Madan Atul K, Raafat Aml, Hunt John P, Rentz David, Wahle Mark J, Flint Lewis M
Department of Surgery, Tulane University, New Orleans, Louisiana, USA.
J Trauma. 2002 Mar;52(3):540-3. doi: 10.1097/00005373-200203000-00020.
The risk of blood and body fluid exposure and, therefore, risk of blood-borne disease transmission is increased during trauma resuscitations. Use of barrier precautions (BPs) to protect health care workers (HCWs) from exposure and infection has been codified in hospital rules and in national trauma education policy. Despite these requirements, reported rates of BP compliance vary widely. The reasons for noncompliance are not known. This study assesses self-reported rates of BP usage during resuscitations among trauma professionals, explores reasons for noncompliance, and compares self-reported compliance rates with actual observed compliance rates.
A survey regarding BPs was distributed to all HCWs involved in trauma resuscitations at our Level I trauma center. All surgical and emergency medicine residents as well as attending faculty from both disciplines and nursing staff were included in this study. A total of 161 surveys were distributed and 123 were returned.
Most HCWs (114 of 123 [93%]) reported at least one exposure (usually intact skin contact) to blood or other body fluids. A considerable variation in the type of BP used was reported for those HCWs who reported use of BPs "all of the time." Of the HCWs who reported universal use of BPs, reported usage rates were as follows: gloves, 105 of 123 (85%); eyewear (no side protectors), 58 of 123 (47%); eyewear (side protectors), 20 of 123 (16%); gowns, 22 of 123 (18%); and masks, 5 of 123 (4%). The two most common reasons for noncompliance were "time factors" (61%) and "BPs are too cumbersome" (29%). Observed compliance rates were statistically significantly lower than self-reported rates in all BPs except gloves (p < 0.02).
The wide variation in BP use and the gap between perceived and actual usage that we have observed suggest that the effectiveness of current educational approaches to ensure BP use is inadequate.
在创伤复苏过程中，血液和体液暴露的风险增加，因此血源性疾病传播的风险也会增加。医院规定和国家创伤教育政策已将使用屏障防护措施（BPs）来保护医护人员（HCWs）免受暴露和感染的要求进行了编纂。尽管有这些要求，但报告的BP依从率差异很大。不依从的原因尚不清楚。本研究评估了创伤专业人员在复苏过程中自我报告的BP使用率，探讨了不依从的原因，并将自我报告的依从率与实际观察到的依从率进行了比较。
向我们一级创伤中心参与创伤复苏的所有医护人员发放了一份关于BPs的调查问卷。本研究纳入了所有外科和急诊医学住院医师以及这两个学科的主治教员和护理人员。共发放了161份调查问卷，回收了123份。
大多数医护人员（123人中的114人[93%]）报告至少有一次接触血液或其他体液（通常是完整皮肤接触）。对于那些报告“一直”使用BPs的医护人员，所报告的BP使用类型存在相当大的差异。在报告普遍使用BPs的医护人员中，报告的使用率如下：手套，123人中的105人（85%）；眼镜（无侧护罩），123人中的58人（47%）；眼镜（有侧护罩），123人中的20人（16%）；隔离衣，123人中的22人（18%）；口罩，123人中的5人（4%）。不依从的两个最常见原因是“时间因素”（61%）和“BPs太笨重”（29%）。除手套外，所有BPs的实际观察依从率在统计学上均显著低于自我报告率（p < 0.02）。
我们观察到的BP使用的广泛差异以及感知使用和实际使用之间的差距表明，当前确保BP使用的教育方法的有效性不足。
