医务人员院内感染传染性非典型肺炎的环境和行为因素分析

目的寻找影响医务人员院内感染传染性非典型肺炎(SARS)的环境和行为因素,为制定预防控制措施提供依据.方法于2003年3月选择收治病人较多的广州市有代表性的9家医院,通过访谈了解医院收治病人、预防控制措施和医务人员发病等情况;现场考察收治科室的环境布局和通风情况;问卷调查其中7家医院医务人员的暴露、卫生习惯、防护等行为因素和发病情况.通过单因素分析和非条件Logistic回归分析影响SARA发病的行为因素.结果 9家医院参与SARS病人诊治的医护人员罹患率为0～24.6%,差异有显著性(χ2=141.73,P＜0.01).2003年1月23日前收治病人的4家医院的罹患率为7%～24.6%,3家零感染的医院均为1月30日后收治SARS病人.零感染的医院都是分区合理、医患通道分开、医生办公室与病房分开及通风良好的医院.发生严重院内感染的医院都存在分区不合理、交叉污染、通风不良或方向错误等情况.单因素分析结果显示:"参与抢救"、"常规进入病区"、"在病区吃饭、饮水、抽烟"、"戴口罩"、"戴12层口罩"、"穿隔离衣"戴眼罩"、"穿鞋套"、戴手套"、"洗手消毒"、"漱口液嗽口"、"鼻眼粘膜保护"、"服抗病毒药"、"回家前洗澡换衣"等行为因素与发病有关.前3项因素OR为2.002～2.600,后11项因素OR为0.160～0.698.经非条件logistic回归分析最终进入模型的有:参与抢救及方式(OR=1.841)、常规进入病区(OR=6.527)、穿隔离衣(OR=0.634)、穿鞋套(OR=0.554)、戴手套(OR=0.487)、嗽口液漱口(OR=0.582)、戴眼罩(OR=0.393)、抗病毒药(OR=0.290);其中前2项为危险因素,后6项为保护性因素.结论环境因素与行为都是影响医务人员院内感染的重要因素;收治SARS病人必须在符合规范的医院/病房;医务人员必须严格防护.     

广州市某医院医务人员传染性非典型肺炎医院内感染情况调查分析

目的　探讨广州市某医院医务人员医院内感染传染性非典型肺炎 (SARS)的影响因素。方法　访谈了解医院收治患者、医务人员感染发病等情况 ,现场调查病区环境和消毒情况 ,采用统一问卷调查医护人员与患者接触程度及防护行为。结果　医院共收治 10 4例SARS患者 (其中 4 0例重症患者 ) ,2 5名医务人员感染发病 ,其中ICU罹患率最高 ,为 9 6 % (12 /12 5 )。感染发病和未感染发病医务人员在个人防护上 ,戴口罩、穿隔离衣、用鞋套、戴手套、消毒洗手和及时洗澡换衣等措施的采用差异有显著性 (P <0 0 1)。结论　医务人员院内感染可能受病区环境 (条件 )、消毒措施、患者的传染性、医务人员与患者接触程度及个人防护等多方面的影响 ;个人防护是医务人员预防感染的最后防线     

SARS患者转运工作指南

1　全套防护服全套防护服包括连身防护服、帽子、鞋套、防护眼镜、12层以上纱布口罩 +戴鼻夹外科口罩 (或N 95口罩 )、胶皮手套、长筒胶靴和隔离衣。2　穿防护服流程2 .1　穿连身防护服、隔离衣、长筒胶靴。2 .2　戴工作帽 ,盖住头发 ,两耳和颈部。2 .3　戴口罩 (口罩要戴严 )。2 .4　戴防护镜。2 .5　戴胶皮手套 (手破损时要求戴两层 )。工作帽→口罩→连身防护服→防护镜→隔离服→长筒胶靴→手套3　工作流程工作区域应分清洁区、半污染区、污染区。隔离车上备有全套防护服 (若干套 )、小型喷雾器 (内配 0 5 %过氧乙酸消毒液 )、黄色垃…     

医护人员防护着装指南

1　发热门诊防护要求适用于发热门诊的工作人员。1.1　穿防护服 (内层 )、隔离衣 (外层 ) ,戴工作帽、12层以上棉纱口罩 +带鼻夹的外科口罩 (或只戴N 95口罩 )、防护眼镜、乳胶手套和鞋套。1.2　每接诊一位患者后立即更换手套 ,并进行手的清洗或消毒 (消毒采用快速手消毒剂揉搓 ) ,接诊SARS或疑似患者后必须更换隔离衣。1.3　离开发热诊室应卫生通过。2　SARS病区防护要求适用于SARS病区的工作人员 (医、护、技、工勤 ) ,接触SARS标本的检验人员 ,污衣、污物处理人员 ,SARS尸体运送及解剖人员 ,运送患者的医务人员及司机。2 .1　进…     

广州市某医院预防SARS感染防护措施效果分析

目的 寻找院内感染SARS的危险因素，评估医院预防控制措施效果。方法 访谈了解医院防治SARS和医务人员发病的总体情况；现场考察相关病区的环境状况；问卷调查78名参加SARS救治工作的医务人员卫生习惯、预防措施的执行情况，并用ELISA法检测其中67人血清中的抗-SARS抗体。结果 该院共收治确诊和疑似SARS患281例，医务人员罹患率为1％(4／395)。隔离病区有2名护工感染发病，ICU有2名医生发病，1人死亡。医院采用通风良好的外廊式楼房做隔离病区，ICU收治重症患。隔离病区采取一系列严格的消毒隔离措施。医务人员有良好的个人防护和卫生习惯，100％戴口罩和洗手消毒，戴手套、穿隔离衣、穿鞋套、戴眼罩、漱口、粘膜保护等防护措施的采用率分别为74．4％、66．7％、46．2％、9．0％、24．4％和9．0％；医务人员预防服药率为57．7％。67份血清抗-SARS抗体全部阴性。结论 良好的卫生习惯和防护意识、对隔离防护制度的严格执行是防止SARS院内感染的关键环节，消毒、隔离、个人防护等主要干预措施是保护医务人员的重要防线。     

护理人员职业损伤的危险因素及自我防护

目的树立崇高的敬业精神，采取自我防护措施，减少职业损伤及感染。方法组织培训学习相关防治知识，掌握了解可引起职业损伤的因素，采取自我防护措施，加强一次性锐器管理，避免因违反操作规程或粗心大意造成感染。结果认识传染病的各种传播途径，加强防范和做好个人防护，规范戴口罩、帽子、手套，必要时穿隔离衣，戴防护镜等，清洁洗手按六步法进行。结论树立职业安全意识，统一认识经血液、体液传播疾病的高危因素，规范护理操作，采取严格的隔离防护措施。控制医源性经血传播疾病。     

71名医务人员在SARS病区个人防护调查

目的了解医务人员在SARS病区工作中个人防护过程出现错误的环节,降低医务人员的感染机会. 方法把穿脱隔离衣等过程设计成22个问题条目,并制成观察表,由3名安全防护员进行监督和检查,并认真记录每日4班的防护情况,出现错误后及时纠正. 结果在穿衣和脱衣过程中均存在不同的错误,其中穿衣过程错误率平均12.24%,其中健之素擦手错误率占54.93%,其次是口罩、工作帽、手套、眼罩分别为13.62%、11.27%、9.86%、8.45%;脱衣程序错误率平均21.78%,其中健之素擦手错误率占70.43%,其次泡雨靴、脱正穿隔离衣、喷雾、脱手套分别为52.11%、29.58%、19.70%、15.96%;脱衣错误率明显高于穿衣,男性错误率明显高于女性,高级职称错误率高于低级职称,但与科别无关. 结论医务人员在进入SARS病区中均出现不同防护错误,对医务人员规范的培训和监督是预防错误的关键,加强监督力度是实现医务人员零感染的重要环节.     

mxA基因多态性与SARS病毒易感性的病例对照研究

目的探讨黏病毒抗性蛋白1（MxA）基因多态性与人群严重急性呼吸综合征（SARS）发病间的关系。方法采用病例对照研究，用聚合酶链反应-限制性片段长度多态性分析检测mxA基因启动子-88位G／T多态性位点，对SARS传播的相关因素进行问卷调查，并用SPSS软件进行单因素和多因素分析。结果选取了66例SARS病例和64名对照进行研究。与GG基因型相比，含等位基因T的基因型（GT＋TT）在病例中的构成比（81．3％）显著高于对照组（62．5％），0R值（95％CJ）为2．700（1．208～6．037）。多因素logistic回归分析结果表明，在调整了与SARS病例接触时戴口罩，穿防护服，戴眼罩等相关因素后，与GG基因型相比，含等位基因T的基因型（GT＋TT）仍与SARS发病有显著性关联，调整OR值（95％CI）为2．911（1．027～8．250）。结论mxA基因启动子-88位G／T多态性可能与中国汉族人群SARS发病的基因易感性有关。     

SARS流行期间医务人员个人防护状况调查

目的　了解医务人员在传染性非典型肺炎流行期间的个人防护状况和防护效果。方法　采用整群抽样方法抽取广东省 9家医院 ,用问卷调查方式对其中接触过传染性非典型肺炎病人的 16 4 5名医务人员进行调查。结果　戴 <12层口罩的医务人员的感染率高于戴≥ 12层者 (χ2 =14 32 8,P <0 0 1) ;使用衣帽一体隔离服比使用衣帽分体的隔离服的医务人员的感染率低 (χ2 =13 5 4 6 ,P <0 0 1) ;穿 1层隔离服的医务人员的感染率明显高于穿 1层以上者 (χ2 =2 0 6 5 9,P <0 0 1) ;戴眼罩的医务人员的感染率明显低于未戴眼罩者 (χ2 =6 6 92 4 ,P <0 0 1) ;戴手套的感染率明显低于未戴手套者 (χ2 =30 814 ,P <0 0 1) ;使用非接触式洗手装置的医务人员的感染率低于使用接触式洗手装置者 (χ2 =19 2 83,P <0 0 1)。结论　建议医务人员采取严格的个人防护措施。     

医务人员感染传染性非典型肺炎的影响因素分析

目的　分析医务人员感染传染性非典型肺炎 (SARS)的影响因素 ,为控制SARS在院内的传播 ,降低医护人员的SARS发病率和医院内感染水平提供一定的参考依据。方法　采用整群抽样方法抽取了广东省 9家医院 ,问卷调查了 9家医院中接触过SARS病人的 164 5名医务人员以及相关的科室。对影响医务人员感染SARS的因素进行了非条件Logistic回归的多因素分析。结果　共筛选出 7个可能与感染SARS有关的因素分别是 :医务人员的职业 (医生、护士和护理员 ) ,参与吸痰操作 ,诊治SARS病人时是否戴眼罩 ,洗手装置 ,隔离服的层数 ,通常戴口罩个数和初始接触病人是否戴口罩。在调查的 48个科室中 ,81.3 %的科室进行了严格的隔离分区 ,80 %的房间能够经常开窗通风 ,83 .3 % (4 0 /4 8)的科室使用紫外灯消毒 ,91.7% (4 4 /4 8)的科室使用过氧乙酸熏蒸喷雾消毒剂消毒 ,3 9.6%的科室使用循环风紫外线消毒。结论　医务人员应采取严格的分级防护措施 ;医院的科室应加强隔离与消毒措施 ;采取综合防治措施以确保医务人员的健康与安全     

Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: a case series.

OBJECTIVE: To review the severe acute respiratory syndrome (SARS) infection control practices, the types of exposure to patients with SARS, and the activities associated with treatment of such patients among healthcare workers (HCWs) who developed SARS in Toronto, Canada, after SARS-specific infection control precautions had been implemented. METHODS: A retrospective review of work logs and patient assignments, detailed review of medical records of patients with SARS, and comprehensive telephone-based interviews of HCWs who met the case definition for SARS after implementation of infection control precautions. RESULTS: Seventeen HCWs from 6 hospitals developed disease that met the case definition for SARS after implementation of infection control precautions. These HCWs had a mean age (+/-SD) of 39+/-2.3 years. Two HCWs were not interviewed because of illness. Of the remaining 15, only 9 (60%) reported that they had received formal infection control training. Thirteen HCWs (87%) were unsure of proper order in which personal protective equipment should be donned and doffed. Six HCWs (40%) reused items (eg, stethoscopes, goggles, and cleaning equipment) elsewhere on the ward after initial use in a room in which a patient with SARS was staying. Use of masks, gowns, gloves, and eyewear was inconsistent among HCWs. Eight (54%) reported that they were aware of a breach in infection control precautions. HCWs reported fatigue due to an increased number and length of shifts; participants worked a median of 10 shifts during the 10 days before onset of symptoms. Seven HCWs were involved in the intubation of a patient with SARS. One HCW died, and the remaining 16 recovered. CONCLUSION: Multiple factors were likely responsible for SARS in these HCWs, including the performance of high-risk patient care procedures, inconsistent use of personal protective equipment, fatigue, and lack of adequate infection control training.     

Appropriate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbreak in Singapore

Background: Singapore was affected by an outbreak of severe acute respiratory syndrome (SARS) from 25 February to 31 May 2003, with 238 probable cases and 33 deaths.

Aims: To study usage of personal protective equipment (PPE) among three groups of healthcare workers (HCWs: doctors, nurses, and administrative staff), to determine if the appropriate PPE were used by the different groups and to examine the factors that may determine inappropriate use.

Methods: A self-administered questionnaire survey of 14 554 HCWs in nine healthcare settings, which included tertiary care hospitals, community hospitals, and polyclinics, was carried out in May–July 2003. Only doctors, nurses, and clerical staff were selected for subsequent analysis.

Results: A total of 10 236 valid questionnaires were returned (70.3% response); 873 doctors, 4404 nurses, and 921 clerical staff were studied. A total of 32.5% of doctors, 48.7% of nurses, and 77.1% of the administrative staff agreed that paper and/or surgical masks were "useful in protecting from contracting SARS". Among this group, 23.6% of doctors and 42.3% of nurses reported working with SARS patients. The view that a paper and/or surgical mask was adequate protection against SARS was held by 33.3% of doctors and 55.9% of nurses working at the A&E unit, 30.5% of doctors and 49.4% of nurses from medical wards, and 27.5% of doctors and 37.1% of nurses from intensive care units. Factors which predicted for agreement that paper and/or surgical masks were protective against SARS, included HCW's job title, reported contact with SARS patients, area of work, and Impact Events Scale scores.

Conclusion: A variety of factors determine appropriate use of personal protective equipment by HCWs in the face of a major SARS outbreak.

     

Cluster of severe acute respiratory syndrome cases among protected health-care workers--Toronto,Canada, April 2003

Infections among health-care workers (HCWs) have been a common feature of severe acute respiratory syndrome (SARS) since its emergence. The majority of these infections have occurred in locations where infection-control precautions either had not been instituted or had been instituted but were not followed. Recommended infection-control precautions include the use of negative-pressure isolation rooms where available; N95 or higher level of respiratory protection; gloves, gowns, and eye protection; and careful hand hygiene. This report summarizes a cluster of SARS cases among HCWs in a hospital that occurred despite apparent compliance with recommended infection-control precautions.     

Personal protective equipment and antiviral drug use during hospitalization for suspected avian or pandemic influenza

For pandemic influenza planning, realistic estimates of personal protective equipment (PPE) and antiviral medication required for hospital healthcare workers (HCWs) are vital. In this simulation study, a patient with suspected avian or pandemic influenza (API) sought treatment at 9 Australian hospital emergency departments where patient-staff interactions during the first 6 hours of hospitalization were observed. Based on World Health Organization definitions and guidelines, the mean number of "close contacts" of the API patient was 12.3 (range 6-17; 85% HCWs); mean "exposures" were 19.3 (range 15-26). Overall, 20-25 PPE sets were required per patient, with variable HCW compliance for wearing these items (93% N95 masks, 77% gowns, 83% gloves, and 73% eye protection). Up to 41% of HCW close contacts would have qualified for postexposure antiviral prophylaxis. These data indicate that many current national stockpiles of PPE and antiviral medication are likely inadequate for a pandemic.     

Severe acute respiratory syndrome (SARS) and healthcare workers

The recent outbreak of severe acute respiratory synt drome (SARS) was spread by international air travel, a direct result of globalization. The disease is caused by a novel coronavirus, transmitted from human to human by droplets or by direct contact. Healthcare workers (HCWs) were at high risk and accounted for a fifth of all cases globally. Risk factors for infection in HCWs included lack of awareness and preparedness when the disease first struck, poor institutional infection control measures, lack of training in infection control procedures, poor compliance with the use of personal protection equipment (PPE), exposure to high-risk procedures such as intubation and nebulization, and exposure to unsuspected SARS patients. Measures to prevent nosocomial infection included establishing isolation wards for triage, SARS patients, and step-down; training and monitoring hospital staff in infection-control procedures; active and passive screening of HCWs; enforcement of droplet and contact precautions; and compliance with the use of PPE.     

SARS transmission among hospital workers in Hong Kong

Despite infection control measures, breakthrough transmission of severe acute respiratory syndrome (SARS) occurred for many hospital workers in Hong Kong. We conducted a case-control study of 72 hospital workers with SARS and 144 matched controls. Inconsistent use of goggles, gowns, gloves, and caps was associated with a higher risk for SARS infection (unadjusted odds ratio 2.42 to 20.54, p < 0.05). The likelihood of SARS infection was strongly associated with the amount of personal protection equipment perceived to be inadequate, having <2 hours of infection control training, and not understanding infection control procedures. No significant differences existed between the case and control groups in the proportion of workers who performed high-risk procedures, reported minor protection equipment problems, or had social contact with SARS-infected persons. Perceived inadequacy of personal protection equipment supply, infection control training <2 hours, and inconsistent use of personal protection equipment when in contact with SARS patients were significant independent risk factors for SARS infection.     

新冠肺炎个人防护有效培训形式研究

 目的 探讨个人防护用品穿脱培训的有效形式。方法 将医务人员随机分为三组(第一组:视频培训;第二组:现场演示培训;第三组:一对一实操培训)进行个人防护用品穿脱培训,培训结束后对三组人员进行考核,评价培训效果。穿脱个人防护用品步骤考核采用评分表评分和定性的方法(脱防护服之前涂荧光粉以判断脱时荧光粉是否沾染衣服或皮肤的定性方法)考核。结果 每组考核169人,第三组考核合格率为85.21%,高于第二组(56.21%)、第一组(34.32%);护理、医技、医疗三类岗位中,以护理人员考核合格率最高(71.57%,141/197),医技人员合格率最低(42.11%,64/152);在穿脱个人防护用品步骤考核中,以佩戴医用口罩的密合性试验、脱连体防护服+手卫生合格率最低(分别为64.69%、60.95%)。三组培训成员、三类不同岗位类别,以及穿、脱个人防护用品各步骤考核合格率比较,差异均有统计学意义(均P<0.005)。荧光定性检测合格率为69.43%。结论 一对一实操的培训优于现场演示和视频培训,培训时应着重强调医用防护口罩的密合性试验,脱防护服时避免其污染衣服或皮肤。     

Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among healthcare workers

The traffic control bundle consists of procedures designed to help prevent epidemic nosocomial infection. We retrospectively studied the serial infection control measures to determine factors most effective in preventing nosocomial infections of healthcare workers (HCWs) during the 2003 Taiwanese severe acute respiratory syndrome (SARS) epidemic. Fever screening stations, triage of fever patients, separating SARS patients from other patients, separation of entrances and passageways between patients and HCWs, and increasing hand-washing facilities all demonstrated a protective effect for HCWs (univariate analysis; P<0.05). By multiple logistic regression: (i) checkpoint alcohol dispensers for glove-on hand rubbing between zones of risk, and (ii) fever screening at the fever screen station outside the emergency department, were the significant methods effectively minimising nosocomial SARS infection of HCWs (P<0.05). The traffic control bundle should be implemented in future epidemics as a tool to achieve strict infection control measures.     

2010年某医院医护人员手卫生状况调查

[目的]了解临床科室医护人员手卫生自我评估情况,为进一步研究医护人员手卫生依从性的影响因素及探索提高手卫生依从性的措施提供参考依据。[方法]2010年2月,对某三级甲等医院临床科室的525名医护人员进行调查。[结果]调查525人,96.59%认为手卫生与院内感染有必然联系,84.95%提出有手卫生相关培训的需求,对手卫生设施和配置感觉比较方便的占90.86%;认为每次洗手应该消耗时间<5s的占6.10%,5～9s的占32.38%,10～29s的占37.71%,≥30s的占23.81%;自己洗手行为较差的时刻是在直接接触病人前、脱去手套后、工作结束/告一段落后,洗手者分别占78.67%、69.52%、70.87%;认为自己手卫生不及时的原因,主要是工作忙碌而忘记洗手(占64.19%)和认为洗手用品对皮肤有刺激(占23.67%)。[结论]某医院临床科室医护人员的手卫生状况较好。医护人员认为不及时洗手的原因主要是工作忙碌忘记洗手。     

Proposal for an approach with default values for the protection offered by PPE, under European new or existing substance regulations

Introduction of personal protective equipment (PPE) in the process of quantitative exposure and risk assessment should be addressed carefully. PPE which have been designed and manufactured according to CE-criteria and have proved to pass relevant test criteria, can be classified as "proper functioning". However, test criteria for PPE are not equal to levels of protection which can be achieved in the workplace, because actual workplace exposure scenarios, fit, maintenance and storage may differ substantially from the test conditions.The proper use of PPE is related to issues which form a part of a PPE-programme. Such a programme should be implemented in a company to ensure selection of proper PPE and information, training and instruction of employees how to wear PPE properly.Assigned protection factors (APFs) for different designs of respiratory protective devices (RPD) have been introduced to quantify effectiveness of RPD in the workplace. Similar APFs are proposed for dermal protection (gloves and clothing). In general biological monitoring studies show lower reduction of internal exposure than estimated by reduction of external exposure. Therefore, conservative estimates of protection by PPE, i.e. the lowest APFs, are proposed for risk assessment purposes if "proper use of proper functioning" PPE as part of a PPE-programme cannot be demonstrated.