Kelen G D, DiGiovanna T A, Celentano D D, Kalainov D, Bisson L, Junkins E, Stein A, Lofy L, Scott C R, Sivertson K T
Division of Emergency Medicine, Johns Hopkins University School of Medicine, Balitmore, MD 21210.
J Acquir Immune Defic Syndr (1988). 1990;3(10):987-94.
In a study undertaken to determine compliance with Universal Precautions, we observed 129 personnel performing 1,274 interventions on 151 consecutive critically ill and injured patients in an emergency department setting in July 1988. Barrier precautions were fully adhered to 44.0% of the time. During interventions in patients with profuse bleeding, adherence was only 19.5% in contrast to 44.7% for those who were not bleeding. Adherence was 56.4% during minor interventions but only 16.7% during major procedures. Adherence rates varied among health care providers: residents, 58%; emergency staff physicians, 38%; consultant physicians, 43%; emergency nursing staff, 44%; paramedics, 8%; radiology technicians, 14%; and housekeeping, 91%. In a follow up questionnaire that ascertained reasons for lack of compliance, 47% of providers indicated that there was not always sufficient time to put on protective material, 33% felt that precautions interfered with skillful performance of procedures, and 23% stated that materials were uncomfortable. Only 2.7% felt that Universal Precautions did not work. Since there is no proven postexposure prophylaxis for human immunodeficiency virus, Universal Precautions must be rigorously followed until such time as they are shown not to be effective or an alternate approach is developed. Strategies to improve compliance and improvements in barrier technology need to be developed.
在一项旨在确定是否遵守通用防护措施的研究中，我们于1988年7月在一家急诊科观察了129名工作人员对151名连续的危重伤病患者进行的1274次干预操作。屏障防护措施的完全遵守率为44.0%。在对大出血患者进行干预时，遵守率仅为19.5%，而对无出血患者的遵守率为44.7%。小手术时的遵守率为56.4%，但大手术时仅为16.7%。不同医护人员的遵守率各不相同：住院医生为58%；急诊科医生为38%；会诊医生为43%；急诊护士为44%；护理人员为8%；放射技师为14%；后勤人员为91%。在一份询问不遵守原因的后续调查问卷中，47%的医护人员表示，总是没有足够的时间穿戴防护用品，33%的人认为防护措施会干扰手术的熟练操作，23%的人表示防护用品穿着不舒服。只有2.7%的人认为通用防护措施不起作用。由于目前尚无经证实的针对人类免疫缺陷病毒的暴露后预防措施，因此必须严格遵守通用防护措施，直到证明其无效或开发出替代方法为止。需要制定提高遵守率的策略并改进屏障技术。
