Courington K R, Patterson S L, Howard R J
Department of Surgery, University of Florida College of Medicine, Gainesville.
Arch Surg. 1991 Jan;126(1):93-6. doi: 10.1001/archsurg.1991.01410250099016.
Adherence to universal blood and body fluid precautions was studied in surgical patient care areas of a university hospital in an effort to identify potentially hazardous health care personnel practices. Surgical teams of an 18-unit operating room, three surgical ward patient care teams, and patient care personnel in a 16-bed surgical intensive care unit were observed during routine patient care activities before (study 1) and after (study 2) specific educational programs were held to improve universal precaution compliance. Overall, infractions occurred in 57% of 549 observed procedures in study 1 and in 58% of 616 observed procedures in study 2. In study 1, infractions occurred in 75% of operating room procedures, 30% of surgical ward procedures, and 75% of surgical intensive care unit procedures. Study 2 procedure infraction rates were 81%, 32%, and 40%, respectively. Only surgical intensive care unit compliance significantly improved. Noncompliance with universal precautions occurs frequently during the care of patients who have undergone surgery, with the type of infraction and specific offender varying according to patient locale. These violations appear unamenable to one-time educational efforts. Substantial overall improvement may arise from ongoing educational programs directed at specific personnel who care for patients who have undergone surgery.
为了确定医疗保健人员潜在的危险行为，我们对一所大学医院外科患者护理区域遵守通用血液和体液预防措施的情况进行了研究。在开展旨在提高通用预防措施依从性的特定教育项目之前（研究1）和之后（研究2），我们在一个拥有18个单元的手术室的手术团队、三个外科病房患者护理团队以及一个拥有16张床位的外科重症监护病房的患者护理人员进行常规患者护理活动期间进行了观察。总体而言，在研究1观察的549例手术中有57%出现违规行为,在研究2观察的616例手术中有58%出现违规行为。在研究1中，手术室手术的违规率为75%，外科病房手术的违规率为30%，外科重症监护病房手术的违规率为75%。研究2的手术违规率分别为81%、32%和４０%。只有外科重症监护病房的依从性有显著提高。在接受手术患者的护理过程中，不遵守通用预防措施的情况经常发生，违规类型和具体违规者因患者所在区域而异。这些违规行为似乎无法通过一次性教育努力得到改善。针对护理接受手术患者的特定人员开展持续教育项目可能会带来显著的整体改善。
