目的探索乡村医疗废物管理的有效方法,降低因医疗废物引起的院内院外感染。方法随机抽取广西桂林市荔浦县马岭、蒲芦、修仁、青山、杜莫、东昌等6个乡镇,对以上乡镇所有的村卫生室、个体诊所和赤脚医生等乡村医疗机构的医生进行医疗废物回收相关知识的问卷调查,从培训与考核、配备必要设备、规范医疗废物处置行为、押金制度等进行干预,干预3个月后开展相同内容的问卷调查并进行干预前后的比较分析。结果共调查6个乡镇156所村卫生室(362名村医,无护士)、30所个体诊所(42名医生,无护士)和41名赤脚医生,共调查乡村医疗机构227家、医生445人。干预前医疗废物基本不回收,干预后全部按规定回收处置;干预前14项医疗废物回收相关知识的知晓率为18.88%~63.37%,干预后为80.00%~97.53%,干预前后总知晓率分别为37.27%、76.10%,干预前后各项目及总知晓率的比较差异均有统计学意义(P<0.01);村卫生室、个体诊所和赤脚医生三类医生干预前平均知晓率分别为37.79%(1 915/5 068))、62.59%(368/588)、6.79%(39/574)和干预后平均知晓率分别为89.09%(4 515/5 068)、90.65%(533/588)、78.40%(450/574),三类医生干预前后平均知晓率差异均有统计学意义(均P<0.01)。结论经知识层面、硬件配套、规范行为、经济杠杆4个方面综合干预后,乡村医生医疗废物回收相关知识知晓率明显提高,医疗废物回收从基本不回收变成全部规范回收处置。 Objective To explore effective ways to manage medical waste in rural areas and to reduce nosocomial and extra-hospital infections caused by medical waste. Methods Six towns (Maling, Pulu, Xiu Ren, Qingshan, Duomo and Dongchang) in Lipu County, Guilin City, Guangxi Autonomous Region were selected randomly. The doctors of rural medical institutions such as village clinics, individual clinic and barefoot doctors Conduct a questionnaire survey on knowledge related to the recovery of medical wastes. Intervention from training and assessment, provision of necessary equipment, standardization of medical waste disposal and deposit system, etc. After 3 months of intervention, a questionnaire survey of the same content was conducted and comparative analysis was conducted before and after the intervention. Results A total of 156 village clinics (362 village doctors, no nurses), 30 individual clinics (42 doctors, no nurses) and 41 barefoot doctors in 6 townships were surveyed. A total of 227 rural medical institutions and 445 doctors . Before the intervention, medical waste was basically not recovered, and all the medical waste was recovered and disposed after the intervention. The awareness rate of the 14 medical waste recovery related knowledge was 18.88% -63.37% before intervention and 80.00% -97.53% after the intervention, before and after the intervention (37.27%, 76.10% respectively). There were significant differences in all the items before and after the intervention (P <0.01). The average pre-intervention rates among village clinic, individual clinics and barefoot doctors were 37.79% (1915/5 068), 62.59% (368/588) and 6.79% (39/574), respectively. The average awareness rate after intervention was 89.09% (4 515/5 068) and 90.65% (533/588) respectively. 78.40% (450/574). There was significant difference in average awareness rate before and after intervention among the three types of doctors (all P <0.01). Conclusion After the comprehensive intervention in four aspects of knowledge level, hardware support, normative behavior and economic lever, the awareness rate of rural doctors about medical waste recovery was significantly increased, and the recovery of medical waste from basic non-recovery to full standard recovery.