换输液瓶时护士需不需要戴口罩？

草原星空

象这种该做未做的环节在院感控制中有很多，主要是长期的不良习惯和感控意识不强，需要时间来逐一强化。

grglk9339

同意老师们的观点，但从国外回来的老师讲，在国外是不需要戴口罩的。是否需要戴口罩有没有科学依据，实际工作中（大大小小的医院）完全落实了没有，每个人心里都有数，是否必要？个人认为更应该有科学依据才好。

wjllulu

这里也有一个是否应戴口罩的讨论：
Intrathecal injection warrants mask worn by clinician during procedure
From the June 18, 2009 issue

    Last month, two women who had just given birth to healthy babies developed bacterial meningitis following intrathecal injections of anesthesia by the same anesthesiologist. One of the mothers, who was only 30 years old, died within days of acquiring the infection, while the other mother is still recovering. Cultures identified Streptococcus salivarius, a common organism found in the mouth and respiratory tract, as the bacteria that caused the meningitis in both women.

     The department of health in Ohio, where this incident occurred, investigated the adverse events, collecting patient, drug, and equipment samples and reviewing the practices associated with the delivery of spinal or epidural anesthesia during labor. According to a news report,1 the health department identified infection control problems as well as inadequate patient monitoring post spinal anesthesia as contributory to the events. In particular, the health department determined that the events may have been linked to the anesthesiologist’s failure to wear a mask during the administration of spinal medications. The health department’s inspectors also found outdated medications in the labor and delivery area but did not conclude they were linked to the outbreak, as the microorganism implicated in the events is common in nasal and oropharyngeal flora.

According to the medical director at the hospital where the events happened, anesthesiology teams did not routinely wear surgical masks during spinal/epidural procedures （为什么以前不戴？是没要求? 还是不执行？）—although they do now. Wearing a mask during these procedures may seem a reasonable precaution, even though bacterial meningitis or infections such as epidural abscesses are rare sequelae of spinal anesthesia. Yet, the issue has been widely debated, and literature on this topic can be found in support of both wearing and not wearing a mask.（ 如同我们论坛今天的这个热议题目一样讨论热烈！）

Proponents of wearing a mask cite common sense and well-established evidence proving the effectiveness of universal precautions (to protect worker and patient) as adequate to convince anesthesiologists to wear a mask during administration of spinal/epidural anesthesia. However, if more evidence is needed, proponents point to multiple studies that link bacterial meningitis and epidural abscesses to Streptococcus pathogens cultured from the nose or throat of clinical staff, including anesthesiologists. Moreover, laboratory evidence corroborates the clinical value of surgical masks in preventing the transmission of organisms from the upper airway and limiting bacterial contamination of a surface.（这些事实是正方的辩词！）

Opponents of wearing a mask during spinal/epidural anesthesia suggest there are more case reports and studies in the literature that describe the occurrence of bacterial meningitis and epidural abscesses despite the anesthesiologist wearing a face mask than there are implicating the anesthesiologist when no mask was worn. They acknowledge that case reports often implicate nose and throat flora of the anesthesiologist, but suggest that the studies do not prove the anesthesiologist (or other clinician) actually caused the infection. Some studies of iatrogenic bacterial meningitis and epidural abscesses also fail to mention whether a mask was worn or not during the procedure, making it difficult to draw accurate conclusions on the subject. While one well-cited study showed that face masks decreased growth in agar plates placed 30 cm in front of anesthesiologists who talked for several minutes, the same study showed increased bacterial growth once the masks had been worn for 15 minutes when compared to wearing no mask at all. Since anesthesiologists rarely change their masks during a procedure (and may use the same mask for the entire day), the mask may increase the risk of transmitting a bacterial infection. The need to wear a mask during a spinal/epidural procedure is also questioned on the basis of evidence that masks do not actually decrease the rate of surgical wound infections. （这些情况是反方的辩词！）

    In 2004, the Centers for Disease Control and Prevention (CDC) investigated eight cases of post-myelography meningitis that were reported or identified through a survey. Blood and/or cerebrospinal fluid of all eight cases yielded Streptococcal species consistent with nasal and oropharyngeal flora, and there were changes in the cerebrospinal fluid indices and clinical status indicative of bacterial meningitis. Equipment and products used during these procedures (e.g., contrast media) were excluded as probable sources of contamination. Procedural details available for seven cases determined that antiseptic skin preparations and sterile gloves had been used. However, none of the clinicians wore a face mask, giving rise to the speculation that droplet transmission of nasal and oropharyngeal flora was the most likely explanation for these infections. (说不清楚就是重大嫌疑！)

     In October 2005, the Healthcare Infection Control Practices Advisory Committee (HICPAC) reviewed this evidence as well as cases of bacterial meningitis and epidural abscesses previously reported in the literature. HICPAC concluded that there is sufficient evidence to warrant the additional protection of a face mask worn by the individual placing a catheter or injecting material into the spinal or epidural space. Thus, the CDC recommends wearing a mask when carrying out these procedures, including myelograms and lumbar punctures. （为何到2005年才强调戴口罩？而且还只是IB?）The recommendation is categorized on the basis of existing scientific data as “1B”: Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale. (A category “1A” recommendation would be based on strong support by well-designed experimental, clinical, or epidemiological studies.)

     The decision by HICPAC and CDC to recommend wearing a mask was based in large part on evidence that face masks are effective in limiting the dispersal of oropharyngeal droplets and are currently recommended as an evidence-based practice for the placement of central venous catheters. Although the absence of a mask during initiation of spinal or epidural anesthesia may not necessarily cause the patient to develop an infection, most evidence points to the fact that it makes the procedure a safer one. It would appear that not wearing a mask is hard to justify when identical organisms have been grown from patient cultures and nasal swabs from anesthesiologists who did not wear a mask.（我想这就是我们需要的最佳答案吧。）

为有暗香来

戴口罩是应该的，必需的。只要是操作就应该戴口罩。

豌豆369

医务人员做到一般防护也应戴口罩~~

守望者06

防止对输液过程造成污染，应该属于无菌操作，要戴的，必须。

烟雨红尘

回复 1# 茉莉花开


    这还算好的了，我有一次跟某科护士长说，有护士输液时未戴口罩，她居然问我“输液是属于无菌操作吗？”无语。

huanghuimin

我院静脉输液与换液均需戴口罩，更换液体是静脉输液过程中的一个步骤，同时更换过程中对密闭的液体有短暂的暴露（插针的过程）

吕永红123

应该戴口罩，换液体也是无菌操作。