凉山州第一人民医院医务人员锐器伤职业暴露调查

Investigation of Sharp Instrument Injury in Occupational Exposure in Hospital Medical Staff in Liangshan First People's Hospital

目的探讨凉山州第一人民医院医务人员锐器伤职业暴露的危险因素及应对措施。方法对医务人员在2011年8月1日-31日期间里的锐器伤发生情况进行问卷式和面对面提问式相结合的方式进行调查,共调查医务人员1 112名,包括医生288名,护士589名,医技人员180名,其他55名;采用《医务人员锐器伤调查问卷》进行筛查,筛查后与发生锐器伤的人员面对面交谈,并填写《医务人员锐器伤危险因素调查表》。用医务人员职业暴露监测系统(EPINeT)进行统计分析。结果发生锐器伤45例,发生率为4.05%,护士发生锐器伤的比例较高,达到了5.3%,医生为4.5%,医技人员较低为0.56%,其他人员发生锐器伤的可能性较小,经四格表的χ2检验,医生与护士锐器伤的发生率差异无统计学意义(χ2=0.010,P>0.05)。锐器伤发生的主要时机以抽血(占16%)、拔出动静脉针(占14%)、双手回套针帽(占14%)、手术缝针(占12%)以及将针头放入锐器盒(占10%)为主;发生的场所以普通病房(占60%)和手术室(占22%)为主;锐器伤发生的器械以一次性注射器(占32%)、静脉留置针(占18%)、真空采血针(占16%)和手术缝针(占14%)为主。结论医生和护士是锐器伤发生的高危人群,应采取一系列措施降低其发生职业暴露的风险,包括增加医护人员数量、加强职业培训、禁止双手回套针帽、采用安全留置针和使用皮肤粘合剂以及采用腹腔镜、阴道镜进行手术等措施,尽量降低医护人员的职业暴露风险。

Objective To approach the risk factors and reply intervention of sharp instrument injury in occupational exposure in medical staff.Methods We used questionnaire and face-to-face question method to investigate the condition of sharp instrument injury of 1 112 medical staff from August 1 to 31,2011.The medical staff included 288 doctors,589 nurses,180 medical technicians,and 55 others.The staff was asked to write questionnaire of medical staff sharp instrument injury,and the screened individuals were asked to fill the questionnaire of risk factors of medical staff sharp instrument injury after face-to-face talk with the investigators.EPINeT was used to analyze statistically.Results There were 45 injury cases,and the incidence rate was 4.05%.The injury ratio of nurses was higher（5.3%）,and docotros（4.5%） and technician（0.56%） were lower.The others were unlikely to be injured.The result of χ2 test showed that there was no statistically significant between nurses and doctors（χ2=0.010,P〉0.05）.The main opportunity of the injury included withdrawal（16%）,pulling out arteriovenous fistula needle（14%）,covering back needle hat（14%）,sewing needle（12%） and putting pinhead to sharp instrument box（10%）.The main occurring place were general wards（60%） and operating rooms（22%）;the main apparatus included disposable syringe（32%）,vein remaining needle（18%）,vacuum blood taking needle（16%）,and sewing needle（14%）.Conclusions Doctors and nurses were the main high-risk population.we should take a series of intervention to reduce occupational exposure risk,including increasing medical staff amount,strengthening on-professional training,forbidding covering back needle hat,using safe vein remaining needle,surgical appliance adhesive,peritoneoscope and gynecatoptron.