免提技术在减少手术室损伤方面的有效性。
Effectiveness of the hands-free technique in reducing operating theatre injuries.
作者信息
Stringer B, Infante-Rivard C, Hanley J A
机构信息
Department of Epidemiology and Biostatistics, Faculty of Medicine and Dentistry, University of Western Ontario, London, Canada.
出版信息
Occup Environ Med. 2002 Oct;59(10):703-7. doi: 10.1136/oem.59.10.703.
BACKGROUND
Operating theatre personnel are at increased risk for transmission of blood borne pathogens when passing sharp instruments. The hands-free technique, whereby a tray or other means are used to eliminate simultaneous handling of sharp instruments, has been recommended.
AIMS
To prospectively evaluate the effectiveness of the hands-free technique in reducing the incidence of percutaneous injuries, contaminations, and glove tears arising from handling sharp instruments.
METHODS
For each of 3765 operations carried out in main and surgical day care operating theatres in a large urban hospital, over six months, circulating nurses recorded the proportion of use of the hands-free technique during each operation, as well as other features of the operation. The hands-free technique, considered to be used when 75% or more of the passes in an operation were done in this way, was used in 42% of operations. The relative rate of incidents (percutaneous injuries, contaminations, and glove tears) in operations where the hands-free technique was used and not used, with adjustment via multiple logistic regression for the different risk profiles of the two sets of operations, was calculated.
RESULTS
A total of 143 incidents (40 percutaneous injuries, 51 contaminations, and 52 glove tears) were reported. In operations with greater than 100 ml blood loss, the incident rate was 4% (18/486) when the hands-free technique was used and 10% (90/880) when it was not, approximately 60% less. When adjusted for differences in type and duration of surgery, emergency status, noisiness, time of day, and number present for 75% of the operation, the reduction in the rate was 59% (95% CI 23% to 72%). In operations with less than 100 ml blood loss, the corresponding rates were 1.4% (15/1051) when the hands-free technique was used and 1.5% (19/1259) when it was not used. Adjustment for differences in risk factors did not alter the difference.
CONCLUSIONS
Although not effective in all operations, use of the hands-free technique was effective in operations with more substantial blood loss.
背景
手术室工作人员在传递锐器时感染血源性病原体的风险增加。推荐采用免手持技术，即使用托盘或其他方式避免同时接触锐器。
目的
前瞻性评估免手持技术在减少因处理锐器导致的经皮损伤、污染及手套破损发生率方面的有效性。
方法
在一家大型城市医院的主手术室和日间手术中心进行的3765例手术中，巡回护士在六个月的时间里记录了每次手术中免手持技术的使用比例以及手术的其他特征。免手持技术被定义为当手术中75%或更多的传递操作采用此方式时使用，42%的手术使用了该技术。计算使用和未使用免手持技术的手术中事件（经皮损伤、污染及手套破损）的相对发生率，并通过多重逻辑回归对两组手术不同的风险特征进行调整。
结果
共报告了143起事件（40例经皮损伤、51例污染和52例手套破损）。在失血超过100毫升的手术中，使用免手持技术时事件发生率为4%（18/486），未使用时为10%（90/880），降低了约60%。在对手术类型和持续时间、急诊状态、噪音水平、手术时间以及75%手术过程中的在场人数差异进行调整后，发生率降低了59%（95%可信区间23%至72%）。在失血少于100毫升的手术中，相应的发生率分别为1.4%（15/1051）和1.5%（19/1259）。对风险因素差异进行调整并未改变这一差异。
结论
尽管免手持技术并非对所有手术都有效，但在失血较多的手术中使用该技术是有效的。
Zotero 插件