艾滋病病毒职业暴露20例调查分析

目的有效预防和控制医务人员在工作中发生职业暴露而感染艾滋病病毒。方法对20名接触艾滋病患者出现职业暴露者的工作人员的暴露途径、暴露后的处理方式和工作人员身体状况等因素进行调查分析。结果职业暴露发生率为62.5%,暴露的主要途径是经皮肤性损伤暴露,医护人员对发生暴露的危险性认识不够,职业防护能力较低。结论只要加强职业安全教育,严格执行艾滋病医院感染管理中的防范和处理措施,可以大大减少艾滋病的职业暴露,预防职业感染。     

The Georgia Rural-Based Nurse Model: Primary Care for Persons with HIV/AIDS

Abstract The need for specialized HIV education for nurses working in rural areas will increase as the incidence of HIV infection increases in rural areas. Public health nurses provide a viable alternative to providers in acute care facilities and will continue to be the primary care providers for persons with HIV/AIDS in rural areas. While approaches to HIV/AIDS education should include clinical treatment as the core, clinical knowledge alone will not promote the development of caring communities. The Rural-Based Nurse Model provides a comprehensive curriculum that addresses the many complex issues associated with the care of persons with HIV/AIDS. Additionally, participants are linked with care providers who serve clients across the continuum of HIV disease. Through meaningful educational opportunities and provider networking, this program has the potential for improving the quality of care in rural areas for persons with HIV/AIDS. HIV/AIDS education programs will require individualized community strategies that consider existing resources and barriers. However, the Rural-Based Nurse Model provides a formula for HIV/AIDS education that can be easily adapted to other settings.     

Identifying HIV/AIDS primary care development needs

AIM: This paper reports a study aimed at identifying the primary health care experiences of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Malaysia. The rationale behind the study was to enable informed action for developing more responsive and effective primary care. BACKGROUND: Reports such as from the World Health Organisation forecast sharp escalations in the incidence of HIV/AIDS in Malaysia and the Asia-Pacific region within the next few years. With sparse information on the course of infection on the local population and an understanding of health care needs of those afflicted, health services would be ill-prepared for projected increases. METHOD: Semi-structured interviews were conducted with a convenience sample of 99 patients attending two major HIV/AIDS clinics in Malaysia. FINDINGS: Several gaps in care provision were highlighted, such as with treatment/consultation facilities and availability and accessibility of information. What is also evident is that there are a number of good support services available but not well publicized to those in need of them. That includes health professionals who could be making appropriate referrals. The lack of communications and inter-professional working appears to be part of the problem. CONCLUSION: The findings provide baseline data and preliminary insights to government and other service providers towards advancing, optimizing and refining existing policies and infrastructure. Although the availability of a number of primary care facilities have been identified, the study indicates the need for more effective co-ordinated efforts with clear leadership to pull together scarce resources towards the aim of some degree of seamless primary care provision. It is suggested that nurses would be well placed for such a role in view of the nature of their education and training that helps prepare them for the multi-faceted role.     

HIV/AIDS knowledge and self-efficacy among Nepalese adolescents: a peer education program

The purposes of this study were to develop and test the effectiveness of an HIV/AIDS peer education program in improving Nepalese adolescents HIV/AIDS knowledge and self-efficacy in one of the schools in Nepal. A modified format of the program "Teens for AIDS Prevention" (TAP) was used in this study. A quasi-experimental design was used to test the effectiveness of the peer education program. A convenience sample of 121 ninth grade Nepalese students from an urban high school participated at baseline. The final paired sample included 118 students. The results demonstrated a significant positive relationship between HIV/AIDS knowledge and self-efficacy. Nepalese adolescents' HIV/AIDS knowledge and self-efficacy improved after the peer education intervention. Therefore, school personnel, health care providers, and government and nongovernment organizations should consider developing and implementing school-based HIV prevention programs such as the peer education program.     

Educational intervention with international nurses and changes in knowledge, attitudes and willingness to provide care to patients with HIV/AIDS

This paper reports the findings of a study which examines the relationship between the use of an educational intervention with nurses from several Asian countries and changes in knowledge, attitudes and willingness to care for patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). A pre-test and post-test questionnaire was used to collect the data. The results indicate, that whilst there was an improvement in knowledge following the educational intervention, there is a need for further improvement in the knowledge levels of the nurses. The method of contracting the virus is less influential in shaping students' attitudes towards people with HIV/AIDS. Fear of contagion is evident; this increases when more invasive clinical procedures are being carried out. What is also evident is that multiple levels of infection control protocols are used with patients. Fear of contagion is also apparent in the participants' willingness to work with colleagues and patients with HIV/AIDS. While the participants stated that they were more willing to work with colleagues and patients with HIV/AIDS following the educational intervention, they said that they would continue to take additional precautions for fear of contracting HIV in the workplace. The conclusion emphasizes that it is important for education about HIV/AIDS to be incorporated within current undergraduate and in-service programmes.     

Knowledge and Attitudes about HIV/AIDS among Homoeopathic Practitioners and Educators in India

This study is designed to assess AIDS knowledge among Homeopathy educators and physicians in India, which has not been evaluated previously. India now has the largest number of HIV infected persons worldwide, with an estimated cumulative 5.1 million infections. Homeopathy is the dominant system among the nationally-recognized alternative or complementary systems of medicine, which collectively provide health care to around 600 million people in India. Homeopathy, with its holistic and patient-centered approach, has a wide reach to people at risk of contracting human immunodeficiency virus (HIV). Participants were 68 homeopathy physicians (34 educators and 34 practitioners) who completed a CDC questionnaire measuring HIV/AIDS Knowledge regarding AIDS. This study reports the current level of knowledge of, and attitudes about, HIV/AIDS among homeopathy educators and practitioners. These findings will assist in the development of an education module to equip homeopathic health care personnel to impart accurate AIDS information and prevention counseling to their patients in an efficient manner.     

Coming full circle: mentorship in HIV/AIDS care.

The role of the mentor has been found to be crucial for learning, yet mentorship in HIV/AIDS nursing care has not been well documented. The purpose of this study was to (a) examine the characteristics of a nurse mentor in HIV care as perceived by nursing and medical students and HIV staff, and (b) explore an HIV nurse mentor's perceptions of her role and responsibilities in the professional development of students and staff. Mentorship, as a process of "coming full circle," was highlighted by the mentor's accounts of early influences in her career as well as students' and staff members' intents to facilitate the professional development of the next generation. The legacy of excellent HIV nursing care can be continued if expert HIV nurse mentors are identified and encouraged to work with students, inexperienced nurses, and health care providers. Health care institutions have a responsibility to foster mentorship in HIV/AIDS care to assure quality health care for clients and the professional development of expert nurses in HIV/AIDS care.     

AIDS and prehospital personnel: knowledge and prevention of occupational exposure

OBJECTIVES: Prehospital personnel, including law enforcement officers, paramedics, and fire-fighters, may be exposed to the human immunodeficiency virus (HIV) while working. This study of prehospital personnel sought to determine: 1) their knowledge of the acquired immune syndrome (AIDS) and HIV transmission; 2) the extent of AIDS training received; 3) self-assessment of risk for HIV infection; and 4) precautions adopted to reduce occupational risk of exposure to HIV. METHODS: A survey was administered to pre-hospital personnel in a large Southern California jurisdiction. The response rate was 41% (n = 1,756) in 10 city and county departments where respondents were employed. Law enforcement officers (44%), firefighters (44%), and paramedics (12%) comprised the sample. RESULTS: Respondents had accurate knowledge about AIDS, but incorrect perceptions about HIV transmission. A minority believed that HIV could be contracted from casual contact. Training relating to AIDS was not frequent. Preventive practices were infrequent in the work setting, with precautions used less than 50% of the time on eight of 10 measures. One-third of these prehospital personnel assessed their risk for HIV infection as medium to high, largely attributable to fear of occupational exposure. CONCLUSIONS: Improved educational programs regarding HIV/AIDS are needed for prehospital personnel to increase the use of preventive occupational practices in the field.     

Does the level of prehospital care influence the outcome of patients with altered levels of consciousness?

HYPOTHESIS: Significant differences exist in the outcome of patients with altered level of consciousness (ALOC) cared for by advanced life support (ALS) compared with basic life support (BLS) prehospital providers. METHODS: Patients transported by ambulance to a community teaching hospital during an 11-month period were studied retrospectively. Study patients were those considered not alert by prehospital personnel. Exclusion criteria included; trauma, intoxication, drowning, shock, and cardiac arrest. Data were abstracted from the ambulance reports and hospital records. RESULTS: Two hundred three patients with an ALOC were identified; 113 were transported by ALS providers (56%) and 90 (44%) by BLS providers. Prehospital levels of consciousness, according to the "alert, verbal, painful, unresponsive" scale (ALS vs BLS) were: "verbal" (40% vs 51%), "painful" (23% vs 23%), and "unresponsive" (37% vs 25%). The mean value for some time was 15 +/- 6 minutes for ALS versus 10 +/- 4 minutes for BLS (p < 0.001). On arrival in the emergency department, the LOC of 72 (64%) ALS patients and 58 (64%) BLS patients had improved to "alert." The level of consciousness in one ALS patient worsened. Fifty-two ALS (46%) and 38 (42%) BLS patients were admitted. Principal final diagnoses were seizure (27% ALS vs 38% BLS), hypoglycemia (23% ALS vs 23% BLS), and stroke (22% ALS vs 20% BLS). Remaining diagnoses each constituted less than 7% of total discharge diagnoses. No statistically significant differences in measures of outcome were noted between ALS or BLS patients. Diagnoses of seizure, stroke, and hypoglycemia were studied individually. No differences in admission rate, mortality rate, or disposition were identified. Hypoglycemic patients conveyed by ALS providers had significantly shorter emergency department treatment times than did those transported by BLS providers (160 +/- 62 minutes ALS vs 229 +/- 67 minutes BLS [p < 0.005]). CONCLUSION: Advanced life support levels of care of patients with an ALOC does not significantly change outcome compared with those receiving BLS care with the exception of shorter emergency department treatment times for hypoglycemic patients.     

AIDS epidemiology and pathology. Implications for intensive care units.

The acquired immunodeficiency syndrome (AIDS) evolves from infection with the human immunodeficiency virus (HIV). The HIV attacks the hosts' immune and neuroendocrine systems, rendering the host susceptible to a myriad of chronic and acute conditions requiring intensive care. This article reviews epidemiologic and pathologic trends associated with HIV infections that have the potential to increase demands for admission to intensive care units. Research describing potential predictors of survival among patients with HIV-related conditions is also described. In addition, possible implications for practice, education, and research are discussed.     

Treatment of HIV/AIDS in the nursing home: variations in rural and urban long-term care settings

OBJECTIVES: With the increased use of antiretroviral therapy, more patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are surviving for long periods of time. The aim of this study was to determine the availability of specialty HIV/AIDS services in long-term care facilities, and to determine differences in the availability of these services between rural and urban nursing homes. METHODS: 1,423 nursing homes from the 1999 National Nursing Home Survey were stratified by rural/urban status and compared using chi2 analysis and logistic regression. RESULTS: Less than 1% of surveyed nursing homes in the United States provided specialty HIV/AIDS services. While there was evidence that larger nursing homes are more likely to provide HIV/AIDS-related services, there were no significant differences between rural and urban nursing homes in the provision of specialty HIV/AIDS services. CONCLUSIONS: A vast majority of nursing homes in the United States do not provide any specialty areas for HIV/AIDS care. As our population ages and the life span of those diagnosed with HIV/AIDS continues to increase, nursing homes will begin to see patients diagnosed with HIV/ AIDS among those seeking care.     

A structured interview approach to evaluate HIV training for medical care providers.

HIV/AIDS education trainings and self-reported changes in provider behavior resulting from the trainings were evaluated in a structured interview with 24 health care providers. The participants were asked to provide concrete examples of behavior changes related to eight specific areas in the provision of HIV/AIDS medical care. The structured interview process also served as an effective needs assessment of future training topics and of the modalities desired by the providers. The authors' results suggest that by carrying out a structured interview of training attendees, training programs can be more precisely evaluated, and strengths and gaps in overall HIV/AIDS provider education can be better identified and addressed.     

Preventive counseling, screening, and therapy for the patient with newly diagnosed HIV infection

The epidemic of human immunodeficiency virus (HIV) continues, and the infection is converting into a treatable chronic disease; therefore, it is increasingly important for family physicians to be current with and comfortable in providing basic care to patients infected with HIV. Important aspects of counseling and patient education include stabilization of psychosocial issues and prevention of HIV transmission through behavior change counseling. Reporting HIV and acquired immunodeficiency syndrome (AIDS) is mandatory in most states, whereas partner notification laws vary from state to state. Baseline evaluation includes screening for comorbid conditions such as viral hepatitis, syphilis, and tuberculosis, as well as common HIV-related manifestations such as recurrent candidal infections and thrombocytopenia. Baseline testing includes CD4+ T-lymphocyte cell counts and HIV viral RNA levels to assess HIV disease stage, and numerous studies to screen for opportunistic infections. Initial preventive interventions include patient education to reduce exposure to infections, treatment of comorbid conditions such as human papillomavirus-related dysplasia, and vaccinations such as for pneumococcus and hepatitis B. Prophylaxis against opportunistic pathogens is recommended when CD4+ cell counts fall below 200 cells per mm3. Lastly, the indications for antiretroviral therapy include symptomatic patients or those with AIDS, and pre-AIDS patients with CD4+ cell counts of 200 to 350 cells per mm3 or HIV RNA above 55,000 to 100,000 copies per mL.     

医务人员艾滋病病毒职业暴露后预防措施的探讨

目的对我院医务人员艾滋病病毒(HIV/AIDS)职业暴露发生的经过、上报流程、危险程度评估和处理措施做初步分析,探讨暴露后如何实施最佳的预防和处理措施。方法根据卫生部制定的《医务人员艾滋病病毒职业暴露防护工作指导原则》,对我院某科发生的医务人员HIV/AIDS职业暴露的资料进行回顾性分析。结果医务人员在发生HIV/AIDS职业暴露后心理都比较恐慌,担心与害怕被感染。上报院感科后及时给予有效的指导及使用抗病毒转录暴露后预防措施(post-exposure prophylaxis,PEP)的实施,跟踪3个月至1年的临床医学观察后,未发现1例感染者。结论临床医务人员属高风险职业,在医疗护理操作中极易发生HIV/AIDS职业暴露,医院感染管理部门应制定一系列完善的上报程序及防护措施,提高医务人员的防控意识及加强相关知识的教育和培训。     

Students' decisions to select HIV services for clinical experiences

The ever-growing numbers of persons living with HIV/AIDS emphasizes the need for highly trained healthcare professionals to care for this population. Understanding why nursing and medical students would choose HIV services for clinical rotations, and the impact of those clinical experiences on their future professional practice, is key to recruiting healthcare providers to care for this population.     

The impact of HIV/AIDS on the African American woman and child: epidemiology, cultural and psychosocial issues and nursing management.

The approach to understanding the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) must include the African American woman and children as persons at high risk. This information must be documented in all epidemiology, cultural and psychosocial aspects of care, and nursing management reports. Approximately twenty years after it was first recognized, AIDS is still traveling across the globe at full speed, with very little brake power. In the United States, the African American heterosexual woman continues to be the fastest growing group of persons with the acquired immunodeficiency syndrome. The proportion of cases increased drastically in the period from 1993 to October 1995, with women totaling 18 percent of the total cases (Newman & Wofsy, 1997). The impact that cultural and psychological issues have had on women and children living with HIV or AIDS is immense, involving not only the potential burdens of physical deterioration, but also the stress of accompanying lifestyle and role changes. These issues involve processes in adjusting and adapting to HIV infection that are important not only because of their centrality to the coping individual, but because they directly affect the success of treatment and prevention (Jaccard, Wilson & Radecki, 1995).     

HIV infection in athletes. What are the risks? Who can compete?

The activities of athletes and personnel who provide their medical care may place them at slightly greater risk for infection with human immunodeficiency virus (HIV) than their nonathletic peers. At this point, there is no reason to disallow participation of athletes who are HIV-infected. Thus, sports physicians need to assume that they are at risk for accidental exposure to HIV and use appropriate precautions. Most important, physicians can educate athletes, coaches, and trainers to practice "safe" athletics and medical care to minimize the risks of exposure to and transmission of HIV. Testing for HIV can be encouraged for athletes who may be at risk and should be done for any athlete who specifically requests it. Physicians should encourage further study to clarify the specific issues and risks of HIV infection created by athletic competition and prepare to deal with the changing knowledge about HIV and AIDS.     

Systematized HIV/AIDS education for student nurses at the University of Ibadan, Nigeria: impact on knowledge, attitudes and compliance with universal precautions

This paper reports the findings of a study which examines changes in a group of Bachelor of Science (BSc) nursing students' perceptions, knowledge of and attitudes towards human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), accruing from attempts at a systematized education for the cohort. Based upon a 3-month study of 141 registered nurses enrolled in a BSc nursing programme at the University of Ibadan, Nigeria, it investigates alterations in knowledge and attitudes resulting from intense instruction on HIV/AIDS, AIDS patient care, and compliance with universal precautions. With regard to knowledge enhancement and attitudinal transformation, the research reveals that a number of positive changes occurred over the period of the study. Not only were the nurses better informed about AIDS than previously, but their attitudes towards the disease and patient care had become considerably more liberal, as well as their disposition to comply with universal precautions. The conclusion emphasizes that it is very important for education about HIV/AIDS to be incorporated within current undergraduate and in-service training programmes for Nigerian nurses.     

Out-of-hospital Provider Use of Epinephrine for Allergic Reactions: Pilot Program

Objective: To describe experience with an out-of-hospital provider program for the recognition and field management of allergic reactions by advanced life support (ALS) and basic life support (BLS) providers.
Methods: Data sheets completed between June 1, 1988, and August 31, 1993, and records from receiving sites (physicians' offices or EDs) were reviewed for information regarding the presentation of the allergic reaction, the time course and treatment provided out of hospital, and the clinical outcome at the receiving health care facility.
Results: Thirty-seven data sheets were completed during the study period. Fourteen (38%) of the providers were BLS providers. The epinephrine was supplied from the emergency medical services (EMS) provider's personal kit in 35% of the cases, from an EMS vehicle in 57% of the cases, and by the patient in 8% of the cases. Availability of the kits allowed administration of epinephrine prior to the arrival of the first EMS vehicle in 41 % of the instances and prior to physician on-line medical command in 65% of all the instances (predominantly by BLS providers). Overall, 77% of the patients experienced alleviation of their symptoms of respiratory difficulty, swelling, or rash after epinephrine administration, while 20% were unchanged and 3% worsened. All patients receiving epinephrine had an ED diagnosis of allergic reaction, and no adverse event was encountered on follow-up of the patients treated.
Conclusions: Severe allergic reactions can be reliably identified and safely managed by out-of-hospital providers, including BLS providers. Providing personal anaphylactic treatment kits and increasing the pool of providers trained to manage allergic reactions (including BLS providers) can often decrease the time to treatment.     

A forensic nursing protocol for initiating human immunodeficiency virus post-exposure prophylaxis following sexual assault

The use of human immunodeficiency virus post-exposure prophylaxis (HIV PEP) should be considered in the care of sexual assault patient populations. In order to effectively implement HIV PEP following sexual assault, healthcare providers need to have a working knowledge of HIV transmission risk factors following a sexual exposure and protocols for initiating HIV PEP. Being able to implement evidence-based practices that address each of these factors is paramount to successful prevention of HIV transmission following a sexual assault exposure. Most healthcare practitioners, however, lack the specialized knowledge needed to address these issues in the expeditious manner necessitated by a potential HIV exposure. Implications: This paper is designed to provide healthcare providers with a basic understanding of HIV transmission risk factors and the knowledge and skills needed to effectively implement HIV PEP following a sexual assault exposure.