165例医务人员职业暴露分析

Analysis of Occupational Exposure among 165 Medical Staff

目的了解我院医务人员职业暴露情况。方法对我院2005-2009年职业暴露的人员结构、暴露源、暴露时的情况(暴露方式、暴露地点、暴露时防护措施)、暴露后处理(包括紧急处理、上报、预防用药、监测)等情况进行回顾性调查。结果共发生职业暴露165例,其中护士94例,医师59例,保洁人员12例。暴露源为艾滋病病毒/艾滋病(HIV/AIDS)64例,乙肝30例,丙肝5例,梅毒21例,狂犬病40例。暴露方式:锐器伤73例,完整皮肤60例,破损皮肤、粘膜32例。职业暴露发生于临床各科室。暴露时无任何防护措施101例,戴手套64例,穿隔离衣8例。紧急处理64例;立即上报58例。预防用药HIV/AIDS3例,乙肝13例,梅毒8例,狂犬病40例。定期检测HIV/AIDS42例,乙肝30例,丙肝5例,梅毒21例。目前无一例感染发生。结论职业暴露的高危人群主要是低年资、低职称、临床一线医务人员,暴露源以血源性传染疾病为主,暴露方式以锐器伤为主,ICU、手术室、呼吸内科等为血源性疾病职业暴露发生较多的科室,部分医务人员防护意识薄弱、未严格执行标准预防,正确处理是职业暴露后的重要补救措施。

Objective To investigate the risk of occupational exposure among medical staff in our hospital.Methods Occupational exposure accidents from 2005 to 2009 were retrospectively reviewed.The investigation included the exposed population, exposure sources, circumstances of exposure occurrence and protective measures including immediate treatment, reporting, prophylaxis and follow-up and monitoring.Results A total of 165 subjects （94 nurses, 59 physicians, and 12 cleaning service workers） were found to have exposure to infectious materials.Of these 165 subjects, 64 were found to have exposure to HIV, 30 to HBV, 5 to HCV, 21 to syphilis and 40 to rabies.73 subjects were injured by sharp instruments, 60 had contact with blood or other body fluids with uninjured skin and 32 had contact with injured skin or mucous.Exposure occurred in almost all clinical departments, especially in ICU, operating room and respiratory department.101 cases did not take any protection measures, 64 wore gloves and only 8 wore protective gown.Proper actions, such as immediate treatment （64 cases） and reporting （58 cases）, were taken after exposure.Post-exposure prophylaxis was given to the exposed personnel：3 for HIV, 13 for HBV, 8 for syphilis and 40 for rabies exposure.Follow-up and periodic evaluation were performed among 42 cases of HIV, 30 cases of HBV, 5 case of HCV and 21 cases of syphilis.Nobody was infected after receiving the post-exposure prophylaxis.Conclusion Elementary medical staff are at high risk of having occupational exposure in hospital, especially the blood-borne disease.Needle stick injuries represented the majority of cases and this mode of exposure was mainly occurred in ICU, and operating room.These occupational exposures occurred because some medical staff members were not aware of occupational exposure and not take standard precaution strategies strictly.Occupational post-exposure prevention measures are the main strategies to decrease the risk of infection.