我国医院临床护士职业性锐器刺伤调查

A pooling analysis of occupational sharp injury on clinical nurses in China

目的分析我国临床护士职业性锐器刺伤的发生、发展规律，为制定我国血源性病原体职业防护标准提供参考依据。方法从209篇护士锐器刺伤调查分析的检索文献中，筛选出26个回顾性调查项目，进行统计分析。结果2001年以来，共在全国23个城市的229家医院调查护士19171名，81．37％的护士过去1年中至少发生过1次锐器刺伤。2004年前护士锐器刺伤率、针刺伤率和污染针刺伤率分别为8．68、4．17和2．68次／人·年，2005年后下降为3．42、2．54和1．58次／人·年；锐器刺伤以针刺伤（54．31％）和玻璃伤（38.31％）为主；针刺伤主要发生在收集和整理废弃针（24．90％），拔针和分离针头（22．62％），注射、抽血、穿刺和加药（21．10％），给针头重戴帽（15．62％）等环节；锐器刺伤报告率9．42％，手套佩戴率19．22％，培训率40．66％，乙肝疫苗接种率66．67％。临床护士的锐器刺伤率与护士年人均门诊量呈正相关。结论锐器刺伤率与护士工作量和相关法律法规的贯彻落实等相关，护士锐器伤的预防措施亟待加强，应尽快发布并宣贯血源性病原体职业卫生防护标准。

Objective To estimate the occupational sharp injury incidence and the diversity of the injury and the preventive control methods between the different levels of hospitals and the different areas of hospitals among nurses in China. Methods An electronic search of relevant online databases was undertaken. Twenty six retrospective investigation reports were identified from 209 reports based on the filter standards after a systematic review of them. The data were pooled for analysis. Results 19 171 clinical nurses recalled the sharp injuries in the past year which came from 229 hospitals in 23 cities in China. 81.37% had sustained at least one sharp injury. The polled average number of episodes of occupational sharp injuries and needle stick and contaminated needle stick were 8.68, 4.17 and 2.68 episode per person per year before 2004 and fell to 3.42, 2.54 and 1.58 episode per person per year after 2005 ,respectively. The needle stick injuries and broken glass injuries accounted for 54.31% and 38.31% ,respectively. The needle stick injuries mainly occurred in collecting or sorting of used sharps instrument （24.90%）, withdrawing needle or separating it from container （22.62%）, during use of the item such as inserting needle or draw a blood sample or puncturing or inject drug （21.01 %）, recapping used needles （15.62% ）. 9.42% of the episodes were reported, 19.22 % of the nurses wore gloves while doing procedures on patients, 40.66% of the nurses accepted work safety training and 66.67% of them were immunized with Hepatitis B vaccine. Conclusion The sharp injuries are correlated with work load, the making and implementation of the rules, the levels and districts of the hospitals. The prevention control methods on sharp injury should be strengthened and the key point is to issue and propagandize the guideline of prevention and control for occupational exposure to bloodborne pathogen.