新型冠状病毒感染疫情防控期间防护装备所致医护人员皮肤损伤的发生率及流行特征研究

背景　医疗器械相关性皮肤损伤主要发生于危重患者和矫形患者，一直是全球住院患者安全管理和专科护理的研究热点，但尚缺乏关于医护人员的报道。本次新型冠状病毒感染疫情防控期间，大量医护人员奋战在抗击疫情第一线，长时间穿戴防护装备容易引起皮肤损伤，严重危害了医护人员的健康，也增加了其被感染的风险，如何保护医护人员免受伤害成为亟待解决的问题。目的　探讨新型冠状病毒感染疫情防控期间防护装备所致医护人员皮肤损伤的发生率及流行特征，为制定有效的防护对策提供依据。方法　由本课题组研制调研问卷，主要内容包括医护人员的基本情况、防护装备佩戴情况、皮肤损伤情况、针对皮肤损伤的防护措施及损伤后处理情况。问卷通过“问卷星”网站发布，于2020-02-08至2020-02-15通过微信向抗击疫情一线的医护人员进行推送，采用自愿参与、手机“问卷星”在线填写的方法完成调研。1周内完成调研数据收集，建立数据库，并对医护人员的皮肤损伤发生率、损伤类型及流行特征进行统计分析。结果　共回收有效问卷2 901份，来源于我国19个省、3个自治区、4个直辖市的145家医院。其中，男214例（7.38%）、女2 687例（92.62%），医生147例（5.07%）、护士2 754例（94.93%）。825例（28.44%）医护人员因佩戴防护装备发生皮肤损伤，合计皮肤损伤数量为2 794处。主要皮肤损伤类型为压力性损伤〔771例（26.58%），人均2.53处〕、潮湿相关性皮肤损伤〔256例（8.83%），人均2.77处〕、皮肤撕裂伤〔42例（1.45%），人均3.12处〕。在发生皮肤损伤的825例医护人员中，存在≥2类皮肤损伤者221例（26.79%）。单因素分析显示：对于防护装备所致皮肤损伤发生率，男性高于女性（P<0.05），31~45岁者高于≤30岁者（P<0.016 7），工龄>10年者高于工龄<5年者（P<0.016 7），医生高于护士（P<0.05），武汉防疫定点医院高于其他医院（P<0.003 3）、其他医院中传染科高于其他科室（P<0.003 3），三级防护高于二级防护、二级防护高于一级防护（P<0.016 7），而不同连续佩戴时间医护人员皮肤损伤发生率间无统计学差异（P>0.05）。结论　抗疫防护装备所致医护人员皮肤损伤的发生率较高，并有多种类型、多个部位损伤并存现象，建议采取减压、减轻摩擦力、吸湿、护肤的综合预防措施减少医护人员皮肤损伤，同时关注性别、年龄、工作岗位等人力资源管理因素。

The Incidence and Epidemic Characteristics of Medical Staff's Skin Injuries Caused by Personal Protective Equipment for Fighting against 2019-nCoV Infection

Background　The medical device-related pressure injury（DRPI），which mainly occurs in critical patients and orthopedic patients，has been a research hotspot for the safety management and specialized care of inpatients worldwide，but there have been few reports on DRPI of medical staff.During the prevention and control of COVID-19，a large number of medical staff are fighting at the front.However，wearing protective equipment for a long time can easily cause skin injury，which seriously harms the medical staff and increases their risk of infection.Therefore，how to protect medical personnel from skin damage is an urgent problem.Objective　To investigate the incidence and epidemic characteristics of medical staff's skin injuries caused by personal protective equipment in fighting against the COVID-19 in order to provide a basis for the formulation of effective protection countermeasures.Methods　A research questionnaire was developed by our research group，including the basic information of medical staff，the wearing situation of protective equipment，the skin damage situation，preventive measures against skin damage，and the post-injury treatment.The questionnaire was released through the Questionnaire Star website to front-line medical staff fighting against the COVID-19 through Wechat app from February 8 to 15 in 2020.The survey was completed by voluntary participation and online filling.The survey data were collected in one week and a database was established.Statistical analysis was made on the incidence of skin injuries，the types of injuries，and epidemic characteristics.Results　A total of 2 901 effective questionnaires were collected from 145 hospitals in 19 provinces，3 autonomous regions and 4 municipalities in China.Among them，there were 214（7.38%） males and 2 687（92.62%） females，and 147（5.07%） doctors and 2 754（94.93%） nurses.And 825（28.44 %） cases of the medical staff suffered skin injuries due to wearing protective equipment，and the total number of skin damage sites was 2 794.The main types of skin injuries were pressure injury〔771（26.58%）cases，2.53 per capita〕，moisture-associated skin damage〔256（8.83%）cases，2.77 per capita〕，and skin tear〔42（1.45%）cases，3.12 per capita〕.Of the 825 medical staff who had skin injuries，221（26.79%） cases had skin injuries≥2 types.Univariate analysis showed that the incidence of skin injuries caused by protective equipment was higher in men than in women（P<0.05），in those aged 31-45 than in those ≤30（P<0.016 7），in those who worked >10 years than in those who worked <5 years（P<0.016 7），in doctors than in nurses（P<0.05），in designated epidemic prevention hospitals in Wuhan than in other hospitals（P<0.003 3）and among other hospitals，in Infectious Disease Department than in other departments（P<0.003 3），and in tertiary protection than in secondary protection followed by primary protection（P<0.016 7）.However，there was no significant difference in the incidence of skin injuries among medical staff with different continuous wearing time of protective equipment（P>0.05）.Conclusion　The incidence of skin injuries caused by personal protective equipment in fighting against COVID-19 is high among medical staff.Multiple types and multiple sites of skin injuries are coexisted.It is recommended to take comprehensive preventive measures of pressure relief，friction reduction，moisture absorption，and skin care to reduce skin damage of medical staff.Meanwhile，it is suggested to pay attention to human resource management factors such as gender，age，and job position.