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医院门诊室交叉感染风险基础信息调研与人源特性研究
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Basic Information Survey and Human Characteristics Study of Cross-Infection Risk in Hospital Outpatient Rooms
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    摘要:

    医院门诊室具有人流量大、病毒负载率高、患者免疫力差、医患间近距离接触频繁等特点,是呼吸道传染病传播的高危场所.本研究首先通过对长沙市两所三甲医院的门诊室开展问卷调查和现场调研,描述了门诊室就诊过程中医患人员行为特征,评估了交叉感染风险,之后基于实验测试和CFD模拟,揭示了患者呼出污染物扩散规律,最后探讨了目前防控措施的有效性.问卷和现场调研结果表明,门诊室防控漏洞较多,即窗户与空调不常开启,通风情况较差,诊室内不设净化器,消毒液使用频次较低,且存在摘下口罩、肢体接触等高风险行为.调研发现,门诊室1名医生1 d最多诊治了70名患者,患者的就诊时长平均为6~13 min左右,诊室内部人员数量最多达到6~8人,且常伴随人员走动,易加速呼出物的扩散,因此严格限制进入诊室的人员数量十分必要.实验测试和模拟结果表明,不同人员呼出物的运动轨迹和峰值浓度之间存在显著差异,展示了复杂的人源特性.呼气模式对于整个过程的峰值浓度影响较小,但呼吸和说话过程会导致面部前方长时间保持高浓度状态.佩戴口罩可以大幅降低污染物水平扩散,但是会造成竖直方向上扩散距离的增加.本研究结果预期为提出和改进门诊室防控措施提供基础数据.

    Abstract:

    Hospital outpatient rooms are characterized by high pedestrian flow, high viral load, poor patient immunity, and frequent close contact between doctors and patients, making them a high-risk site for the transmission of respiratory infections. In this study, we first described the behavioral characteristics of patients and doctors during outpatient visits and assessed the risk of cross-infection through questionnaires and on-site research in outpatient rooms of two third-class hospitals in Changsha, followed by experimental tests and CFD simulations to reveal the dispersion pattern of exhaled flow from patients, and finally explored the effectiveness of current prevention and control measures. The results of the questionnaire and on-site research showed that there were many loopholes in prevention and control in outpatient rooms, i.e. windows and air conditioning were not always open, ventilation was poor, there were no purifiers in the room, disinfectant was used less frequently, and there were high-risk behaviors such as removing masks and physical contact. The research found that one doctor in the outpatient room treated up to 70 patients a day, the average length of a patient's visit was around 6~13 minutes, the number of people inside the room could reach up to 6~8, and was often accompanied by people walking around, which tended to accelerate the spread of exhaled flow, so it was necessary to strictly limit the number of people entering the room. Experimental tests and simulations showed significant differences between the trajectories and peak concentrations of exhaled flow from different people, demonstrating the complex nature of human sources. Exhalation patterns have a small effect on peak concentrations throughout, but breathing and speaking can result in high concentrations being maintained in front of the face for long periods. Wearing a mask significantly reduces the horizontal dispersion of pollutants, but causes an increase in dispersion distance in the vertical direction. The results of this study are expected to provide basic information for proposing and improving prevention and control measures in outpatient rooms.

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AI Zhengtao?,LIN Chen, JIA Zhongjian.医院门诊室交叉感染风险基础信息调研与人源特性研究[J].湖南大学学报:自然科学版,2023,(9):195~206

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  • 在线发布日期: 2023-10-07
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