ICU医护人员艾滋病职业暴露的预防干预研究

目的探讨重症监护病房（ICU）内人类免疫缺陷病毒（HIV）职业暴露的原因和综合预防干预的疗效。方法选择2009年1月至2010年12月本院ICU发生HIV职业暴露的患者为对照组（25例）,自2011年1月至2012年12月采用综合预防干预措施的患者作为干预组（53例）。对照组采用口罩、手套、隔离服等防护措施;综合干预组在对照组防护措施的基础上,采取AIDS患者进入ICU后常规在日间放置深静脉置管、动脉置管、密闭式吸痰管和防护面罩,由高年资、心理素质好的医护人员进行有创操作等综合预防措施。比较两组HIV职业暴露人数/收治获得性免疫缺陷综合征（AIDS）病例数比值的差异。结果 4年间本院ICU共收治AIDS危重患者78例,发生HIV职业暴露共7例,采取综合干预措施使HIV职业暴露人数/收治AIDS病例数的比值由20%减低至4%（χ^2=13.2,P〈0.05）。结论 ICU内收治AIDS患者发生HIV职业暴露的风险较高,采取综合干预措施能够降低ICU内HIV职业暴露的风险。

Intervention study on prevention of human immunodeficiency virus occupational exposure in Intensive Care Unit

Objective To investigate the factors of occupational exposure to human immunodeficiency virus（HIV） in Intensive Care Unit（ICU） and explore the effect of comprehensive protection strategy. MethodsThe occupational exposure cases to HIV in our ICU from January 2009 to December 2010 were collected as a control group（25 cases）, using conventional protection mearements including masks, gloves and isolation clothing. The occupational exposure cases to HIV from January 2011 to December 2012 were collected as intervention group（53 cases）, using a comprehensive prevention strategy including protective mask, isolating clothing, gloves and the closed suction pipe for patients, severe acquired immune deficiency syndrome（AIDS） patients conventionally receive deep venous and arterial catheter on daytime when they admit to ICU, and invasive operation by the seniority of nurses and doctors with good psychological quality and operative ability. The ratio of occupational exposure cases to HIV/AIDS cases in ICU were compared. Results There were 78 severe AIDS cases admitted to our ICU during the last four years, among those occupational exposure to HIV were 7 cases. The ratio of occupational exposure cases to HIV/AIDS cases significantly reduced from 20% to 4% by comprehensive prevention strategy（χ^2 = 13.2,P〈0.05）. Conclusions Risk of occupational exposure to HIV is higher of patients with AIDS in ICU. Comprehensive protection interventions strategy could reduce incidence of occupational exposure to HIV in ICU.