医务人员脱下个人防护装备时的污染
：医务人员脱下个人防护装备时的污染2016年01月09日 ⁄Original Investigation
Contamination of Health Care Personnel During Removal of Personal Protective Equipment
Myreen E. Tomas, Sirisha Kundrapu, Priyaleela Thota, et al
JAMA Intern Med. 2015; 175(12): 1904-1910.
doi:10.1001/jamainternmed.2015.4535
Published online October 12, 2015.
摘要
IMPORTANCE重要性
Contamination of the skin and clothing of health care personnel during removal of personal protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for infection.
医务人员在脱下个人防护装备(PPE)时皮肤和衣物的污染可能引起致病菌的传播，并增加医务人员发生感染的风险。
OBJECTIVES目的
To determine the frequency and sites of contamination on the skin and clothing of personnel during PPE removal and to evaluate the effect of an intervention on the frequency of contamination.
确定脱下PPE时皮肤及衣物发生污染的发生率及部位，评价干预措施对污染发生率的影响。
DESIGN, SETTING, AND PARTICIPANTS试验设计，场所及参加者
We conducted a point-prevalence study and quasi-experimental intervention from October 28, 2014, through March 31, 2015. Data analysis began November 17, 2014, and ended April 21, 2015. Participants included a convenience sample of health care personnel from 4 Northeast Ohio hospitals who conducted simulations of contaminated PPE removal using fluorescent lotion and a cohort of health care personnel from 7 study units in 1 medical center that participated in a quasi-experimental intervention that included education and practice in removal of contaminated PPE with immediate visual feedback based on fluorescent lotion contamination of skin and clothing.
2014年10月28日至2015年3月31日，我们进行了一项时点患病率研究及准实验性(quasi-experimental)干预研究。对2014年11月17日至2015年4月21日的数据进行分析。参加者包括俄亥俄州东北部4所医院的医务人员（使用荧光溶液进行脱下污染PPE的模拟），以及一个医学中心的7个病房（参加了一项准实验性干预研究，包括有关脱下污染PPE的宣教与操作，并根据皮肤及衣物荧光溶液污染情况立即进行视频反馈）。
MAIN OUTCOMES AND MEASURES主要预后指标
The primary outcomes were the frequency and sites of contamination on skin and clothing of personnel after removal of contaminated gloves or gowns at baseline vs after the intervention. A secondary end point focused on the correlation between contamination of skin with fluorescent lotion and bacteriophage MS2, a nonpathogenic, nonenveloped virus.
主要预后指标为脱下污染的手套或隔离衣后，皮肤和衣物污染的发生率及部位的基线数值及干预后数值。次要预后终点为皮肤发生荧光溶液污染及噬菌体MS2（一种非致病性无荚膜病毒）污染的相关性。
RESULTS结果
Of 435 glove and gown removal simulations, contamination of skin or clothing with fluorescent lotion occurred in 200 (46.0%), with a similar frequency of contamination among the 4 hospitals (range, 42.5%-50.3%). Contamination occurred more frequently during removal of contaminated gloves than gowns (52.9% vs 37.8%, P = .002) and when lapses in technique were observed vs not observed (70.3% vs 30.0%, P < .001). The intervention resulted in a reduction in skin and clothing contamination during glove and gown removal (60.0% before the intervention vs 18.9% after, P < .001) that was sustained after 1 and 3 months (12.0% at both time points, P < .001 compared with before the intervention). During simulations of contaminated glove removal, the frequency of skin contamination was similar with fluorescent lotion and bacteriophage MS2 (58.0% vs 52.0%, P = .45).
在总共435次脱下手套和隔离衣的模拟操作中，共有200次(46.0%)发生了皮肤或衣物的荧光溶液污染，4所医院的污染发生率相似（范围42.5-50.3%）。与脱下隔离衣相比，脱下污染手套时更容易发生污染(52.9% vs 37.8%, P = .002)，观察到出现错误时更容易发生污染(70.3% vs 30.0%, P < .001)。干预措施使得脱下手套和隔离衣时皮肤及衣物污染发生率降低（干预前60.0% vs 干预后18.9%，P < .001），这一效果在1个月和3个月后仍然持续（两个时间点均为12.0%，与干预前相比P < .001）。在脱下污染手套的模拟操作中，皮肤被荧光溶液污染的发生率与噬菌体MS2的污染发生率相似(58.0% vs 52.0%, P = .45)。
CONCLUSIONS AND RELEVANCE结论及意义
Contamination of the skin and clothing of healthcare personnel occurs frequently during removal of contaminated gloves or gowns. Educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE.
医务人员脱下污染手套或衣物时经常发生皮肤及衣物的污染。包括对皮肤和衣物污染情况立即进行视频反馈在内的教育措施能够显著降低脱下PPE时污染的风险。 医务人员脱下污染手套或衣物时经常发生皮肤及衣物的污染.这种情况可能是我们平时常有发生的。 此文章对感控日常工作的指导意义真大啊！ 学习了！谢谢分享{:1_1:}{:1_1:} 谢谢老师分享，学习了。 谢谢分享，以后在职业防护培训时，强调要正确脱防护用品，否则会造成再次污染。 谢谢老师分享，学习了。 谢谢分享，路过学习了！ 谢谢老师分享，学习了。 认真学习了，平时还真的没注意这一块，感谢老师的分享。 以前还没有关注到此类问题，多谢老师提醒 研究细致，数据有说服力！ 在培训时也特别强调脱防护服防止再次污染，很关键，谢谢分享！ 路过学习了，谢谢老师分享 ”医务人员脱下个人防护装备时的污染“…手卫生作为最后一层重要保障。谢谢！
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