天津市某三级甲等医院医护人员职业暴露分析及管理策略

Analysis on occupational exposure among medical staff and its management policy in a third-grade class-A hospital of Tianjin

目的通过分析医院发生职业暴露的相关因素,探讨有效防护对策,提高医院的职业防护管理能力和水平。方法采用回顾性统计分析的方法,对2012年1月—2013年12月天津市某三级甲等综合医院上报市医院感染质量控制中心的所有职业暴露事件,共计79例次。逐例分析职业暴露发生的高危人群、高危科室、高危环节、暴露部位、暴露源、暴露后处理追踪等情况。结果 79例暴露事件中,2012年报告31例,2013年报告48例。岗位分布为护士35例,占44.3%;实习护士9例,占11.4%;医生27例,占34.2%;实习医生3例,占3.8%。69例损伤在手指,占87.3%;7例损伤在手臂,占8.9%;3例损伤在眼结膜,占3.8%。损伤程度为轻度的76例,重度3例。暴露源为血液的61例,阴道分泌物3例;暴露源病原体分布中乙型肝炎居多,占35.4%。结论应充分认识医院职业暴露管理的重要性,完善管理制度,规范各项操作规程,加大防护用品和设施投入,加强督导,确保预防措施落实到位,加强人文关怀,全面提升职业暴露防护管理的水平。

[ Objective ] To analyze the factors associated with the occupational exposure in hospital, probe the possible protection methods, and improve the management ability and level of occupational protection in hospital.[ Methods ]Using the a retrospective analysis, there were 79 cases of occupational exposure in a third-grade class-A hospital of Tianjin, which were reported to Tianjin Center for Nosocomial Infection Quality Control from January 2012 to December 2013. The high risk groups of occupational exposure, high risk departments, high risk links, exposed positions, exposure sources and post-exposure treatment were analyzed. [Results] Among 79 occupational exposure cases, 31 cases were reported in 2012, and 48 cases were reported in 2013. There were 35 cases of nurse, 9 cases of practice nurse, 27 cases of doctor and 3 cases of intern, which accounted for 44.3%, 11.4%, 34.2% and 3.8%, respectively. There were 69 cases of injuries in fingers, accounting for 87.3%, while 7 cases were damaged in the arms and 3 cases were damaged in eye conjunctiva, which accounted for 8.9% and 3.8% respectively. As for the injury degree, 76 cases were mild and 3 cases were severe. 61 cases were exposed to blood, and 3 cases were exposed to vaginal secretions. Most of exposure pathogens were hepatitis B virus, accounting for 35.4%. [ Conclusion ] It is necessary to realize the importance of occupational exposure management in hospital, perfect the management system, standardize the operational procedures, enhance the investment in protective equipment and facilities, strengthen the supervision, strictly implement the prevention measures, strengthen the humanistic care, and improve the management level of occupational exposure protection.