诊断学理论与实践

诊断学理论与实践 ›› 2022, Vol. 21 ›› Issue (02): 178-183.doi: 10.16150/j.1671-2870.2022.02.015

• 抗疫实践交流 • 上一篇    下一篇

新型冠状病毒疫情相关防疫工作人员感染防控实践调查分析及对策

施莺莺a, 钟旭b, 刘嘉琳c, 何乐d, 熊少洁e, 翁懿f, 丁成唯e, 杨溢g, 陈伟红h, 邱力萍i, 辛海光j()   

  1. a. 上海交通大学医学院附属瑞金医院 手术室,上海 200025
    b. 上海交通大学医学院附属瑞金医院 内分泌科,上海 200025
    c. 上海交通大学医学院附属瑞金医院 重症医学科,上海 200025
    d. 上海交通大学医学院附属瑞金医院 北部院区药剂科,上海 200025
    e. 上海交通大学医学院附属瑞金医院 胃肠外科,上海 200025
    f. 上海交通大学医学院附属瑞金医院 口腔科,上海 200025
    g. 上海交通大学医学院附属瑞金医院 心脏外科,上海 200025
    h. 上海交通大学医学院附属瑞金医院 肾脏内科,上海 200025
    i. 上海交通大学医学院附属瑞金医院 院长办公室,上海 200025
    j. 上海交通大学医学院附属瑞金医院 感染科,上海 200025
  • 收稿日期:2022-05-13 出版日期:2022-05-30 发布日期:2022-04-25
  • 通讯作者: 辛海光 E-mail:xinhgrj@163.com
  • 基金资助:
    2019年度“创新行动计划”上海市青年科技英才扬帆计划(19YF1429400);2019年上海市“医苑新星”青年医学人才培养资助计划(沪卫人事（2020）87号)

Hospital infection prevention and control practices in anti-epidemic medical staff and workers during COVID-19 epidemic: investigation and countermeasures

SHI Yingyinga, ZHONG Xub, LIU Jialinc, HE Led, XIONG Shaojie, WENG Yf, DING Chengweie, YANG Yg, CHEN Weihonh, QIU Lipingi, XIN Haiguangj()   

  1. a. Department of operating room, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    b. Department of Endocrinology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    c. Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    d. Department of Pharmacy of North Branch, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    e. Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    f. Department of Stomatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    g. Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    h. Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    i. Department of Director′s Office, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    j. Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2022-05-13 Online:2022-05-30 Published:2022-04-25
  • Contact: XIN Haiguang E-mail:xinhgrj@163.com

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摘要：

目的：调查新型冠状病毒（新冠）感染疫情期间,抗疫医护及工勤人员在医院感染防控（感控）实践（感控意识、措施执行）中的差异,分析并提出相应对策。方法：自主设计感控实践调查问卷,通过互联网问卷调查形式,对2022年3月至4月期间我院参加抗疫工作的医护及工勤人员250人开展实践及培训效果调查。结果：共回收问卷208份,有效问卷192份,其中医护人员158人（82.3%）,保洁、保安等工勤人员34人（17.7%）。工勤人员与医护人员进入隔离点前对新冠肺炎相关知识知晓比例（58.8% 比 89.2%）、医院感控制度流程知晓比例（67.6%比91.1%）、口罩的规范使用比例（82.4%比98.7%）、职业暴露后处置流程的知晓比例（58.8%比98.7%）、感控意识程度（47.1%比98.7%）、生活区感控执行情况（47.1%比94.3%）间存在显著差异（P<0.05）。工勤人员在污染区工作期间出现多汗、呼吸不畅、头晕乏力等身体不适者所占的比例显著低于医护人员（2.9%比11.5%,P<0.001）。通过开展情景模拟化培训考核及实时全程“一对一”现场监督等针对性的措施后,这两类群体的感控实践规范均得到显著改善,医护人员对新冠肺炎相关知识的知晓程度由89.2%上升到99.4%,（P<0.001）,工勤人员由58.8%上升到85.3%（P=0.015）;医护人员对医院感控制度流程的知晓程度由91.1%上升到98.7%（P=0.002）,工勤人员从67.6%上升到100%（P<0.001）。工勤人员中医院感控考核成绩为90~95分的比例从29.4%上升到38.2%,95分以上的比例从32.4%上升到58.8%（P<0.001）。结论：工勤人员的感控实践规范执行及感控意识低于医护人员,是引发医院感染的高风险人群。采用情景模拟化培训考核方式、实时全程进行“一对一”现场监督等措施,能有效提高医护尤其是工勤人员的感控意识和实践能力。

关键词: 新型冠状病毒肺炎, 医护人员, 工勤人员, 感染防控培训

Abstract:

Objective: To investigate differences in infection control awareness, and related implementation of measures between anti-epidemic medical staff and workers during the outbreak of novel coronavirus (COVID-19) infection, and to propose corresponding countermeasures. Methods: A self-designed questionnaire on the practice of infection control and implement were conducted, and 250 medical staff and workers participating in the anti-epidemic work in our hospital from March to April 2022 were investigated online. Results: A total of 208 valid questionnaires were recovered, of which 192 were valid questionnaires, including 158 medical staff (82.3%) and 34 (17.7%) workers. Before entering the isolation point, the proportion of workers vs medical staff who knew the knowledge about COVID-19, hospital infection control procedures, standardized use of masks, awareness of occupational post-exposure disposal procedures, awareness of sensory control and implementation of sensory control in living areas were 58.8% vs 89.2%, 67.6% vs 91.1%, 82.4% vs 98.7%, (58.8% vs 98.7%), (47.1% vs 98.7%), (47.1% vs 94.3%) (P<0.05). However, the proportion of discomfort such as sweating, poor breathing, dizziness and fatigue during work in the polluted area was significantly lower than those of medical staff（2.9% vs 11.5%, P<0.001）. Then targeted measures such as scenario simulation training assessment and real-time "one-to-one" on-site supervision were performed,and the infection control practice norms of these two groups have been significantly improved. The proportion of medical staff with knowledge about new coronary pneumonia and aware of the hospital infection system process increased to 99.4% (P<0.001) and to 98.7% (P=0.002), respectively, while of workers increased to 85.3% (P=0.015) and to 100% (P<0.001). The proportion of workers got a score of 90-95 on hospital infection theory and operation increased from 29.4% to 38.2%, and the proportion with a score of 95 or above increased from 32.4% to 58.8% (P<0.001). Conclusions: The implement and and awareness of infection control practice in workers is worse than those of medical staff, and workers are a high-risk group for hospital infection. The scenario simulation training and real-time assessment methods, whole process "one-to-one" on-site supervision can effectively improve the awareness and practical ability of medical staff, especially workers.

Key words: COVID-19, Hospital workers, Medical staff, Infection prevention and control training

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