医务人员经血源传播疾病职业暴露危险因素与预防

OCCUPATIONAL EXPOSURE RISK FACTOR AND PREVENTIVE MEASURE OF BLOOD TRANSMITTED DISEASE OF MEDICAL STAFF

目的了解医务人员在经血源传播性疾病职业暴露的危险因素,并探讨预防措施,为防止医务人员职业暴露,保障医务人员健康提供参巧。方法对163例医务人员被患者的血液、体液等污染的锐器伤或被患者的血液、体液等直接喷溅污染了粘膜或破损皮肤的原因、方式以及发生地点、工作类别、职称等因素进行调查分析和追踪。结果共发生职业暴露163例次,暴露率10.2%。暴露原因锐器伤146例次,占总数的89.6%。暴露率以手术室最高(占71.7%),其次为急诊科(47.5%)。暴露人群以护士、初级以下职称暴露率最高,分别为26.4%、14.3%。不同科室、职业、职称发生职业暴露的差异有统计学意义(p均<0.005)。发生职业暴露后,均进行紧急和进一步处理、追踪,无发现职业暴露感染个案。结论医护人员经血液传播疾病的职业感染危险性增加,锐器伤是造成医务人员职业暴露而引发血源传播性疾病感染的最高危因素,低年资护士是血源传播性疾病职业暴露发生最高危群体。医务人员尤其护士的防护意识仍较薄弱,不按规程操作是导致职业暴露的最危险因素。加强安全知识和技能的训练,规范操作,纠正不良工作习惯和行为,减少针刺伤乃是预防医务人员职业暴露的最有效对策。

Objective To investigate the occupational exposure risk factors of blood transmitted disease of medical staff and explore the preventive measures ; provide reference for the prevention of occupational exposure and ensuring medical staffs health. Methods 163 medical staffs that contacted the patients＇ blood, body fluid or con- taminated sharp were observed ; the cause, mode and site of occupational exposure, working category and professional title of medical staffs were investigated and followed up. Results The occupational exposure was 163 case - times and the exposure rate was 10. 2%. The exposure caused by sharp injures was 146 case - times （89. 6% ） ; the exposure rate of operation room was highest （71.7%）, then emergency department （47.5%） ; the exposure rate of nurses and was 26.4% and 14. 3%. There was significant difference in different department, occupation and profession title （p 〈 0.05 ）. No exposure infection found. Conclusion The risks of occupational infection to blood transmitted disease of medical staff are increased, the sharp injure is the highest risk factor to cause the occupational exposure of medical staff and blood transmitted disease ; the low past service nurses are the high risk population to cause occupational exposure and blood transmitted disease. The weak protection consciousness of medical staffs （especial nurses） and operating not according to rules are the most risk factor to cause occupational exposure. Strengthening the training of safety knowledge and skill, standard operation, correcting the bad working habit and reducing needle stick injuries are the most effective countermeasure to prevent the occupational exposure of medical staffs.