医护人员血源性职业暴露监测分析与预防策略

Monitoring of blood-borne occupational exposure to medical staff and preventive strategies

目的了解建立防止血源性职业暴露防护体系后医护人员职业暴露情况,为完善职业防护策略提供科学依据,实现规范化职业安全管理模式。方法建立血源性职业暴露防护体系,采用前瞻性和回顾性调查相结合的方法,调查医院522名医护人员2009年7月-2011年6月医源性锐器伤发生、血液/体液暴露、锐器伤人员的防护意识、全员标准预防依从性执行情况。结果 522名医护人员中,共发生职业暴露180人,发生率为34.48%,其中锐器伤152人,发生率为29.12%,血液/体液暴露28人,发生率为5.36%;锐器伤种类主要是注射针头、玻璃,其次为带翼针头及缝合针,分别占34.25%、27.12%、13.70%及10.41%;锐器伤操作环节主要是掰安瓿,其次为配加药时和处理使用后锐器,分别占26.58%、14.25%、11.23%;职业暴露人员中,69.44%未进行乙型肝炎疫苗预防接种、6.67%未穿戴防护用品、3.89%未规范处理伤口。结论职业安全防护体系的建立与实施,有效地预防与减少了医护人员血源性职业暴露的发生,降低了职业暴露的风险。

OBJECTIVE To provide the scientific basis for improving occupational protection and standardized occupational management mode by means of investigating the occupational exposure after establishing the protection system of blood-borne exposure. METHODS The protection system of blood-borne exposure was established, the incidence of occupational exposure, the awareness of the protection of sharp instrument injury, blood/body fluid exposure, and the execution of standard prevention compliance among 522 medical staff from Jul 2009 to Jun 2011 were investigated with the prospective and retrospective investigation method. RESULTS Among 522 medical staff, there were 180 with occupational exposure （34. 48%）, among which the sharp instrument injury were in 152 （29. 12%）, and exposure to blood/body fluid were in 28 （5. 36%） ; the sharp instrument injuries were mainly injector needle stick （34. 25%） and glass （27. 12%）, followed by needle with wings （13.70 %） and suture needle （10.41%） ; the links in which the injuries occurred were the dealing with ampoules （26.58%）, drug dispensing （14. 25%） and the disposal of used sharp instruments（11. 23%） ; there were 69.44% of the medical staff who did not receive hepatitis B vaccination, 6. 67% of the medical staff who didnrt wear protective equipment, and 3. 89% of the medical staff who didn＇t receive disposal with wound by standard measures. CONCLUSION The establishment and implementation of the protection system of occupational safety can effectively prevent and reduce the blood-borne occupational exposure to medical staff, decreasing the risk of occupational exposure.