新型冠状病毒肺炎防治中个人防护装备穿脱流程的关键环节剖析

目的对个人防护装备(personal protective equipment,PPE)穿脱的关键问题进行剖析,以确保新型冠状病毒肺炎救治工作中医护人员的人身安全。方法通过模拟训练和临床实践,总结PPE穿脱过程中的注意事项,重点培训脱卸流程中洗手、脱手套、互相喷洒、脱隔离衣、脱靴套、脱面屏、脱护目镜、脱连体防护服、脱医用防护口罩各操作步骤的关键点。结果该PPE穿脱流程关键细节描述清楚,受训队员容易掌握,医护人员在PPE穿脱过程中规范、科学、省力。结论PPE穿脱流程的关键环节剖析对从事烈性传染病救治的医护人员加强自身防护、降低因防护不当导致的患病率具有重要指导意义。     

荧光示踪法在应急支援护士个人防护装备培训中的应用研究

目的 探究荧光示踪法在护士个人防护装备培训中的应用效果。方法 采用荧光示踪法联合传统培训方法对疫情期间抽组的200名应急支援队护士进行个人防护装备培训,并进行理论与操作的考核。结果 应用荧光示踪法培训后应急支援队护士的理论考核全部合格,操作考核成绩优于应用前,穿脱个人防护装备时间均缩短（P<0.01）。结论 荧光示踪法应用于护士个人防护装备培训,有助于护士快速正确掌握个人防护装备穿脱操作技能,提高效率。     

整建制接管新型冠状病毒肺炎病区团队防护的问题及对策

目的探讨整建制接管新型冠状病毒肺炎病区团队防护的问题及对策。方法通过医护及感染管理人员共同总结,找出新型冠状病毒肺炎收治各环节中存在的问题,分析改进,提出对策。结果通过对医院具体情况实地考察、新型冠状病毒肺炎团队人员构成、前期援鄂和本团队近一个月来的实际工作总结,发现存在感染管理环节薄弱,穿脱防护装备不规范,新型冠状病毒肺炎患者存在心理障碍致言行过激,防护装备本身及穿戴原因发生鼻面部等压力性损伤。针对医院实际情况设定防护布局及流程,及时进行防护知识及防护装备穿戴培训,改进防护装备穿戴方法,做好新型冠状病毒肺炎患者的护理,特别是心理护理。至今无一人发生职业暴露及新型冠状病毒肺炎感染,后期医护人员面部压力损伤未再发生。结论注重新型冠状病毒肺炎患者医护过程中的薄弱环节,及时提出对策改良,能有效降低医护人员的职业暴露及感染风险。     

新型冠状病毒肺炎疫情期间临床一线护士日常工作防护要点

本文总结新型冠状病毒肺炎疫情期间临床一线护士日常工作中的防护要点,包括帽子、口罩、防护镜/防护面屏、防护服、鞋套的穿脱;病房空气消毒、物品消毒;治疗接触过程中的行为隔离;个人防护要点。     

利比里亚中国埃博拉治疗中心医务人员防护体会

总结利比里亚中国ETU医务人员预防埃博拉病毒感染的综合防护措施。建立感染防控组,设立区域标识目视化,限制医务人员活动路线,制定详细的个人防护装备穿脱流程,加强个人防护措施、物体表面消毒等防护措施落实,更好地保护医务人员自身的安全。154名医务人员共进入隔离病房6 000余人次,无一人感染,实现了"打胜仗,零感染"的目标。     

SARS隔离区防护措施的改进

严重急性呼吸综合征 (SARS ,SevereAcuteRespiratorySyndrome)具有较强的传染性 ,可通过近距离空气飞沫、接触病人分泌物传播 ,医护人员掌握正确的防护方法对于有效控制疾病传播是十分重要的。现将防护重点介绍如下。1　医护人员防护培训合理正确的使用新型防护装置 ,规范穿、脱隔离衣流程 ,严格三区两入口的路径管理。2　改进护理措施将已往“湿式扫床法”改为将消毒后的潮湿小毛巾固定于床单表面 ,采取中线划分由右向左 ,由上向下的清理床单方法 ,实施避免扬尘的“固定式扫床法”。操作完开窗通风半小时后 ,再行常规查房、治疗和护理…     

新型冠状病毒肺炎病区护士个人防护问题与对策

目的针对在抗击新型冠状病毒肺炎护士个人防护出现的问题找出对策,为制订更加完善的感染控制管理和提高护士应对个人防护能力提供参考。方法个人防护相关问题主要有:初入专病病区时,个人专业知识不足,病区布局欠专业导致个人感染风险高,个人防护规范和流程有待改进等;防护用具使用中,护目镜与面屏起雾、手套容易松落、防护用具引起压力性损伤,影响细致操作,给救治任务增加了难度,影响了工作效率。针对此,逐一制定了对策,包括:双人互相监督防护用品穿脱质量,明确工作区域划分,改良穿脱防护服流程;用洁肤柔涂护目镜与面屏,改变手套的材质、型号选择和佩戴方法,使用敷料进行面部预防性保护,等等。结果执行防护难题的对策措施后,提高了护理工作效率与质量,初步做到了本病区的护士零感染。结论分级防护必须在严格落实标准预防的基础上,根据病原体的传播途径,加强个人防护用品的规范使用,碰到实际问题需要进行应对方法的探索与改进。防护重点在于防护意识要更新,从工作习惯、动作习惯去改变。     

新型冠状病毒肺炎流行期间医护人员抑郁倾向影响因素研究

目的探讨新型冠状病毒肺炎流行期间医护人员抑郁倾向的影响因素,为重大公共卫生事件发生时医护人员抑郁倾向的早期识别、早期干预提供依据。方法采用一般资料调查表和患者健康问卷对592名医护人员进行调查,采用Logistic回归分析进行抑郁倾向影响因素分析。结果新型冠状病毒肺炎流行期间医护人员有抑郁倾向为78名,占13.18%,影响医护人员抑郁倾向的因素为个人防护装备是否充足、是否认为容易受感染、是否有类似症状以及是否害怕感染(P<0.05)。结论新型冠状病毒肺炎流行期间医护人员存在抑郁倾向,因此需要多部门合作,为医护人员提供合适的个人防护装备,同时加强各地区医护人员的社会支持与激励,帮助医护人员积极应对,提升心理健康水平。     

方舱医院工作人员穿脱个人防护用品的自我认知状况调查

目的： 调查新型冠状病毒流行期间方舱医院不同工作人员穿脱个人防护用品的认知状况,以便针对问题展开重点培训,为医院感染防控培训工作提供依据。方法：选取2022年4月14日至2022年5月20日上海某方舱医院工作人员共499名,通过问卷星收集不同人群的基本情况及其对穿脱个人防护用品的认知状况,对不同分组工作人员之间存在的差异之处进行分析讨论。结果：医生组、护理组平均分数均高于非医护人员组；其中穿防护服、脱隔离衣这2个条目评分,医生组、护理组、非医护人员组三组之间存在显著差异,有统计学意义(P<0.05)；穿防护服、脱防护服、穿隔离衣、脱隔离衣、戴帽子、手卫生消毒行事后分析两两比较后,护理组高于非医护人员组,差异具有统计学意义(P<0.05)；穿防护服,医生组平均分数高于护理组高于非医护人员组,组间比较差异均有统计学意义(P<0.05)。结论：非医护人员穿脱个人防护用品整体认知评分低于医生组、护理组,需要在日常工作中继续督导,强化培训及考核,进一步提高其对穿脱个人防护用品的认知,最大可能的降低院内感染发生的风险。     

一种指导医务人员脱卸个人防护装备的智能语音提示交互系统的设计与应用

目的 观察一种指导医务人员脱卸个人防护装备的智能语音提示交互系统在临床实践应用中的效果。方法 采用智能语音交互技术为基础，设计一种指导医务人员脱卸个人防护装备的交互系统，推广应用于重庆市5所医院，149名医务人员进行应用实践。收集和调查医务人员使用装置前后脱卸防护装备的程序正确率、个人紧张情绪缓解程度、使用系统的满意率、对智能交互系统操作掌握及接受度。结果 149名医务人员使用智能交互语音提示系统时操作流程正确率为100%,系统使用前、后脱卸防护装备时的紧张程度具有显著性差异(P<0.05);有无接受个人防护装备培训对掌握智能交互系统操作的难易程度具有显著性差异(P<0.05),不同专业对智能交互系统清晰指导脱卸操作流程评价具有显著性差异(P<0.05);医务人员使用系统的满意率为100%。结论 智能语音提示交互系统能够明显降低人员心理紧张情绪，提高个人防护装备脱卸正确率，降低职业暴露风险，提高医务人员满意度，使用依从性好。     

Factors that affect the duration of wearing disposable personal protective equipment by healthcare professionals in Wuhan during treatment of COVID‐19 patients: An epidemiological study

The purpose of this study of healthcare workers who cared for COVID‐19 patients was to identify factors that affected the duration of wearing personal protective equipment (PPE). The results of this study will provide initial guidance to practicing clinicians and a foundation for further research on this topic. This cross‐sectional study examined 139 frontline healthcare professionals who worked at a single hospital in Wuhan, China, from March 16 to April 1, 2020. General and demographic data, physical and mental status, use of personal protective equipment, type of hospital work, and duration of wearing personal protective equipment were recorded. The mean duration of wearing personal protective equipment was 194.17 min (standard deviation: 3.71). Multiple linear regression analysis indicated that the duration of wearing personal protective equipment was significantly associated with the presence of a chronic disease, working hours when feeling discomfort, lack of patient cooperation and subsequent psychological pressure, prolonged continuous wearing of personal protective equipment, feeling anxious about physical strength, and the presence of fatigue when wearing personal protective equipment. These factors should be considered by practicing healthcare professionals and in future studies that examine the optimal duration of wearing personal protective equipment.     

二、三级防护装备所致医护人员潮湿相关性皮肤损伤的现况分析及对策

目的分析二、三级防护装备所致的医护人员潮湿相关性皮肤损伤发生特征、相关因素和预防现况,为制订防治对策提供依据。方法2020年2月8—22日,采用便利抽样法,选取全国161家医院的1814名医护人员为研究对象。设计问卷上传问卷星网站,将问卷链接发送至医护人员的微信工作群,医护人员自愿采用手机在线填写和提交人口学资料、潮湿相关性皮肤损伤资料和预防措施资料等。从网站导出数据,双人核对后建立数据库。采用SPSS软件分析其潮湿相关性皮肤损伤的发生特征、相关因素、预防现况,并提出对策。结果1761名来自全国161家医院的医护人员提交了问卷,其中男性290名(16.47%),女性1471名(83.53%)。潮湿相关性皮炎现患率为18.85%(332/1761),其中三级防护装备现患率高于二级装备,差异有统计学意义(P=0.001)。穿戴时间>4 h组的发生率高于≤4 h组,差异有统计学意义(P<0.05)。多部位现患率高于单部位(P<0.001)。二项Logistic回归分析显示,主要的关联因素中呈现增加风险的有出汗潮湿(OR=168.52,P<0.001)、佩戴三级防护装备(OR=1.65,P<0.05),损伤前采取预防措施仅占12.72%(224/1761)。结论二、三级防护装备所致的医护人员潮湿相关性皮肤损伤发生率较高,其中出汗潮湿和三级装备是主要风险因素,预防不足。需要加强评估、洁肤、润肤、护肤、吸湿等预防策略,损伤后需在预防基础上做好局部抗炎和保护处理。     

Safe Handling of Chemotherapy in the Perioperative Setting

Safe handling of chemotherapeutic agents during administration and disposal is critical. Most antineoplastic agents are toxic compounds that are carcinogenic, mutagenic, or teratogenic. Direct contact may cause irritation of the skin, eyes, and mucous membranes. Perioperative personnel should know how to handle hazardous materials safely to protect the patient, other staff members, and themselves. These safety precautions include appropriately identifying the patient; correctly preparing, verifying, and documenting the chemotherapeutic agents being administered; consistently wearing personal protective equipment; transporting the chemotherapeutic agent in a puncture-resistant container labeled “chemotherapy”; properly disposing of the chemotherapeutic agent and supplies; and handling a spill if one occurs.     

Influence of air-purifying respirators on the simulated first response emergency treatment of CBRN victims

AIM: Medical first responders and emergency room personnel potentially are threatened by exposure to primary or secondary intoxication by chemical, biological, radiological or nuclear (CBRN) substances. The impact of personal respiratory protection by air-purifying respirators on the performance of resuscitation requires evaluation. This will help to improve major incident planning and measures for protecting medical staff. METHODS: We investigated the influence of two air-purifying respirator designs on the resuscitation of simulated CBRN victims. Fourteen UK paramedics followed a standardised resuscitation algorithm, either unprotected or wearing a bi-ocular and a panoramic visor respirator in a randomised crossover design. Treatment times and wearer comfort was determined and compared. RESULTS: We did not find any difference in treatment times between the groups wearing respiratory protection and the controls (189+/-8.3s for the controls, 191+/-9.5s for the panoramic visor mask and 206+/-9.1s for the bi-ocular respirator [mean+/-S.E.M.]). Tracheal intubation appeared to be the most time consuming task. In a questionnaire, volunteers were of the opinion that orientation whilst wearing the respirator with the panoramic visor was better compared to the bi-ocular one (85% versus 15%). With respect to the fit, the majority (79%) rated the bi-ocular respirator as more comfortable. CONCLUSIONS: Modern personal respiratory protection has only a negligible effect in the delay on the short term treatment during well defined simulated scenarios with a single CBRN casualty. Furthermore, air-purifying respirators with panoramic visors seem to allow a better orientation for medical first responders during simulated resuscitation.     

Medical emergency motorcycles: are they safe?

OBJECTIVE: Ambulances in emergency medical services (EMS) might be supplemented or supported by vehicles that lack the capacity to transport a patient, especially in crowded urban areas. This paper addresses the safety of a first-response vehicle, the medical emergency motorcycle (MEM), which is driven by an emergency medical technician provider. We analysed the number of crashes, as well as the incidence and nature of injuries sustained. MATERIAL AND METHODS: A prospective study was conducted from July 2004 to January 2007. Administrative data were collected over this period regarding MEMs operating in a metropolitan EMS group who had responded to 3626 calls. The MEM responders use limited equipment to perform initial assessments and interventions (basic life support and defibrillation). Undergoing an emergency driving course and wearing protective equipment are mandatory. We analysed the number of crashes, the proper use of the protective equipment, and the type and severity of the injuries sustained. RESULTS: Accidents included 12 (n=12) motorcycle falls, resulting in three injured MEM drivers. No fatality was registered. One serious injury and two slight accidents occurred. One victim presented a dental trauma and another presented minor abrasion skin lesions. The third sustained a femur fracture. The first and second victims had not been using the protective equipment properly. CONCLUSION: MEMs can impart a quick and efficient response to EMS services in urban areas, if managed with acceptable levels of safety. Defensive driving courses as well as correct use of personal protective equipment can improve security.     

The effect of severe acute respiratory syndrome (SARS) on emergency airway management

From early March 2003 to late May 2003, severe acute respiratory syndrome (SARS) was detected in Singapore. The increase in workload and new infection control procedures were thought to affect resuscitation and airway management. Our aim was to study the effects of wearing of personal protective equipment (PPE) and powered air-purifying respirator (PAPR) and the restriction in the number of resuscitation personnel on airway management during the SARS crisis. Data was collected prospectively through an ongoing emergency airway registry. The data was divided into three periods: (1) before PPE was instituted from 1 November 2002 to 31 March 2003; (2) during SARS (when PPE use was mandatory) from 1 April to 31 July 2003; (3) post-SARs (when PPE use was non-mandatory but encouraged) from 1 August to 31 March 2004. There was no change in patient demographics during the three periods. There were significant increases in the proportion of resuscitation cases and airway interventions during the SARS period compared to the pre-SARS period. The resident medical officer intubation rate decreased from 45.1% pre-SARS to 35.2% during SARS and 17.7% post-SARS. The complication rates were 10.5%, 9.9% and 9.4% in periods 1-3, respectively. Restriction in the number of healthcare staff attending to each patient may have influenced the department's decision to allow only the most confident or experienced personnel to manage the airway. The exposure of junior medical officers in emergency airway management during SARS and the immediate post-SARS period was decreased. This trend should be monitored further and intervention may be necessary should it continue to decline.     

7S精益常态化管理对体检科人员及设备管理的效果分析

目的探讨7S精益常态化管理在体检科人员及设备管理中的应用效果。方法我院于2018年7月开始实施7S精益常态化管理,选取实施前后1年本院体检科体验者各200名作为研究对象,比较实施前后体检科的护理质量、设备管理水平、对体验过程满意度情况。结果实施后健康体检者对就诊秩序维持、流程指导及体检环境的护理质量评分明显高于实施前(P<0.05);实施后,设备应用人员对设备管理基础及维修和综合评价评分明显高于实施前(P<0.05);实施后,健康体检者对体检环境、人员、设备及检验过程的满意程度高于实施前(P<0.05)。结论7S精益常态化管理用于体检科能够完善就诊秩序及流程,提升体检满意度,满足设备相关人员对设备管理及维修需求。     

厂矿医院医疗废物管理现状的调查分析

目的：了解我市厂矿医院医疗废物管理现状,并提出改进措施。方法：随机抽查市区10所厂矿医院,采用现场查看和问卷调查相结合的方法进行。结果：8所医院的医疗废物暂存点设置不合理,5所未设置警示标识,4所未配备个人防护用品和管理制度;对医务人员进行医疗废物分类相关知识的抽查中,共抽查196名,能准确回答的占44.90%,较为准确回答的占30.10%,回答不准确的占25%。结论：医院应加强宣传力度,提高全体医务人员认识;加大经费投入,做好从业人员个人防护;加强一次性无菌医疗用品的回收处理;建立医院医疗废物管理组织,完善管理制度,规范工作流程,以此处理好医疗废物问题,防止医源性感染。     

Lack of compliance with basic infection control measures during cardiopulmonary resuscitation-Are we ready for another epidemic?

OBJECTIVE: Healthcare workers in the emergency department are particularly vulnerable to communicable disease. This study aimed to evaluate compliance with standard precautions by analysis of the incidence and systems sources of such contaminations and by quantifying the use of personal protective equipment. METHOD: A prospective observational study from 1 November 2005 to 30 April 2006, using analysis of video segments. Videotapes were recorded in two rooms designed for cardiopulmonary resuscitation of out-of-hospital cardiac arrests, and compliance with basic infection control measures by all emergency department crews was monitored. RESULTS: A total of 44 consecutive performances of cardiopulmonary resuscitation were recorded for time-motion analysis. The percentages of staff wearing personal protective equipment were 90%, 50%, 20% and 75% for masks, eye protection, gowns and gloves, respectively. Compliance ranking scored doctors as high, trainees as moderate and nursing staff as low. Overall contamination rate was 16.9x10(-2)events/person-min. The two leading systems sources for contamination were lack of specific task assignments among rescuers (44%) and inadequate preparation for procedures (42%). CONCLUSIONS: Among healthcare workers in the emergency setting, the study disclosed suboptimal compliance with basic infection control measures, including use of personal protective equipment and avoiding contamination. By further time-motion analysis of resuscitation sessions, major systems sources and strategies for improvement could be identified.