医护人员自我防护调查分析

目的 增强医护人员自我防护意识，了解自我防护状况。方法 采用问卷调查法抽查医护人员关于卫生保健、防护知识等内容进行调查分析。结果 236名医护人员中做过上岗前体检40．3％，做过定期体检25％；每个工作日洗手次数＜30次89％，＞30次11％；皮肤被利器刺伤过86．9％；掌握常用消毒剂作用40．2％，正确掌握戊二醛灭菌时间5．9％；因物品供应不上较少应用防护措施57．1％；认为必要参加防护知识培训95．3％；感染过常见医院感染性疾病有49．6％。结论 要加强卫生保健、卫生洗手、做好标准预防、加强学习宣教、预防感染。     

临沧市45例医护人员艾滋病病毒职业暴露情况分析

[目的]了解临沧市医护人员HIV职业暴露发生的原因、方式、危险程度等情况,为进一步找出对策及防护措旋提供依据。[方法]对临沧市2005年～2009年45例医护人员HIV职业暴露的情况进行分析。[结果]45名被调查的医护人员中男性9人,占20％;女陛36人,占80％。医生21人（外科12人、检验科4人、妇产科3人、门诊2人）,占46．67％;护士24人（外科、妇产科、传染科分别为5人,检验科、急诊科、门诊内科分别为3人）,占53．33％。暴露的原因主要是在手术、输液、采血、护理及销毁针具时不慎被针头刺伤,针刺伤34人,占75．56％,污染皮肤黏膜11人,占24．44％。暴露后立即进行处理的有28人,占62．22％;有39人服药,4小时以内服药的有30人,占66．67％。45例HIV职业暴露者均未彼感染。[结论]医务人员对艾滋病传播途径及HIV职业暴露相关知识认识不够,安全防护意识淡薄,缺乏自我防护知识与技能。因此,制定安全防护管理制度,加强医务人员艾滋病知识的学习,严格遵守安全操作规程,在接触患者血液或分泌物时做最严格的防护,是减少和避免HIV职业暴露发生的关键。     

医务人员职业暴露及认知现状调查分析

目的：探讨医务人员职业暴露发生原因与防护措施。方法：利用自制的调查表，对某院2007--2008年医务人员职业暴露发生、认知态度及需求情况进行问卷调查。结果：两年期间共发生68例职业暴露，发生率为5．19％，以护士为主（占80．88％），暴露种类以锐器伤为主（占86．76％），暴露源以血液为主（占94．11％），病原体以乙肝（48．53％）、梅毒（23．53％）、丙肝（14．71％）为主，发生原因以医务人员刺伤自己为主（87．76％），防护手套使用率为19．12％，均无使用防护眼镜。职业暴露发生后，有41．18％、22．06％的医务人员表示出害怕与无可奈何心理状态，95．59％的医护人员期望得到职业暴露防护培训及医疗保障。结论：该院医护人员对职业暴露的防护意识较为淡簿，应加强职业安全防护知识培训，健全安全防护组织网络体系，执行安全操作标准，规范操作行为，加强心理干预。     

医务人员职业暴露和防护状况调查及对策

目的了解医院工作人员职业安全防护状况,探讨增强防护意识,完善防护措施的举措。方法采用问卷调查法对本院工作人员,包括医生、护士、工勤人员,对关于职业暴露的防护意识及防护措施等项目进行调查分析。结果 308名被调查的医务人员中,锐器刺伤≤5次者168人,占职业暴露人数的54.55%;5~10次者50人,占职业暴露人数的16.23%;11~20次者20人,占职业暴露人数的6.49%;≥20次者70人,占22.73%。其中医务人员被刺伤环节最高发于收集、清洗器械时刺伤,其次为配药、加药时匆忙、粗心。锐器刺伤发生率与自我防护意识强弱有关,防护意识强者,刺伤发生率低,防护意识弱者,刺伤发生率高,两者之间差异显著(P<0.001)。多数医务人员表示其安全防护意识多来源于院内学习培训,工作经验及同事间交流。结论临床医务人员职业暴露的发生率很高,应完善管理制度强化防护意识,加强职业安全防护教育,规范医院工作人员的操作行为,使用安全性能好的医疗护理器材。     

供应室医务人员职业安全防护调查分析

目的加强供应室医务人员的职业安全防护意识. 方法采用自行设计的调查表以访谈和问卷相结合的方法进行调查分析. 结果 78名供应室医务人员中正确洗手的仅占10.3%;正确应用擦手工具7.7%;正确掌握消毒剂用途及效能46.2%;被利器刺伤后能正确处理伤口71.8%;52.6%的人较少应用防护措施的原因是认为遇到的传染病患者少、思想上不够重视、防护用品供应不上;有91%的医务人员认为有必要加强职业防护知识的学习;有76.9%的人认为需加强院科领导的重视及医院感染控制部门的监控力度. 结论加强职业安全防护知识的宣教;熟练应用防护技术,做好标准预防;加强安全管理,保证防护措施的应用;加强防护措施应用的监督力度.     

医务人员标准预防能力的调查分析与对策

采用自行设计的医务人员标准预防能力知识问卷对医务人员进行调查。共发放调查表357份，回收330份，回收率92．44％。医务人员标准预防知识平均知晓率为83．94％；知晓率最高者为护士（92．81％），其次为医技人员（87．06％），医生知晓率最低（69．81％）。医务人员对手部卫生的依从性：认为接触每例患者后需洗手的医务人员占90．30％，其中护士高达100．00％，极少数医生认为不需要洗手，另有9．09％的医务人员认为工作忙顾不上洗手；实践操作中，75．76％的医务人员接触每例患者后立即洗手，3．64％的医务人员待全部工作结束后洗手，20．61％的医务人员因工作忙顾不上洗手。以上结果提示，医务人员的标准预防能力有待提高，医院应加强医疗职业安全教育的培训，以有效预防医院感染的发生。     

皮肤性病医院护士锐器伤分析及防护

目的了解皮肤性病医院护士锐器伤的发生率和刺伤原因等，提出护士职业暴露防护措施，维护护士身心健康。方法采取回顾性调查，对2004—2005年皮肤性病医院临床护士所发生的61人次锐器损伤原因进行分析。结果被调查13人中，13人均被锐器所刺伤，其刺伤率为100％。2年内发生锐器伤61例次，被调查者人均年刺伤2．6次，其中52．5％被传染病患者的血液、体液污染的针头所刺伤。结论树立职业防护管理理念，建立健全职业防护管理制度、防护流程，教育培训护士安全防护，严格遵守操作规程是防止护士发生锐器伤和减少感染血源性疾病的关键。     

医务人员职业暴露监测分析及干预措施探讨

目的：了解医务人员职业暴露的相关危险因素,探讨有效干预措施,减少医务人员职业暴露的发生。方法：对2011年1月-2012年12月58名医务人员职业暴露监测资料进行统计分析。结果：职业暴露主要以30岁以下、工龄小于4年的医务人员为主,其中护士职业暴露发生率最高,占55．18％,医师次之占25．86％;职业暴露地点主要以病房和手术室,分别占56．90％和34．48％;暴露方武主要以针刺伤为主,占87．93％,处理针头、手术缝合分别占20．69％和18．97％,是发生职业暴露的主要环节。暴露源以HBV、HCV为主,分别占60．35％和20．69％,暴露后均能正确处理伤口,经随访未出现医务人员感染现象。结论：制定严格的职业安全防护制度,加强医务人员职业安全培训及操作技术培训,提高职业防护意识,执行标准预防,规范操作行为,能有效减少医务人员职业暴露的发生。     

护士职业防护中存在的问题与对策

探讨护理人员工作中职业防护存在的问题及防护措施。通过观察护理人员的日常工作、各项操作技术,发现护理人员对经血传播疾病职业暴露预防意识淡薄,洗手不规范,不能正确使用手套,易被锐利器物刺伤等。防护中应做到：严格执行标准预防原则,加强职业防护培训,严格洗手,一旦发生职业暴露,应立即进行局部处理,及时上报,并定期监测和预防性用药。加强护理人员的自身防护,认真执行各项防护措施。     

医学生职业防护现状调查分析

目的 了解医学生的自我职业防护状况与防护技能的掌握程度。方法 对62名医学实习生进行职业防护问卷调查。结果 掌握足够的职业防护知识技能的仅5人（8，06％）；能正确实施标准预防技术仅2人（3．23％）；58人（97．55％）只知道在无菌操作前洗手与戴口罩，操作后的洗手往往被忽视；受到锐器伤、高风险职业暴露后，担心会感染某种传染性疾病的62人（100％）。结论 医学生对标准预防认知不足，知识不系统、不完整，职业防护意识薄弱，应该引起医学院校和临床教学医院的重视。     

3种不同手卫生方法效果观察

目的 观察3种不同手卫生处置方法的效果,为医务人员提供便利、可靠的手卫生方法.方法 选择临床医护人员90名,随机分为3组,设肥皂洗手组30人,卫生手消毒组30人,先洗手后卫生手消毒组30人;洗手组使用肥皂,卫生手消毒组使用速干手消毒剂,先洗手后卫生手消毒组是先用肥皂再用速干手消毒剂洗手,干后立即用含相应中和剂的无菌洗脱液的无菌棉拭子采样双手标本送检,37℃培养48 h,观察3组人员手部细菌菌落数.结果 肥皂洗手、卫生手消毒、先洗手后卫生手消毒合格率分别为76.7％、93.3％、100.0％,均未检出致病菌;肥皂洗手与卫生手消毒比较、卫生手消毒与先洗手后卫生手消毒比较差异无统计学意义,肥皂洗手与先洗手后卫生手消毒比较差异有统计学意义(P＜0.05).结论 3种手卫生方法均可用于临床医务人员的手部清洗除菌,先洗手后卫生手消毒效果最佳,卫生手消毒效果优于肥皂洗手.     

2012年大连市某区级医院护理人员手卫生认知状况调查

[目的]了解基层医院护理人员手卫生认知状况,为医院手卫生管理提供依据。[方法]2012年11月,在大连市某区级医院抽取204名临床科室的在岗护理人员进行问卷调查。[结果]调查204名护理人员,知道接触患者黏膜、破损皮肤前要洗手的占75.98%,知道接触患者黏膜、破损皮肤后要洗手的占70.10%,知道给患者测量生命体征后要洗手的占85.78%,知道穿隔离衣前要洗手的占71.08%,知道脱隔离衣后要洗手的占68.14%,知道摘手套后要洗手的占为58.82%,知道接触患者周围环境物品后要洗手的占72.55%;96.57%认识到严格做好手卫生工作对患者和自身的双向保护作用,83.33%能够完成＂一病患一洗手＂;认为消毒剂刺激皮肤、有异味而影响洗手的占27.94%,洗手次数太多没必要的占0.98%,手卫生设施位置不合理而影响洗手的占21.57%,手卫生设施配备不合理影响洗手的占23.04%,工作繁忙没有时间洗手的占30.39%,简单操作没必要洗手的占9.80%。[结论]大连市某区级医院临床护理人员手卫生知识水平一般。     

Nursing home outbreak of invasive group a streptococcal infections caused by 2 distinct strains.

OBJECTIVE: To identify factors contributing to a cluster of deaths from invasive group A streptococcus (GAS) infection in a nursing home facility and to prevent additional cases. DESIGN: Outbreak investigation. SETTING: A 146-bed nursing home facility in northern Nevada. METHODS: We defined a case as the isolation of GAS from a normally sterile site in a resident of nursing home A. To identify case patients, we reviewed resident records from nursing home A, the local hospital, and the hospital laboratory. We obtained oropharyngeal and skin lesion swabs from staff and residents to assess GAS colonization and performed emm typing on available isolates. To identify potential risk factors for transmission, we performed a cohort study and investigated concurrent illness among residents and surveyed staff regarding infection control practices. RESULTS: Six residents met the case patient definition; 3 (50%) of them died. Among invasive GAS isolates available for analysis, 2 distinct strains were identified: emm11 (3 isolates) and emm89 (2 isolates). The rate of GAS carriage was 6% among residents and 4% among staff; carriage isolates were emm89 (8 isolates), emm11 (2 isolates), and emm1 (1 isolate). Concurrently, 35 (24%) of the residents developed a respiratory illness of unknown etiology; 41% of these persons died. Twenty-one (30%) of the surveyed employees did not always wash their hands before patient contacts, and 27 (38%) did not always wash their hands between patient contacts. CONCLUSIONS: Concurrent respiratory illness likely contributed to an outbreak of invasive GAS infection from 2 strains in a highly susceptible population. This outbreak highlights the importance of appropriate infection control measures, including respiratory hygiene practices, in nursing home facilities.     

北京市3~12岁儿童正确洗手行为家庭影响因素

  目的  了解北京市学龄前儿童及小学生正确洗手行为及其家庭影响因素,为进一步开展洗手相关健康干预提供参考。  方法  2020年11—12月,利用问卷星软件使用自行设计的调查问卷对北京市9个区36所幼儿园和18所小学的7 494名儿童家长开展线上调查。调查内容为儿童及其家庭基本情况,家长对新型冠状病毒肺炎(以下简称“新冠肺炎”)防护知识正确知晓、对疫情风险感知程度、为儿童提供洗手指导等的情况,以及儿童的洗手行为。  结果  学龄前儿童正确洗手的比例为70.2%,高于小学生(61.9%)(χ2=57.63,P＜0.01)。学龄前儿童家长知晓洗手相关知识(36.2%,33.4%)、对疫情风险感知低(28.9%,25.4%)、提供洗手指导(99.1%,97.9%)的比例均高于小学生家长,差异均有统计学意义(χ2值分别为6.72,22.84,18.68,P值均＜0.05),学龄前儿童家长自我效能高的比例(75.7%)低于小学生家长(78.2%)(χ2=6.43,P=0.04)。多因素Logistic回归分析结果显示,无论学龄前儿童还是小学生,城区、家长自我效能较高、风险感知低、为儿童提供洗手指导,儿童正确洗手的可能性高;对于学龄前儿童,非独生子女与正确洗手行为呈负相关(OR=0.79,95%CI=0.69~0.92);对于小学生,女童正确洗手的可能是男童1.21倍(95%CI=1.06~1.39),家长知晓知识者是不知晓者的1.20倍(95%CI=1.04~1.40,P值均＜0.05)。  结论  学龄前儿童洗手行为优于小学生,家长对于新冠肺炎疫情、洗手行为的认知,自我效能以及采取的指导行为对于儿童健康行为养成有不同程度的影响。应采取措施进一步提高家长指导儿童预防传染病的能力和自我效能。     

荆门市个体诊所医护人员手卫生状况调查

目的了解我市个体诊所医护人员手卫生知识掌握情况及洗手执行情况,寻找存在的问题,提出管理对策。方法采用问卷调查的方法,对L16家个体诊所医护人员进行手卫生知识、洗手指征、影响洗手的原因等进行调查,同时实地察看各诊所的洗手设施及医护人员的洗手行为。结果医护人员对洗手的重要性的认知率最高,为73．7％,对《医务人员手卫生规范》的认知率最低,为26．2％：接触患者血液、体液、分泌物之后的洗手率最高,为100％,接触患者周围环境和物品后的洗手率最低,为14．3％;影响洗手的主要原因是思想上不重视,认为洗不洗手关系不大,所占比例为75．6％,少数人是因工作忙忽视手的卫生或洗手设施不足所致。结论我市个体诊所医务人员存在的主要问题是对手卫生的重要性认识不足,洗手执行率低。必须加强专项培训,减少医院感染。     

Effect of a 1 min hand wash on the bactericidal efficacy of consecutive surgical hand disinfection with standard alcohols and on skin hydration

BACKGROUND: In most surgical theatres, a 1 min or even longer hand wash is routine as part of the pre-operative hand disinfection. But its benefit has recently been seen critically. METHODS: We have therefore investigated the effect of a 1 min hand wash on skin hydration and on the efficacy of consecutive surgical hand rubbing with three standard alcohols (60% propan-1-ol, 60% propan-2-ol, 80% ethanol; all v/v) on the resident hand flora. Three types of treatment were performed: (i) a 1 min pre-wash before surgical hand disinfection, (ii) no pre-wash before surgical hand disinfection and (iii) no pre-wash but use of a brush for 1 min during disinfection procedure. The efficacy of the alcohols was determined according to prEN 12791 with the same 20 volunteers in paired groups. To assess the effect of the hand wash on skin hydration, 10 volunteers washed their hands with sapo kalinus for 1 min and dried hands with a paper towel. Skin hydration was measured with a corneometer before the hand wash and subsequently up to 10 min thereafter both on the palm and dorsum of hands. We also tested the reduction of bacterial spores by a 15 s hand wash according to EN 1499 after artificial contamination of hands of 14 volunteers with spores of B. stearothermophilus. RESULTS: Propan-1-ol (60%) was most effective with a mean log10 reduction of 2.11, followed by ethanol (80%) with a mean log10 reduction of 1.76 and propan-2-ol (60%) with a mean log10 reduction of 0.57 (all immediate effect without hand wash). The efficacy of the alcohols was neither significantly improved nor impaired by a preceding 1 min hand wash, but there is a trend towards better efficacy on dry hands. Using a brush for 1 min during disinfection resulted in a better efficacy with all alcohols. An anaylsis of variance revealed that the immediate effect of ethanol (p = 0.013) and propan-2-ol (p = 0.001) is significantly influenced by the variation of treatments which is mainly explained by the effect of brushing during disinfection. But no significant difference between treatment variations was found in the sustained effect with any of the alcohols. Skin hydration increased significantly by a 1 min hand wash for up to 10 min despite drying hands with a paper towel. A 15 s hand wash reduced the number of bacterial spores significantly from log10 3.84 to log10 1.99 (p = 0.001). CONCLUSIONS: There is no benefit of a hand wash as part of surgical hand disinfection except that a short hand wash of 15 s can effectively reduce spores. The best time for this short hand wash is at the beginning of work in hospital, but at the latest in the sluice of the operating theatre about 10 min before applying an alcohol-based hand rub to give the skin enough time to dry.     

新型冠状病毒肺炎疫情前后个人手卫生状况及影响因素调查

目的 了解新型冠状病毒肺炎疫情发生前、后公众的洗手相关行为及影响因素。 方法 通过中国疾病预防控制中心官方微信公众号平台发放电子调查问卷。 结果 调查期间后台访问13 193次,共收集有效问卷7 011份。日常生活每天洗手>10次的比例从疫情前15.0%提升到疫情后48.3%,洗手次数小于3次的比例从疫情前13.3%下降到疫情后1.5%。每次洗手时间大于20 s的比例疫情前22.2%提升到疫情后51.7%,每次洗手小于10 s的比例疫情前35.3%下降到疫情后4.0%。手消毒液的使用率从疫情前40.6%增至疫情后84.0%。多因素logistic分析结果显示,疫情发生后男性、学生、初中及以下文化程度更有可能在日常生活中洗手次数<3次/d。 结论 新型冠状病毒肺炎疫情后公众对勤洗手预防病毒感染的接受程度高,需要针对性提升男性、学生和初中以下文化程度人群的手卫生教育,认识到洗手的重要性。     

Influence of rings on the efficacy of hand sanitization and residual bacterial contamination.

BACKGROUND: Previous studies, conducted before widespread use of scrubless, alcohol-based hand sanitizers, demonstrated increased residual bacterial counts after hand hygiene on hands with jewelry. OBJECTIVE: To compare the impact of finger rings on the effectiveness of scrubless and water-aided alcohol-based hand sanitization methods with that of povidone-iodine scrub. DESIGN: Randomized, controlled study.Setting. University hospital.Participants. Sixty volunteer subjects from a pool of perioperative staff and medical students. INTERVENTION: After recruitment, participants wore a ring on one hand and no ring on the other hand. They were randomly assigned to perform hand hygiene with a povidone-iodine scrub, an alcohol wash, or a waterless alcohol-chlorhexidine lotion (n=20 subjects per method). After subjects completed hand hygiene, gloves were placed on their hands by means of sterile methods, and a "glove juice" technique was used to obtain samples for culture. The number of colony-forming units in each culture was counted, and the data were compared. RESULTS: There was no significant difference in the number of bacteria between hands with and hands without rings for the groups that used alcohol wash or alcohol-chlorhexidine lotion. However, for the povidone-iodine group, the number of bacteria on hands with rings was greater than the number on hands without rings (P<.05). The hands of participants who used waterless alcohol-chlorhexidine had the lowest bacterial count, regardless of the presence of rings (P<.01). CONCLUSIONS: The presence of rings does not negatively impact the effectiveness of alcohol-based hand sanitizers. Use of waterless alcohol-chlorhexidine lotion resulted in the lowest bacterial count.     

Evaluation of a patient-empowering hand hygiene programme in the UK.

Partners in Your Care, a patient education behavioral model for increasing handwashing compliance and empowering the patient with responsibility for their care was evaluated in an acute care hospital in Oxford, UK. A controlled prospective intervention study comparing medical and surgical patients was performed. Ninety-eight patients were eligible for the study. Thirty-nine patients (40%) agreed to participate in the programme Partners in Your Care by asking all healthcare workers who were going to have direct contact with them "Did you wash your hands?" Compliance with the programme was measured through soap/alcohol usage and handwashings per bed day before and after its introduction. Partners in Your Care increased handwashing on average 50%. Healthcare workers washed hands more often with surgical patients than with medical (P< 0.05). Alcohol gel was used on less than 1% of occasions. Sixty-two percent of patients in study felt at ease when asking healthcare workers "Did you wash your hands?" Seventy-eight percent received a positive response (washed hands). All patients asked nurses, but only 35% asked physicians. Partners in Your Care increased handwashing compliance in the UK. This programme empowers patients with responsibility for their care, provides infection control staff with a continuing means for providing handwashing education without additional staff and can save costs for a hospital.