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目的:研究医务人员在医院内感染严重急性呼吸综合征(SARS)有关影响因素,以探讨罹患SARS的保护因素和危险因素,并为今后更好地预防和控制院内感染提供科学依据。方法:采用病例对照研究方法,在3家发生SARS院内感染的综合性医院,用调查问卷形式收集资料。运用卡方检验和Fisher精确概率法,对调查因素逐一进行单因素分析,明确其对SARS发病是否有显著意义,并根据OR值确定其为保护因素或危险因素。然后进行多因素分析,通过非条件Logistic回归统计,综合分析保护因素和危险因素的作用,确定哪些因素作用更为重要,即是具有独立作用的保护因素或危险因素。结果:在56个调查因素中,有22个因素与医务人员感染SARS有显著关联。其中,对SARS感染有保护作用的因素有19个,危险因素有3个。对上述22个因素的非条件Logistic回归统计,结果表明在所有因素中,穿两层防护服(OR=0.053)、接受过防护知识培训(OR=0.072)、戴手套(OR=0.102)、用碘伏擦拭或浸泡进行手消毒(OR=0.231)和办公区通风良好(OR=0.32)是独立的有显著作用的保护因素;参加气管插管操作(OR=30.793)是独立的危险因素。结论:对高危医务人员实施严格的防护和消毒措施是避免感染的关键环节,同时及时进行相关知识培训和提供有效的通风环境是避免感染SARS的重要因素。
Objective: To study the influencing factors of SARS among medical staff in hospital so as to explore the protective factors and risk factors of SARS, and provide a scientific basis for better prevention and control of nosocomial infections in the future. Methods: A case-control study was conducted to collect data from three general hospitals with SARS nosocomial infections in questionnaires. Using the chi-square test and Fisher’s exact test, univariate analysis of the investigation factors one by one to determine whether it has significant significance for the pathogenesis of SARS, and according to OR value to determine its protective factor or risk factors. And then carry on the multivariate analysis, through non-conditional Logistic regression statistics, a comprehensive analysis of the protective factors and risk factors, to determine which factors play a more important role, that is, with independent role of protective factors or risk factors. Results: Of the 56 surveyed factors, 22 were significantly associated with SARS infection among medical staff. Among them, there are 19 protective factors against SARS infection and 3 risk factors. Non-conditional Logistic regression analysis of the above 22 factors showed that wearing protective clothing (OR = 0.072), gloves (OR = 0.102), protective clothing Hand disinfecting with Iodovium rubbing or soaking (OR = 0.231) and well-ventilated office space (OR = 0.32) were independent protective factors with significant effect. Intratracheal intubation (OR = 30.793) was an independent risk factor. Conclusion: The implementation of strict protection and disinfection measures for high-risk medical personnel is a key step to avoid infection. At the same time, timely training on relevant knowledge and providing an effective ventilation environment are important factors in avoiding SARS.