三级甲等综合医院医务人员职业暴露现况分析

Analysis on the Occupational Exposure of Medical Staff in A Grade-A Tertiary General Hospital

目的了解医务人员职业暴露的发生与上报情况,为制定针对性的预防控制措施提供参考依据。方法统计2017-09/2018-08期间襄阳市中心医院职业暴露的上报数据,自行设计调查问卷对该段时间内医务人员职业暴露发生情况进行调查。结果 2017-09/2018-08期间本院共上报职业暴露112例,发生职业暴露的医务人员中有58例工龄低于3年,占全部职业暴露人员的51. 8%。暴露地点主要为临床治疗室和病房内。暴露方式以锐器伤为主,占全部职业暴露人员的76. 8%。暴露环节主要为处置医废和拔针。医务人员日常诊疗过程中防护用品规范使用率较低,是导致体液喷溅职业暴露发生的主要原因。暴露源患者有51. 8%为乙肝患者,但发生职业暴露的医务人员仅有47. 3%具有乙肝免疫能力。医务人员职业暴露上报率仅为8. 4%,未上报的原因依次为暴露源患者无传染性疾病、自觉暴露情况不严重、工作太忙而忘记上报以及嫌麻烦不愿进行上报。结论低工龄医务人员在进行静脉穿刺和手术缝合时易发生职业暴露,且职业暴露上报率低,主要原因是对职业暴露的危害重视不足,认为暴露源患者无传染性疾病或者自觉暴露不严重便不进行上报。医疗机构应切实加强对低工龄医务人员职业防护知识的培训,以降低职业暴露的危害。

Objective To understand the occurrence and reporting of occupational exposure of medical staff and provide evidence for the targeted prevention and control measures.Methods The reporting data of occupational exposure of Xiangyang central hospital,a grade-A tertiary general hospital,in September 2017 to August 2018 was collected and a simple questionnaire was conducted to investigate the occupational exposure of medical staff during this period.Results From September 2017 to August 2018,a total of 112 occupational exposures were reported in Xiangyang central hospital.Among the medical workers who had occupational exposure,58 had been working for less than 3 years,accounting for 51.8%.Clinical treatment room and ward were the main location of exposure.The main way of exposure was sharp instrument injury, accounting for 76.8%.The exposure generally occurs in the process of medical waste disposal removal.The low standard usage rate equipment during daily medical treatment and needle of protective was the main cause of occupational exposure of body fluid splashing.The exposure source patients with infectious diseases were mainly hepatitis B,accounting for 51.8%,while only 47.3%of medical staff had hepatitis B immunity. Moreover,only 8.4%of medical staff with occupational exposure was reported.The reasons for not reporting were listed in order,the exposure source was not contagious,the conscious exposure was not serious,the workers were too busy to forget reporting,and they were not willing to report.Conclusion Occupational exposure is easy to occur when medical staff of low working age performs venipuncture and surgical suture, and the reporting rate of occupational exposure is low.The main reasons are that insufficient attention is paid to the consequences of occupational exposure,and exposure source patients are not considered to have infectious diseases or are not voluntarily reported without serious exposure.Medical institutions should strengthen the education of occupational protection knowledge of medical personnel of low working age to reduce the occupational exposure and its harm.