多重耐药菌感染患者陪护人员手部接触行为的调查研究

 目的 了解多重耐药菌（MDRO）感染患者陪护人员手部与患者、环境表面及陪护人员自身的接触行为。方法 2019年3月-2020年7月对2所大学附属医院收治的MDRO感染患者的陪护人员进行直接观察。由训练有素的观察员使用自行设计的观察量表记录陪护人员手部与患者、环境表面及其自身的接触情况和频次。结果 陪护人员最常接触的为患者（89.82%），其次为近患者区（88.94%）。陪护人员频繁接触的环境表面包括床栏（80.09%）和床面（68.58%）。陪护人员自我接触时触摸口罩和躯干的比率分别为46.02%、36.73%。陪护人员手部与环境表面总接触频次在不同科室存在差异，内科的接触频次高于外科（P<0.05）。陪护人员手部与患者接触频次在不同陪护时段有差异，治疗护理高峰期、探访时段的患者接触频次高于晨晚间护理时段（P<0.05）。结论 陪护人员在为MDRO感染患者提供照护时，频繁与患者、环境表面及自身接触，可能导致MDRO感染的传播。

Implementation of health education for confirmed COVID-19 patients

Objective To evaluate problems in health education during coronavirus disease 2019 (COVID-19) epidemic period, and provide basis for hospitals to strengthen patient health education under regular status of epidemic prevention and control. Methods From April 1, to May 10, 2020, patients with confirmed COVID-19 in COVID-19 wards of Mudanjiang area were randomly selected and investigated by trained investigators, basic characteristics of the respondents,implementation of health education on hand hygiene(HH), wearing masks, opening windows for ventilation, closing doors, keeping wards clean, cough etiquette were recorded and filled in questionnaire. Results A total of 173 valid questionnaires were collected, COVID-19 patients who participated in the survey all received health education before admission, 73.41% (n=127) of whom received health education on cough etiquette, 98.27% (n=170) wore masks(94.12%n=160] wore surgical masks); among isolation wards of 173 COVID-19 patients, the ratio of fully equipped HH facilities was 22.54% (n=39), 77.46% (n=134) were without fully equipped HH facilities, equipping rate of paper towels was the lowest (n=48, 27.75%). COIVID-19 patients who had fully equipped HH facilities performed HH more frequently per day(χ²=15.93,P<0.001);compared with only equipped with alcohol-based hand rub or not, when equipped with alcohol-based hand rub and other HH facilities, patients wash their hands more frequently per day(χ²=4.16,P=0.040);compared with not equipped with paper towels, when equipped with paper towels, patients wash their hands more frequently per day (χ²=15.03, P<0.001). The proportion of implementation of keeping indoor clean was the highest (n=166, 95.95%), and that of cough etiquette was the worst (n=107, 61.85%). With the increase of patients' age, proportion of poor implementation of cough etiquette was higher(χ²=19.66,P<0.001), implementation of cough etiquette in patients in general wards was better than that in critical care wards(χ²=15.82,P<0.001), correct rate of cough etiquette in patients receiving health education on cough etiquette was higher than that in patients without receiving health education on cough etiquette (χ²=94.57,P<0.001). Conclusion During the COVID-19 epidemic, health education level of patients is improved, but there are still some deficiencies, hospital should continue to strengthen the propaganda and education on respiratory tract hygiene and cough etiquette, improve self-protection awareness of patients as well as reduce infection risk of patients and health care workers.