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艾滋病患者隐瞒病史住病房 院内感染敲警钟
2010年05月27日 13:45 来源：钱江晚报
“前后不到半年，我已经收到两个这样的病人了，都是年轻的男孩子，同性恋，都患了严重的肺炎，后来一查，都是艾滋病病毒携带者。但他们自己都不肯承认是艾滋病病毒携带者，都隐瞒病史来看病。这样的病人让我们很为难，一方面，治疗绕了很多弯路，另一方面，给不知情的医生护士还有同病房患者带来感染风险！”昨天，记者接到省城某大医院呼吸科医生朱奕豪的电话。他说，最近连续碰到艾滋病患者在医院隐瞒病史看病或住院，作为一名医生，他很担忧，希望这些病人正视病情，更不要对医生隐瞒，以致影响同病房病友，引发恐慌。
隐瞒病史住进病房，死于呼吸衰竭
31岁的阿亮(化名)一走进医院急诊室，医生就感觉他的病不轻，脸色异常苍白，呼吸也很困难。呼吸科副主任医师朱奕豪在做检查时，发现了病人的一个细节，阿亮耳朵上戴了锃亮的耳钉，右脚上还戴了一条红色脚链。于是在开检查单时，朱医师勾了一项HIV(艾滋病病毒)检测。
第二天，检查报告中，朱医师发现，阿亮有严重的肺炎，而且HIV初筛为阳性！朱医师开始有点担心了。在日常的触诊检查、护士抽血时，都没有带手套等防护措施，如果阿亮确实是艾滋病感染者，而又碰巧医护人员暴露伤口的皮肤直接接触了他的血液样本，那感染的风险很高。
为了确认病情，朱医师跟阿亮进行了一次对话。
“我们检测你的HIV呈阳性，你是感染者吗？”
阿亮沉默。
“你是同性恋吗？”阿亮沉默了一下，在一张纸上写了两个字“同志”，旁边画了“√”。
阿亮没有医保，身上也没有钱，收入医院时因为他病情严重医院开通了绿色通道，但现在，医生有点犯难了。好不容易，医生问到了阿亮老家姐姐和父母的电话号码。没想到，姐姐的反应很大：“我没这个弟弟，你们打错了！他在外面的事情，跟我一点关系也没有！”
而当医生说了阿亮的严重病情之后，姐姐那边开始啜泣：“都是他自己作出来的！”当天晚上，阿亮的父母和姐姐赶到了杭州。
阿亮的情况的确不太好。一度气急窒息时，朱奕豪医师毫不犹豫地给他做心肺复苏，近距离接触，阿亮气道中的分泌物随时会喷出来。阿亮的父母感动得跪在医生脚下。父母流着泪说，儿子其实去年就查出感染了这个病，家里人又怕又恨。从那以后，阿亮混迹在杭州与家人几乎没有联系。
去年年底，朱医师也接触过另一个隐瞒病史住院的艾滋病人。“那个人给我印象太深刻了，他大学刚毕业，来杭工作，很帅的小伙子。来住院时，症状和阿亮几乎一模一样。住院几天，小伙子高烧不退，几乎陷入昏迷，身边只有一个男孩子照顾他。后来我才发现他是艾滋病感染者，照顾他的是同性恋伴侣。因为病情严重，用药几乎不起作用了，我们通知他远在外省的父母赶来，最后小伙子死于呼吸衰竭。”后来，全科接触过这个小伙子的医护人员，都去做了一次HIV病毒检测，所幸没人被感染。
记者与艾滋患者面对面，他说“看病真的有点难”
通过辗转的联系，昨天，记者见到了阿亮。阿亮说，自己还在医院继续治疗，从去年到现在，这已经是第三次住院了。
“为什么要隐瞒HIV病情去住院呢？”记者问。
“我知道自己有结核病，年初我去了一家结核病专科医院住院治疗。当时我身上有一个脓包，需要切开排脓治疗，其实只是在病房里就能完成的小手术，但当时医生拒绝给我做这个切排手术。无奈下，我只好去六院，才做了这个手术。但六院没有结核科，治疗不够专业。我还去过浙一，省中，如果医生知道你是感染者，多数会委婉拒绝。”阿亮说。
阿亮叹口气，说隐瞒病史也是无奈的事。毕竟自己也是病人，有求医的需要。“我查过浙江省的艾滋病防治法，医院不能拒收艾滋病感染者的，但事实上，还是经常碰壁。”
“人们对这个病认识还是太少，有些医生一听说是HIV，态度都还蛮好，但就是劝我转院。”
阿亮说，他的一些病友，一旦免疫力降低发生感染时，经常的做法就是在一家医院住3天院做消炎治疗，然后再换一家医院住3天。如果超过3天，有些医生就会怀疑感染的原因，会进一步查原因，他们要赶在医生察觉之前走掉。
医院防范措施不到位，医生无奈委婉拒绝
按照艾滋病防治法，艾滋病感染者也有正常就医的权利，医院不能无故拒收。但为什么很多医院还是委婉拒绝呢？
一位相关专家告诉记者，主要是因为目前很多医院预防院内感染达不到理想的水平，不光艾滋病病人，乙肝、梅毒等传染病，在医院治疗时都有发生院内感染的风险。
记者昨日在几家大医院的门诊、输液室、病房观察，院内感染的防范状况的确让人担心。
早上，某医院内科查房，医生拿着一叠病例一个个病人看过来，有时候要用手按一按病人腹部触诊，或用听诊器听听病人胸腔内的情况，这位医生，没有带手套，也没有做到触诊之后洗手后再接触下一个病人。
在输液室，护士在给病人扎针时，多数戴了手套，但也有一些护士，在为小孩子、老人找血管时，并不戴手套。
在某医院急诊观察室内，一位病人刚刚转入住院部，护工手脚麻利地撤掉了被用过的床单，患上新的床单，但没有对床头柜、床头呼叫铃等物品进行消毒，就接收了下一个病人。
如何降低院内感染？一位医院的院感科负责人告诉记者，每天开窗通风，每天紫外线照射消毒2次；每个病床用一套式湿扫用具，床头柜一桌一抹布，用毕先清洁后消毒处理；床单、被套每周更换1次；地面湿扫除后消毒液拖地或喷洒消毒液；室内置垃圾桶，垃圾密闭运送；患者出院、转科或死亡后对整个病区进行消毒处理。
艾滋病患者隱瞞病史住病房院內感染敲警鐘
2010年05月27日13:45 來源：錢江晚報
“前後不到半年，我已經收到兩個這樣的病人了，都是年輕的男孩子，同性戀，都患了嚴重的肺炎，後來一查，都是艾滋病病毒攜帶者。但他們自己都不肯承認是艾滋病病毒攜帶者，都隱瞞病史來看病。這樣的病人讓我們很為難，一方面，治療繞了很多彎路，另一方面，給不知情的醫生護士還有同病房患者帶來感染風險！ ”昨天，記者接到省城某大醫院呼吸科醫生朱奕豪的電話。他說，最近連續碰到艾滋病患者在醫院隱瞞病史看病或住院，作為一名醫生，他很擔憂，希望這些病人正視病情，更不要對醫生隱瞞，以致影響同病房病友，引發恐慌。
隱瞞病史住進病房，死於呼吸衰竭
31歲的阿亮(化名)一走進醫院急診室，醫生就感覺他的病不輕，臉色異常蒼白，呼吸也很困難。呼吸科副主任醫師朱奕豪在做檢查時，發現了病人的一個細節，阿亮耳朵上戴了鋥亮的耳釘，右腳上還戴了一條紅色腳鍊。於是在開檢查單時，朱醫師勾了一項HIV(艾滋病病毒)檢測。
第二天，檢查報告中，朱醫師發現，阿亮有嚴重的肺炎，而且HIV初篩為陽性！朱醫師開始有點擔心了。在日常的觸診檢查、護士抽血時，都沒有帶手套等防護措施，如果阿亮確實是艾滋病感染者，而又碰巧醫護人員暴露傷口的皮膚直接接觸了他的血液樣本，那感染的風險很高。
為了確認病情，朱醫師跟阿亮進行了一次對話。
“我們檢測你的HIV呈陽性，你是感染者嗎？”
阿亮沉默。
“你是同性戀嗎？”阿亮沉默了一下，在一張紙上寫了兩個字“同志”，旁邊畫了“√”。
阿亮沒有醫保，身上也沒有錢，收入醫院時因為他病情嚴重醫院開通了綠色通道，但現在，醫生有點犯難了。好不容易，醫生問到了阿亮老家姐姐和父母的電話號碼。沒想到，姐姐的反應很大：“我沒這個弟弟，你們打錯了！他在外面的事情，跟我一點關係也沒有！”
而當醫生說了阿亮的嚴重病情之後，姐姐那邊開始啜泣：“都是他自己作出來的！”當天晚上，阿亮的父母和姐姐趕到了杭州。
阿亮的情況的確不太好。一度氣急窒息時，朱奕豪醫師毫不猶豫地給他做心肺復蘇，近距離接觸，阿亮氣道中的分泌物隨時會噴出來。阿亮的父母感動得跪在醫生腳下。父母流著淚說，兒子其實去年就查出感染了這個病，家里人又怕又恨。從那以後，阿亮混跡在杭州與家人幾乎沒有聯繫。
去年年底，朱醫師也接觸過另一個隱瞞病史住院的艾滋病人。 “那個人給我印象太深刻了，他大學剛畢業，來杭工作，很帥的小伙子。來住院時，症狀和阿亮幾乎一模一樣。住院幾天，小伙子高燒不退，幾乎陷入昏迷，身邊只有一個男孩子照顧他。後來我才發現他是艾滋病感染者，照顧他的是同性戀伴侶。因為病情嚴重，用藥幾乎不起作用了，我們通知他遠在外省的父母趕來，最後小伙子死於呼吸衰竭。”後來，全科接觸過這個小伙子的醫護人員，都去做了一次HIV病毒檢測，所幸沒人被感染。
記者與艾滋患者面對面，他說“看病真的有點難”
通過輾轉的聯繫，昨天，記者見到了阿亮。阿亮說，自己還在醫院繼續治療，從去年到現在，這已經是第三次住院了。
“為什麼要隱瞞HIV病情去住院呢？”記者問。
“我知道自己有結核病，年初我去了一家結核病專科醫院住院治療。當時我身上有一個膿包，需要切開排膿治療，其實只是在病房裡就能完成的小手術，但當時醫生拒絕給我做這個切排手術。無奈下，我只好去六院，才做了這個手術。但六院沒有結核科，治療不夠專業。我還去過浙一，省中，如果醫生知道你是感染者，多數會委婉拒絕。”阿亮說。
阿亮嘆口氣，說隱瞞病史也是無奈的事。畢竟自己也是病人，有求醫的需要。 “我查過浙江省的艾滋病防治法，醫院不能拒收艾滋病感染者的，但事實上，還是經常碰壁。”
“人們對這個病認識還是太少，有些醫生一聽說是HIV，態度都還蠻好，但就是勸我轉院。”
阿亮說，他的一些病友，一旦免疫力降低發生感染時，經常的做法就是在一家醫院住3天院做消炎治療，然後再換一家醫院住3天。如果超過3天，有些醫生就會懷疑感染的原因，會進一步查原因，他們要趕在醫生察覺之前走掉。
醫院防範措施不到位，醫生無奈委婉拒絕
按照艾滋病防治法，艾滋病感染者也有正常就醫的權利，醫院不能無故拒收。但為什麼很多醫院還是委婉拒絕呢？
一位相關專家告訴記者，主要是因為目前很多醫院預防院內感染達不到理想的水平，不光艾滋病病人，乙肝、梅毒等傳染病，在醫院治療時都有發生院內感染的風險。
記者昨日在幾家大醫院的門診、輸液室、病房觀察，院內感染的防範狀況的確讓人擔心。
早上，某醫院內科查房，醫生拿著一疊病例一個個病人看過來，有時候要用手按一按病人腹部觸診，或用聽診器聽聽病人胸腔內的情況，這位醫生，沒有帶手套，也沒有做到觸診之後洗手後再接觸下一個病人。
在輸液室，護士在給病人扎針時，多數戴了手套，但也有一些護士，在為小孩子、老人找血管時，並不戴手套。
在某醫院急診觀察室內，一位病人剛剛轉入住院部，護工手腳麻利地撤掉了被用過的床單，患上新的床單，但沒有對床頭櫃、床頭呼叫鈴等物品進行消毒，就接收了下一個病人。
如何降低院內感染？一位醫院的院感科負責人告訴記者，每天開窗通風，每天紫外線照射消毒2次；每個病床用一套式濕掃用具，床頭櫃一桌一抹布，用畢先清潔後消毒處理；床單、被套每週更換1次；地面濕掃除後消毒液拖地或噴灑消毒液；室內置垃圾桶，垃圾密閉運送；患者出院、轉科或死亡後對整個病區進行消毒處理。
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艾滋病成为第一大死因病种[刘君]的对策与思考 AIDS infection in hospital wards to conceal a history of living sounded the alarm bell
At 13:45 on the May 27, 2010 Source: Qianjiang Evening News
"Took less than six months, I have received two such patients, and all the young boys, gay, all suffering from severe pneumonia, was a check, are living with HIV. But they themselves are unwilling to admitted that the AIDS virus carriers, have a history of concealment to see the doctor. This patient is very difficult for us, on the one hand, treatment around a lot of detours, on the other hand, to the knowledge of doctors and nurses have brought the risk of infection in patients with the ward! "Yesterday, the reporter received a major hospital in the provincial capital Respiratory medical Zhu Yi Hao on the phone. He said the recent series of AIDS patients in the hospital met to conceal a history of medical treatment or hospitalization, as a doctor, he was very worried and hope that these patients face illness, but not to conceal, which affects the same care patients, triggering panic.
History was admitted to conceal unit, died of respiratory failure
31-year-old-liang (a pseudonym) entered the hospital emergency room, the doctor felt his disease can not be light, his face pale, breathing very difficult. Dr Zhu Yi Hao, deputy director of respiratory doing inspection, a detail found in the patient, wearing a shiny ear-liang's earring, right foot still wearing a red Anklet. So at the beginning of checklists, Zhu, MD, a hook HIV (AIDS virus) test.
The next day, check the report, doctors found that Chu-liang serious pneumonia, and HIV screening was positive! Zhu, MD, began a little worried. Check in daily palpation, blood when nurses are not brought gloves and other protective measures, if indeed AIDS-liang, who happened to health care workers exposed to direct contact with the skin wound of his blood samples, that risk of infection high.
In order to confirm the patient's condition-liang Zhu, MD, conducted a dialogue with.
"We have detected that your HIV positive, you are infected with it?"
Liang silence.
"Are you gay?" Liang silent a moment, a piece of paper to write the word "comrade", next to the painting of the "√".
Liang no health insurance, who have no money, income at the hospital because he was seriously ill hospital opened a green channel, but now the doctor a little gum tree. Finally, the doctor asked about her sister and parents liang home phone number. Unexpectedly, a great sister's reaction: "I did not this brother, you wrong! He was out of things to do with me not!"
When the doctor said the serious illness-liang, the sisters began to weep over there: "all his own to come!" Night-liang's parents and sister arrived in Hangzhou.
Liang have really not good. Shortness of breath once asphyxia, Zhu Yi Hao, MD, do not hesitate to give him cardiopulmonary resuscitation, close contact, liang airway secretions emitted at any time. Liang's parents moved to kneel at the foot of a doctor. Parents said with tears, her son found last year in fact infected with the disease, family fear and hate. Since then, the Hangzhou-liang blend into almost no contact with their families.
Late last year, Zhu, MD, also conceal a history of contact with another patient of AIDS. "That impressed me so deeply personal, he just graduated from college, work in Hangzhou, handsome young man. To the hospital, almost exactly the same symptoms and liang. Hospitalized a few days, guys high fever, almost into a coma, only around a boy to take care of him. Then I discovered he was HIV infected, to take care of his homosexual partner. as a serious condition, medication is almost does not work, we notice his parents rushed away in the provinces, the last boy died of respiratory failure. "Later, general contact with the boy's medical staff have done an HIV virus, but fortunately no one was infected.
HIV patients face to face with the reporter, he said, "really hard for medical treatment"
Ties through various twists and turns, yesterday, the reporter saw liang. Liang said he is in hospital to continue treatment, since last year, this is the third time in the hospital.
"Why hide it HIV disease to the hospital?" A reporter asked.
"I know they have TB, year, I went to a specialist hospital treatment of tuberculosis. At that time I have a pustule upon the need to cut drainage and treatment, in fact, can be done only in the ward's minor surgery, but doctors refused to give me time all rows do this surgery. helpless, I had to go to six homes, only had the surgery. but not TB Division Six homes, professional treatment is not enough. I've been a Zhejiang, Province, if doctors know that you are infected, Most will be politely declined. "liang said.
Liang sighed and said that history is helpless to conceal something. After all he is patient, there is the need for medical treatment. "I checked the AIDS Prevention Act, Zhejiang Province, the hospital can not refuse HIV-infected persons, but in fact, still often run into a wall."
"People know too little about this disease, some doctors heard that is HIV, attitudes are also just fine, but is transferred to persuade me."
Liang said his some patients, once reduced immunity to infection, it is often the practice is to stay at a hospital three days in hospital to do anti-inflammatory treatment, and then pulls a hospital stay 3 days. If more than 3 days, some doctors suspected it will cause further investigate the reasons, they have to catch before the doctor noticed gone.
Hospital precautions in place, doctors helpless politely declined
In accordance with the AIDS Prevention and Control Act, AIDS has the right to normal medical treatment, hospitals can not be unreasonably refused. Why many hospitals or euphemistically down?
Experts told a reporter, mainly because the current preventing nosocomial infections in many hospitals failed to achieve the level of not only AIDS, hepatitis B, syphilis and other infectious diseases, Zai hospital on both the risk of nosocomial infection.
Reporters yesterday at several major hospitals, clinics, infusion room, ward observations, the situation of nosocomial infection prevention is indeed worrying.
Morning medical rounds in a hospital, doctors took a stack of cases of patients over here, and sometimes to hand pressing a patient abdominal palpation, or chest with a stethoscope to hear the case patient, the doctor, did not take gloves, do not wash their hands after contact with palpation after the patient next.
In the infusion room nurses to patients in the acupuncture treatment, most wearing the gloves, but there are a number of nurses for the children, the elderly find blood vessels, it does not wear gloves.
Observation in a hospital emergency room, one patient had just transferred to inpatient, nursing workers deft hands and feet were used to removed the sheets, suffering from a new sheet, but no bedside cabinet, bedside call bell and other items were disinfected, the to receive the next patient.
How to reduce nosocomial infection? Sense of Section 1 of the hospital official told reporters that day, windows open for ventilation, ultraviolet light disinfection 2 times a day; each bed type with a wet brush tools, a bedside table cloth, after disinfection with Bixian Qing Jie ; bed sheet, quilt cover replacement of 1 per week; the ground after the disinfectant to eliminate wet mop or spray disinfectant; room built-in trash, refuse delivery closed; patients discharged from hospital, change programs or after the death of disinfection of the entire ward.
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