医务人员呼吸道感染影响因素的巢式病例对照研究

Nested case-control study on the risk factors of respiratory infection among healthcare workers

目的探索医务人员在院内感染呼吸道传染病的影响因素，针对性的提出院感防范重点及感染控制改进建议。方法本研究采用巢式病例对照研究的方法。选取北京市东城区和西城区的9家二级以上医院，将符合条件的医务人员作为一个队列，对其医疗行为进行为期一个月的观察。依据咽拭子病原学检测结粜削定研究对象的呼吸道感染状况，并将他们分为病例组和对照组。通过问卷调查了解并比较肼组人员在职、眦暴露与防护行为等方面的差异。数据分析应用STATA11．0软件完成，危险因素的分析采用非条件Logistic回归。结果共有481名医务人员完成本次研究，随访率为100％。在481名研究对象中有40例经实验室确诊为呼吸道感染，纳入病例组，其他441人纳入对照组。单因素分析显示，医院级别、工作科室、高危操作、接触病人后洗手等四个因素可能与医务人员发生呼吸道感染相关。多因素非条件logistic回归分析发现，共有2个因素进入回归方程，其中从事高危操作（OR=2．42，95％CI1．06～5．50）为发生呼吸道感染的危险因素，接触病人后洗手（OR=0．41，95％CI0．19—0．89）为保护性因素。结论为防止医务人员在院内感染呼吸道传染病，针对其危险因素所采取的干预措施亟待开展。

Objective To examine risk factors associated with respiratory infections among healthcare workers. Methods A nested case-control study was conducted in a cohort of 481 healthcare workers who worked at hospitals of level two or level three in Beijing. The respiratory infection was confirmed by threat swab testing. Questionnaire and diary card were used to record the exposure and protection of the healthcare workers. Univariate analysis and mutivariate logistic regression analyses were used for data analyze by using STATA11.0. Results All of the 481 healthcare workers were completed the follow up. There are 40 of them were confirmed as respiratory infection as the ease group and 441 non-respiratory infection subjects were included into control group. Univariate analysis showed that factors such as hospital level, working at high risk department, hands washing and high risk procedure were all associated with respiratory infection. Results of multivariate logistic regression analysis showed that variables such as washing hands af- ter touching patients （ OR = 0. 41,95% CI0. 19 - 0. 89）, and high risk procedure （ OR = 2. 42,95% CI1.06 - 5.50） were all correlated to respiratory infection. Conclusions Specific measures targeting risk factors should be conducted to protect the healthcare works from nosoeomial respiratory infection.