综合医院手术室实习护生血源性职业暴露及标准预防现状的调查研究

发布时间：2018-01-08 11:27

本文关键词：综合医院手术室实习护生血源性职业暴露及标准预防现状的调查研究　出处：《东南大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过调查了解目前综合医院手术室实习护生血源性职业暴露的现状和接受职业防护教育的基本情况,了解手术室实习护生标准预防知识掌握情况以及标准预防执行的现状;分析其主要影响因素,针对性提出合理化建议,从而提高手术室实习护生职业防护以及标准预防的认知水平,在临床实习前做好各项准备工作,贯彻执行标准预防的各项措施,最大程度降低血源性职业暴露风险,从而降低院内感染发生率。方法:通过方便抽样选择江苏省某中医院手术室实习护生230名作为调查对象,采用以问卷调查为主,访谈和现场观察相结合的调查方法,应用SPSS18.0统计软件对资料进行统计描述和统计推断,主要采用构成比、卡方检验、相关分析、单因素分析以及多因素分析对结果进行阐述、分析。结果:本次研究共抽取江苏省某中医院手术室实习护生230人,发放230份调查问卷,回收有效问卷224份,问卷有效率98.67%;手术室实习护生血源性职业暴露及标准预防知识、执行情况调查问卷克隆巴赫系数为0.91,调查问卷具有良好的信度;内容效度指数I-CVI=1,S-CVI=0.96,调查问卷具有良好的内容效度。本次调查中手术室实习护生均为本科和专科学历,无中专学历,其中本科学历占比偏低(20.1%),平均年龄21.2岁,女生占绝大多数(93.3%)。手术室实习护生血源性职业暴露频繁,大部分护生实习期间接触过乙肝、艾滋病等血源性传播疾病患者。将本次调查中手术室实习护生接触乙肝病毒携带者和艾滋病毒携带者的情况进行卡方检验,χ2为10.61,P小于0.05,差异有统计学意义。手术室实习护生血源性职业暴露的主要威胁来源于乙型肝炎病毒,但是仅有70.1%的实习护生注射过乙肝疫苗,39.7%的实习护生乙肝抗体为阳性。实习护生实习期间针刺伤发生率很高,95.1%的护生实习期间发生过针刺伤,发生针刺伤时大部分实习护生处于抢救病人的工作状态,其次是工作比较繁忙时,发生针刺伤后,99%的护生都及时进行了必要的处理,但每次都汇报的比例不高,仅占17%。不汇报的原因大部分是认为轻微不足以汇报,其次是不知道向谁汇报。大部分手术室实习护生接受过标准预防教育,但接受标准预防教育的次数少,平均1-2次。接受标准预防教育的途径主要是传统途径,96.9%的实习护生认为需要继续接受标准预防和职业防护的相关培训。标准预防相关知识缺乏,尤其是手术室相关专科知识缺乏,本科学历的手术室实习护生标准预防知识掌握情况优于专科学历的手术室实习护生。职业防护用具使用率低,护目镜的的使用率仅为21%,隔离衣使用率仅为18%,影响实习护生戴护目镜、穿隔离衣的主要原因是不易获得。手套使用不规范,影响实习护生戴手套的主要原因是戴手套手感不好,影响操作。大部分手术室实习护生注射器、手术刀片等锐器处理较为规范,医疗垃圾的分类较为理想,但是手术刀、缝针的传递规范化程度较低,接触血液传播疾病患者时戴双层手套情况差,连台手术手术间清洁不彻底,一人一床单被套执行不到位。与手术室专科性强,实习护生专科理论知识缺乏以及专科操作不熟练有关。结论:手术室实习护生血源性职业暴露严重,主要面临乙型肝炎病毒的威胁,职业防护不到位。卫生行政主管部门应规范各级医院的职业防护用品配备,确保各类人员获得必需的职业防护用品。实习护生普遍自我防护意识差,对自身乙肝抗体情况不了解,未能全部进行疫苗接种或补种。因此学校在临床实习前动员实习护生检测乙肝抗体情况并注射乙肝疫苗。大部分实习护生进行临床实习前接受了标准预防和职业防护教育,但次数少,专科针对性差。接受标准预防教育和职业防护的途径以传统途径为主。医学院校可以考虑增加标准预防和职业防护教育的课时数,丰富教学形式。标准预防相关知识缺乏,尤其是手术室专科防护知识缺乏,需要进行系统的专科职业防护教育。手术室带教老师可针对手术室特点采用多种教学形式向实习护生讲解面临的职业暴露风险以及防护对策。标准预防执行情况不容乐观。尤其是手术室专科标准预防执行情况令人堪忧。建议规范操作流程并推广使用安全型耗材。
[Abstract]:Objective: To investigate the current status of general hospital operation room practice hematogenous occupation exposure and the basic acceptance of occupation protection education for nursing students, nursing students in the operation room to understand and master the current status of standard prevention knowledge of standard prevention; analysis of the main influencing factors, puts forward reasonable suggestions, so as to improve the cognitive level of nursing practice in operation room health protection and prevention of occupation standard, do the preparatory work in clinical practice, the implementation of the measures of prevention standards, to minimize the risk of blood borne occupation exposure, so as to reduce the incidence of nosocomial infection. Methods: by convenience sampling in Jiangsu Province in a hospital operation room nursing students of 230 as the research object, using the based on a questionnaire survey method, interviews and field observation combined with the application of statistical software SPSS18.0 for statistical data Description and statistical inference, mainly by constituent ratio, chi square test, correlation analysis, single factor analysis and multi factor analysis of the results described and analyzed. Results: the study from Jiangsu Provincial Hospital of traditional Chinese medicine operation room, 230 nursing students, issued 230 questionnaires, 224 valid questionnaires, questionnaire the efficiency of the 98.67% nursing students in the operation room; hematogenous occupation exposure and standard prevention knowledge, the implementation of the questionnaire clone of Bach coefficient is 0.91, the questionnaire has good reliability; the content validity index of I-CVI=1 and S-CVI=0.96, the questionnaire has good content validity. Operation room the survey of nursing students for undergraduate and college education, no secondary education, undergraduate education accounted for the low (20.1%), the average age is 21.2 years old, girls are in the majority (93.3%). Nursing students in the operation room of hematogenous occupation exposed frequently, most of nursing students in internship The contact between the hepatitis B patients, AIDS and other blood borne diseases. The operation room in this investigation practice exposure to hepatitis B virus carriers and HIV carriers in nursing students of the chi square test, 2 x 10.61, P less than 0.05, the difference was statistically significant. Nursing students in the operation room the main sources of threat exposure to blood borne hepatitis occupation hepatitis B virus, but only 70.1% of the injected hepatitis B vaccine internship nursing students, 39.7% nursing students of hepatitis B antibody was positive. Nursing students during the period of high incidence of needlestick injuries among nursing students during the internship, 95.1% had needle needle stabbed when most of nursing students in rescuing patients working state, then work is busy, the needle stabbed, 99% nursing students were carried out in a timely manner the necessary treatment, but each reporting ratio is not high, only accounted for a large part of 17%. does not report is recognized For the slight to report, then do not know who to report to. Most of nursing students in the operation room received the standard preventive education, but the number of accepted standard prevention education, the average 1-2 times. Way of accepting standard prevention education is mainly traditional way, 96.9% internship training that continue to accept the standard prevention and protection for occupation the standard of nursing students. Prevention of lack of knowledge, especially the lack of knowledge related to operation room specialist, undergraduate nursing students in the operation room of standard prevention knowledge is better than college degree nursing students in the operation room. Occupational protective equipment utilization rate is low, the use of goggles the rate was only 21%, the usage rate of scrubs is only 18%. Wear goggles to student nurses' practice, the main reason is not easy to wear gowns. Gloves are not standardized, the main reason of nursing students wearing gloves is wearing gloves hand feeling not good practice effect, Effect of injector operation. Most of nursing students in operation room surgery practice, sharp blade processing is standard, classification of medical waste is ideal, but the scalpel, needle transfer standardization degree is low, wearing double gloves of blood transmitted diseases in patients with poor contact, even surgery operating room cleaning is not thorough, a bedspread the implementation is not in place. And the operation room specialized nursing students, lack of specialized knowledge and the specialized operation is not skilled. Conclusion: nursing students in the operation room of hematogenous occupation exposure is serious, the main face of hepatitis B virus threats, occupation protection is not in place. The health administrative departments at all levels should occupation protection standard hospital equipped to ensure all kinds of personnel to obtain occupation protective equipment required. Students generally poor awareness of self protection practice, lack of understanding of their own cases of hepatitis B antibody, not all disease Inoculation or replant. So the school in the clinical practice of detection of hepatitis B antibody and mobilization of hepatitis B vaccine for nursing students. Most of nursing students before clinical practice accepted standard prevention and occupation protection education, but fewer college targeted poor. Accept the standard way of prevention education and occupation protection in the traditional way.. medical colleges can consider increasing the number of hours in the standard prevention and occupation protection education, enrich the teaching forms. The standard prevention of lack of knowledge, especially the lack of knowledge of specialized in operation room door, the need for specialized vocational protection education system. Teachers can according to the operation room operation room features using a variety of teaching forms to the nursing students on the face occupation exposure and protection countermeasures. Standard prevention situation is not optimistic. Especially the implementation of worrying prevention operation room specialist standard. It is recommended to standardize the operation process and promote the use of safe consumables.

【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R47

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