HIV可疑阳性急诊麻醉1例报道

随着艾滋病（AIDS）感染者的增多，医务人员感染艾滋病病毒（HIV）的危险性也随之增加。在HIV／AIDS患者的医疗护理中，职业暴露是威胁医务人员健康安全的严峻问题。作者通过1例HIV可疑阳性患者急诊手术麻醉处理，总结麻醉人员如何避免HIV／AIDS职业暴露的经验，报道如下。     

临床护士对艾滋病病毒职业暴露防范知识调查及对策

目的调查临床护士对艾滋病(AIDS)病人或艾滋病病毒(HIV)感染者职业暴露的防范知识和职业暴露后正确处理方法的掌握状况,以便有目的地进行培训和有针对性地制定防范措施。方法对23家医院920名护士有关HIV职业暴露预防知识及处理方法的掌握状况进行调查。结果92%护士对AIDS的传播途径认识正确;68%护士对AIDS病人或HIV感染者体液、使用过的医疗器械、床上用品等处理有正确认识;23%护士对AIDS病人或HIV感染者用过的针头刺破皮肤的紧急处理方法有正确认识。结论为了保障护理人员职业安全防护,应加强临床护士对HIV职业性暴露相关知识和HIV职业性暴露后正确处理方法的培训,以确保临床护理人员职业的安全。     

青年学生HIV感染者和AIDS患者自我暴露现状的调查研究

目的 调查青年学生HIV感染者和AIDS患者自我暴露现状并探索其影响因素,为制订自我暴露相关护理干预措施提供依据。方法 便利选取于北京佑安医院、北京地坛医院、北京302医院门诊就诊的110例青年学生HIV感染者和AIDS患者作为研究对象,采用一般资料调查表、HIV自我暴露问卷、简易应对方式量表、医疗社会支持量表、自尊量表及艾滋病知识问卷进行调查。采用 Logistic 回归分析确定自我暴露的影响因素。 结果 有 64 例青年学生 HIV 感染者和 AIDS 患者自我暴露,占 58.2% 。 Logistic 回归分析表明婚姻状况、最近 1 次 CD4 + 细胞化验结果、感知歧视是青年学生HIV感染者和AIDS患者自我暴露的影响因素 （P<0.05）。结论 本研究中青年学生HIV感染者和AIDS患者自我暴露水平较高。医务人员应了解青年学生HIV感染者和AIDS患者自我暴露现状及影响因素,对其进行有效的评估,采取有针对性的干预措施促进其自我暴露。     

医务人员HIV职业暴露的处置与预防

1 医务人员HIV-1职业暴露 HIV-1的职业暴露是指卫生保健人员在职业工作中与艾滋病病毒感染者的血液、组织或其他体液等接触而具有感染HIV的危险。 医务人员在为普通病人和艾滋病病人提供医疗服务的同时，发生职业暴露也成为HIV感染的高危人群之一。因此控制医院交叉感染，预防职业暴露感染已经成为预防HIV感染／艾滋病的主要措施之一。     

艾滋病患者急诊手术职业暴露与防护的护理管理

随着艾滋病的感染率急骤增加,HIV职业暴露的因素及防护越来越引起医务人员的重视。作者等对岳阳市强制戒毒所277名吸毒人员进行HIV检测,发现吸毒人群中HIV感染率达4．69％（13／277）。戒毒自残者送医院急诊手术的患者逐渐增多。如何进行HIV阳性患者的手术配合是手术室护士面临的一个新课题。作者等在临床实践中,针对艾滋病感染者急诊手术,采取正确的临床路径,以减少职业危害。     

临床护理人员HIV/AIDS防护行为依从性的调查分析

根据世界卫生组织和联合国艾滋病(AIDS)规划署共同发布的报告显示,2006年全球已有艾滋病病毒(HIV)携带者3950万人.目前,我国AIDS患者数呈逐年上升趋势,截至2007年10月底,全国累计报告HIV感染者和AIDS患者223 501例,其中AIDS患者62 838例,死亡报告22 205例[1].随着来医院就诊的HIV感染者和AIDS患者不断增多,医务人员的职业接触机会也越来越多,已证实被污染针头刺伤后感染HIV的概率为0.3%[2].由于医务人员特别是护士长期工作在与患者密切接触的第一线,从而使职业暴露感染HIV/AIDS的危险增加[3-4].推广和强化医务人员的职业防护意识与防护措施是预防职业暴露感染HIV/AIDS的关键.     

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。     

临床护士HIV职业暴露防护知识的研究现状

自1981年在美国首次发现艾滋病(AIDS)以来,艾滋病以极快的速度在全球范围内蔓延扩散[1].我国的艾滋病在经历了散发期和局部流行期后,现在正处于广泛流行期,流行形势十分严峻[2].随着艾滋病流行的快速增长,临床就诊的人类免疫缺陷病毒(HIV)感染者和AIDS病人越来越多,临床医护人员进行医疗活动时,HIV职业暴露的机会也会增加.护士对HIV的职业暴露认知和防护知识直接影响到HIV的防治效果及自身健康[3].现对临床护士HIV职业暴露、防护现状及知识需求的研究进展综述如下.     

乡镇医院医务人员艾滋病职业暴露防护知识及行为调查

截至2013年9月30日，全国共报告现存活艾滋病病毒感染者和艾滋病患者约43．4万例。近年来，农村人口在艾滋病患者及感染者中占据比重越来越大，而且，研究表明，在艾滋病高发区，门诊艾滋病患者多集中在村级医疗机构，住院患者多集中在乡镇卫生院。根据这一现状，国家已经将基层卫生机构作为艾滋病防治的服务平台之一。作为基层卫生服务的提供者，乡镇医院医务人员应该做好为艾滋病患者及感染者提供服务的准备。因此他们不仅要掌握艾滋病治疗的相关知识，也要掌握艾滋病职业暴露的防护知识。     

艾滋病医源性传播及预防

艾滋病 (AIDS)自 1981年在美国首次报告以来 ,已迅速在世界各地蔓延。世界卫生组织 (WTO)和联合国艾滋病规划署 (UNAIDS)估计 2 0 0 2年底全世界活着的人免疫缺陷病毒 (HIV) /AIDS感染者达到 4 0 0 0万 ,其中仅 2 0 0 2年就有5 0 0万例新感染者。随着AIDS感染者的增多 ,医务人员和患者在医疗环境中感染HIV的危险性增加。HIV/AIDS医源性暴露已成为全球的公共卫生问题。HIV/AIDS医源性暴露包括输用被HIV污染的血液制品、侵袭性医疗操作和使用被HIV污染的精液人工受精等。[1] 我国目前处于HIV感染增长期 ,[2 ] 医源性暴露…     

Acceptance and disclosure of HIV status through an integrated community/home-based care program in South Africa

AIM: To report the outcome of a comparative study among people living with HIV/AIDS (PLWHAs) served by an integrated community/home-based care (ICHC) programme and those who are not in any home-based care programme in terms of acceptance and disclosure of the HIV status. BACKGROUND: One of the major challenges in HIV/AIDS care in developing countries is acceptance and disclosure of a positive HIV status by PLWHAs. Denial and non-disclosure of HIV status hinders prevention efforts as well as access to treatment, care and support for PLWHAs. METHODS: Quantitative data were collected in 2004 from a group of PLWHAs served by the ICHC programme and a group that was not receiving any community/home-based care. Data were compared between the two groups in terms of acceptance and disclosure of HIV status. FINDINGS: The ICHC was effective in improving acceptance and disclosure of the HIV-positive status by PLWHAs in the programme. PLWHAs in the ICHC programme did not find disclosure of their status difficult, and had disclosed their positive HIV status to more people than those who are not in any programme. PLWHAs in the ICHC programme not only disclosed their positive HIV status within their family network and households, but also disclosed to the community in general, sports group, religious groups and other social networks. CONCLUSIONS: Community/home-based care programmes can serve as catalysts for acceptance and disclosure of a positive HIV status by PLWHAs.     

新疆地区护理人员艾滋病预防与职业暴露防护知识及防护行为的调查

目的了解新疆地区护理人员艾滋病预防与HIV职业暴露防护知识及防护行为的现状,针对存在问题提出相应对策。方法2007年10—11月,用自行设计的调查问卷对新疆艾滋病重灾区的21家医院的489名护理人员进行调查。结果护理人员对艾滋病预防及职业暴露与防护知识的总体掌握情况不足;对艾滋病病毒的灭活、HIV职业暴露后感染的监测与预防等知识的得分较低;不同民族、学历、工作科室的护理人员,艾滋病防护知识认知情况存在差异;护理人员艾滋病防护相关行为有待规范与加强。结论应重视护理人员HIV职业暴露与防护相关知识的培训,提高防护意识,执行安全操作,改善医疗环境,并健全护理人员HIV职业暴露与防护管理体系。     

照护艾滋病患者的感染科护士工作满意度调查

目的：调查照护艾滋病患者的感染科护士的工作满意度,并分析相关影响因素。方法本文以某地区4所三甲医院照护艾滋病患者的感染科护士为研究对象,采用护士工作满意度量表测量感染科护士的工作满意程度,并分析相关影响因素。结果照护艾滋病患者的感染科护士工作总体满意度（59.2±8.5）分。 Logistic回归分析结果显示学历水平、收入状况、工作时间是影响感染科护士工作满意度的因素。结论护理管理者需要提升感染科护士的内外因素,有助于改善工作满意度,从而进一步提升护理服务质量及患者满意度。     

Needlestick and sharps injury prevention

Every day while caring for patients, nurses are at risk to exposure to bloodborne pathogens potentially resulting in infections such as HIV or hepatitis B and C. These exposures, while preventable, are often accepted as being a part of the job. In the United States, needlestick injuries have begun to decrease from an estimated one million exposures per year in 1996 to 385,000 per year in 2000. This decline has resulted from the protections afforded by the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard. Reasons for the success in decreasing needlestick and sharps injuries may be attributed to the elimination of needle recapping and the use of safer needle devices, sharps collection boxes, gloves and personal protective gear, and universal precautions. The prevention of needlestick injuries has made slow progress over the past 20 years since the HIV epidemic drew attention to the deadly nature of health care work and to protection of health care worker health and safety. In Africa, where the AIDS virus originated and where the prevalence of the human immunodeficiency virus (HIV) among hospitalized patients is highest in the world, attention has been directed only recently at protecting health care workers. Nurses, especially those infected from a preventable exposure, have been at the forefront of advocacy for prevention. This article includes a review about the hazard of exposure to bloodborne pathogens and epidemiology of occupational infection. The author discusses how to apply standard methods of occupational health and industry hygiene using the hierarchy of controls framework to prevent exposure to blood, and discusses evidence-based prevention and efficacy of particular control measures. Legislative progress and implementation of enforceable policy to protect health care workers is outlined.     

Postexposure prophylaxis for HIV

Postexposure prophylaxis represents an advance in the management of percutaneous exposure to HIV in the workplace, but its efficacy in other settings needs further study. Three types of occupational exposure, percutaneous, mucous membrane, skin contact or loss of skin integrity, the postexposure prophylaxis to be used or offered, and the risk data and assessment for HIV acquisition are examined. Analysis of HIV transmission through percutaneous exposure reveals that occupational risk for health care workers is increased by deep injury to the exposed worker, visible blood on the injuring device, exposure of the device to source patients' vein or artery, and source patient's death from AIDS within 60 days of the accident. Prophylaxis for percutaneous exposure, if indicated, should be initiated within 1 to 2 hours to be effective. HIV antibody titers should be measured immediately and at 6 weeks, 12 weeks, and 6 months after exposure. AZT prophylaxis following percutaneous occupational exposure has dramatically decreased transmission in this setting and multiple drug regimens have become the standard of care to further increase efficacy. Sexual contact is the most frequent means of transmitting HIV infection and reducing exposure is the mainstay of public health efforts. Prophylaxis after non-occupational exposures such as sexual intercourse or sharing needles could potentially decrease transmission, although efficacy has not yet been demonstrated. Routine prophylaxis after sexual exposure may be an ineffective strategy.     

Nurses' health education program in India increases HIV knowledge and reduces fear.

Few health care facilities are adequately prepared to manage and care for HIV/AIDS patients in India. Nurses play a critical role in patient care but are often ill-equipped to deal with their own fears of occupational risk and handle the clinical aspects of HIV/AIDS care, leading to stigma and discrimination toward HIV-positive patients. The authors examine the impact of a 4-day HIV/AIDS health education program on knowledge and attitudes of nurses in a government hospital. This education program was developed using a training of trainers model and qualitative research. A total of 21 master trainers underwent 6 days of training and began training of 552 hospital nurses (in 2004-2005). Using a pretest-posttest design, the authors assessed changes in knowledge and attitudes of 371 trained nurses. Significant improvements were seen in nurses' HIV/AIDS knowledge in all areas including care, treatment, and issues of confidentiality and consent. Fear of interaction with people living with HIV/AIDS was reduced significantly. The short course was successful in increasing nurses' knowledge in all aspects. There is great potential to expand this stigma-reduction intervention to other public and private hospitals.     

护理专业实习学生对艾滋病职业防护知识认知及行为的调查分析

目的 了解护理专业实习学生对艾滋病职业防护知识的认知及行为现状,探讨加强艾滋病职业防护的对策.方法 采用自制问卷,按便利抽样法对274名护理专业实习学生进行不记名问卷调查.结果 实习学生基本上掌握了艾滋病的基本知识,但对窗口期、非传染性体液等的认知率都低于70％;80.3％未接受过艾滋病职业暴露相关知识的培训,22.6％曾接诊或护理过艾滋病感染者或患者,18.6％在职业暴露后未采取正确的处理方法;46.4％对艾滋病患者持同情态度,仅32.8％有护理艾滋病患者的意愿;22.6％在戴手套、消毒双手、针头处理等预防血液、体液污染方面未能正确处理,不同学历的护理专业实习学生在预防艾滋病职业暴露的防护措施方面差异有统计学意义(x2=20.95,P＜0.01).结论 护理专业实习学生对艾滋病职业防护知识认知不够系统和全面,在实习中未采取全面的职业防护措施,加强相关知识的系统教育及行为干预有助于实习学生有效地应对严峻的艾滋病防治工作形势.     

医务人员HIV／AIDS职业暴露目标性监测

目的:了解医务人员在HIV/AIDS患者诊疗工作中的职业暴露情况和防护措施。方法:从2003年10月至2004年9月,使用统一的表格,对每位有职业暴露危险的医务人员进行目标性监测。结果:2003年10月至2004年9月发生HIV/AIDS职业暴露7例,职业暴露百分率为0.86%,感染率为0,职业暴露后监测率为100%。讨论:提高医务人员整体防护能力,重视医疗职业安全教育,牢固掌握职业暴露的正确处理方法,准确监测,加强医院防护基础建设,执行标准预防措施,规范防护流程,是避免医务人员在HIV/AIDS患者诊疗工作中发生医源性感染的有效措施。     

Surveillance of HIV exposure and postexposure prophylaxis among health care workers in Greece

OBJECTIVE: Many developed countries have implemented surveillance systems for monitoring occupational exposure to HIV. The aim of the present study was to analyze surveillance data on HIV postexposure prophylaxis (PEP) for health care workers (HCWs) in Greece. DESIGN: All data reported to the Hellenic Centre for Disease Control and Prevention between January 1996 and June 2005 were analyzed. SAMPLE AND MEASUREMENT: 188 reported occupational exposures to HIV were analyzed, retrospectively. RESULTS: Most exposures were in the physicians (37.8%), followed by the nursing personnel (18.6%). Nearly 38% of the HCWs were males and the predominant type of biological material involved in the exposure was blood (74.5%). Two drugs were used for PEP in 23.4% of the HCWs, and 3 drugs in 66.5% of the reported cases. CONCLUSIONS: Greek guidelines provide guidance for treating HCWs after occupational exposure to HIV. In our study, antiretroviral treatment, a three-drug regimen in the majority of the cases, was prescribed after evaluation of specially appointed physicians. The surveillance system of occupational exposure to HIV in HCWs should be further developed and enhanced in order to monitor and evaluate the risk factors surrounding the incidents.     

护士工作压力与职业耗竭感的相关性研究

目的：探讨武汉市三级医院护士工作压力与职业耗竭感的关系。方法：应用工作压力问卷、职业耗竭感问卷对武汉市3所三级医院的176名护士进行问卷调查,分析工作压力与职业耗竭感之间的关系。结果：护士面临较大的工作压力,其中来自工作环境与性质的压力最大（19.39±7.95）;护士职业耗竭感从整体状况来看并不十分严重,但情绪衰竭体验比较严重;护士职业耗竭感与工作压力呈正相关（r=0.219,P〈0.01）,随工作压力的增加,职业耗竭感的程度变得更为严重。结论：护士工作压力对职业耗竭感有重要影响,建议护理管理者采取有效的管理方法,减少护士的工作压力,从而减轻其职业耗竭感。