| 摘要: |
| 目的 了解抗击新型冠状病毒肺炎（COVID-19）疫情下不同级别医院的感染防护现况，为职业感染防护提供策略和建议。方法 选取不同级别医院的一线医师，于2020年3月2日至9日通过微信平台进行网络调研。通过问卷星调研平台设计调查问卷，内容包括一线医师基本信息、防护知识内容、抗击疫情工作环境、医用防护用品管理和防护措施实施情况等。结果 共回收有效问卷966份，由上海市15个区9所三级综合性医院、42所社区卫生服务中心的一线医师填写。社区卫生服务中心一线医师的COVID-19疫情相关知识培训率高于三级综合性医院［90.45%（644/712）vs 79.53%（202/254），χ2=20.528，P=0.001］，根据COVID-19相关内容识别相应类别患者（χ2=27.108，P=0.009）、手部卫生消毒和防护服穿脱（χ2=22.666，P=0.001）及正确处理医疗废弃物（χ2=74.251，P=0.001）等的掌握程度均优于三级综合性医院。COVID-19防护措施执行过程中，社区卫生服务中心一线医师能够严格按需、按防护强度更换一次性防护服的比例［31.74%（226/712）］高于三级综合性医院［25.20%（64/254）］，差异有统计学意义（χ2=33.229，P=0.001）。社区卫生服务中心与三级综合性医院一线医师在正确实施患者的标本采集、防护面罩更换频率、疫情期间每周在院工作时长方面的差异均无统计学意义（P均>0.05）。结论 在本次COVID-19疫情防护中，社区卫生服务中心起到了重要的网底作用。部分防护措施在社区卫生服务中心和三级综合性医院之间有所不同，需进一步完善降低医疗机构COVID-19职业感染风险的合理措施。 |
| 关键词: 社区卫生服务中心 新型冠状病毒肺炎 综合性医院 全科医学 问卷调查 |
| DOI：10.16781/j.0258-879x.2020.04.0388 |
| 投稿时间：2020-03-26修订日期：2020-04-08 |
| 基金项目:中华医学会医学教育分会中国高等教育学会医学教育专业委员会医学教育研究课题（2018B-N11008）． |
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| Prevention against coronavirus disease 2019 in community health service centers and tertiary hospitals in Shanghai: a survey of current situation |
| WANG Hui,WANG Fang-tao,SUN Xiao-ting,XU Xiang-huai,ZHAO Xin-xin |
(1. Department of General Surgery, Tongji Hospital, Tongji University, Shanghai 200065, China;
2. School of Public Health and Primary Care, Tongji University School of Medicine (in Preparation), Shanghai 200092, China;
3. Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji University, Shanghai 200065, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the current status of infection control of coronavirus disease 2019 (COVID-19) in hospitals of different levels, providing strategies and suggestions for occupational infection prevention. Methods The frontline health workers of hospitals of different levels were selected to finish the questionnaire survey by WeChat from Mar. 2 to 9, 2020. The questionnaire was designed with “questionnaire star”, including the basic information of health workers, the protection knowledge, the working environment against the epidemic, the management of medical protective products and the implementation of protective measures. Results A total of 966 valid questionnaires were collected and filled out by the health workers of nine tertiary hospitals and 42 community health service centers (CHSCs) in 15 districts of Shanghai. The training rate of COVID-19 epidemic protective knowledge in CHSCs was higher than that in tertiary hospitals (90.45% [644/712] vs 79.53% [202/254]), the difference was statistically significant (χ2=20.528, P=0.001). CHSCs had better COVID-19-related knowledges of identifying the corresponding categories of patients (χ2=27.108, P=0.009), hand disinfection, wearing and taking off protective clothing (χ2=22.666, P=0.001), and correctly managing medical waste (χ2=74.251, P=0.001). During the implementation of COVID-19 protective measures, the proportion of the CHSCs that could change disposable protective clothing strictly according to needs and protection intensity was significantly higher than that in tertiary hospitals (31.74% [226/712]) vs 25.20% [64/254]) (χ2=33.229, P=0.001). However, there were no statistically significant differences in the correct implementation of patient specimen collection, the frequency of changing protective mask, and working hours in hospital every week during the epidemic (all P>0.05). Conclusion CHSCs play an important role in the prevention of the COVID-19 epidemic. There are differences in some measures of epidemic prevention between CHSCs and tertiary hospitals. It is necessary to further improve the measures to reduce the risk of COVID-19 occupational infection in the medical institutions. |
| Key words: community health service center coronavirus disease 2019 general hospital general medicine questionnaire survey |
