2015—2017年广州市某三甲医院医务人员血源性职业暴露调查

Investigation of blood-borne occupational exposure among medical staff in a grade-A tertiary hospital of Guangzhou City from 2015-2017

目的了解2015—2017年广州市某三甲医院医务人员发生血源性职业暴露的特点,分析危险因素,探讨有针对性的防护措施。方法回顾性调查2015—2017年广州市某三甲医院发生的304例医务人员血源性职业暴露案例,收集和分析暴露者性别、工作岗位、工作年限、暴露地点、操作环节、锐器物种类、暴露源情况及随访结果。结果在304名血源性职业暴露医务工作者中,以护理人员为主,占66.45%;以工龄0～5年的医务人员为主,占67.76%;暴露时关联操作前3位为处理针、处理医疗废物和实验操作,分别占38.82%、14.14%和12.83%;暴露身体部位主要为手部,占89.80%;血源性病原体主要为乙肝病毒、梅毒螺旋体和丙肝病毒,共占91.99%。发生暴露后86.51%的暴露者有采取紧急处理和消毒,97.37%的暴露者立即电话报告医院感染管理科并进行及时调查评估,随访后未发现有医务人员感染情况。结论低年资护理人员和医生是血源性职业暴露的高危人群,培训不到位、职业防护意识薄弱和风险评估不足是导致血源性职业暴露的重要原因。医院应建立健全医务人员职业防护培训考核体系,切实落实基础技能操作培训和实操演练,提高乙肝疫苗接种率,改善医务人员工作环境。

[Objective]To investigate the characteristics of blood-borne occupational exposure among medical staff in a grade-A tertiary hospital of Guangzhou City from 2015-2017,analyze the risk factors,and put forward the targeted prevention measures.[Methods]A total of 304 cases of blood-borne occupational exposure in a grade-A tertiary hospital of Guangzhou City from 2015-2017 were retrospectively investigated,and the data of gender,operating post,working years,exposure place,exposed procedure,exposed items,exposed sources and follow-up result were collected and analyzed.[Results]Among the 304 medical workers with blood-borne occupational exposure,the nurses accounted for 66.45%,and those with working age of 0-5 years accounting for 67.76%.The first three exposed procedures were dealing with the needle,disposing the medical waste and making experimental operation,which accounted for 38.82%,14.14% and 12.83%,respectively.89.80% of medical workers have hurt their hands,which was the commonest injured part.Additionally,the main blood-borne pathogens were hepatitis B virus,Treponema pallidum and hepatitis C virus,accounting for 91.99%.86.51% of the exposed workers have taken emergency treatment and disinfection.97.37% of the exposed workers have phoned the department of infection control and they also got immediately assessment.Finally,there was no infective person among these cases after the follow-up visit.[Conclusion]Nurses and doctors with lower length of service are the high risk group of blood-borne occupational exposure.Lack of training,weak awareness of occupational protection and lack of risk assessment are the significant reasons of occupational exposure.The hospitals should establish a thorough training and evaluating system and implement the basic training and maneuver among all the medical staff.In addition,it is also important to increase the vaccination rate of hepatitis B and improve the working environment.