﻴﻛ ﺯﺍ ﺭﺎﻤﻴﺑ ﻱﺎﻴﺣﺍ ﻱﺍﺮﺑ<br />
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V<br />
VI<br />
VII
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
. ﺪﻨﻳﺎﻤﻧ ﻖﻳﺭﺰﺗ ﺍﺭ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٧١<br />
. ﺩﻮﺷ ﻩﺩﺎﻔﺘﺳﺍ ﻥﺎﻫﺩ ﻪﺑ ﻥﺎﻫﺩ ﺲﻔﻨﺗ<br />
B ﺖﻴﺗﺎﭙﻫ ﻦﺴﻛﺍﻭ ﻲﻜﺷﺰﭘ ﻞﻨﺳﺮﭘ ، B ﺖﻴﺗﺎﭙﻫ ﻪﺑ ﻼﺘﺑﺍ ﺯﺍ ﻱﺮﻴﮔﻮﻠﺟ ﺭﻮﻈﻨﻣ ﻪﺑ<br />
ﻭ ﻥﺪﺑ ﻱﺎﻫ ﻁﺎﺨﻣ ﺮﻳﺎﺳ ﺎﻳ ﻥﺎﻫﺩ ،ﻢﺸﭼ ﻁﺎﺨﻣ ﻪﺑ ﻲﻧﻮﻔﻋ ﻩﻮﻘﻟﺎﺑ ﺩﺍﻮﻣ ﺮﻳﺎﺳ ﺎﻳ ،ﻥﻮﺧ ﻥﺪﺷ ﻩﺪﻴﺷﺎﭘ ﺕﺭﻮﺻ ﺭﺩ<br />
. ﺩﻮﺷ ﺵﺭﺍﺰﮔ ﺪﻳﺎﺑ ﻪﻬﺟﺍﻮﻣ ،ﻥﺪﺑ ﻪﺑ ﺰﻴﺗ ﻙﻮﻧ ﻱﺎﻴﺷﺍ ﺎﻳ ﻥﺯﻮﺳ ﻦﺘﻓﺭ ﻭﺮﻓ ﺎﻳ<br />
ﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻭ ﺭﺍﺮﻘﺘﺳﺍ ﻞﺤﻣ ـ<br />
ﻪﺑ ﺭﺩﺎﻗ ﺎﻳ ﺪﻨﻛ ﻲﻤﻧ ﻱﺭﺎﻜﻤﻫ ﻂﻴﺤﻣ ﻝﺮﺘﻨﻛ ﺎﻳ ﺖﺷﺍﺪﻬﺑ ﻆﻔﺣ ﺭﺩ ﺎﻳ ﺩﺯﺎﺳ ﻲﻣ ﻩﺩﻮﻟﺁ ﺍﺭ ﻂﻴﺤﻣ ﻱﺭﺎﻤﻴﺑ ﺮﮔﺍ<br />
. ﺩﻮﺷ ﻢﻫﺍﺮﻓ ﻲﺻﻮﺼﺧ ﻕﺎﺗﺍ ﻱﻭ ﻱﺍﺮﺑ ،ﺖﺴﻴﻧ ﻱﺭﺎﻜﻤﻫ<br />
،ﺍﻮﻫ)<br />
ﺏﻭﺮﻜﻴﻣ ﺎﻳ ﺖﻧﻮﻔﻋ ﻝﺎﻘﺘﻧﺍ ﻩﻮﺤﻧ ﺱﺎﺳﺍﺮﺑ<br />
ﺖﺳﺍ ﻡﺯﻻ ﻲﻫﺎﮔ ،ﺩﺭﺍﺪﻧﺎﺘﺳﺍ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ ﺖﻳﺎﻋﺭ ﺮﺑ ﻩﻭﻼﻋ<br />
ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ،ﻕﺎﺗﺍ ﻱﺍﻮﻫ ﻪﻳﻮﻬﺗ ،ﻲﺻﻮﺼﺧ ﻕﺎﺗﺍ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﺪﻨﻧﺎﻣ ﺪﻧﻮﺷ ﺖﻳﺎﻋﺭ ﻲﺻﺎﺧ ﻱﺎﻫ ﻁﺎﻴﺘﺣﺍ ،(<br />
ﺱﺎﻤﺗ ،ﺕﺍﺮﻄﻗ<br />
. ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺭﺎﻤﻴﺑ ﻲﻳﺎﺠﺑﺎﺟ ﺶﻫﺎﻛ ﻭ ﻩﺪﻨﻨﻛ ﻲﻧﻮﻔﻋ ﺪﺿ ﻩﺩﺎﻣ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ﻭ ﺶﻜﺘﺳﺩ ،ﻥﺎﮔ ،ﻚﺳﺎﻣ<br />
•<br />
•<br />
VIII<br />
ﺖﺳﺩ ﻦﺘﺴﺷ<br />
.( ١٥ ،١٤)<br />
ﺪﻳﺁ ﻲﻣ ﺭﺎﻤﺷ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺯﺍ ﻱﺮﻴﮕﺸﻴﭘ ﻩﺍﺭ ﻦﻳﺮﺘﻤﻬﻣ ﻲﻳﺎﻬﻨﺗ ﻪﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ<br />
ﻱﺎﻫ ﻥﻮﺑﺎﺻ ﺎﺑ ﺖﺳﺩ ﻦﺘﺴﺷ . ﺩﺮﻴﮔ ﺕﺭﻮﺻ ﻲﺑﻭﺮﻜﻴﻣﺪﺿ ﻉﺍﻮﻧﺍ ﺎﻳ ﻲﻟﻮﻤﻌﻣ ﻱﺎﻫ ﻥﻮﺑﺎﺻ ﻂﺳﻮﺗ ﺪﻧﺍﻮﺗ ﻲﻣ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ<br />
ﺎﺑ ﺖﺳﺩ<br />
ﻦﺘﺴﺷ .( ﻲﻜﻴﻧﺎﻜﻣ ﺵﻭﺭ)<br />
ﺪﻧﻮﺷ ﻩﺩﻭﺩﺯ ﺖﺳﻮﭘ ﻱﻭﺭ ﺯﺍ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﺎﺗ ﺩﻮﺷ ﻲﻣ ﺚﻋﺎﺑ ﻲﺸﻜﺑﺁ ﻭ ﻲﻟﻮﻤﻌﻣ<br />
ﻲﻧﻮﻔﻋ ﺪﺿ ﻥﺁ ﻪﺑ ﻪﻛ ﺩﺩﺮﮔ ﻲﻣ ﺎﻫ ﻥﺁ ﺪﺷﺭ ﺭﺎﻬﻣﺎﻳ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻥﺪﺷ ﻪﺘﺸﻛ ﺚﻋﺎﺑ ﻲﺑﻭﺮﻜﻴﻣ ﺪﺿ ﺕﻻﻮﺼﺤﻣ<br />
. ﺪﻨﻳﻮﮔ ﻥﺩﺮﻛ<br />
ﺮﺜﻛﺍ . ﺖﺳﺍ ﺖﻗﻮﻣ ﻉﺍﻮﻧﺍ ﻭ ﺖﺑﺎﺛ ﺎﻳ ﻢﻴﻘﻣ ﻱﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻱﺍﺭﺍﺩ ﻲﻜﺷﺰﭘ ﻥﺎﻨﻛﺭﺎﻛ ﺖﺳﺩ ﺖﺳﻮﭘ<br />
ﻡﺭﺪﻴﭘﺍ ﻲﻘﻤﻋ ﻱﺎﻫ ﻪﻳﻻ ﺭﺩ ﺎﻫ ﻥﺁ % ٢٠ ﺎﺗ<br />
١٠ ﺩﻭﺪﺣ ﻲﻟﻭ ﺪﻧﺭﺍﺩ ﺭﺍﺮﻗ ﻲﺤﻄﺳ ﻱﺎﻫ ﻪﻳﻻ ﺭﺩ ﺖﺳﻮﭘ ﻢﻴﻘﻣ ﻱﺎﻫ ﺏﻭﺮﻜﻴﻣ<br />
ﺪﺿ ﺩﺍﻮﻣ ﻪﻠﻴﺳﻮﺑ ﻻﻮﻤﻌﻣ ﻲﻟﻭ ﺪﻧﻮﺸﻧ ﻙﺎﭘ ﻲﻟﻮﻤﻌﻣ ﻱﺎﻫ ﻥﻮﺑﺎﺻ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﻱﻮﺸﺘﺴﺷ ﻝﺎﺒﻧﺪﺑ ﺖﺳﺍ ﻦﻜﻤﻣ ﻪﻛﺪﻧﺭﺍﺩ ﺭﺍﺮﻗ<br />
ﻱﺎﻫ ﺏﻭﺮﻜﻴﻣ ﻥﺩﻭﺩﺯ ﺚﻋﺎﺑ ﻲﻟﻮﻤﻌﻣ ﻥﻮﺑﺎﺻ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ . ﺩﺩﺮﮔ ﻲﻣ ﺭﺎﻬﻣ ﻥﺎﺷﺪﺷﺭ ﺎﻳ ﻩﺪﺷ ﻪﺘﺸﻛ ،ﻲﺑﻭﺮﻜﻴﻣ<br />
.( ١٦)<br />
ﺪﺷ ﺪﻫﺍﻮﺧ ﺖﺳﻮﭘ ﻲﺘﻗﻮﻣ<br />
ﺯﺍ ﺪﻨﺗﺭﺎﺒﻋ ﺖﺳﺩ ﻦﺘﺴﺷ ﻱﺎﻫ ﻥﻮﻴﺳﺎﻜﻳﺪﻧﺍ<br />
: ﺪﻨﻳﻮﺸﺑ ﺍﺭ ﺩﻮﺧ ﻱﺎﻫ ﺖﺳﺩ ﻪﺸﻴﻤﻫ ﺪﻳﺎﺑ ﻞﻨﺳﺮﭘ ،ﻱﺭﻮﻓ ﺭﺎﻴﺴﺑ ﺩﺭﺍﻮﻣ ﺭﺩ ﺰﺟ ﻪﺑ<br />
ﺖﺳﺩ ﺯﺍ ﺎﻫ ﺶﻜﺘﺳﺩ ﻥﺩﺮﻛ ﺝﺭﺎﺧ ﺯﺍ ﺲﭘ ( ١<br />
ﻱﺭﺎﻛ ﺖﻔﻴﺷ ﻉﻭﺮﺷ ﺭﺩ ( ٢<br />
ﺩﻮﺧ ﻲﻨﻴﺑ ﻥﺩﺮﻛ ﻙﺎﭘ ﺎﻳ ﻪﻓﺮﺳ ،ﻥﺩﺮﻛ ﻪﺴﻄﻋ ﺯﺍ ﺲﭘ ﺰﻴﻧ ،ﺎﻫ ﺖﺳﺩ ﻥﺪﺷ ﻩﺩﻮﻟﺁ ﻡﺎﮕﻨﻫ ( ٣<br />
ﻥﺍﺭﺎﻤﻴﺑ ﺎﺑ ﺱﺎﻤﺗ ﻞﺻﺍﻮﻓ ﺭﺩ ( ٤<br />
ﻥﺍﺭﺎﻤﻴﺑ ﻱﺎﻫﻭﺭﺍﺩ ﻪﻴﻬﺗ ﺯﺍ ﻞﺒﻗ<br />
( ٥
٣٧٢/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﺖﻟﺍﻮﺗ ﻪﺑ ﻦﺘﻓﺭ ﺯﺍ ﺲﭘ ( ٦<br />
ﻲﻤﺟﺎﻬﺗ ﺕﺎﻣﺍﺪﻗﺍ ﻡﺎﺠﻧﺍ ﺯﺍ ﻞﺒﻗ ( ٧<br />
ﻲﻨﻤﻳﺍ ﻢﺘﺴﻴﺳ ﺪﻳﺪﺷ ﺏﻮﻛﺮﺳ ﺭﺎﭼﺩ ﺩﺍﺮﻓﺍ ﻭ ﻥﺍﺩﺍﺯﻮﻧ ﺪﻨﻧﺎﻣ ﺮﻳﺬﭘ ﺐﻴﺳﺁ ﻥﺍﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﺯﺍ ﻞﺒﻗ ( ٨<br />
ﻢﺧﺯ ﺎﺑ ﺱﺎﻤﺗ ﺯﺍ ﺪﻌﺑ ﻭ ﻞﺒﻗ ( ٩<br />
ﻥﺩﺭﻮﺧ ﺍﺬﻏ ﺯﺍ ﻞﺒﻗ ( ١٠<br />
ﻑﻭﺮﻇ ﺪﻨﻧﺎﻣ ﺩﺭﺍﺩ ﺩﻮﺟﻭ ﺍﺰﻳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺏﻭﺮﻜﻴﻣ ﺎﺑ ﺎﻫ ﻥﺁ ﻲﮔﺩﻮﻟﺁ ﻝﺎﻤﺘﺣﺍ ﻪﻛ ﻲﻳﺎﻴﺷﺍ ﻪﺑ ﻥﺩﺯ ﺖﺳﺩ ﺯﺍ ﺪﻌﺑ ( ١١<br />
ﻥﺍﺭﺎﻤﻴﺑ ﻥﺪﺑ ﺕﺎﺤﺷﺮﺗ ﻱﺭﻭﺁ ﻊﻤﺟ ﻞﻳﺎﺳﻭ ﻭ ﻥﺍﺭﺎﻤﻴﺑ ﺭﺍﺭﺩﺍ ﻱﺮﻴﮔ ﻩﺯﺍﺪﻧﺍ<br />
ﻅﺎﺤﻟ ﺯﺍ ﻪﻛ ﻲﻳﺎﻫ ﺏﻭﺮﻜﻴﻣ ﺎﺑ ﺩﺭﺍﺩ ﻝﺎﻤﺘﺣﺍ ﻪﻛ ﻲﻧﺍﺭﺎﻤﻴﺑ ﺎﻳ ﺖﻧﻮﻔﻋ ﺭﺎﭼﺩ ﻥﺍﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﺯﺍ ﺲﭘ ( ١٢<br />
ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻉﻮﻧ ﺪﻨﭼ ﻪﺑ ﻡﻭﺎﻘﻣ ﻱﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺪﻨﻧﺎﻣ ﺪﻨﺷﺎﺑ ﻩﺪﺷ ﻩﺰﻴﻧﻮﻠﻛﺪﻧﺭﺍﺩ<br />
ﻲﺻﺎﺧ ﺖﻴﻤﻫﺍ ﻱﮊﻮﻟﻮﻴﻣﺪﻴﭘﺍ<br />
ﻦﺘﺴﺷ ﺖﺳﺩ ﻱﺎﻫ ﺵﻭﺭ<br />
ﻦﻴﺗﻭﺭ ﺎﻳ ﻝﻮﻤﻌﻣ ﺵﻭﺭ ﻪﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ـ I<br />
ﻩﺪﻨﻨﻛ ﻲﻧﻮﻔﻋ ﺪﺿ ﺎﻳ ﻲﺑﻭﺮﻜﻴﻣ ﺪﺿ ﺩﺍﻮﻣ ﻪﻠﻴﺳﻭ ﻪﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ـ II<br />
ﺏﺁ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﻥﻭﺪﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ـ III<br />
ﻦﻴﺗﻭﺭ<br />
ﺭﻮﻃ ﻪﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ـ I<br />
ﻪﺑ ﺎﻫ ﺖﺳﺩ ﺡﻮﻄﺳ ﻡﺎﻤﺗ ﻢﻜﺤﻣ ﻥﺪﻴﻟﺎﻣ ﻭ ( ﺪﻣﺎﺟ ،ﻊﻳﺎﻣ)<br />
ﻲﻟﻮﻤﻌﻣ ﻥﻮﺑﺎﺻ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﻥﺩﺮﻛ ﺩﻮﻟﺁ ﻒﻛ ﻞﻣﺎﺷ<br />
ﺎﻫ ﺖﺳﺩ ﺲﭙﺳ . ﺪﺸﻜﺑ ﻝﻮﻃ ﻪﻴﻧﺎﺛ ١٥ ﺎﺗ ١٠ ﺪﻳﺎﺑ ﻞﺣﺍﺮﻣ ﻡﺎﻤﺗ . ﺖﺳﺍ ( ﺏﺁ ﺮﻴﺷ)<br />
ﻱﺭﺎﺟ ﺏﺁ ﺎﺑ ﺎﻫ ﻥﺁ ﻲﺸﻜﺑﺁ ﻭ ﺮﮕﻳﺪﻜﻳ<br />
ﻥﺩﺮﻛ ﻚﺸﺧ ﻱﺍﺮﺑ ﻪﻛ ﻱﺬﻏﺎﻛ ﻝﺎﻤﺘﺳﺩ<br />
ﺎﺑ ﺏﺁ ﺮﻴﺷ ﻦﺘﺴﺑ ﺕﺭﻮﺻ ﺭﺩ . ﺪﻧﺩﺮﮔ ﻚﺸﺧ ﻱﺬﻏﺎﻛ ( ﻪﻟﻮﺣ)<br />
ﻝﺎﻤﺘﺳﺩ ﺎﺑ ﺪﻳﺎﺑ<br />
. ﺩﻮﺷ ﻲﻣ ﻱﺮﻴﮔﻮﻠﺟ ﻚﻨﻴﺳ ﻭ ﺏﺁ ﺮﻴﺷ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﺩﺪﺠﻣ ﻲﮔﺩﻮﻟﺁ ﺯﺍ ،ﺖﺳﺍ ﻩﺪﺷ ﻩﺩﺎﻔﺘﺳﺍ ﻥﺁ ﺯﺍ ﺎﻫ ﺖﺳﺩ<br />
% ٢ ﻦﻳﺪﻳﺰﮕﻫﺮﻠﻛ ﻭ ﺏﺍﺮﻜﺳﺍ ( ﻦﻳﺩﺎﺘﺑ)<br />
ﺎﻫ ﺖﺳﺩ ﻥﺩﺮﻛ ﻲﻧﻮﻔﻋ ﺪﺿ ﺎﻳ ( ﻩﺪﻨﻨﻛ ﻲﻧﻮﻔﻋ ﺪﺿ)<br />
ﻲﺑﻭﺮﻜﻴﻣ ﺪﺿ ﺩﺍﻮﻣ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ـ<br />
ﻦﻳﺩﻮﻳﺍ ﻥﻭﺪﻳﻭﻮﭘ ﻝﻮﻠﺤﻣ ﺯﺍ ﻥﺍﻮﺗ ﻲﻣ ﺎﻫ ﺖﺳﺩ ﻥﺩﻮﻤﻧ ﻲﻧﻮﻔﻋ ﺪﺿ ﻱﺍﺮﺑ<br />
. ﺩﺮﻛ ﻩﺩﺎﻔﺘﺳﺍ<br />
: ﺯﺍ ﺪﻨﺗﺭﺎﺒﻋ ﻲﺑﻭﺮﻜﻴﻣﺪﺿ ﺩﺍﻮﻣ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﻥﺩﺮﻛ ﻲﻧﻮﻔﻋﺪﺿ ﻱﺎﻫ ﻥﻮﻴﺳﺎﻜﻳﺪﻧﺍ<br />
ﻪﺑﺎﺸﻣ ﻲﻤﺟﺎﻬﺗ ﺕﺎﻣﺍﺪﻗﺍ ﺎﻳ ﻲﺣﺍﺮﺟ ﻝﺎﻤﻋﺍ ﻡﺎﺠﻧﺍ ﺯﺍ ﻞﺒﻗ ( ١<br />
. ﺖﺳﺍ<br />
ﻱﺭﻭﺮﺿ ﺎﻫ ﻥﺁ ﻱﺍﺮﺑ ﺎﻫ ﻁﺎﻴﺘﺣﺍ ﻲﻀﻌﺑ ﺖﻳﺎﻋﺭ ﺎﻳ ﺪﻧﺍ ﻩﺪﺷ ﻪﻟﻭﺰﻳﺍ ﻪﻛ ﻲﻧﺍﺭﺎﻤﻴﺑ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ﻦﻴﺣ ( ٢<br />
(Nursery) ﻩﺎﮔﺭﺍﻮﺧﺮﻴﺷ ﺎﻳ ( NICU)<br />
ﻥﺍﺩﺍﺯﻮﻧ ﻩﮋﻳﻭ ﺖﺒﻗﺍﺮﻣ ﺶﺨﺑ ﻪﺑ ﺩﻭﺭﻭ ﺯﺍ ﻞﺒﻗ ( ٣<br />
ﺏﺁ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﻥﻭﺪﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ـ<br />
ﺏﺁ ﻪﺑ ﻮﺸﺘﺴﺷ ﻱﺍﺮﺑ ﻪﻛ ﻱﺩﺍﻮﻣ ﺯﺍ ﺩﺭﺍﺪﻧ ﺩﻮﺟﻭ ﺏﺁ ﺎﺑ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ﻞﻳﺎﺳﻭ ﻭ ﻚﻨﻴﺳ ﻪﻛ ﻲﺻﺎﺧ ﻊﻗﺍﻮﻣ ﺭﺩ<br />
% ٤<br />
II<br />
ﺎﻳ<br />
III
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٧٣<br />
. ﺩﻮﺷ ﻲﻣ ﻩﺩﺎﻔﺘﺳﺍ ،ﻞﻜﻟﺍ ﺪﻨﻧﺎﻣ ،ﺪﻧﺭﺍﺪﻧ ﺯﺎﻴﻧ<br />
: ﻪﺟﻮﺗ<br />
ﻊﺿﻮﻣ ﺖﺳﻮﭘ ﻥﺩﺮﻛ ﻩﺩﺎﻣﺁ ﺖﻬﺟ ﻲﻳﺎﻬﻨﺗ ﻪﺑ ﺪﻳﺎﺒﻧ ﺰﮔﺮﻫ ﻲﺘﻴﻓﺮﻇ ﺭﺎﻬﭼ ﻡﻮﻴﻧﻮﻣﺁ ﺕﺎﺒﻴﻛﺮﺗ ﺎﺑ ﻲﻟﻮﻤﻌﻣ ﻥﻮﺑﺎﺻ ﺯﺍ<br />
. ﺪﺷﺎﺑ ﻪﺘﺷﺍﺩ ﺖﻴﺳﺎﺴﺣ ﻝﻮﺒﻗ ﺩﺭﻮﻣ ﻩﺪﻨﻨﻛ ﻲﻧﻮﻔﻋ ﺪﺿ ﺩﺍﻮﻣ ﻡﺎﻤﺗ ﻪﺑ ﺭﺎﻤﻴﺑ ﻪﻜﻨﻳﺍ ﺮﮕﻣ ﺩﻮﺷ ﻩﺩﺎﻔﺘﺳﺍ ﻲﺣﺍﺮﺟ<br />
.( ١٧)<br />
ﺩﺍﺩ ﺶﻫﺎﻛ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ % ٥٠<br />
ﻥﺍﻮﺗ ﻲﻣ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ﺎﺑ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻪﻟﺎﺑﺯ ﻝﺮﺘﻨﻛﻭ ( Sterilization)<br />
ﻱﺯﺎﺳ ﻥَﻭﺮﹶﺘِﺳ ،(<br />
Disinfection)<br />
ﻲﻳﺍﺩﺯﺪﻨﮔ<br />
ﺩﺭﻮﻣ ﺭﺩ ﻲﺸﻣ ﻂﺧ ﻦﻴﻴﻌﺗ ﻭ ﻱﺰﻳﺭ ﻪﻣﺎﻧﺮﺑ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺖﻬﺟ ﻱﺭﻭﺮﺿ ﺕﺎﻣﺍﺪﻗﺍ ﺯﺍ ﻲﻜﻳ<br />
ﻝﺎﺒﻧﺩ ﻪﺑ<br />
ﻥﺍﺭﺎﻤﻴﺑ ﻪﺑ ﺖﻧﻮﻔﻋ ﻝﺎﻘﺘﻧﺍ ﻝﺎﻤﺘﺣﺍ ﺍﺮﻳﺯ ﺖﺳﺍ ﻥﺎﺘﺳﺭﺎﻤﻴﺑﺭﺩ ﻞﻳﺎﺳﻭ ﻭ ﺕﺍﺰﻴﻬﺠﺗ ﻱﺯﺎﺳ ﻥﻭﺮﺘﺳ ﻭ ﻲﻳﺍﺩﺯﺪﻨﮔ<br />
. ﺖﺳﺍ ﺕﻭﺎﻔﺘﻣ ﻲﻳﺍﺩﺯﺪﻨﮔ ﺢﻄﺳ ،ﻡﺯﺍﻮﻟ ﺩﺮﺑﺭﺎﻛ ﻪﺑ ﻪﺘﺴﺑ .( ١٨)<br />
ﺩﺭﺍﺩ ﺩﻮﺟﻭ ﻪﺸﻴﻤﻫ ﻞﻳﺎﺳﻭ ﻲﮔﺩﻮﻟﺁ<br />
ﻥﻭﺮﺘﺳ ،ﻲﻳﺎﻴﻤﻴﺷ ﺎﻳ ﻲﻜﻳﺰﻴﻓ ﺪﻨﻳﺁﺮﻓ ﻦﻴﺣ ﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺭﻮﭙﺳﺍ ﻞﻣﺎﺷ ﻲﺑﻭﺮﻜﻴﻣ ﻲﺗﺎﻴﺣ ﻝﺎﻜﺷﺍ ﻡﺎﻤﺗ ﺐﻳﺮﺨﺗ<br />
ﻻﺎﺑ ﺢﻄﺳﺭﺩ ﻲﻳﺍﺩﺯﺪﻨﮔ<br />
ﻥﺁ ﻪﺑ ،ﺪﻧﻮﺷ ﺐﻳﺮﺨﺗ ﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺭﻮﭙﺳﺍ ﺰﺠﺑ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻡﺎﻤﺗ ﺮﮔﺍ ﻲﻟﻭ ﺩﺭﺍﺩ ﻡﺎﻧ ﻱﺯﺎﺳ<br />
،ﻞﻳﺎﺳﻭ<br />
ﻥﺩﺮﻛ ﻙﺎﭘ ﺎﻳ ( Decontamination)<br />
ﻲﮔﺩﻮﻟﺁ ﻊﻓﺭ ،ﻲﻳﺍﺩﺯﺪﻨﮔ ﺎﻳ ﻱﺯﺎﺳ ﻥﻭﺮﺘﺳ ﺯﺍ ﻞﺒﻗ ﺖﺳﺍ ﻲﻬﻳﺪﺑ . ﺪﻨﻳﻮﮔ<br />
ﺐﻳﺮﺨﺗ ﺎﻳ ﻥﺩﻮﻤﻧ ﺭﺎﻬﻣ ﻱﺍﺮﺑ ( Germicide)<br />
ﻲﻳﺎﻴﻤﻴﺷ ﺶﻛ ﺏﻭﺮﻜﻴﻣ ﻩﺩﺎﻣ ﻚﻳ ﺯﺍ ﺮﮔﺍ . ﺖﺳﺍ ﻱﺭﻭﺮﺿ<br />
ﺍﺬﻟ . ﺪﻨﻳﻮﮔ ( Antisepsis)<br />
ﻥﺩﺮﻛ ﻲﻧﻮﻔﻋ ﺪﺿ ﻞﻤﻋ ﻦﻳﺍ ﻪﺑ ﺩﻮﺷ ﻩﺩﺎﻔﺘﺳﺍ ﻩﺪﻧﺯ ﺖﻓﺎﺑ ﺎﻳ ﺖﺳﻮﭘ ﻱﻭﺭ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ<br />
. ﺩﺮﻛ ﻩﺩﺎﻔﺘﺳﺍ ﺀﺎﻴﺷﺍ ﻭ ﺡﻮﻄﺳ ﻲﻳﺍﺩﺯﺪﻨﮔ ﻱﺍﺮﺑ ﺪﻳﺎﺒﻧ ﻩﺪﻨﻨﻛ ﻲﻧﻮﻔﻋ ﺪﺿ ﺩﺍﻮﻣ ﺯﺍ<br />
ﺎﻳ ﻥﻮﺧ ﺎﺑ ﺱﺎﻤﺗ ﺭﺩ ﻪﻛ ﺎﻫ ﻥﺯﻮﺳ ﻭ ﺎﻫ ﺮﺘﺗﺎﻛ ﺪﻨﻧﺎﻣ ( Critical Devices)<br />
ﻲﻧﺍﺮﺤﺑ ﺎﻳ ﻲﺗﺎﻴﺣ ﻞﻳﺎﺳﻭ ﻱﺍﺮﺑ<br />
ﺱﺎﻤﺗ ﺭﺩ ﻁﺎﺨﻣ ﺎﺑ ﻪﻠﻴﺳﻭ ﺮﮔﺍ . ﺩﻮﺷ ﻩﺩﺮﺑ ﺭﺎﻜﺑ ﻱﺯﺎﺳ ﻥﻭﺮﺘﺳ ﺵﻭﺭ ﺪﻳﺎﺑ ﻂﻘﻓ ،ﺪﻧﺭﺍﺩ ﺭﺍﺮﻗ ﻥﺪﺑ ﻞﻳﺮﺘﺳﺍ ﻱﺎﻫ ﺖﻤﺴﻗ<br />
ﺭﺩ ﻪﻠﻴﺳﻭ ﻲﻳﺍﺩﺯﺪﻨﮔ ﻲﻟﻭ ﺖﺳﺍ ﺢﺟﺭﺍ ﻲﻳﺍﺩﺯﺪﻨﮔ ﺮﺑ ﻱﺯﺎﺳ ﻥﻭﺮﺘﺳ ،ﭖﻮﻜﺳﻭﺪﻧﺍ ﻩﺎﮕﺘﺳﺩ ﺪﻨﻧﺎﻣ ،(<br />
Semicritical)<br />
ﺪﺷﺎﺑ<br />
ﻪﻛ ﻥﻮﺧﺭﺎﺸﻓ ﻱﺮﻴﮔ ﻩﺯﺍﺪﻧﺍ ﻩﺎﮕﺘﺳﺩ ﻭ ﻲﺷﻮﮔ ﺪﻨﻧﺎﻣ ﻲﻠﻳﺎﺳﻭ ﻱﺍﺮﺑ . ﺩﺩﺮﮔ ﻲﻣ ﺏﻮﺴﺤﻣ ﻲﻟﻮﺒﻗ ﻞﺑﺎﻗ ﺵﻭﺭ ﺰﻴﻧ ﻻﺎﺑ ﺢﻄﺳ<br />
ﻦﻴﺋﺎﭘ ﺢﻄﺳ ﺭﺩ ﻲﻳﺍﺩﺯﺪﻨﮔ ﺎﻬﻨﺗ ،ﺎﻫﺭﺍﻮﻳﺩ ﻭ ﺡﻮﻄﺳ ،ﻦﻴﻣﺯ ﻒﻛ ﺖﻓﺎﻈﻧ ﺎﻳ ،ﺪﻧﺭﺍﺩ ﺱﺎﻤﺗ ( Noncritical)<br />
ﻢﻟﺎﺳ ﺖﺳﻮﭘ ﺎﺑ<br />
. ﺖﺳﺍ ﻲﻓﺎﻛ ،ﺢﻄﺳ ﺎﻳ ﻪﻠﻴﺳﻭ ﻥﺩﺮﻛ ﻙﺎﭘ ﺎﻳ<br />
( ١٩)<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻱﺯﺎﺳ ﻥﻭﺮﺘﺳ ﻭ ﻲﻳﺍﺩﺯﺪﻨﮔ ﻱﺎﻫ ﺵﻭﺭ<br />
. ﻲﺣﺍﺮﺟ ﻱﺰﻠﻓ<br />
ﻞﻳﺎﺳﻭ ﻱﺍﺮﺑ ( ﻪﻘﻴﻗﺩ ٣٠ ﺎﺗ ١٥ ﺕﺪﻣ ﻪﺑ ﺩﺍﺮﮔ ﻲﺘﻧﺎﺳ ﻪﺟﺭﺩ ١٢١)<br />
( ﺖﻋﺎﺳ ﻚﻳ ﺕﺪﻣ ﻪﺑ ﺩﺍﺮﮔ ﻲﺘﻧﺎﺳ ﻪﺟﺭﺩ ١٧١)<br />
.<br />
ﺕﺭﺍﺮﺣ ﻪﺑ ﺱﺎﺴﺣ ﻲﺣﺍﺮﺟ ﻞﻳﺎﺳﻭ ﻭ ﻲﻜﻴﺘﺳﻼﭘ ﺩﺍﻮﻣ ﻱﺍﺮﺑ<br />
•<br />
ﻱﺯﺎﺳ ﻥﻭﺮﺘﺳ ( ﻒﻟﺍ<br />
ﺭﺎﺨﺑ ﺎﻳ ﻭﻼﻛﻮﺗﺍ<br />
ﻚﺸﺧ ﺕﺭﺍﺮﺣ<br />
ETO ﺎﻳ ﻦﻠﻴﺗﺍ ﺪﻴﺴﻛﺍ ﺯﺎﮔ<br />
•<br />
•<br />
•
٣٧٤/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﻚﻴﺘﺳﻼﭘ ﺪﻨﻧﺎﻣ ﺕﺭﺍﺮﺣ ﻪﺑ ﺱﺎﺴﺣ ﻞﻳﺎﺳﻭ ﻱﺍﺮﺑ ﻢﻛ ﺕﺭﺍﺮﺣ ﺭﺩ ﺭﺎﺨﺑ ﻭ ﺪﻴﺋﺪﻟﺎﻣﺮﻓ ﺯﺎﮔ<br />
( ٢٠)<br />
ﺖﺑﻮﻃﺭ ﻭ ﺕﺭﺍﺮﺣ ﻪﺑ ﺱﺎﺴﺣ ﻲﻜﻴﺘﺳﻼﭘ ﻭ ﻱﺰﻠﻓ ﻞﻳﺎﺳﻭ ﻱﺍﺮﺑ ﺎﻤﺳﻼﭘ ﺯﺎﮔ<br />
( ﺰﺗﻭﺮﭘ ـ ﺮﺘﺗﺎﻛ)<br />
ﺪﻴﺋﺪﻟﺁﺭﺎﺗﻮﻠﮔ ﺪﻨﻧﺎﻣ ﺶﻛ ﺏﻭﺮﻜﻴﻣ ﺕﺎﻌﻳﺎﻣ<br />
ﺖﻨﻠﭙﻤﻳﺍ ﻞﻳﺎﺳﻭ ﻱﺍﺮﺑ ﺎﻣﺎﮔ ﻪﻌﺷﺍ<br />
•<br />
•<br />
•<br />
•<br />
ﻲﻳﺎﻴﻤﻴﺷ ﺩﺍﻮﻣ ﺎﺑ ﻲﻳﺍﺩﺯﺪﻨﮔ ( ﺏ<br />
ﭖﻮﻜﺳﻭﺪﻧﺍ ﻩﺎﮕﺘﺳﺩ ﺪﻨﻧﺎﻣ ،ﻻﺎﺑ ﺢﻄﺳ ﺭﺩ ﻞﻳﺎﺳﻭ ﻲﻳﺍﺩﺯﺪﻨﮔ ﺖﻬﺟ ﺪﻴﺋﺪﻟﺍﺭﺎﺗﻮﻠﮔ<br />
ﺏﺁ ﻭ<br />
(HIV ﻪﺑ ﻩﺩﻮﻟﺁ ﻩﮋﻳﻮﺑ)<br />
ﺪﻴﺳﺍ ﻚﻴﺘﺳﺍﺮﭘ<br />
ﺡﻮﻄﺳ ﻲﻳﺍﺩﺯﺪﻨﮔ ﻱﺍﺮﺑ ﺭﺍﺩﺮﻠﻛ ﺕﺎﺒﻴﻛﺮﺗ<br />
ﺖﺳﻮﭘ ﻲﻧﻮﻔﻋ ﺪﺿ ﻱﺍﺮﺑ ﺪُﻳ<br />
ﻱﻭﺎﺣ ﺕﺎﺒﻴﻛﺮﺗ<br />
ﺖﺳﻮﭘ ﻲﻧﻮﻔﻋﺪﺿ ﺖﻬﺟ ﻞﻜﻟﺍ<br />
ﺡﻮﻄﺳ ﻲﻳﺍﺩﺯﺪﻨﮔ ﺪﻨﻧﺎﻣ ﻦﻴﺋﺎﭘ ﺢﻄﺳ ﺭﺩ ﻲﻳﺍﺩﺯﺪﻨﮔ ﻱﺍﺮﺑ ﻲﺘﻴﻓﺮﻇ ﺭﺎﻬﭼ ﻡﻮﻴﻧﻮﻣﺁ ﺕﺎﺒﻴﻛﺮﺗ<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
: ﻪﺟﻮﺗ<br />
ﻲﺑﻭﺮﻜﻴﻣ ﻅﺎﺤﻟ ﺯﺍ ﺭﻮﻓ ﺎﻳ ﻦﻠﻴﺗﺍ ﺪﻴﺴﻛﺍ ﺎﻳ ﻭ ﻭﻼﻛﻮﺗﺍ ﻩﺎﮕﺘﺳﺩ ﺪﻨﻧﺎﻣ ﻩﺪﻨﻨﻛ ﻥﻭﺮﺘﺳ ﻱﺎﻫ ﻩﺎﮕﺘﺳﺩ ﻱﺍ ﻩﺭﻭﺩ ﻝﺮﺘﻨﻛ<br />
ﺭﻮﻈﻨﻣ ﻪﺑ ،ﺕﺭﺍﺮﺣ ﻪﺑ ﻡﻭﺎﻘﻣ ﻱﺎﻫ ﻞﻴﺳﺎﺑ ﻱﻭﺎﺣ ﻚﻳﮊﻮﻟﻮﻴﺑ ﻱﺎﻫ ﺺﺧﺎﺷ ﺎﺑ ( Microbiologic Monitoring)<br />
. ﺖﺳﺍ ﻱﺭﻭﺮﺿ ﺎﻫﻥﺁ<br />
ﺩﺮﻜﻠﻤﻋ ﺯﺍ ﻦﺘﻓﺎﻳ ﻥﺎﻨﻴﻤﻃﺍ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻪﻟﺎﺑﺯ ﻊﻓﺩ ﻭ ﻱﺭﻭﺁ ﻊﻤﺟ<br />
.( ٢١)<br />
ﺖﺳﺍ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻱﺭﻭﺮﺿ ﺕﺎﻣﺍﺪﻗﺍ ﺯﺍ ﻲﻜﻳ ﺮﻄﺧ ﻲﺑ ﻞﻜﺷ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻪﻟﺎﺑﺯ ﻊﻓﺩ ﻭ ﻱﺭﻭﺁ ﻊﻤﺟ<br />
ﻪﻛ ﺩﺩﺮﮔ ﻲﻣ ﻕﻼﻃﺍ ﻚﻳﮊﻮﻟﻮﻴﺑﺮﻴﻏ<br />
ﻭ ﻚﻳﮊﻮﻟﻮﻴﺑ ﺯﺍ ﻢﻋﺍ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻩﺪﺷ ﻊﻓﺩ ﻪﻟﺎﺑﺯ ﻉﺍﻮﻧﺍ ﻡﺎﻤﺗ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻪﻟﺎﺑﺯ<br />
ﺕﺎﻣﺍﺪﻗﺍ ﻡﺎﺠﻧﺍ ﺯﺍ ﻲﺷﺎﻧ ﻪﻛ ﺖﺳﺍ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻪﻟﺎﺑﺯ ﺯﺍ ﻲﺸﺨﺑ ﻲﻜﺷﺰﭘ ﻪﻟﺎﺑﺯ . ﺩﺭﺍﺪﻧ ﺩﻮﺟﻭ ﺎﻫ ﻥﺁ ﺯﺍ ﺩﺪﺠﻣ ﻩﺩﺎﻔﺘﺳﺍ ﺪﺼﻗ<br />
ﻝﺎﻘﺘﻧﺍ ﻲﻳﺎﻧﺍﻮﺗ ﻪﻛ ﺖﺳﺍ ﻲﻜﺷﺰﭘ ﻪﻟﺎﺑﺯ ﺯﺍ ﻲﺸﺨﺑ<br />
ﻞﻣﺎﺷ ﻲﻧﻮﻔﻋ ﻪﻟﺎﺑﺯ . ﺪﺷﺎﺑ ﻲﻣ ﻥﺍﺭﺎﻤﻴﺑ ﺖﻬﺟ ﻲﻧﺎﻣﺭﺩﻭ ﻲﺼﻴﺨﺸﺗ<br />
. ﺩﺭﺍﺩ ﺍﺭ ﻲﻧﻮﻔﻋ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ<br />
ﺪﻨﺗﺭﺎﺒﻋ ﻪﻛ ﺪﻨﻛ ﻲﻣ ﻲﻘﻠﺗ ﻲﻧﻮﻔﻋ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻪﻟﺎﺑﺯ ﻉﻮﻧ ﺞﻨﭘ ،(<br />
CDC)<br />
ﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﺰﻛﺮﻣ<br />
ﻂﻴﺤﻣ ﺯﺍ ﺖﻇﺎﻔﺣ ﻥﺎﻣﺯﺎﺳ . ﺰﻴﺗ ﻙﻮﻧ ﻱﺎﻴﺷﺍ ﻭ ﻥﻮﺧ ،ﻩﺩﻮﻟﺁ ﺕﺎﻧﺍﻮﻴﺣ ﻪﺷﻻ ،ﻚﻳﮊﻮﻟﻮﺗﺎﭘ ،ﻚﻳﮊﻮﻟﻮﻴﺑﻭﺮﻜﻴﻣ ﻱﺎﻫ ﻪﻟﺎﺑﺯ ﺯﺍ<br />
ﻲﻧﻮﻔﻋ ﺰﻴﻧ ﺍﺭ ﻱﺮﺴﻣ ﺽﺍﺮﻣﺍ ﻪﺑ ﻼﺘﺒﻣ ﻥﺍﺭﺎﻤﻴﺑ ﻱﺯﺎﺳﺍﺪﺟ ﺯﺍ ﻞﺻﺎﺣ ﻪﻟﺎﺑﺯ ،ﻕﻮﻓ ﻪﻟﺎﺑﺯ ﻉﻮﻧ ﺞﻨﭘ ﺮﺑ ﻩﻭﻼﻋ ( EPA)<br />
ﺖﺴﻳﺯ<br />
. ﺩﺮﻴﮔ ﻲﻣ ﺮﻈﻧ ﺭﺩ<br />
ﻞﻳﺎﺳﻭ ﻊﻓﺩ ،ﻪﻧﺎﮔﺍﺪﺟ ﻲﻜﻴﺘﺳﻼﭘ ﻱﺎﻫ ﻪﺴﻴﻛﺎﻳ ﻑﻭﺮﻇ ﺭﺩ ﺎﻫ ﻥﺁ ﻥﺩﺍﺩ ﺭﺍﺮﻗ ﻭ ﺮﮕﻳﺪﻜﻳ ﺯﺍ ﺎﻫ ﻪﻟﺎﺑﺯ ﻥﺩﻮﻤﻧ ﺍﺪﺟ<br />
ﻭ ﺮﻄﺧ ﻲﺑ ﻊﻓﺩ ﻪﺑ ،ﻲﻧﻮﻔﻋ ﻱﺎﻫ ﻪﻟﺎﺑﺯ ﻱﻭﺭ ﺹﻮﺼﺨﻣ ﺐﺴﭼﺮﺑ<br />
ﺩﻮﺟﻭ<br />
ﻭ ،ﻢﻜﺤﻣ ﻭ ﻡﻭﺎﻘﻣ ﻑﻭﺮﻇ ﻞﺧﺍﺩ ﺭﺩ ﺰﻴﺗ ﻙﻮﻧ<br />
.<br />
ﺪﻨﻛ ﻲﻣ ﻚﻤﻛ ﺎﻫ ﻪﻟﺎﺑﺯ ﻦﺌﻤﻄﻣ
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٧٥<br />
ﺎﻫ ﻥﺁ ﻥﺪﻧﺍﺯﻮﺳ ﻭ ﺭﺎﺨﺑ ﺎﺑ ﺎﻫ ﻥﺁ ﻱﺯﺎﺳ ﻥﻭﺮﺘﺳ ،ﻲﻧﻮﻔﻋ ﻱﺎﻫ ﻪﻟﺎﺑﺯ ﻊﻓﺩ ﻱﺎﻫ ﺵﻭﺭ ﻦﻳﺮﺘﻧﺍﺯﺭﺍ ﻭ ﻦﻳﺮﺗﺮﺛﻮﻣ<br />
ﻱﺍﺮﺑ ﻪﻟﺎﺑﺯ ﻥﺪﻧﺍﺯﻮﺳ . ﺪﻧﺩﺮﮔ ﻥﻭﺮﺘﺳ ﺭﺎﺨﺑ ﺎﺑ ﺪﻳﺎﺒﻧ ﻥﺎﻃﺮﺳ ﺪﺿ ﻱﺎﻫﻭﺭﺍﺩ ﻭ ﻮﻴﺘﻛﺍﻮﻳﺩﺍﺭ ﺩﺍﻮﻣ ﻱﺎﻫ ﻪﻟﺎﺑﺯ ﻲﻟﻭ ،ﺪﺷﺎﺑ ﻲﻣ<br />
ﺏﻮﺴﺤﻣ ﻝﺁﺪﻳﺍ ﺵﻭﺭ ،ﺰﻴﺗ ﻙﻮﻧ ﻱﺎﻴﺷﺍ ﻭ ﻚﻳﮊﻮﻟﻮﺗﺎﭘ ﻱﺎﻫ ﻪﻟﺎﺑﺯ ﻱﺍﺮﺑ ﻭ ﺖﺳﺍ ﺐﺳﺎﻨﻣ ﻲﻧﻮﻔﻋ ﻱﺎﻫ ﻪﻟﺎﺑﺯ ﻉﺍﻮﻧﺍ ﻡﺎﻤﺗ<br />
. ﺪﻧﻮﺷ ﻪﺘﺨﻳﺭ ﺏﻼﺿﺎﻓ ﻞﺧﺍﺩ ﻪﺑ ﻲﻳﺎﻴﻤﻴﺷ ﺩﺍﻮﻣ ﺎﺑ ﻲﻳﺍﺩﺯﺪﻨﮔ ﺯﺍ ﺲﭘ ﺪﻨﻧﺍﻮﺗ ﻲﻣ ﺰﻴﻧ ﻊﻳﺎﻣ ﻱﺎﻫ ﻪﻟﺎﺑﺯ . ﺩﺩﺮﮔ ﻲﻣ<br />
ﺎﻫ ﻚﻴﺗﻮﻴﺑ<br />
ﻲﺘﻧﺁ ﻪﺑ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﺖﻣﻭﺎﻘﻣ ﺯﺍ ﻱﺮﻴﮔﻮﻠﺟ<br />
ﺕﺪﻣ ﻝﻮﻃ ﻭ ﻲﺷﻮﺧﺎﻧ ﻭ ﺮﻴﻣ ﻭ ﮒﺮﻣ ﺶﻳﺍﺰﻓﺍ ﺚﻋﺎﺑ ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻉﺍﻮﻧﺍ ﻪﺑ ﺎﻫ ﻱﺮﺘﻛﺎﺑ ﺖﻣﻭﺎﻘﻣ ﺶﻳﺍﺰﻓﺍ<br />
ﺚﻋﺎﺑ ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﺪﺣ ﺯﺍ ﺶﻴﺑ ﻑﺮﺼﻣ . ﺩﻮﺷ ﻲﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺏﺎﺴﺘﻛﺍ ﻝﺎﺒﻧﺪﺑ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖﻣﺎﻗﺍ<br />
ﺶﻴﺑ . ﺩﻮﺷ ﻲﻣ ﻞﻣﺎﺷ ﺍﺭ ﺎﻫ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻲﻳﻭﺭﺍﺩ ﻱﺎﻫ<br />
ﻪﻨﻳﺰﻫ ﻞﻛ % ٥٠ ﺎﺗ ٢٠ ﻪﻛ ﻱﻮﺤﻧ ﻪﺑ ﺩﺩﺮﮔ ﻲﻣ ﺰﻴﻧ ﻲﻟﺎﻣ ﻊﺑﺎﻨﻣ ﻑﻼﺗﺍ<br />
ﺩﻭﺪﺣ ﻪﻛ ﺖﺳﺍ ﻲﻟﺎﺣﺭﺩ ﻦﻳﺍ ﻭ ﺪﻧﺮﻴﮔ ﻲﻣ ﺭﺍﺮﻗ ﻥﺎﻣﺭﺩ ﺖﺤﺗ ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﺎﺑ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻱﺮﺘﺴﺑ ﻥﺍﺭﺎﻤﻴﺑ ﺯﺍ ﻲﻤﻴﻧ ﺯﺍ<br />
. ﺪﻧﺍ ﻪﺘﻓﺭ ﺭﺎﻜﺑ ( ٢٢)<br />
ﺐﺳﺎﻨﻣﺎﻧ ﺕﺪﻣ ﻪﺑ ﺎﻳ ﻂﻠﻏ ﺯﻭﺩ ،ﻂﻠﻏ<br />
ﻱﻭﺭﺍﺩ ﻞﻜﺷ ﻪﺑ ﻩﺪﺷ ﺰﻳﻮﺠﺗ ﻱﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻡﺎﻤﺗ % ٥٠<br />
ﺪﻫﺩ ﻲﻣ ﻥﺎﺸﻧ ﺶﻳﺍﺰﻓﺍﺮﺑﺍﺮﺑ ٢٠٠ ﻦﻴﺴﻳﺎﻣﻮﻜﻧﺍﻭ ﻑﺮﺼﻣ ﻲﺟﺭﺎﺧ ﻲﻫﺎﮕﺸﻧﺍﺩ ﺰﻛﺮﻣ ﻚﻳ ﺭﺩ ﻩﺪﺷ ﻡﺎﺠﻧﺍ ﻱﺎﻫ ﻲﺳﺭﺮﺑ ﻖﺒﻃ<br />
.( ١٧)<br />
ﺩﻮﺷ ﻲﻣ ﻱﺭﻭﺮﺿﺮﻴﻏ<br />
ﻩﺩﺎﻔﺘﺳﺍ ﻥﺁ ﺯﺍ ﺩﺭﺍﻮﻣ ﻡﻮﺳ ﻭﺩ ﺭﺩ ﻲﻟﻭ<br />
ﻞﻴﻤﺤﺗ ﺎﻜﻳﺮﻣﺁ ﺭﻮﺸﻛ ﻪﺑ ﺭﻻﺩ ﻥﻮﻴﻠﻴﻣ ٤ ﻝﺩﺎﻌﻣ ﻱﺍ ﻪﻨﻳﺰﻫ ﻪﻧﺎﻴﻟﺎﺳ ﻪﻛ ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻪﺑ ﺖﻣﻭﺎﻘﻣ ﺭﻮﻬﻇ<br />
ﺩﺍﺪﻌﺗ ﺶﻳﺍﺰﻓﺍ ،ﻲﻤﺟﺎﻬﺗ ﺕﺎﻣﺍﺪﻗﺍ ﺯﺍ ﺮﺘﺸﻴﺑ ﻩﺩﺎﻔﺘﺳﺍ ﺯﺍ ﻲﺷﺎﻧ ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻱﺎﺠﺑﺎﻧ<br />
ﻑﺮﺼﻣ ﺮﺑ ﻩﻭﻼﻋ ﺪﻨﻛ ﻲﻣ<br />
ﺶﻳﺍﺰﻓﺍ .( ٢٣)<br />
ﺪﺷﺎﺑ ﻲﻣ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻪﻨﻴﻣﺯ ﺭﺩ ﻲﻠﻤﻋ ﺕﺎﻜﻧ ﺖﻳﺎﻋﺭ ﻡﺪﻋ ﻭ ﻲﻨﻤﻳﺍ ﺺﻘﻧ ﺭﺎﭼﺩ ﻭ ﺱﺎﺴﺣ ﻱﺎﻫ ﻥﺎﺑﺰﻴﻣ<br />
ﻲﺘﻣ ﻪﺑ ﻡﻭﺎﻘﻣ ﺱﻮﺋﺭﺁ<br />
ﻙﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ ﺯﻭﺮﺑ ﻭ ﺖﺳﺍ ﺩﻮﻬﺸﻣ ICU ﺭﺩ ﻩﮋﻳﻮﺑ ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻪﺑ ﺎﻫ ﺏﻭﺮﻜﻴﻣ ﺖﻣﻭﺎﻘﻣ ﺯﻭﺮﺑ<br />
ﻪﺑ ﻭﺭ ICU ﺭﺩ ﻡﻭﺎﻘﻣ ﻲﻔﻨﻣ ﻡﺮﮔ ﻱﺎﻫ ﻞﻴﺳﺎﺑ ﻭ ،(<br />
VRE)<br />
ﻦﻴﺴﻳﺎﻣﻮﻜﻧﺍﻭ ﻪﺑ ﻡﻭﺎﻘﻣ ﻙﻮﻛﻭﺮﺘﻧﺍ ،(<br />
MRSA)<br />
ﻦﻴﻠﻴﺳ<br />
ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻚﻳ ﻪﺑ ﺖﻣﻭﺎﻘﻣ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺩﺭﺍﻮﻣ % ٧٠ ﺭﺩ ﻞﻗﺍﺪﺣ ﺩﻮﺟﻮﻣ ﺭﺎﻣﺁ ﻖﺒﻃ ﻭ ( ٢٤)<br />
ﺪﺷﺎﺑ ﻲﻣ ﺶﻳﺍﺰﻓﺍ<br />
. ﺩﺭﺍﺩ ﺩﻮﺟﻭ<br />
ﻡﺎﻤﺗ % ١٠ ﺎﺗ ٥ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺮﻴﮔ ﻪﻤﻫ . ﺩﺭﺍﺩ ﺩﻮﺟﻭ ﻲﺑﻭﺮﻜﻴﻣ ﺖﻣﻭﺎﻘﻣ<br />
ﺰﻴﻧ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻱﺮﻴﮔ ﻪﻤﻫ ﺭﺩ<br />
ﻪﻌﻟﺎﻄﻣ ﻦﻴﺣ . ﺩﺭﺍﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺵﺮﻳﺬﭘ ١٠٠٠٠ ﺮﻫ ﺭﺩ ﻚﻳ ﻝﺩﺎﻌﻣ ﻲﻋﻮﻴﺷ ﻭ ﻩﺪﺷ ﻞﻣﺎﺷ ﺍﺭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺩﺭﺍﻮﻣ<br />
ﻪﺑ ﻙﻮﻛﻭﺮﺘﻧﺍ ﺩﺭﺍﻮﻣ % ٦٩ ﻭ ﻦﻴﻠﻴﺳ ﻲﺘﻣ ﻪﺑ ،ﺱﻮﺋﺭﺁ ﻙﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ ﻱﺎﻫ ﻱﺮﺘﻛﺎﺑ % ٨٥ ﻪﻛ ﺪﻳﺩﺮﮔ ﺺﺨﺸﻣ ﻱﺮﻴﮔ ﻪﻤﻫ<br />
. ﺪﻧﺍ ﻩﺩﻮﺑ ﻡﻭﺎﻘﻣ ﻦﻴﺴﻳﺎﻣﻮﻜﻧﺍﻭ<br />
،ﻒﻴﻄﻟﺍ ﻊﻴﺳﻭ ﻱﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻑﺮﺼﻣ ﺖﻳﺩﻭﺪﺤﻣ ﺪﻨﻧﺎﻣ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﻪﻣﺎﻧﺮﺑ ﺖﻳﺎﻋﺭ ﺎﺑ<br />
ﻥﺍﻮﺗ ﻲﻣ ﺎﻫ ﺖﺳﺩ ﻦﺘﺴﺷ ﺮﺑ ﺪﻴﻛﺎﺗ ﻭ ﻥﺎﻨﻛﺭﺎﻛ ﺵﺯﻮﻣﺁ ،ﺎﻫ ﻚﻴﺗﻮﻴﺑ ﻲﺘﻧﺁ ﻱﺮﻴﮔﺭﺎﻜﺑ ﺖﻬﺟ ﻲﻧﺎﻣﺭﺩ ﻱﺎﻫ ﻞﻛﻮﺗﻭﺮﭘ ﻦﻳﻭﺪﺗ<br />
.( ٢٥)<br />
ﺖﺳﺎﻛ ﻲﺑﻭﺮﻜﻴﻣ ﻱﺎﻫ ﺖﻣﻭﺎﻘﻣ ﺯﻭﺮﺑ ﺯﺍ<br />
ﺕﺍﺩﺎﻬﻨﺸﻴﭘ<br />
. ﺖﺳﺍ ﻩﺪﺸﻧ ﻪﺘﺧﺍﺩﺮﭘ ﺖﺳﺍ ﻪﺘﺴﻳﺎﺷ ﻪﻛ ﻥﺎﻨﭼ ﻥﺁ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻞﻀﻌﻣ ﻪﺑ ﻥﻮﻨﻛﺎﺗ ﺎﻣ ﺭﻮﺸﻛ ﺭﺩ ﻪﻧﺎﻔﺳﺎﺘﻣ<br />
ﺖﺑﺎﺛ ﺖﺴﭘ ﻥﺍﺪﻘﻓ ،ﻲﻫﺩ ﺵﺭﺍﺰﮔ ﻱﺎﻫ ﻢﺘﺴﻴﺳ ﻡﺪﻋ ،(<br />
٢٦)<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻝﺎﻌﻓ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﺩﻮﺟﻭ ﻡﺪﻋ
٣٧٦/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
ﻩﮋﻳﻭ ﻲﻫﺎﮕﺸﻧﺍﺩ ﻭ ﻚﻴﻣﺩﺎﻛﺁ ﻲﺷﺯﻮﻣﺁ<br />
ﺰﻛﺍﺮﻣ ﺩﻮﺒﻧ ﻭ ﻥﺎﻧﺁ ﺭﺮﻜﻣ ﺾﻳﻮﻌﺗ ﻭ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻥﺍﺭﺎﺘﺳﺮﭘ ﻱﺍﺮﺑ ﻲﻧﺎﻣﺯﺎﺳ<br />
ﻪﺠﻴﺘﻧ ﺭﺩ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺰﻛﺮﻣ ﻱﺎﻫ ﻪﺘﻴﻤﻛ ﺮﻴﮕﻤﺸﭼ ﺖﻴﻟﺎﻌﻓ ﻡﺪﻋ ،(<br />
٢٨ ،٢٧)<br />
ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻥﺍﺭﺎﺘﺳﺮﭘ<br />
ﻭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖﺴﻳﮊﻮﻟﻮﻴﻣﺪﻴﭘﺍ ﻱﺮﻴﮔﺭﺎﻜﺑ ﻡﺪﻋ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﻪﺘﻴﻤﻛ ﻱﺎﻫ ﺖﻴﻟﺎﻌﻓ ﺱﺎﻜﻌﻧﺍ ﻭ ﺏﺎﺗﺯﺎﺑ ﻦﺘﺷﺍﺪﻧ<br />
ﺚﻋﺎﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺎﺑ ﻲﻜﺷﺰﭘﺍﺮﻴﭘ ﻱﺎﻫ ﻪﺘﺷﺭ ﺮﻳﺎﺳ ﻭ ﻲﻜﺷﺰﭘ ﻱﺎﻫ ﻪﺘﺷﺭ<br />
ﻥﺎﻳﻮﺠﺸﻧﺍﺩ ﻲﻳﺎﻨﺷﺁ ﻡﺪﻋ ﻩﺮﺧﻻﺎﺑ<br />
ﻪﻛ ﺪﺷﺎﺒﻧ ﺩﻮﺟﻮﻣ ﺭﻮﺸﻛ ﺭﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﺯﻭﺮﺑ ﻭ ﻉﻮﻴﺷ ﻥﺍﺰﻴﻣ ﺎﺑ ﻪﻄﺑﺍﺭ ﺭﺩ ﻲﻘﻴﻗﺩ ﻭ ﺢﻴﺤﺻ ﺭﺎﻣﺁ ﺎﺗ ﺪﻧﺍ ﻩﺪﺷ<br />
ﺺﻳﺎﻘﻧ ﺡﻼﺻﺍ ﺭﻮﻈﻨﻣ ﻪﺑ . ﺩﻮﻤﻧ ﺪﻫﺍﻮﺧ ﻪﺟﺍﻮﻣ ﺖﺴﻜﺷ ﺎﺑ ﺍﺭ ﻪﻨﻴﻣﺯ ﻦﻳﺍ ﺭﺩ ﻪﻠﺧﺍﺪﻣ ﻭ ﻱﺰﻳﺭ ﻪﻣﺎﻧﺮﺑ ﻪﻧﻮﮔﺮﻫ<br />
ﻥﺎﻜﻣﺍ ﺩﻮﺧ<br />
: ﺩﻮﺷ ﻲﻣ ﻪﻴﺻﻮﺗ ﺩﻮﺟﻮﻣ<br />
ﺖﺑﺎﺛ ﺖﺴﭘ ﺹﺎﺼﺘﺧﺍ ﻖﻳﺮﻃ ﺯﺍ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻭ ﻱﺰﻛﺮﻣ ﻱﺎﻫ ﻪﺘﻴﻤﻛ ﻥﺩﻮﻤﻧ ﻝﺎﻌﻓ •<br />
ﻦﻳﺍ ﻚﻴﻣﺩﺎﻛﺁ ﺵﺯﻮﻣﺁ ﻭ ﺪﻧﺭﺍﺩ ﺖﺨﺗ ٢٥٠ ﺯﺍ ﺶﻴﺑ ﻪﻛ ﻲﻳﺎﻫ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺭﺎﺘﺳﺮﭘ ﻲﻧﺎﻣﺯﺎﺳ<br />
،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﺴﻳﮊﻮﻟﻮﻴﻣﺪﻴﭘﺍ ﻱﺮﻴﮔﺭﺎﻜﺑ ،ﻥﺎﻧﺁ ﻖﻳﻮﺸﺗ ﻭ ﻥﺍﺭﺎﺘﺳﺮﭘ<br />
ﻱﻭﺭﺍﺩ ﻭ ﻥﺎﻣﺭﺩ ﻱﺎﻫ ﺖﻧﻭﺎﻌﻣ ﺭﺩ ﺩﻮﺟﻮﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺰﻛﺮﻣ ﻱﺎﻫ ﻪﺘﻴﻤﻛ ﻱﻮﺳ ﺯﺍ ﺏﺎﺗﺯﺎﺑ ﻪﺋﺍﺭﺍ<br />
ﺎﻫ ﻪﺘﻴﻤﻛ ﺖﻴﻟﺎﻌﻓ ﺹﻮﺼﺧ ﺭﺩ ﻪﻌﺑﺎﺗ ﻱﺎﻫ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻪﺑ ﺎﻫ ﻩﺎﮕﺸﻧﺍﺩ<br />
ﻥﺍﺭﺎﻴﺘﺳﺩ ﻭ ﻥﺎﻳﻮﺠﺸﻧﺍﺩ ﻱﺍﺮﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﻲﻠﻤﻋ ﻭ ﻱﺮﻈﻧ ﺪﺣﺍﻭ ﺺﻴﺼﺨﺗ •<br />
ﻲﻜﺷﺰﭘﺍﺮﻴﭘ ﻭ ﻲﻜﺷﺰﭘ ﻱﺎﻫ ﻩﻭﺮﮔ ﺮﻳﺎﺳ ﻥﺎﻳﻮﺠﺸﻧﺍﺩ ﻭ ﻲﻜﺷﺰﭘ ﻱﺎﻫ ﻪﺘﺷﺭ<br />
ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺹﻮﺼﺧ ﺭﺩ ﻂﺑﺮﻳﺫ ﻲﻳﺍﺮﺟﺍ ﻭ ﻲﻤﻠﻋ ﻱﺎﻫ ﻥﺎﻣﺯﺎﺳ ﻪﻴﻠﻛ ﻲﮕﻨﻫﺎﻤﻫ ﻭ ﻱﺭﺎﻜﻤﻫ •<br />
ﺎﻫ ﻩﺎﮕﺸﻧﺍﺩ ﻥﺎﻣﺭﺩ ﻭ ﺖﺷﺍﺪﻬﺑ ﻱﺎﻫ ﺖﻧﻭﺎﻌﻣ ﻭ ﺎﻫ ﻱﺭﺎﻤﻴﺑ ﺖﻳﺮﻳﺪﻣ ﺰﻛﺮﻣ ﺪﻨﻧﺎﻣ<br />
،ﻲﻧﺎﻬﺟ ﻲﻤﻠﻋ ﺕﺎﻋﻼﻃﺍ ﻦﻳﺮﺧﺁ ﻝﺎﻘﺘﻧﺍ ﺭﻮﻈﻨﻣ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ<br />
ﻦﻤﺠﻧﺍ ﻞﻴﻜﺸﺗ •<br />
ﻭ ﻪﻨﻴﻣﺯ ﻦﻳﺍ ﺭﺩ ﻲﺗﺎﻘﻴﻘﺤﺗ ﻱﺎﻫ ﺡﺮﻃ ﻪﺋﺍﺭﺍ ،ﺭﻮﺸﻛ ﺮﺳﺍﺮﺳ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﻪﺘﻴﻤﻛ ﻦﻴﺑ ﺕﺎﻋﻼﻃﺍ ﻝﺩﺎﺒﺗ<br />
. ﺎﻫ ﻥﺁ ﺭﺎﺸﺘﻧﺍ<br />
: ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻢﻴﺗ ﻱﺎﻀﻋﺍ ﺵﺯﻮﻣﺁ ﻥﺩﻮﻤﻧ ﻚﻴﻣﺩﺎﻛﺁ •<br />
ﻱﺭﺎﺘﺳﺮﭘ ﻩﺪﻜﺸﻧﺍﺩ ﻖﻳﺮﻃ ﺯﺍ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺭﺎﺘﺳﺮﭘ ـ<br />
ﺏﻭﺮﻜﻴﻣ ﻩﻭﺮﮔ ﺎﻳ ،ﺖﺷﺍﺪﻬﺑ ﻩﺪﻜﺸﻧﺍﺩ ﻖﻳﺮﻃ ﺯﺍ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ<br />
ﻲﻜﺷﺰﭘ ﻩﺪﻜﺸﻧﺍﺩ ﻖﻳﺮﻃ ﺯﺍ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻚﺷﺰﭘ ـ<br />
( ﺱﺎﻨﺷﺭﺎﻛ)<br />
ﻲﻨﻴﻟﺎﺑ ﺖﺴﻳﮊﻮﻟﻮﻴﺑﻭﺮﻜﻴﻣ ـ<br />
ﻲﻜﺷﺰﭘ ﻩﺪﻜﺸﻧﺍﺩ ﻲﺳﺎﻨﺷ<br />
ﺮﺠﻨﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻪﺑ ﻪﻛ ﻲﻧﺎﻣﺭﺩ ﻭ ﻲﺼﻴﺨﺸﺗ ﻲﻤﺟﺎﻬﺗ ﺕﺎﻣﺍﺪﻗﺍ ﻱﺎﻫ ﻪﻨﻳﺰﻫ ﻥﺩﻮﻤﻧ ﺖﺑﺎﺛ<br />
ﺶﻳﺍﺰﻓﺍ ﺪﻨﻧﺎﻣ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻪﺑ ﻥﺍﺭﺎﻤﻴﺑ ﻱﻼﺘﺑﺍ ﺯﺍ ﻲﺷﺎﻧ ﻱﺎﻫ ﻪﻨﻳﺰﻫ ﻪﻴﻠﻛ ﻞﻴﻤﺤﺗ ﻡﺪﻋ ﻭ ﺪﻧﺩﺮﮔ ﻲﻣ<br />
. ﻥﺍﺭﺎﻤﻴﺑ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻲﻧﺎﻣﺭﺩ ﻭ ﻲﺼﻴﺨﺸﺗ ﻱﺎﻫ ﻪﻨﻳﺰﻫ ﺶﻳﺍﺰﻓﺍ ،ﻱﺮﺘﺴﺑ ﻥﺎﻣﺯ<br />
•<br />
ﻪﺻﻼﺧ<br />
ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﺭﺎﻤﻴﺑ ﺵﺮﻳﺬﭘ ﺯﺍ ﺲﭘ ﺖﻋﺎﺳ ٧٢ ﺎﺗ ٤٨ ﻪﻛ ﺩﻮﺷ ﻲﻣ ﻕﻼﻃﺍ ﻲﺘﻧﻮﻔﻋ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ<br />
ﺶﻳﺍﺰﻓﺍ<br />
% ٣٦ ( ١٩٩٥ ﻝﺎﺳ ﺎﺗ)<br />
ﻝﺎﺳ ٢٠ ﻲﻃ ﻭ ﻩﺩﻮﺑ ﺮﻴﻐﺘﻣ % ١٠ ﺎﺗ ٢/<br />
٥ ﺯﺍ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻥﺍﺰﻴﻣ . ﺪﺘﻔﻴﺑ ﻕﺎﻔﺗﺍ
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٧٧<br />
ﺭﻮﻃ ﻪﺑ ،ﻩﺪﺷ ﺮﺠﻨﻣ ﺎﻜﻳﺮﻣﺁ ﺭﺩ ﺭﻻﺩ ﻥﻮﻴﻠﻴﺑ ٥ ﻝﺩﺎﻌﻣ ﻱﺍ ﻪﻨﻳﺰﻫ ﻑﻼﺗﺍ ﻪﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻪﻧﺎﻴﻟﺎﺳ . ﺖﺳﺍ ﻪﺘﺷﺍﺩ<br />
ﺯﻭﺭ ٣٠ ﺎﺗ ١ ﺚﻋﺎﺑ ﻭ ﺖﺳﺍ ﻩﺪﻳﺩﺮﮔ ﺐﺴﺘﻨﻣ ،ﺮﻴﻣ ﻭ ﮒﺮﻣ % ٣ ﻪﺑ ﻭ ﺪﻣﺎﺠﻧﺍ ﻲﻣ ﻼﺘﺒﻣ ﻥﺍﺭﺎﻤﻴﺑ % ١ ﮒﺮﻣ ﻪﺑ ﻢﻴﻘﺘﺴﻣ<br />
ﻱﺭﺍﺭﺩﺍ ﻩﺎﮕﺘﺳﺩ ﺖﻧﻮﻔﻋ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻦﻳﺮﺗ ﻊﻳﺎﺷ . ﺩﻮﺷ ﻲﻣ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ﻱﺮــﺘﺴﺑ ﺕﺪﻣ ﻝﻮﻃ ﺶﻳﺍﺰﻓﺍ<br />
ﻥﻮﺧ ﺵﺩﺮﮔ ﻩﺎﮕﺘﺳﺩ ﺖﻧﻮﻔﻋ ﻭ (% ٢٤)<br />
ﻲﺣﺍﺮﺟ ﻢﺧﺯ ﺖﻧﻮﻔﻋ ﻭ (% ٢٠ ﺎﺗ ١٥)<br />
ﻲﻧﻮﻣﻮﻨﭘ ﻥﺁ ﺯﺍ ﺲﭘ ﻭ ﻩﺩﻮﺑ ( % ٤٠ ﺎﺗ ٣٠)<br />
ﻭ ﻩﺩﻮﺑ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺐﺒﺴﻣ ﻞﻣﺍﻮﻋ ﺎﻫ ﻱﺮﺘﻛﺎﺑ ،ﺩﺭﺍﻮﻣﺮﺜﻛﺍ ﺭﺩ ﺎﻫ ﻲﺳﺭﺮﺑ ﻲﻃ . ﺪﻨﺷﺎﺑ ﻲﻣ ﺖﻧﻮﻔﻋ ﻊﻳﺎﺷ ﻉﺍﻮﻧﺍ (% ١٠)<br />
ﻩﻭﺮﮔ ﺭﺩ ﺏﻭﺮﻜﻴﻣ ﻦﻳﺮﺗ ﻊﻳﺎﺷ)<br />
ﺱﻮﺋﺭﺁ ﻙﻮﻛﻮﻠﻴﻓﺎﺘﺳﺍ ،(<br />
ﻦﻴﻐﻟﺎﺑ ﺭﺩ ﻱﺮﺘﻛﺎﺑ ﻦﻳﺮﺘﻌﻳﺎﺷ)<br />
ﻲﻟﻮﻛﺎﻴﺸﻳﺮﺷﺍ ،ﺎﻫ ﻱﺮﺘﻛﺎﺑ ﻦﻴﺑ ﺭﺩ<br />
ﻩﺍﺭ ﻦﻳﺮﺘﻤﻬﻣ ﺪﻨﺘﺴﻫ ﺎﻫ ﻢﺴﻴﻧﺎﮔﺭﺍﻭﺮﻜﻴﻣ ﻦﻳﺮﺗ ﻊﻳﺎﺷ ،ﻼﻴﺴﺒﻠﻛ ﻭ ﻙﻮﻛﻭﺮﺘﻧﺍ ،ﺍﺯﻮﻨﻳﮊﻭﺮﺋﺁ ﺎﻧﻮﻣﻭﺩﻮﺴﭘ ،(<br />
ﻥﺍﺩﺍﺯﻮﻧ ﻭ ﻝﺎﻔﻃﺍ<br />
. ﺖﺳﺍ ﻥﺎﺘﺳﺭﺎﻤﻴﺑﺭﺩ ﻢﻴﻘﺘﺴﻣ ﺮﻴﻏ ﺎﻳ ﻭ ﻢﻴﻘﺘﺴﻣ ﺱﺎﻤﺗ ،ﺖﻧﻮﻔﻋ ﻝﺎﻘﺘﻧﺍ<br />
،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﻪﺘﻴﻤﻛ ﻥﺩﻮﻤﻧ ﻝﺎﻌﻓ ﺯﺍ ﺪﻨﺗﺭﺎﺒﻋ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺎﻫ ﻱﮋﺗﺍﺮﺘﺳﺍ<br />
ﻦﺘﺴﺷ ﺮﺑ ﺪﻴﻛﺎﺗ ،ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻥﺍﺭﺎﺘﺳﺮﭘ ﻩﮋﻳﻮﺑ ﻭ ﻥﺎﻨﻛﺭﺎﻛ ﺵﺯﻮﻣﺁ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﺖﺒﻗﺍﺮﻣ ﻡﺎﻈﻧ ﻱﺭﺍﺮﻗﺮﺑ<br />
ﻝﻮﺻﺍ ﻭ ﺕﺎﻜﻧ ﺖﻳﺎﻋﺭ ،ﻡﺯﻻ ﺕﻼﺧﺍﺪﻣ ﻡﺎﺠﻧﺍ ﻭ ﻱﺮﻴﮔ ﻪﻤﻫ ﺩﺭﺍﻮﻣ ﻲﺑﺎﻳﺯﺭﺍ ،ﻥﺍﺭﺎﻤﻴﺑ ﺐﺳﺎﻨﻣ ﻱﺯﺎﺳﺍﺪﺟ ،ﺎﻫ ﺖﺳﺩ<br />
ﻲﺘﻧﺁ ﻑﺮﺼﻣ ﺖﻳﺩﻭﺪﺤﻣ ﻭ ﺎﻫ ﻥﺁ ﻱﺯﺎﺴﻨﻤﻳﺍ ﻭ ﻥﺎﻨﻛﺭﺎﻛ ﺯﺍ ﺖﺒﻗﺍﺮﻣ ،ﻪﻟﺎﺑﺯ ﻲﺘﺷﺍﺪﻬﺑ ﻊﻓﺩ ،ﻱﺯﺎﺳ ﻥﻭﺮﺘﺳ ﻭ ﻲﻳﺍﺩﺯﺪﻨﮔ<br />
ﺭﺩ ﺎﻬﻨﺗ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ،ﺕﺍﺪﻴﻬﻤﺗ ﻡﺎﻤﺗ ﻱﺮﻴﮔﺭﺎﻜﺑ ﻢﻏﺮﻴﻠﻋ ﻪﻛ ﺖﺳﺍ ﺮﻛﺫ<br />
ﻥﺎﻳﺎﺷ . ﻒﻴﻄﻟﺍ ﻊﻴﺳﻭ ﻱﺎﻫ ﻚﻴﺗﻮﻴﺑ<br />
.( ٣١ ،٣٠<br />
،٢٩)<br />
ﺪﻨﺘﺴﻫ ﻱﺮﻴﮕﺸﻴﭘ ﻞﺑﺎﻗ ﺩﺭﺍﻮﻣ ﻡﻮﺳ ﻚﻳ<br />
ﻊﺑﺎﻨﻣ<br />
1) F. Marc, La. Force. The Control of Infections in Hospitals, In : Richard P. Wenzel. Prevention and<br />
Control of Nosocomial lnfections, 3rd edition, U.S.A. Williams & Wilkins, 1997, Pp. 3-17.<br />
2) Robert P. Gaynes. Surveillance of Nosocomial Infections. In : John V. Benneth philip S.<br />
Brachman. Hospital infection, 4th edition , U.S.A. Lippincott - Raven, 1998 , P65-84 .<br />
3) Alicia J. Mangram et al. Guideline for Prevention of SSI, CDC Public Health Services, Infection<br />
Control & Hospital Epidemiol ، April 1999, Vol 20, No 4, 247-278.<br />
ﺕﺎﻣﺪﺧ ﻭ ﻲﻜﺷﺰﭘ ﻡﻮﻠﻋ ﻩﺎﮕﺸﻧﺍﺩ ،ﻥﺍﺮﻬﺗ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ ﻱﺮﺳﺍﺮﺳ ﺶﻳﺎﻤﻫ ﻦﻴﻣﻭﺩ ﺕﻻﺎﻘﻣ ﻪﻋﻮﻤﺠﻣ ـ ٤<br />
٠ ١٣٧٩ ﺖﺸﻬﺒﻳﺩﺭﺍ ،ﻥﺍﺮﻬﺗ ﻲﻧﺎﻣﺭﺩ ﻲﺘﺷﺍﺪﻬﺑ<br />
5) Marc J Struelens; Hospital Infection Control, Donald Armstrong & Jonathan Cohen, Infectious<br />
Diseases, U.S.A, Mosby, 1999, P3- 10 .<br />
. ١٣٧٣ ﺕﺭﺎﺷﺍﺮﺸﻧ ﺰﻛﺮﻣ ،ﻥﺍﺮﻬﺗ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ : ﻪﻠﻴﻤﺟ ،ﻱﻭﺯﺭﻮﻧ ـ ٦<br />
،ﺐﻴﺒﻃ ﺮﺸﻧ ﻭ ﻩﺩﺍﺯﺭﻮﻤﻴﺗ ﺕﺍﺭﺎﺸﺘﻧﺍ ،ﻥﺍﺮﻬﺗ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻭ ﻱﺮﻴﮕﺸﻴﭘ : ﻦﻳﺮﻴﺷ ،ﻲﻤﻬﻓﺍ ﻭ ﻦﻴﺴﺣ ،ﻲﻧﺎﻤﻴﻠﺳ ﻞﺻﺍ ـ ٧<br />
٠ ١٢ ﺎﺗ ٣ ﻪﺤﻔﺻ ،١٣٧٩<br />
8) WHO , EMRO. Surveillance of Communicable Diseases, 1998, pp. 1-30 .
٣٧٨/<br />
ﻲﻤﻬﻓﺍ ﺮﺘﻛﺩ ،ﻲﻗﺎﺒﻟﺍﺪﺒﻋ ﻲﺟﺎﺣﺮﺘﻛﺩ ،ﻲﻧﺎﻤﻴﻠﺳﺮﺘﻛﺩ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ / ٧ ﺭﺎﺘﻔﮔ<br />
9) Denis M Cardo & David M. Bell; Bloodborne Pathogen Transmission in HCWS, Risk &<br />
Prevention Strategies: Infectious Disease Clinics of North America, June 1997 , Vol 11, No.2:P 331-<br />
345 .<br />
10) SusanE. Beekman & Bradly N. Doebbeling; Frontiers of Occupational Health, New Vaccines,<br />
New Prophylactic Regimens & Management of the HIV - infected Worker: Infectious Disease<br />
Clinics of North America, June 1997, Vol. 11, NO.2:P 313-329 .<br />
،ﻱﺮﻴﺴﻣﺮﮔ ﻭ ﻲﻧﻮﻔﻋ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻪﻠﺠﻣ:<br />
( ﻱﺭﻮﻓ ﻡﺍﺪﻗﺍ ﻪﺑ ﺯﺎﻴﻧ)<br />
ﻲﻜﺷﺰﭙﻧﺍﺪﻧﺩ ﻱﺎﻫ ﺪﺣﺍﻭ ﺭﺩ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ : ﻦﻴﺴﺣ ،ﻲﻧﺎﻤﻴﻠﺳ ﻞﺻﺍ ـ ١١<br />
. ٧١ـ٧٣<br />
ﺕﺎﺤﻔﺻ ،ﻡﻮﺳ ﻝﺎﺳ ،٨<br />
ﻩﺭﺎﻤﺷ ،١٣٧٧<br />
12) Julia S. Garner, RN, MN; Guidelines for Isolation Precautions in Hospital , the Hospital<br />
Infection Control Advisory Commit- tee. CDC Prevention Guidelines, 1996; 17; 53-80.<br />
13) Shaffer, et al. Infection prevention & Safe practice , U.S.A, Mosby's 1996.<br />
14) Julia S. Garner & Martin S. Favero; Guidelines for Handwashing & Hospital Environmental<br />
Control. CDC. MMWR 1988; 37,NO.24.<br />
15) Julia S. Garner & Martin S. Favero; Guidelines for Hondwashing & Hospital Environmental<br />
Control. Hospital Infection Prog. CDC. , U.S.A. 1999.<br />
16) http // :WWW. hopkins - id. edu/ infcontrol / policy / procedures. htm.<br />
17) http : // WWW. nanda.net .<br />
18) Mandell, Douglas & Bennett, s. Principles & Practice of Infectious Diseases, U.S.A, Churchill<br />
Livingstone Inc, 2000; Vol 2: 2995-3005.<br />
. ١٣٧٤ ﻱﺩ ،ﺏﺎﺘﻛ ﻪﻨﻴﺋﺁ . ﻥﺍﺮﻬﺗ ،ﺖﺴﻳﺯ ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ<br />
ﺭﺩ ﻥﺎﻧﺁ ﺩﺮﺑﺭﺎﻛﻭ ﺎﻫ ﻩﺪﻨﻨﻛ ﻲﻧﻮﻔﻋﺪﺿ ﻭ ﺎﻫﺍﺩﺯﺪﻨﮔ . ﻪﻟﺍ ﺖﻣﺍﺮﻛ ،ﻝﺪﻧﺎﻤﻳﺍ ـ ١٩<br />
،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺯﻮﻣﺁ ﺯﺎﺑ ﺶﻳﺎﻤﻫ ﺕﻻﺎﻘﻣ ﻪﻋﻮﻤﺠﻣ ،ﻲﭘﻮﻜﺳﻭﺪﻧﺍ ﻕﺎﺗﺍ ﺭﺩ ﺖﻧﻮﻔﻋ ﺯﺍ ﻱﺮﻴﮕﺸﻴﭘ . ﺎﺿﺭ ،ﻩﺩﺍﺯ ﻚﻠﻣ ـ<br />
. ١١٨ـ١٢٦<br />
ﺕﺎﺤﻔﺻ ،١٣٧٧<br />
ﺖﺸﻬﺒﻳﺩﺭﺍ ،ﻥﺍﺮﻬﺗ ﻲﻧﺎﻣﺭﺩ ﻲﺘﺷﺍﺪﻬﺑ ﺕﺎﻣﺪﺧ ﻭ ﻲﻜﺷﺰﭘ ﻡﻮﻠﻋ ﻩﺎﮕﺸﻧﺍﺩ ،ﻥﺍﺮﻬﺗ<br />
ﻩﺭﺎﻤﺷ ،١٣٧٦<br />
. ﻱﺮﻴﺴﻣﺮﮔ ﻭ ﻲﻧﻮﻔﻋ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻪﻠﺠﻣ : ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻲﻧﻮﻔﻋ ﻱﺎﻫ ﻪﻟﺎﺑﺯ . ﻢﺳﺎﻘﻟﺍﻮﺑﺍ ،ﺎﺿﺭ ﺭﻮﭘ . ﻦﻴﺴﺣ ،ﻲﻧﺎﻤﻴﻠﺳ<br />
ﻞﺻﺍ ـ ٢١<br />
. ٥٨ـ٦٣<br />
ﺕﺎﺤﻔﺻ ،ﻡﻭﺩ ﻝﺎﺳ ،٦<br />
22) Richard R. Yates: New Intervention Strategies for Reducing Antibiotic Resistance. Chest 1999;<br />
115 : 24 S-27 S.<br />
23) Thomas M. file ،Jr: Overview of Resistance in the 1990 s. chest 1999; 115: 3S-8S.<br />
24) David J. Weder; Ralph Raasch ; and William A. Rurala Nosocomial Infection in the ICU. The<br />
Growing Importance of Antibiotic - Resistant Pathkogens. Chest 199; 115-34S-41S.<br />
25) John M. Boyce: Vancomycin - Resistant Enterococcus. Infectious Disease Clinics of North<br />
America, 1997; Vol. II, No.2:367-384.<br />
26) httP: // WWW. Pedid. uthscsa. edu / 104.htm.<br />
٢٠
ﻂﻴﺤﻣ ﺖﺷﺍﺪﻬﺑ / ٤ ﻞﺼﻓ<br />
ﻲﻣﻮﻤﻋ ﺖﺷﺍﺪﻬﺑ ﻊﻣﺎﺟ ﺏﺎﺘﻛ / ٣٧٩<br />
ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﻱﺯﻮﻣﺁ ﺯﺎﺑ ﺶﻳﺎﻤﻫ ﺕﻻﺎﻘﻣ ﻪﻋﻮﻤﺠﻣ : ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ ﻝﺮﺘﻨﻛ ﺭﺩ ﺵﺯﻮﻣﺁ ﺶﻘﻧ . ﻦﻴﺴﺣ ،ﻲﻧﺎﻤﻴﻠﺳ ـ<br />
٠ ١٣٧٧ ﺖﺸﻬﺒﻳﺩﺭﺍ ٣٥ـ٣٩<br />
ﺕﺎﺤﻔﺻ ،ﻥﺍﺮﻬﺗ ﻲﻧﺎﻣﺭﺩ ﻲﺘﺷﺍﺪﻬﺑ ﺕﺎﻣﺪﺧ ﻭ ﻲﻜﺷﺰﭘ ﻡﻮﻠﻋ ﻩﺎﮕﺸﻧﺍﺩ ،ﻥﺍﺮﻬﺗ ،ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ<br />
ﻝﺎﺳ ،٧<br />
ﻩﺭﺎﻤﺷ . ﻱﺮﻴﺴﻣﺮﮔ ﻭ ﻲﻧﻮﻔﻋ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻪﻠﺠﻣ : ﺎﻫ ﻞﺣ ﻩﺍﺭﻭ ﺕﻼﻜﺸﻣ ﻭ ﻲﻧﺎﺘﺳﺭﺎﻤﻴﺑ ﻱﺎﻫ ﺖﻧﻮﻔﻋ . ﻦﺴﺤﻟﺍﻮﺑﺍ ،ﻲﻔﻳﺮﻇ ﺀﺎﻴﺿ ـ<br />
29) http:www//infectionctrl-onlinecom/hospital-infection.htm<br />
30) http:www//cdc gov/mmwr/preview<br />
٢٧<br />
٢٨<br />
٠ ١٣٧٧ ،٧٢ـ٧٥<br />
ﺕﺎﺤﻔﺻ ،ﻡﻮﺳ<br />
31) William R. Jarvis: Selected Aspects of the Socioeconomic Impact of Nosocomial Infections.<br />
Infection Control & Hospital Epodemiology, August 1996 , Vol. 17(8).<br />
Bibilography<br />
1) Garner Js, Jarvis WR, et al: CDC definitions for Nosocomial Infection, 1988. Infection Control<br />
1988, 16: 128-40.<br />
2) G.A.J. Ayliffe , et al. control of Hospital Infection ،U.K, Chapman & Hall medical , 1999.<br />
3) N.N Damani , Manual of Infection Control Procedures, U.K, GMM, 1997.
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