抗击新型冠状病毒肺炎一线护理人员防护暴露风险事件调查

doi:10.19723/j.issn.1671-167X.2020.04.022

摘要/Abstract

摘要：

目的: 调查抗击新型冠状病毒肺炎(corona virus disease 2019,COVID-19)一线护士防护暴露风险事件现状,为管理者做好护理人员防护提供依据。方法: 便利选取支援武汉的308名护理人员,采用研究团队自行编制的网络问卷进行调查,通过事件回顾的方式对护理人员在防护状态下的7种防护暴露风险事件进行调查。结果: 共有304人填写了有效问卷,88.8%的护理人员接受了防护暴露风险事件预防与应对的培训。7种防护暴露风险事件中,鞋套污染、脱落的发生率相对较高,为53.6%;由于有手套的保护,手部或皮肤污染发生率相对较低,为14.1%;护士心理负担最重的防护暴露风险事件是N95口罩污染、脱落或移位,分值达8.2±2.3。单因素分析发现,支援武汉天数不同,防护风险事件发生的种类数量不同(χ²=14.562,P=0.024);多元有序Logistic回归发现,男性是防护暴露风险事件发生的种类数量的独立保护因素(P=0.019)。结论: 支援武汉的一线护理人员工作中会出现防护暴露风险事件,在工作中既要指导护士防止风险事件的发生,又要指导其有效应对,从而减轻心理负担。

关键词: 冠状病毒感染, 肺炎, 病毒性, 护士, 个人防护装备, COVID-19

Abstract:

Objective: To investigate the current situation of virus exposure risk incidents of nurses against corona virus disease 2019 (COVID-19) in Wuhan, and to provide reference evidence for nursing managers to protect nursing staff who were working in the isolation ward. Methods: In the study, 308 nursing staff against COVID-19 working in the isolation ward in Wuhan were conveniently selected to participate in the investigation. The designed questionnaires including 7 kinds of protective exposure risk events were made by the team of researchers on the basis of literature review and interview with the nurses in Wuhan. All the participants recalled their working experience in the status of dressing in personal protective equipment and filled in the questionnaires online by WeChat according to the same instruction. Results: The questionnaires were filled in validly by a total of 304 nursing staff, of whom 88.8% received emergency training on the prevention and dealing measurement of exposure risk events. The incidence of shoe cover contamination, falling off or torn was relatively high, about 53.6%. Due to the protection of gloves, the incidence of hand or skin contamination was relatively low, about 14.1%. The most nervousness of protective exposure risk event for nurses was N95 mask contamination, falling off or shifting, with a score of 8.2±2.3, showing a higher psychiatric burden. Single factor analysis found that the number of days in Wuhan was different, the number of the types of protective risk events occurred was different (χ²=14.562, P=0.024), orderly multivariate Logistic regression found that men were the independent protective factor for the number of the types of protective exposure risk events that occurred (P=0.019). Conclusion: Protective exposure risk events may occur in the work of nursing staff working in the isolation ward in Wuhan. It is necessary to guide nurses to prevent the occurrence of protective exposure risk events and effectively deal with them, so as to prevent virus exposure and reduce psycholo-gical burden.

Key words: Coronavirus infections, Pneumonia, Viral, Nurses, Personal protective equipment, COVID-19

中图分类号:

R563.1

王秋,郭金玉,孙红,王泠,应菊素,刘慧鑫. 抗击新型冠状病毒肺炎一线护理人员防护暴露风险事件调查[J]. 北京大学学报（医学版）, 2020, 52(4): 711-714.

Qiu WANG,Jin-yu GUO,Hong SUN,Ling WANG,Ju-su YING,Hui-xin LIU. Investigation of protective exposure risk events in nurses against corona virus disease 2019 in Wuhan[J]. Journal of Peking University (Health Sciences), 2020, 52(4): 711-714.

图/表 4

表1

表2

防护暴露风险事件发生后的紧张程度"

Items	Higher nervoursness (score of nervousness≥6), n (%)	The degree of nervousness, $x ?$ ±s
Contamination of hand and skin (n=42)	23 (54.8)	5.8±3.0
Contamination, falling off, or torn of shoe cover (n=160)	71 (45.5)	5.0±2.5
Contamination, falling off or torn of isolation gown (n=84)	55 (65.5)	6.1±2.6
Falling off or shifting of N95 mask (n=62)	55 (88.7)	8.2±2.3
Falling off or shifting of surgical mask (n=38)	29 (78.4)	6.4±2.4
Contamination, falling off or shifting of goggles (n=13)	9 (69.2)	6.6±2.4
Contamination, falling off or shifting of splash screen (n=81)	49 (60.5)	6.1±2.8

表2

表3

表4

参考文献 4

[1]	国家卫生健康委员会. 医疗机构内新型冠状病毒感染预防与控制技术指南(第一版)[EB/OL]. (2020-01-22)[2020-3-8]. http://www.nhc.gov.cn/yzygj/s7659/202001/b91fdab7c3044-31eb082d67847d27e14.shtml.
[2]	付强. 基于COVID-19疫情应对的医疗机构内感染防控实践思考[J]. 中华医院感染学杂志, 2020,30(8):1121-1124.
[3]	国家卫生健康委员会. 新型冠状病毒肺炎诊疗标准(第七版)[EB/OL]. [2020-3-4]. http://www.gov.cn/zhengce/zheng-ceku/2020-02/22/content_5482010.htm.
[4]	赵红, 谢少清, 杨会志, 等. 新冠肺炎医疗队医务人员感染防控相关需求调查[J]. 中国感染控制杂志, 2020,19(5):398-403.

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Items	0 time	1 time	2 times	3 times	≥4 times
Contamination of hand and skin	261 (85.9)	17 (5.6)	9 (3.0)	5 (1.6)	12 (3.9)
Contamination, falling off, or torn of shoe cover	144 (47.4)	62 (20.4)	60 (19.7)	15 (4.9)	23 (7.6)
Contamination, falling off or torn of isolation gown	215 (70.7)	33 (10.9)	25 (8.2)	14 (4.6)	17 (5.6)
Falling off or shifting of N95 mask	241 (79.3)	29 (9.5)	24 (7.9)	6 (2.0)	4 (1.3)
Falling off or shifting of surgical mask	266 (87.5)	19 (6.3)	10 (3.3)	8 (2.6)	1 (0.3)
Contamination, falling off or shifting of goggles	290 (95.4)	4 (1.3)	7 (2.3)	3 (1.0)	0
Contamination, falling off or shifting of splash screen	222 (73.0)	51 (16.8)	19 (6.3)	7 (2.3)	5 (1.6)

Days in Wuhan	≤1 kind	2-4 kinds	≥5 kinds
10-20 d	11 (61.1)	6 (33.3)	1 (5.6)
21-30 d	110 (52.4)	94 (44.8)	6 (2.9)
31-40 d	32 (53.3)	27 (45.0)	1 (1.7)
≥41 d	10 (62.5)	3(18.8)	3 (18.8)

Items	n (%)	B	SE	Wald	P	OR	95%CI
Age		-0.009	0.094	0.008	0.927	1.022	1.201-0.871
Working years		0.041	0.083	0.244	0.621	0.937	1.079-0.813
Gender
Male	41 (16.0)	1.053	0.450	5.480	0.019	0.349	0.843-0.144
Female	216 (84.0)
Days in Wuhan
10-20 d	18 (5.9)	-1.050	0.904	1.348	0.246	2.858	16.827-0.485
21-30 d	210 (69.1)	-0.890	0.722	1.517	0.218	2.435	10.024-0.591
31-40 d	60 (19.7)	-0.849	0.762	1.241	0.265	2.337	10.412-0.525
≥41 d	16 (5.3)
Shifts of one week
≤5	204 (79.4)	-0.440	0.390	1.272	0.259	1.552	3.333-0.723
≥6	53 (20.6)
Working hours for one shift
≤4 h	140 (54.5)	1.513	1.121	1.822	0.177	0.220	1.982-0.025
5-8 h	113 (44.0)	1.266	1.102	1.319	0.251	0.282	2.445-0.033
≥9 h	4 (1.6)