身体力学原理在医护人员脱卸防护装备过程中的应用实践

Practical Application of Body Mechanics Principles in the Process of Health Workers Doffing Personal Protective Equipment

目的探讨身体力学原理在医护人员脱卸防护装备过程中的应用效果。方法对上海某方舱医院的360名医务人员脱卸防护装备要领进行为期一天的集中培训,重点将身体力学原理“扩大支撑面,降低重心,减少重心偏移,利用杠杆原理,创建合适操作空间”,融入个人防护装备脱卸中,通过远程视频监控记录方式,观察医护人员运用身体力学动作后其身体稳定性、污染风险性,操作流畅性等情况。结果二元logistic回归分析结果显示,与未执行相比,(1)执行“防护服身体前倾后微仰”操作可提升脱卸稳定性[优势比(odds ratio,OR)=3.291,95%置信区间(confidence interval,CI):1.627~6.656]、降低污染风险性(OR=0.203,95%CI:0.100~0.412)、提高操作流畅性(OR=20.847,95%CI:8.061~53.916);(2)执行“脱靴套呈前后马步状”操作可提升稳定性(OR=5.299,95%CI:1.041~26.957)、降低污染风险性(OR=0.079,95%CI:0.009~0.692)、提高操作流畅性(OR=16.729,95%CI:1.238~226.077);(3)执行“脱靴套呈踮脚跟抬脚尖”可提升稳定性(OR=19.361,95%CI:8.391~44.671)、降低污染风险性(OR=0.181,95%CI:0.084~0.393)、提高操作流畅性(OR=10.977,95%CI:3.764~32.008);(4)执行“脱口罩身体前倾,脸朝前”可提升稳定性(OR=2.935,95%CI:1.412~6.101)、降低污染风险性(OR=0.123,95%CI:0.059~0.258)、提高操作流畅性(OR=18.126,95%CI:6.665~49.297)。结论在医务人员脱卸个人防护装备过程中,正确合理的力学姿势或动作可有效协助医护人员保持平衡与稳定性,同时避免感染风险发生,在防护技能培训及临床实践中具有推广价值。

Objective To examine the application effect of body mechanics principles in the process of health workers doffing personal protective equipment(PPE).Methods A total of 360 health workers from a Fangcang shelter hospital,also known as alternate care site,in Shanghai were involved in a centralized 1-day training concerning essential skills for taking off PPE.The training was focused on integrating body mechanics principles,including expanding the support surface,lowering the center of gravity,reducing the shift in the the center of gravity,using the principle of leverage,and creating the appropriate operating space,in the PPE doffing process.Through remote video monitoring and recording,observations were made of the physical stability,pollution risks,and operational smoothness of the health workers when they applied body mechanics principles in their actions.Results The results of binary logistic regression showed that,compared with the actions taken without applying body mechanics principles,performing the operation of the body leaning forward and then slightly leaning backward was positively correlated with stability in the doffing process(odds ratio[OR]=3.291,95%confidence interval[CI]:1.627-6.656),negatively correlated with pollution risks(OR=0.203,95%CI:0.100-0.412),and positively correlated with operational smoothness(OR=20.847,95%CI:8.061-53.916);performing the operation of taking off the boot sleeve in a horse-riding stance,with one foot standing ahead of the other,was positively correlated with stability(OR=5.299,95%CI:1.041-26.957),negatively correlated with pollution risks(OR=0.079,95%CI:0.009-0.692),and positive correlated with operational smoothness(OR=16.729,95%CI:1.238-226.077);performing the operation of taking off the boot sleeve by lifting the heel and then the toes was positively correlated with stability(OR=19.361,95%CI:8.391-44.671),negatively correlated with pollution risks(OR=0.181,95%CI:0.084-0.393),and positively correlated with operational smoothness(OR=10.977,95%CI:3.764-32.008);performing the operation of the leaning forward and keeping the face looking forward when taking off the mask was positively correlated with stability(OR=2.935,95%CI:1.412-6.101),negatively correlated with pollution risks(OR=0.123,95%CI:0.059-0.258),and positively correlated with operational smoothness(OR=18.126,95%CI:6.665-49.297).Conclusion In the process of medical staffs doffing PPE,correct and proper mechanical postures and actions can effectively assist medical staffs to maintain balance and stability and reduce the risks of infection,which has major significance and should be widely incorporated in personal protection skills training and applied in clinical practice.