肝胆外科护士职业暴露的危险因素分析及管理对策

Risk factors of occupational exposure to nurses in department of hepatobiliary surgery and management countermeasures

目的分析肝胆外科护士发生职业暴露的危险因素,针对相关危险因素采取切实可行的管理对策。方法采用自行设计的"医护人员职业暴露调查表"对30名肝胆外科护士在2010年9月-2011年8月发生职业暴露的情况进行回顾性调查。结果 30名肝胆外科护士1年中发生锐器伤39例次,发生皮肤、黏膜被患者血液、体液、引流液接触暴露35例次;动静脉穿刺、拔针及拔针后处理不当、分离针头及整理用物、针头回套是发生锐器伤的高危环节;操作时未戴手套为皮肤黏膜接触暴露的主要原因;上午9∶00-10∶00、护士独立值班时、临床工作年限<5年的护士是发生职业暴露的危险因素;护士对职业暴露相关知识及发生暴露后正确的处理流程知晓率低,护士的标准预防及手卫生依从性差。结论通过对护士进行系统、规范的职业暴露相关知识培训,提高其对职业暴露的认识,针对存在的问题采取相应的措施,最大限度地降低护士职业暴露的风险,保障护理人员的职业安全。

OBJECTIVE To analyze the risk factors for occupational exposure to the nurses in department of hepatobiliary surgery so as to propose feasible management countermeasures.METHODS The occupational exposure that occurred in 30 nurses during Sep 2010-Aug 2011 were retrospectively investigated by using self-designed questionnaire.RESULTS There were 39 case-times of sharp instrument injuries that occurred in 30 nurses within 1 year and 35 case-times of the nurses′ skin or mucosa exposed to the patients′ blood,body fluid or drainage fluid;venipuncture and arterial puncture,needle extraction and improper disposal after that,needle separation,and the needle back to the set were the high risk links for the sharp instrument injuries;the operation without wearing gloves was the main cause of the exposure to the skin mucosa;9∶00-10∶00 am,independently on duty,and the work experience less than 5 years were the risk factors for the occupational exposure;the nurses′ awareness to the proper disposal after the exposure was low,and the compliance of hand hygiene and the standard prevention was poor.CONCLUSION The systematic and standardized training of the related knowledge of occupational exposure should be intensified to improve the nurses＇ awareness to occupational exposure so as to take corresponding countermeasures to minimize the risk of occupational exposure and ensure the occupational safety.