医务人员血源传染病职业暴露调查与分析

Occupational exposure to blood-borne infectious diseases among medical staff

目的追踪调查传染病医院医护人员血源性传染病职业暴露的现状,分析危险因素。方法对2007年1月-2011年10月发生血源传染病职业暴露的117名医务人员进行追踪调查,对其职业、暴露源、科室、环节、处理等进行分析并追踪感染情况。结果职业暴露发生率从高到低,依次为护士80.34%、医师17.09%、检验人员1.71%、工人0.85%;暴露源种类依次为:乙型肝炎病毒63.64%,艾滋病病毒9.40%,丙型肝炎病毒3.42%,艾滋病合并梅毒0.85%;主要暴露科室从高到低依次为肝病科39.32%、外科14.53%、妇产科12.82%、肿瘤科11.11%、急诊ICU 7.69%;暴露的主要环节为动静脉穿刺23.08%、整理用物处理废物24.79%、拔针18.8%、手术缝合及外科器械16.24%、抽血及注射14.53%;117名职业暴露者,随访12个月,无1例发生血源性感染。结论加强重点人群、重点部门的培训,增强医务人员个人防护意识是减少职业暴露的关键;发生暴露后,立即熟练处理,实施预防干预措施,完全可以杜绝职业暴露所致的感染。

OBJECTIVE To investigate the current status of occupational exposure to blood-borne diseases among medical staff and analyze risk factors. METHODS Tracking survey was conducted for 117 medical staff with occupational exposure to blood-borne infectious diseases from Jan 2007 to Oct 2011, then the occupation, exposure sources , department , link, and treatment were tracked to observe the incidence of infections. RESULTS The incidence rates of the occupational exposure from high to low were 80.34% among the nurses, 17.09% among the doctors, 1. 71% among the clinical laboratory personnel, and 0. 85% among the workers. Among all the exposures sources, 63.64~ of the medical staff were with the occupational exposure to hepatitis B virus, 9.40% to HIV, 3.42% to hepatitis C virus, and 0.85% to HIV merged with syphilis. Of the main departments where the occupational exposure occurred, 39. 32% occurred in the liver disease department, 14. 53% in the surgery department, 12. 82% in the obstetrics and gynecology department, 11. 11% in the oncology department, and 7.69% in the emergency ICU. Among the main links for the exposure, 23.08% occurred in the arterial and venous puncture, 24. 79% in the waste disposal, 18. 8% in the needle withdrawal, 16. 24% in the surgical suturing and surgical instruments, and 14.53% in the blood drawing and injection. A more than 6-month follow-up of 117 medical staff with occupational exposure found no case of blood bone infection. CONCLUSION To strengthen the training of population in key departments and intensify the personal protection awareness is crucial to the reduction of the occupational exposure; once the exposures occur , they should be treated immediately and skillfully, and the prevention interventions should be implemented so as to completely prevent infections induced by the occupational exposure.