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| 移动式单人空气加压舱对新型冠状病毒肺炎患者实施高压氧治疗的感染控制对策 |
| 张茜1,2△,王海霞1,3△,杨丽英1,4,肖瑛1,5,陈怡1,6* |
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(1. 湖北省武汉市火神山医院感染二科一病区, 武汉 430100;
2. 海军军医大学(第二军医大学)长海医院虹口院区高压氧病区, 上海 200081;
3. 海军军医大学(第二军医大学)海军特色医学中心疾病预防控制科, 上海 200052;
4. 海军军医大学(第二军医大学)长海医院虹口院区伽马刀病区, 上海 200081;
5. 海军军医大学(第二军医大学)长海医院虹口院区护理部, 上海 200081;
6. 海军军医大学(第二军医大学)长海医院感染科, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨新型冠状病毒肺炎（COVID-19）患者在实施高压氧治疗过程中感染控制工作的开展与落实情况，为今后类似公共卫生事件中实施高压氧治疗提供借鉴。方法 组建病区高压氧治疗护理小组，设立专职感染控制护士岗位，明确感染控制护士职责，开展院内感染监测，对感染控制工作各环节进行精细化管理。在专职感染控制护士针对性监督工作实施前后，观察医师、护士、患者的手卫生依从率（手卫生执行次数/手卫生指征总数×100%）。在病区执行高压氧舱消毒制度后，每周定期对高压氧舱内外和病区多个位点采样进行严重急性呼吸综合征冠状病毒2（SARS-CoV-2）核酸检测。采用移动式单人空气加压舱对4例COVID-19患者进行高压氧治疗，观察治疗效果。结果 在专职感染控制护士针对性监督工作实施后，医师、护士、患者的手卫生依从率均较实施前提高［82.94%（175/211）vs 73.27%（148/202）、94.70%（268/283）vs 89.39%（236/264）、78.41%（69/88）vs 46.64%（24/55）］，差异均有统计学意义（χ2=5.663 5、5.308 4、17.997 2，P均<0.05）。专用病房执行高压氧舱消毒制度后，高压氧舱、专用病房运转第1周、第2周时，病房门把手、高压氧舱内、高压氧舱外、转运床表面、病房物品表面SARS-CoV-2核酸检测均为阴性。与高压氧治疗前相比，高压氧治疗后4例患者脉搏血氧饱和度（SpO2）改善［（91.62±3.65）% vs（85.63±4.52）%］，6 min步行距离增加［（346.3±43.6）m vs （272.2±61.9）m］，差异均有统计学意义（t=2.062 1、1.957 4，P=0.042、0.049），且患者均自述胸闷、气促等症状明显好转，复查CT提示肺部炎性病变均有不同程度消退。结论 建立高压氧护理小组，设立感染控制护士，能促进和督导全科人员正确贯彻感染控制制度、落实感染控制措施，保证了病房内COVID-19患者高压氧治疗的感染监测，确保患者和医护人员的安全。 |
| 关键词: 新型冠状病毒肺炎|移动式单人空气加压舱|高压氧|感染控制 |
| DOI：10.16781/j.0258-879x.2020.06.0628 |
| 投稿时间：2020-04-13修订日期：2020-05-09 |
| 基金项目: |
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| Infection control of coronavirus disease 2019 patients receiving hyperbaric oxygen therapy in mobile single air compression chamber |
| ZHANG Qian1,2△,WANG Hai-xia1,3△,YANG Li-ying1,4,XIAO Ying1,5,CHEN Yi1,6* |
(1. The First Ward, Department of Infectious Diseases (Ⅱ), Huoshenshan Hospital, Wuhan 430100, Hubei, China;
2. Department of Hyperbaric Oxygen, Hongkou Branch of Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200081, China;
3. Department of Disease Control and Prevention, Naval Special Medical Center, Naval Medical University (Second Military Medical University), Shanghai 200052, China;
4. Departement of Gamma Knife, Hongkou Branch of Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200081, China;
5. Department of Nursing, Hongkou Branch of Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200081, China;
6. Department of Infectious Diseases, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To study the infection control of patients with coronavirus disease 2019 (COVID-19) during the hyperbaric oxygen therapy, so as to provide references for hyperbaric oxygen therapy in public health events in the future. Methods A hyperbaric oxygen therapy and nursing team in wards and a full-time infection control nurse post were set up, the responsibilities of infection control nurses were defined, nosocomial infection monitoring was carried out, and meticulous management in all aspects of infection control was carried out. The hand hygiene compliance rates (number of hand hygiene execution/total number of hand hygiene indicators×100%) of doctors, nurses and patients were compared before and after supervision by full-time infection control nurses. After the implementation of the hyperbaric oxygen chamber disinfection, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test was performed on multiple sites inside and outside the hyperbaric oxygen chamber and wards every week. Hyperbaric oxygen therapy was given to four COVID-19 patients in mobile single air compression chamber and the therapy effects were observed. Results After supervision by full-time infection control nurses, the hand hygiene compliance rates of the doctors, nurses and patients were all improved (82.94%[175/211] vs 73.27%[148/202], 94.70%[268/283] vs 89.39%[236/264], and 78.41%[69/88] vs 46.64%[24/55]), and the differences were significant (χ2=5.663 5, 5.308 4, and 17.997 2, all P<0.05). After the implementation of the hyperbaric oxygen chamber disinfection, the SARS-CoV-2 nucleic acid test results were negative on the door handle, inside and outside of the hyperbaric oxygen chamber, the surface of the transfer bed and the surface of ward supplies during the first and second weeks. The pulse oxygen saturation (SpO2) and the walking distance in six minutes of patients were both increased after hyperbaric oxygen therapy compared with those before hyperbaric oxygen therapy ([91.62±3.65]% vs[85.63±4.52]% and[346.3±43.6] m vs[272.2±61.9] m), and the differences were significant (t=2.062 1 and 1.957 4, P=0.042 and 0.049). The symptoms such as chest tightness and shortness of breath were significantly improved after hyperbaric oxygen therapy. Computed tomography reexamination showed that the inflammatory lesions of lungs had subsided to different extents. Conclusion Hyperbaric oxygen nursing team and infection control nurse post can promote and supervise the implementation of the infection control system and infection control measures, ensuring the infection monitoring of COVID-19 patients and the safety of patients and medical staff. |
| Key words: coronavirus disease 2019|mobile single air compression chamber|hyperbaric oxygenation|infection control |
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