米国における感染対策専門職制度に関する研究

A Review of the Infection Control System in the United States: Its Practitioners and its Trends

　わが国では，感染対策専門家の制度はまだ確立されていないが，その必要性が叫ばれている。本論文では，世界的にその制度，内容において質・量共に充実している米国の感染対策専門家（ICP）に焦点をあて，CINAHLにより文献研究を行ない，以下の知見を得た。

　①ICPは院内感染対策の樹立と同時に1963年に誕生し，政府関連機関が認める教育システムや，資格認定制度の確立により発展してきた。

　②ICPの認定資格を取得するためには，所定の教育（講習）と試験が義務づけられている。さらに上級の認定制度もあり，その認定書は5年間有効である。

　③ICPは各施設の感染対策委員会の中心的メンバーとして活躍し，院内感染の管理，予防，サーベイランス，検証，教育，研究といった重要な責務を果たしている。

　④ヘルスケアシステムおよび国民のニーズの変化にともなう「ケアの質保証・質改善」に対応するためのICPの今後の課題として，（a）ヘルスケア専門家との連携，（b）ゼネラリストとしてのICP，（c）疫学的知識技術の拡大が考えられる。

　The purpose of this study is to review recent literature regarding the role of the infection control nurse in the United States. Recent relevant literature, published between 1982 and 1995, was selected by using a computerized literature search, cumulative index to nursing and allied health literature (CINAHL).

　Four major points in the development of infection control practitioners (ICPs) were indentified from the literature review :

(1) Since the late 1960s the number of ICPs had increased continuously, through the Center for Disease control training programs, and through training programs developed by members of the Association for Professionals in Infection Control and Epidemiology (APIC) at the national, regional and local chapter levels.

(2) The ICPs became certified upon receiving satisfactory results on the infection of 2 years of work in the field of infection control, and then are authorized to use the title “CIC”. The certification was valid for five years and is renewed after the ICP passed a reexamination.

(3) Six duties of the ICP were identified: management, prevention, surveillance, identification, education, and research.

(4) The cost of health care was constantly restructuring the health care delivery system in the United States. The ICPs also were influenced by these changes. New challanges facing ICPs today were, a) the integration of resources to be shared by infection control and quality assurance, b) the change of role from specialist to generalist, c) the expansion of their roles in the area of epidemiology.