结核定点医院医护人员感染预防控制效果研究

Study on the effect of prevention and control of infection among medical staff in fixed-point hospitals of tuberculosis

目的评估结核定点医院医务人员结核菌潜伏感染率,评价该医院在实施管理控制、环境控制、个人防护等结核菌感染控制预防措施的效果。方法选取2018年1~5月在福建省福州市肺科医院工作的呼吸科及结核病科工作人员101名,将研究对象分为两组:我院呼吸科医护人员56名(其中医生19名,护士37名)、我院结核科医护人员组45名(其中医生11名,护士34名),同时使用结核分枝杆菌感染T细胞斑点实验(T-SPOT.TB)及结核菌素皮肤试验(TST)对两组医护人员进行结核菌潜伏感染率调查,以上两组医护人员既往均无结核病史、无结核病症状,胸片正常。结果呼吸科及结核科医护人员T-SPOT.TB阳性率分别是26.78%、22.22%,两组比较差异无统计学意义(χ~2=0.279,P=0.597),呼吸科及结核科医护人员TST阳性率分别是48.21%、24.44%,两组比较差异有统计学意义(χ~2=6.007,P=0.014);进一步比较呼吸科及结核科医生T-SPOT.TB阳性率分别是31.58%、9.09%,用Fisher精确概率法比较两组差异无统计学意义(P=0.215),呼吸科及结核科医生TST阳性率分别是52.63%、9.09%,用Fisher精确概率法比较两组差异有统计学意义(P=0.023);45名结核科医护人员T-SPOT.TB阳性率及TST阳性率分别为22.22%、24.44%,均明显低于资料显示的我国医护人员结核菌感染率50%~70%。结论在肺结核病房实施管理控制、环境控制、个人防护等预防控制措施对降低医护人员结核菌潜伏感染率效果显著;呼吸科医护人员结核菌潜伏感染率有高于结核科医护人员的趋势。

Objective To evaluate the latent infection rate of tuberculosis among medical staff in fixed-point hospitalsof tuberculosis, and evaluate the effectiveness of preventive measures for tuberculosis infection control in hospitals suchas management control, environmental control and personal protection. Methods A total of 101 patients in the Department of Respiratory and Tuberculosis, who worked in Fuzhou Pulmonary Hospital of Fujian Province from January toMay 2018 were selected and divided into two groups： 56 respiratory medical staff in our hospital, including 19 doctorsand 37 cases of nurses, 45 cases of tuberculosis medical staff in our hospital including 11 doctors and 34 nurses. Atthe same time, the T cell spot infection test（T-SPOT.TB） and the tuberculin skin test（TST） of M. tuberculosis were usedto investigate the latent infection rate of tuberculosis in two groups of medical staff. These two groups of medical staffhad no history of tuberculosis, no symptoms of tuberculosis, and their chest radiographs were normal. Results The positive rates of T-SPOT.TB in respiratory and tuberculosis staff were 26.78% and 22.22%, respectively. There was no significant difference between the two groups（X2=0.279, P=0.597）. The TST positive rates in respiratory and tuberculosismedical staff were 48.21% and 24.44%, respectively. The difference between the two groups was statistically significant（X2=6.007, P=0.014）. The positive rates of T-SPOT.TB in respiratory and tuberculosis patients were 31.58% and 9.09%,respectively. There was no significant difference between the two groups by Fisher＇s exact probability method（P=0.215）.The positive rates of TST in respiratory and tuberculosis patients were 52.63% and 9.09%, respectively. There was significant difference between the two groups by Fisher＇s exact probability method（P=0.023）. T-SPOT.TB positive rate andTST positive rate of 45 tuberculosis medical staff were 22.22% and 24.44%, respectively, which were significantly lowerthan 50%-70% tuberculosis infection rate of Chinese medical staff showed in the data. Conclusion The implementationof management control, environmental control, personal protection and other preventive and control measures in the tuberculosis ward has a significant effect on reducing the latent infection rate of tuberculosis among medical staff. The latent infection rate of tuberculosis in respiratory health care workers is higher than that of tuberculosis medical staff.