医务人员感染严重急性呼吸综合征影响因素的调查研究

摘要

Objective: To investigate the protective factors and risk factors of nosocomial infection of severe acute respiratory syndrome (SARS) among health care workers (HCWs) , and thus provide the scientific basis for prevention and control of nosocomial infection. Methods: With the case-control study,a standardized questionnaire was used for data collection in three general hospitals where nosocomial infection had occurred. Univariate analysis was done at first. All concerned factors about SARS infection were scanned by using Chi-square test and Fisher' s exact test one by one, and determined as to whether they were risk factors or protective factors according to odd ratio (OR) score. Then, multivariate unconditional logistic regression analysis was used to re-analyze the picked-out factors for finding out which factors played independent roles. Results: Twenty-two factors (nineteen protective factors and three risk factors), among the total fifty-six factors, were significantly associated with SARS infection. Multivariate unconditional logistic regression revealed that factors such as double exposure suits ( OR = 0.053 ), education ( OR =0.072), gloves ( OR =0.102), hands sterilized by iodine ( OR =0.231 ), room air ventilation (OR = 0.32), were significantly protective; conversely, tracheal intubation ( OR = 30.793 ) was a significant risk factor. Conclusion: Strict defense and antisepsis measures were pivotal in preventing SARS infection among high-risk medical personnel. Education about associated knowledge and effective air ventilation were also important factors.%目的:研究医务人员在医院内感染严重急性呼吸综合征(SARS)有关影响因素,以探讨罹患SARS的保护因素和危险因素,并为今后更好地预防和控制院内感染提供科学依据.方法:采用病例-对照研究方法,在3家发生SARS院内感染的综合性医院,用调查问卷形式收集资料.运用卡方检验和Fisher精确概率法,对调查因素逐一进行单因素分析,明确其对SARS发病是否有显著意义,并根据OR值确定其为保护因素或危险因素.然后进行多因素分析,通过非条件Logistic回归统计,综合分析保护因素和危险因素的作用,确定哪些因素作用更为重要,即是具有独立作用的保护因素或危险因素.结果:在56个调查因素中,有22个因素与医务人员感染SARS有显著关联.其中,对SARS感染有保护作用的因素有19个,危险因素有3个.对上述22个因素的非条件Logistic回归统计,结果表明在所有因素中,穿两层防护服(OR=0.053)、接受过防护知识培训(OR=0.072)、戴手套(OR=0.102)、用碘伏擦拭或浸泡进行手消毒(OR=0.231)和办公区通风良好(OR=0.32)是独立的有显著作用的保护因素;参加气管插管操作(OR=30.793)是独立的危险因素.结论:对高危医务人员实施严格的防护和消毒措施是避免感染的关键环节,同时及时进行相关知识培训和提供有效的通风环境是避免感染SARS的重要因素.