职业暴露与自我防护对策

目的调查临床护士被针刺伤情况，探讨职业暴露与自我防护对策。方法对临床护理人员进行问卷调查，从中发现护士职业暴露发生的原因。结果46名护理人员被针刺伤者占89．1％，无1人进行针对性免疫注射。在护理操作中戴手套率为零。结论医护人员自我防护意识淡薄，自我防护措施不到位，急需加强职业防护教育，严格执行全面性防护措施，预防感染。     

ICU护士职业暴露危害因素分析及自我防护能力现状调查

目的:调查重症监护病房(ICU)护理人员职业暴露危害因素与自我防护的现状.方法:对市级三所甲等医院ICU 56名护士进行问卷调查,内容包括一般资料、护理操作中是否戴手套、针刺伤情况、身体健康状况、职业暴露危害因素及防护知识等.结果:ICU护士职业暴露危害因素及防护知识知晓率相对较低,尤其是年青护士防护意识差,针刺伤发生率高,针刺伤后血液检测率又相当较低.结论:应加强对ICU护士的职业安全教育,增强防护意识,提高自我防护能力.     

ICU护士职业暴露危害因素分析及自我防护能力现状调查

目的：调查重症监护病房（ICU）护理人员职业暴露危害固素与自我防护的现状。方法：对市级三所甲等医院ICU56名护士进行问卷调查,内容包括一般资料、护理操作中是否戴手套、针刺伤情况、身体健康状况、职业暴露危害因素及防护知识等。结果：ICU护士职业暴露危害因素及防护知识知晓率相对较低,尤其是年青护士防护意识差,针刺伤发生率高,针刺伤后血液检测率又相当较低。结论：应加强对ICU护士的职业安全教育,增强防护意识,提高自我防护能力。     

内科住院患者对护理人员使用手套的态度调查

目的 了解患者对护理人员在临床护理操作中使用手套的态度,加强医院感染管理,降低医院内感染的发生率.方法 通过问卷调查方式对100例内科住院患者进行调查,并对结果 进行统计描述及X2检验.结果 调查显示内科患者对护士在不同操作中戴手套持不同的态度,大部分患者认为护士在进行输液、抽血时不需戴手套;而进行会阴护理、压疮或气管切开换药等操作时则希望护士戴手套,并认为戴手套同时保护了护士和患者.不同年龄、学历的内科住院患者对护士戴手套的态度比较无差异,而不同住院次数的内科住院患者对护士戴手套的态度比较有差异.结论 随着住院次数的增加,患者对医院感染知识的增多,对临床护理人员使用手套持赞同态度的患者比例增加.     

温州市6家医院临床护士化疗防护措施落实情况调查

目的了解临床护士在实施化疗过程中自我防护措施的落实情况,为提高护理人员的职业防护水平、制定改进措施提供依据。方法自行设计调查表对温州市6家二级甲等以上医院的375名临床护士进行化疗防护意识与自我防护措施落实情况调查。结果临床护士化疗防护方面理论知识掌握较好,但具体防护措施落实较差;非肿瘤专科护士比肿瘤专科护士防护措施落实情况差;繁琐的防护措施比简便的防护措施落实情况差;不同医院等级、工龄、职称护士化疗防护措施落实情况差异有统计学意义;而学历则无统计学意义。结论临床护士化疗防护措施落实情况不甚理想,并受医院等级、工龄、职称等多种因素影响,提示医院管理者应重视化疗职业危害的宣传与教育;制定完善的化疗防护规章制度;同时应重视对低年资护士的岗前培训、在职教育与相关操作演练,以切实提高化疗防护措施的落实水平,减少护士的职业损伤。     

产科护理人员职业暴露及防护情况调查与分析

目的了解产科护理人员职业暴露的发生情况，分析原因，探讨进一步防范对策。方法2007年1—12月对我院产科护理人员进行问卷调查包括基本情况、职业暴露情况及护理操作中自我防护情况等。结果126名被调查产科护理人员中，89名有职业暴露的经历，与产科护理有关的职业暴露总次数512次；护理人员自我防护意识差，接触患者血液、羊水和体液时戴眼罩、面罩及穿隔离衣者仅34名，占27．0％，每次接触母乳戴手套者仅6名，占4．8％。每次换尿布戴手套者5名，占4．0％。发生职业暴露后向疾控科上报82名，占65．1％。结论产科护理人员面临的职业暴露风险大，职业防护意识较差，应加强对临床护理人员职业防护知识培训，落实标准预防措施，有效避免产科护理人员的职业暴露。     

影响手术室护理人员感染自我防护意识的相关因素分析

目的探讨手术室护理人员的感染自我防护意识现状及影响因素。方法选取2017年1月至2019年1月我院手术室护理人员88名作为研究对象。通过问卷调查评估护理人员的感染自我防护意识,并对其性别、年龄、文化程度、婚姻状况、工龄、职称、参加感染培训、宗教信仰、自我效能感及职业倦怠感与自我防护意识进行比较,以多因素logistic回归分析护理人员感染自我防护意识的影响因素。结果多因素logistic回归分析显示,年龄、文化程度、工龄、职称、自我效能感评分及职业倦怠感评分是影响手术室护理人员感染自我防护意识的独立危险因素(P<0.05)。结论我院手术室护理人员的感染自我防护意识还存在很大的提升空间,应重视加强护理人员感染相关知识培训,以提高其感染自我防护意识,从全面角度来看,提高护理人员的综合护理能力才是提升护理质量的关键所在。     

传染病院护士护理操作时戴手套情况调查

目的了解传染病院护士在临床护理操作时戴手套情况,以便加强消毒隔离质量。方法采用问卷调查方法,对一所三级甲等传染病院临床护士进行了调查。结果护士为乙肝患者进行护理操作手套使用率为35%最低,护理艾滋病时手套使用率为82.5%,晨晚间护理时手套使用率为15.3%,接触破损皮肤时手套使用率为78.3%。不原意戴手套的原因是认为操作不方便者为77.1%,认为戴手套不舒服者为58.6%,怕病人抱怨者为51.6%。结论传染病院护士对自身职业防护不够重视,没有树立全程预防的观念。     

护理技术操作中洗手及戴手套的执行情况分析

目的 探讨分析护理技术操作中执行洗手及戴手套的情况.方法 采用操作考核与现场考察的方法对全院的122名护理人员在技术操作中执行洗手及戴手套的情况进行调查;采用问卷调查对157名护理实习生对洗手及戴手套的认识进行调查.结果 在临床操作中洗手和戴手套的执行率低,戴手套仍未引起护理人员的重视,包括带教老师.不便于操作是戴手套执行率低的主要原因;在连续操作之间采用快速手消毒剂(ABHR)洗手具有可行性.结论 从岗前培训抓起,应在护理技术操作制度和细节上体现洗手、戴手套,具体到“六步洗手法”和戴手套等,以提高执行的自觉性.     

静脉穿刺后戴手套粘贴输液贴的方法改进

随着医院感染控制的发展和医护人员自身防护意识的不断加强，越来越多的护理操作需要戴手套进行。但是，在实际工作中戴手套有很多不便，尤其是静脉输液后，戴手套粘贴输液敷贴时就比较麻烦。为了更好地实施浙江省护理中心2007年新推出的《护理技术操作程序与质量管理标准》，提高护理人员戴手套的依从性和操作的方便，笔者对戴手套静脉输液中粘贴输液敷贴的方法进行了改进，介绍如下。     

Setting the scene for the paramedic in primary care: a review of the literature

Recognition of the paramedic "profession" began in 2003, with the introduction of statutory registration and the promotion of graduate entry. This paper explores the published evidence which surrounds paramedic practice in an attempt to identify the skills, training, and professional capacity which paramedics of the future will require. A systematic analysis was carried out of key reviews and commentaries published between January 1995 and April 2004, and informal discussions with experts and researchers in the field were undertaken. There remains little high quality published evidence with which to validate many aspects of current paramedic practice. To keep pace with service developments, paramedic training must embrace the complexities of autonomous practice. Undoubtedly in the short term, paramedics must be taught to appropriately identify and manage a far wider range of commonly occurring conditions, minor illnesses, and trauma. However, in the longer term, and more importantly, paramedics must learn to work together to take ownership of the basic philosophies of their practice, which must have their foundation in valid and reliable research.     

Clinical algorithms for prehospital cardiac care

Algorithms for the prehospital management of cardiac arrhythmias were developed and their use by and value to paramedics evaluated. The algorithms, in booklet form, were distributed to half of the Philadelphia paramedic platoons; paramedics in the other platoons followed a narrative protocol that reflected identical contents. An arrhythmia recognition test given 18 months after the algorithm booklets were introduced showed that paramedics who received the booklets scored significantly higher in identifying life-threatening arrhythmias (p = 0.029) than did their counterparts without the booklets. Survival data for 459 patients in ventricular fibrillation treated by paramedics were collected 1 year before and 7 months after the introduction of the algorithm booklets. The paramedics using the algorithms improved their survival rate from 11.25 to 15.1 per cent, while the survival rate for patients treated by paramedics using the narrative protocols decreased from 12.4 to 7.7 per cent. The likelihood of obtaining a ratio of survival odds of this magnitude when there is no true difference is 0.092. Time-to-death was significantly different (p = 0.04) for the two groups of patients. Thus, the use of algorithm booklets as an inexpensive educational aid for paramedics is recommended.     

What are the beliefs and attitudes of paramedics to prehospital thrombolysis? A questionnaire study

Methods: The authors conducted a postal questionnaire study of 250 paramedics in the West Yorkshire Metropolitan Ambulance Service (WYMAS). This included the knowledge of risks and benefits of AMI treatments, and their views on possible paramedic delivered PHT.

Results: 193 paramedics replied (77%); of these 83% felt paramedics could deliver PHT, 67% felt thrombolysis was safe, and only 12% felt that paramedics should not carry out PHT. There was a similar preference towards autonomous PHT (42%) and telemetry with physician directed PHT (46%). 96% wanted a nationally recognised certificate. There were concerns regarding the risks of AMI treatment, with underestimates of the benefits of aspirin, and overestimates of the benefits of thrombolysis. They also greatly overestimated the risks of thrombolysis in terms of extra deaths (71%), and bleeding (90%).

Conclusion: The majority of paramedics in WYMAS responding to the questionnaire supported the principle of PHT. Concerns included the risks of thrombolytic treatment, training, and the medico-legal implications for them as individual paramedics. Models for paramedic thrombolysis for each ambulance service should include the views of paramedics.

     

Performance of Resuscitation Skills by Paramedic Personnel in Chemical Protective Suits

Objectives. Determine whether wearing a chemical protective suit increases time to successful completion of four resuscitation skills. Methods. This prospective experimental study examined the ability of civilian paramedic personnel to complete four resuscitative skills (electrical defibrillation, administration of epinephrine subcutaneously, intravenous cannulation, andtracheal intubation) carried out using standard methods on mannequins under two test conditions (wearing the protective suit andnot wearing the suit). Primary outcome was time to successful completion of each skill. Results. Sixteen paramedics were enrolled andcompleted each skill under two test conditions. Paramedics took longer to complete administration of epinephrine (87 vs. 60 seconds; p < 0.01) andintravenous cannulation (220 vs. 158 seconds; p < 0.01) tasks when wearing a protective suit. Wearing the suit did not impair electrical defibrillation (57 vs. 46 seconds) or tracheal intubation (79 vs 69 seconds). Conclusions. Chemical protective suit use increased time to successful completion of resuscitation skills where fine motor skills are required, namely administration of epinephrine subcutaneously andintravenous cannulation, but did not increase time to successful completion of resuscitation skills requiring gross motor skills, namely electrical defibrillation andtracheal intubation.     

Paramedic Perceptions of Challenges in Out-of-Hospital Endotracheal Intubation

Objective. Paramedics often perform endotracheal intubation (ETI), insertion of a breathing tube, on critically ill out-of-hospital patients. Recent studies highlight important paramedic ETI shortcomings including adverse events, errors, andpoor outcomes resulting from this procedure. Little is known about workforce perceptions of these events. We sought to identify paramedic andphysician perceptions regarding the challenges andpitfalls of out-of-hospital ETI. Methods. We conducted a qualitative study involving paramedic focus groups sessions andindividual interviews with Emergency Medical Services (EMS) physician medical directors. We recorded andtranscribed all sessions. We used inductive theory construction to examine, organize, andclassify thematic patterns. Results. Fourteen paramedics and6 physicians participated. Although paramedics andphysicians recognized problems with paramedic ETI, all participants strongly felt that paramedics should continue to perform the procedure. Physicians andparamedics disagreed about the ability of paramedics to perform neuromuscular blockade-assisted intubation. Both groups identified aspects of paramedic education, skills acquisition, andmaintenance as core issues. Participants also identified broader factors about the structure of emergency services, the role of the medical director, andworkforce culture andprofessionalism. Conclusion. Paramedics andEMS physicians attribute paramedic ETI performance to a myriad of factors involving EMS education, organization, oversight, retention, andprofessionalism. Efforts to improve ETI must include strategies to address multiple aspects of EMS operations andculture.     

Sources of occupational stress among firefighter/EMTs and firefighter/paramedics and correlations with job-related outcomes

INTRODUCTION/OBJECTIVE: This paper reports the results of an initial effort to develop and test a measure of the various sources of job-related stress in firefighter and paramedic emergency service workers. METHODS: A 57-item paper and pencil measure of occupational stressors in firefighter/Emergency Medical Technicians (EMTs) and firefighter/paramedics was developed and administered by anonymous mail survey. RESULTS: More than 2,000 (50% rate of return) emergency service workers completed and returned the surveys. The responses of 1,730 firefighter/EMTs and 253 firefighter/paramedics were very similar in terms of the degree to which job stressors were bothersome. A factor analysis of replies yielded 14 statistically independent "Occupational Stressor" factors which together accounted for 66.3% of the instrument's variance. These Sources of Occupational Stress (SOOS) factor scale scores essentially did not correlate with a measure of the social desirability test-taking bias. Finally, SOOS factors were identified that correlated with job satisfaction and work-related morale of the respondents. Conflict with administration was the job stressor factor that most strongly correlated with reports of low job satisfaction and poor work morale in both study groups. CONCLUSION: The findings suggest that firefighter and paramedic job stress is very complicated and multi-faceted. Based on this preliminary investigation, the SOOS instrument appears to have adequate reliability and concurrent validity.     

Safety of pre-hospital therapy with morphine sulfate.

The safety of prehospital pharmacologic therapy has not been well studied. The authors evaluated field use of morphine sulfate (MS) in San Francisco County over a 6-month period. Paramedics assessed patients for ischemic chest pain (ICP) and/or pulmonary edema (PE), made base hospital contact, and administered 2- to 4-mg doses of intravenous morphine according to treatment protocols. Clinical assessments and patient responses to therapy were recorded by both field paramedics and emergency department (ED) physicians. Safety was evaluated by determining the (1) accuracy of paramedic field assessment, (2) appropriateness of field administration of MS, and (3) therapeutic complications. During the study period, paramedics administered MS to 84 patients. In 69 cases paramedic assessment of either ICP and/or PE corresponded to ED physician diagnosis. In five cases paramedics correctly recognized ICP but missed physical findings of PE. In this group the paramedics' assessment was considered inaccurate but the judgement to give MS was considered appropriate. In the remaining 10 cases paramedics identified ICP or PE but the ED physician diagnosed a different condition. These assessments were considered inaccurate and the management inappropriate. Therefore, overall paramedic accuracy was 77% (true rate 73% to 82%, 95% confidence interval); appropriateness of therapy was 88% (true rate 85% to 92%, 95% confidence interval); and the overall complication rate was 6% (true rate 2% to 12%, 95% confidence interval). Complications of respiratory depression or hypotension occurred in only one of the cases in which MS was inappropriately administered.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of paramedic experience on orotracheal intubation success rates

This study's objective was to determine the effect of paramedic experience on orotracheal intubation success in prehospital adult nontraumatic cardiac arrest patients. This retrospective study analyzed all attempted intubations of prehospital adult nontraumatic cardiac arrest patients between January 1, 1997 and April 30, 1997 in an urban, all ALS service. Data were abstracted from EMS reports and intubation data forms. Variables included months of experience, number of patients in whom intubation was attempted, number of intubation attempts, success per attempt, and success per patient. Ninety-eight paramedics performed 909 intubations on 1066 cardiac arrest patients, yielding an intubation success rate of 85.3%. The median months of experience was 59.5 (Range 5-223). The median number of patients in whom intubation was attempted per paramedic was 10 (Range 1-36). The mean intubation success rate per paramedic was 80.6% (+/- 22.4, 95% CI 76.1, 85.1). There was significant correlation between total number of patients in whom intubation was attempted and intubation success rate (p <.001, R = 0.32). There was no correlation between months of experience and intubation success rate. In conclusion, the number of patients in whom intubation was attempted per paramedic was significantly correlated with the intubation success rate. Months of experience per paramedic had no significant correlation with intubation success rate.     

Paramedic use of advanced life support procedures: experience and attitude survey

To gather information about paramedic use of 11 advanced life-support (ALS) procedures, 74 emergency physicians and 171 paramedics practicing in Utah were surveyed. Response was 66% and 65%, respectively. Performance difficulty, frequency of use, and success rate were evaluated. The willingness of physicians to order, and paramedics to perform each procedure were compared. Physicians' and paramedics' difficulty ratings were significantly different (P less than .001) for only 3 of the 11 procedures. During the study period, paramedics successfully performed 455 procedures; 229 were performed by 15 (13%) of the responding paramedics. The reported success rate for all attempted procedures was 82% (455/557). The number of attempts and the success rate was significantly higher (P less than .05) for paramedics with secondary medically affiliated employment. Paramedics were significantly more willing to perform 7 of the 11 procedures (P less than .001) than physicians were willing to order. We conclude that paramedic and physician difficulty ratings were generally similar, that many types of ALS procedures are rarely performed, that a small percentage of paramedics perform the largest number of ALS procedures, that secondary employment increases paramedics' procedural attempts and improves success rates, and that they are more willing to perform ALS procedures than physicians are to order them.     

Hidden impact of paramedic interventions.

OBJECTIVE: To examine current patterns of deployment and use of emergency ambulance crews in Nottinghamshire, with particular reference to crew status (technician or paramedic), case mix, interventions performed, and operational times. METHODS: A retrospective survey of routinely collected computerised ambulance service despatch data, and patient treatment forms for 242 randomly selected emergency callouts in Nottinghamshire, during September 1994. Data were collected on patient demography, broad diagnostic group, crew status and operational times, and paramedic interventions performed. RESULTS: 170 of 242 callouts (70%) involved a paramedic crew; extended skills were used on 31 of these occasions (18%), predominantly for medical emergencies. Paramedic crews recorded significantly longer on-scene times (median time: 14.0 v 11.5 min, P = 0.04). An examination of the difference between paramedics who performed interventions and those who did not revealed that "intervening" paramedics recorded significantly longer onscene times (median time: 23 v 12 min, P < 0.001), turnaround times (median time: 28 v 18 min, P < 0.001), and total out-of-service times (median time 73 v 51 min, P < 0.001). CONCLUSIONS: The additional time taken by paramedics at the scene of an emergency incident relates to their performance of an intervention, rather than time spent assessing the patient to decide whether stabilisation or immediate evacuation would be most appropriate. Paramedic interventions were most often performed for medical emergencies. The performance of paramedic interventions also extended turnaround times and total out-of-service times.