基于医护人员真实行为的呼吸道传染病风险评估:以门诊耳鼻喉科为例  

Risk assessment of respiratory infectious diseases based on healthcare workers’actual behaviors:an example from otolaryngology outpatient clinics

作　　者：马正文 马慧 MA Zhengwen;MA Hui(School of Nursing,Southern Medical University,Guangzhou 510515,China;Department of Nursing,Chinese People’s Liberation Army General Hospital,Beijing 100853,China)

机构地区：[1]南方医科大学护理学院,广东广州510515 [2]解放军总医院护理部,北京100853

出　　处：《中国感染控制杂志》2025年第4期486-491,共6页Chinese Journal of Infection Control

基　　金：首都卫生发展科研专项重点攻关项目基金(2024-1G-5011)。

摘　　要：目的基于医护人员真实行为信息构建风险评估模型,精准评估医护人员日常工作时病毒暴露量的变化及感染风险。方法以北京市某综合三级甲等医院门诊耳鼻喉科医护人员及患者为研究对象,使用深度摄像机、笔记本电脑、便携式电源、三角支架及可移动硬盘采集和储存相关人员行为信息,具体包括相对位置、人际距离、面部朝向及触摸频率,并使用半监督机器学习算法处理行为数据;最终构建数理模型,评估医护人员操作过程中病毒暴露量及感染风险的变化。结果共采集161917条行为数据,包括外耳道冲洗、鼻内镜、喉内镜、耳内镜,经检查排除后剩余103788条行为数据。门诊耳鼻喉科医护人员在日常工作中平均近距离占比为90.61%,且主要以面对侧(Face-to-Side,F-S)密切接触为主。在进行鼻内镜时,病毒RNA暴露量(viral RNA loads)最高,为0.543~0.745 viral RNA loads/s,总体感染风险为42.74%。通过佩戴N95口罩、医用外科口罩和棉布口罩,感染风险可以分别降至2.44%、14.20%、36.05%。结论门诊耳鼻喉科医护人员日常工作存在较高的职业暴露风险,医护人员应严格佩戴防护用品,并保持适当的人际距离和相对面部朝向。Objective To construct a risk assessment model based on healthcare workers’(HCWs)real behavioral data,and precisely quantify virus exposure dynamics and infection risks of HCWs during routine clinical practice.Methods HCWs and patients from otolaryngology outpatient clinics at a general tertiary first-class hospital in Beijing were selected as the research subjects.Behavior information of relevant individuals including relative position,interpersonal distance,facial orientation,and contact frequency,were recorded and stored using depth cameras,laptops,portable power supplies,tripod stands,and removable hard drives.Behavior data were processed by semi-supervised machine learning algorithms.A mathematical model was finally constructed to assess real-time viral exposure and infection risks during HCWs’procedure.Results A total of 161917 behavioral datasets were captured in this study,including external auditory canal irrigation,nasal/laryngeal/otoscopic endoscopies.After inspection and exclusion,103788 behavioral datasets remained.HCWs in otolaryngology outpatient spent 90.61%of clinical time in close contact on average,predominantly in face-to-side(F-S)orientation.Nasal endoscopy generated peak viral RNA loads,ranging from 0.543 to 0.745 viral RNA loads/s,with an overall infection risk of 42.74%.Infection risks could be reduced to 2.44%,14.20%,and 36.05%when wearing N95,medical surgical,and cotton masks,respectively.Conclusion HCWs in otolaryngology outpatient clinics face high risks of occupational exposure in their daily work.Personal protective equipment should be used strictly,and appropriate interpersonal distance and optimal face orientation should be maintained.

关 键 词：呼吸道传染病 医护人员 行为 暴露量 感染风险 

分 类 号：R183.3[医药卫生—流行病学]