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艾滋病人遭遇“手术难” 医护人员受感染谁埋单
2011年06月16日 15:34:06 来源： 长沙晚报
近日，中国艾滋病病毒携带者联盟撰写的《关于解决我国艾滋病病毒感染者和艾滋病病人“手术难”问题建议》报告在京发布。报告显示，“手术难”是艾滋病感染者就医面临的最突出问题，在各级各类医院都有发生。医生为何不愿给艾滋病感染者和艾滋病病人动手术?其背后最现实的原因是，多数医护人员担心被感染，加之目前还没有出台对因职业暴露而感染HIV的医护人员进行赔偿、补偿或补助的法律规定，导致这一尴尬现状发生。
事实上，除了艾滋病，医护人员还要经常与各种高致病性传染病“亲密接触”。而与其他职业暴露人群不同的是，天职就是救死扶伤的医护人员，面对缺乏保障的感染高危环境，不得不依旧坚持工作，职业暴露已成为他们不得不说的伤痛。
连日来，记者走访了省会多家医院，走近常年工作在这种职业暴露危险性极高的一线医护人员。让他们困惑的是，尽管身处感染高发地，但对于感染后是否属于职业病依然没有定论。
典型案例
护士工作中感染结核病
“对于结核患者的身心痛苦，我感同身受，因为我也曾患过结核病。”湖南省胸科(结核病)医院护士肖言英如今仍坚持在临床一线工作，但她却至今难忘当年不慎感染结核病的经历。
“天天与结核患者打交道，我怎么也没有想到，有一天自己也会住进病房。”据肖言英回忆，2005年夏天的一个午后，原本想像往常一样工作的她突然浑身发抖、直喊冷，体温一度高达40℃。经确诊，她感染了支气管内膜结核。
尽管经治疗后体温降到了正常水平，精神也日渐恢复，但抗结核药物的副作用以及每周一次痛苦的纤维支气管镜治疗，让肖言英身心饱受折磨，至今都心有余悸。
为艾滋病人治病时差点被感染
而对衡阳市第三人民医院2病区护士周晴(化名)来说，一位确诊艾滋病的肝硬化患者的一口带血浓痰，成为了她心中难以抹去的阴影。
据她回忆，当时，她所在的病区收治了一个患有肝硬化的中年男性。通过抗体检测，这是一个艾滋病人。一天，周晴和另一名护士给他插鼻导管，进行吸氧治疗，没想到，这位患者猛咳了一下，一口带血的痰喷在她脸上。尽管她当时戴了口罩，但眼睛暴露在外，患者的口水直接进入了她的眼睛。
周晴被确认为一级职业暴露，此后近1个月，她接受阻断艾滋病病毒药物治疗。在没有确定是否被感染之前的6个月内，她不敢去见父母和一切亲朋戚友，也不敢去碰年幼的儿子一下。直到拿到第5次抽血的化验单，得知自己没事后，她整个人才回过神来。
医院应对
制定相应规范和防治措施
事实上，为了保护工作在临床一线的医护人员，各医院都有相应的规范和防范措施。如：2006年，湖南省胸科医院出台了《关于本所职工患结核病后有关待遇的规定》，其中明确规定：因结核病住院、休假治疗期间卫生防疫津贴、工资照发;医务部门建立和保存好职工的健康档案。据长沙市传染病医院(长沙市第一医院南院)感染科主任杜杰介绍，医务人员在接触传染病人之前，病人、医务人员都要戴口罩，尤其是接触艾滋病患者前要戴上手套等。同时，针对医务人员有可能被感染的情况，医院有一套系统的治疗方案。
“目前，医院对放射机房等建筑的墙壁厚度、门窗设置等，都有严格要求。”湖南省劳动卫生职业病防治所放射卫生科主任技师凌光华表示，同时，医院对从事放射工作的医务人员，发放放射营养津贴，每年安排2-4周的固定休假等。
据长沙市职业病防治所负责人介绍，目前长沙对于放射工作人员，主要通过佩戴个人剂量片等措施进行定量监测。如因工作量增多导致剂量结果超标等情况，要求放射工作单位对放射工作人员减少接触等措施。此外，放射工作人员作为特殊的工作人群，每两年至少进行一次健康检查，并要进行上岗前和离岗后健康检查。
专家呼吁
职业防护问题亟待关注
据了解，目前，除了医务人员放射损伤被列入法定职业病以外，医务人员其他职业暴露导致的伤害还未列入法定职业病范畴。对于医务人员除放射损伤外的职业暴露是属于职业病范畴还是劳动工伤，长沙市传染病医院相关负责人表示，目前尚无定论。
据湖南省胸科医院院长张贻瑞介绍，近几年来，该院感染结核病的护士就有6人，时间集中于2005年到2009年间。所幸的是，这一状况在2009年随着医院新的住院大楼投入使用后基本结束，因为新病房宽敞舒适、通风良好，加上严密科学的各项防护措施，如同为医护人员的职业安全加上了一道“保险锁”。但是，长年和结核患者打交道，医护人员被感染的风险依然存在。“护士感染结核病这一情况引起了医院的高度警惕。不仅是在我们医院，在省内外别的医院也时有发生。”张贻瑞认为，医护人员的职业防护问题亟待关注。
“在确定患者感染艾滋病后为其实施治疗并不是最可怕的，最可怕的是感染了艾滋病毒的急诊病人(如车祸中的伤者、急诊入院的孕妇等)，因为紧急处置前可能完全来不及做相关检查，根本不知道病人是艾滋病感染者。”业内人士表示，在我国，艾滋病已进入快速增长期，这无疑给医护人员带来更大的压力。虽然进行手术时感染艾滋病毒的几率很低,但这种风险也应该得到充分的考虑与体现，应该出台措施对被感染的医护人员给予各种保障，才有可能免除医护人员的后顾之忧。
律师观点
医护人员应受职业病防治法保护
处于职业暴露下的医护人员，是否应该受职业病防治法的保护?对此，湖南全胜律师事务所律师谢少宇表示，我国职业病防治法第二条第二款明确规定“本法所称职业病，是指企业、事业单位和个体经济组织(以下统称用人单位)的劳动者在职业活动中，因接触粉尘、放射性物质和其他有毒、有害物质等因素而引起的疾病。”根据这条规定，身为临床一线的医护人员作为劳动者，与其他劳动者一样也应受到职业病防治法的保护。
对常年处于艾滋、结核等高感染性医疗临床一线的医护人员而言，应该如何维护自己的劳动权益?谢少宇认为，目前，针对临床医护人员可能感染职业病的风险，从法律层面来说，更多的是健全相关的制度，落实相关的法律法规。“其实，有针对性地制定相关法律法规，对因职业暴露而感染艾滋病的医务人员进行高额赔偿，从法律上解除高风险医护人员的心理负担也很重要。与此同时，要进一步对加强对医务人员职业暴露的有关知识培训等，多管齐下，共同保护处于职业暴露下的医护人员的健康和权益。”
名词解释
医护人员职业暴露
指医护人员在从事诊疗、护理活动过程中接触有毒、有害物质或传染病病原体，从而损害健康或危及生命。包括感染性职业暴露、放射性职业暴露、化学性(如消毒剂、某些化学药品)职业暴露及其他职业暴露。 (匡春林 唐江澎)
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2011年5月正式出版的《中国特色医疗金鉴》登载的刘君主任及其机构事迹 |
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AIDS face "difficult operation," Who will pay for health care workers infected
June 16, 2011 15:34:06 Source: Changsha Evening News
Recently, China's HIV carriers Alliance wrote, "on the settlement of China's HIV-infected people and AIDS patients' surgical difficulties" recommendations "report released in Beijing. The report shows that "surgery is difficult," AIDS medical care is the most prominent issues facing the hospitals of various types have occurred. Why doctors do not want to HIV-infected people and AIDS patients surgery? Behind the most practical reason is that most health care workers worried about being infected, coupled with the introduction of not yet infected with HIV due to occupational exposure of medical staff, compensation or benefits The law led to this embarrassing situation happen.
In fact, in addition to AIDS, health care workers also often highly pathogenic infectious disease with a variety of "intimate contact." Occupational exposure groups with other difference is that vocation is the life-saving health care, high risk of infection in the face of the lack of protection of the environment, have to still keep working, occupational exposure they have to say has become a pain.
In recent days, the reporter visited the capital of many hospitals, approached year-round work in this high risk of occupational exposure to first-line health care workers. Let them confused, despite the high incidence of infection in living, but infection is still not conclusive whether the occupational disease.
Typical case
Nurses working in TB
"TB patients for pain and suffering, I identify with, because I also suffered from tuberculosis." Hunan Chest (TB) hospital care Shixiao made in Britain today still insist on the clinical front line, but she has a memorable experience when accidentally TB .
"TB patients every day to deal with, I had no idea how that one day will live in their own ward." According to Shaw made the British memories of a summer afternoon in 2005, originally thought to work as usual, she suddenly trembling, whooped cold, body temperature was as high as 40 ℃. Once diagnosed, she was infected with endobronchial tuberculosis.
Although the body temperature after treatment dropped to normal levels, the growing spirit of recovery, but the side effects of anti-TB drugs and painful weekly bronchoscopy treatment, so that Shaw made the British mental and physical trauma, and so far have a lingering fear.
When medical treatment for the AIDS infection was almost
The Third People's Hospital of Hengyang City, Ward 2 nurse Zhou Qing (pseudonym), a diagnosis of AIDS in patients with cirrhosis of a bloody sputum, become difficult to erase the shadow of her heart.
According to her memories, when she admitted to a ward where the middle-aged men with cirrhosis of the liver. By antibodies, this is a AIDS. Day, week, Qinghe another nurse inserted a nasal cannula to him, for oxygen therapy, did not expect the patient cough a bit fierce, bloody sputum, a spray in her face. Although she was wearing a mask, but the eyes exposed, the patient's saliva directly into her eyes.
Zhou Qing is recognized as an occupational exposure, after nearly a month, she accepted the blocking of HIV drug treatment. In the absence of infection to determine whether the six months before, she did not dare to see parents and all friends and relatives, did not dare to touch the young son about. Until the 5th to get the blood tests alone, that their own right, she recovered the talent.
Hospital response
Develop appropriate standards and control measures
In fact, in the clinical work in order to protect frontline medical workers, hospitals have the appropriate norms and preventive measures. Such as: In 2006, the introduction of the Chest Hospital of Hunan Province "by the workers on the risk of tuberculosis after the treatment requirement", which clearly states: due to tuberculosis hospital, epidemic prevention during treatment vacation allowance, full pay; health departments establish and maintain good employee health records. According to the Changsha City Hospital for Infectious Diseases (First Hospital of Changsha South Institute) introduced Du Jie, director of infection, medical personnel in contact with infectious people before, patients, medical staff must wear masks, especially in contact with AIDS patients to wear gloves before . Meanwhile, for the medical personnel are likely to be infections, the hospital has a system of treatment.
"Currently, the hospital room and other buildings on the radiation thickness of the walls, doors and windows settings, there are stringent requirements." Hunan Provincial Occupational Health, Radiation Control Technicians Ling Guanghua, director of health, said at the same time, hospital medical staff working in radiology, payment of radiation nutritional benefits, annual leave arrangements such as fixed 2-4 weeks.
According to Changsha, the person in charge of occupational disease prevention, currently Changsha for radiation workers, mainly through measures such as wearing personal dose tablets quantitative monitoring. As a result of the increased workload leading to excessive doses of the results, etc., requires unit of radiation work to reduce exposure of radiation workers and other measures. Further, the staff as a special work groups, health checks at least once every two years, and to conduct pre-and post-undergo health checks.
Experts called for
Occupational protection issues need immediate attention
It is understood that, in addition to the medical staff were included in the statutory occupational radiation damage outside the medical staff of other injuries caused by occupational exposure has not been included in the statutory occupational areas. For the medical staff in addition to occupational exposure to radiation injury is outside the scope of occupational disease or work related injuries are, Changsha infectious diseases hospital officials say, has not been determined.
Chest Hospital, according to Zhang Hunan Yi Rui Jieshao, in recent years, the hospital TB nurses have six people, time to focus on 2005 to 2009. Fortunately, this situation with the hospital in 2009, the new hospital building into use the basic end, because the new ward spacious, well-ventilated, with rigorous science of the protective measures, like occupational safety for health care workers added a "safety lock." However, for many years and deal with TB patients, health care workers is the risk of infection still exists. "Nurses TB hospital this has led to a high degree of vigilance not only in our hospital, other hospitals outside the province have occurred." Zhang Yi Rui believes that health care workers of occupational protection issues need immediate attention.
"HIV-infected patients in determining treatment after its implementation is not the most horrible, most horrible thing is infected with the HIV virus emergency patients (such as car accident victims, emergency admissions of pregnant women, etc.), because the emergency disposal of the former may entirely too late to do the relevant checks, do not know the patient is HIV infected. "industry sources in China, AIDS has entered a period of rapid growth, which will undoubtedly bring greater pressure on medical staff. Although the surgery is very low risk of HIV infection, but this risk should be fully considered and reflected, measures should be introduced to give a variety of infected health care workers to protect it possible to remove the medical staff to worry about.
Law point of view
Health care workers should be protected by the Occupational Disease Prevention Law
Under occupational exposure in health care workers, Occupational Disease Prevention Law should be protected? This, Hunan victory Lawyer Xieshao Yu said China's Occupational Disease Prevention Law Article 2.2 specifies that "the Act referred to occupational diseases, is enterprises, institutions and individual economic organizations (hereinafter referred to as employer) of workers in professional activities, contact with dust, radioactive substances and other toxic and hazardous substances and other factors caused the disease. "Under this provision, as the clinical front-line health care workers as workers, as with other workers should be protected by the Occupational Disease Prevention Law.
Perennial in HIV, tuberculosis, high infectious medical clinical front-line health care workers, it should be how to protect their labor rights? Xieshao Yu believes that the current, clinical staff may be infected with diseases for the risk, from a legal perspective, the more is the sound system related to the implementation of relevant laws and regulations. "In fact, targeted to the development of relevant laws and regulations on occupational exposure to HIV-infected medical personnel high compensation, legal release from the psychological burden of high-risk health care workers is also important at the same time, to further strengthen occupational exposure of medical personnel with the knowledge and training, multi-pronged approach, under the joint protection of the health care workers in the occupational exposure to the health and rights. "
Glossary
Health care workers occupationally exposed
Refers to the medical staff in clinics, nursing activities during the exposure to toxic and hazardous substances or infectious pathogens, to the detriment of health or life-threatening. Including infectious occupational exposure, occupational exposure to radiation, chemical (such as disinfectants, some chemicals) occupational exposure and other occupational exposure. (Kuang Chunlin Tang Jiang Peng)
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