医护人员预防SARS医院内感染的个人防护措施效果评价

目的 评价医务人员预防SARS医院内感染个人防护措施的效果,验证SARS的传播途径。方法 在广东省10家收治SARS患者的主要医院进行了成组设计的病例对照研究,对象为常规参加SARS诊治工作且直接抢救重患者的医护人员,共257人,其中病例组77例,对照组180人。采用统一调查表了解调查对象接触SARS患者程度、个人防护情况、卫生习惯、预防服药等方面情况。单因素分析采用X2检验、多因素分析利用非条件logistic回归分析。并用趋势X2检验分析个人防护措施的剂量反应关系和联合使用效果。结果 单因素分析结果显示,一直戴12层及以上口罩、穿隔离衣、用鞋套、戴手套、必要时戴眼罩、消毒洗手、漱口液漱口、用滴鼻滴眼液保护鼻眼黏膜、及时洗澡换衣、“不在病区吃饭/饮水/抽烟”、服oseltamivir phosphate等均有保护作用(P<0.05)。非条件logistic多因素回归分析有显著意义的有戴口罩(OR=0.78,95％CI:0.60～0.99)、戴眼罩(OR=0.20,95％CI:0.10～0.41)和穿鞋套(OR=0.58,95％CI:0.39～0.86)。并且趋势分析显示口罩及口罩类型、穿隔离衣、用鞋套、戴手套、必要时戴眼罩、漱口液漱口、用滴鼻滴眼液保护鼻眼黏膜和及时洗澡换衣等措施存在剂量效应关系。无防护参与SARS患者抢救的医护人员的罹患率高达61.5％(16/26),保护率随防

Effectiveness of personal protective measures in prevention of nosocomfal transmission of severe acute respiratory syndrome

Objective To evaluate the effectiveness of personal protective measures of health care workers (HCWs) against severe acute respiratory syndrome (SARS). Methods A case-control study from ten hospitals in Guangdong, with 180 non-infected and 77 infected staff members that accessed the isolation unit every day, and participated in direct first aid for severe SARS patients. All participants were surveyed about how they were using personal protective equipments (PPE), protective drugs and hygiene habits when caring for patients with SARS. Statistical analysis was done with either X2 or Fisher's exact test for univariate analysis, whereas we used forward stepwise selection (Waldesian) for logistic regression. Results Univariate analysis showed that mask, gown, gloves, goggles, footwear, " hand-washing and disinfecting", gargle, "membrane protection", "taking shower and changing clothings after work", "avoid from eating and drinking in ward", oseltamivir phospha tall had protective effects (P<0.05), but stepwise logistic regression showed significant differences for mask ( OR = 0.78, 95% CI: 0.60-0. 99), goggles (QR = 0.20,95%C/:0.10-0.41) and footwear (OR = 0.58,95% CI:0.39-0.86). Analysis for linear trend in proportions showed that dose response relationship existed in mask, gown, gloves, goggles, footwear, gargle, "membrane protection" and "taking shower and changing dree after work" (P<0.01). The attack rate of HCWs who were rescuing severe SARS patients without any PPE was 61.5% (16/26). It seemed that the more the protective measures were used , the higher the protective effect was (P< 0.001), and could reach 100% if mask, gown, gloves, goggles, footwear, "hand-washing and disinfecting" were all used at the same time. Conclusions Nosocomial infection of SARS can be prevented effectively by precautions against droplets and personal contact. HCWs must take strict protection according to the guidance of WHO or Chinese MOH and pay attention to personal hygiene.