医务人员血源性传染病职业暴露调查分析

An analysis of the occupational exposure of medical personnel to blood-borne infectious diseases

目的了解医务人员血源性传染病职业暴露现状及影响因素,为提高医务人员职业防护意识,规范操作行为,制订防护措施提供科学依据。方法收集2012年1月-2014年12月我院医务人员血源性传染病职业暴露资料,调查分析医务人员在临床工作中发生职业暴露的情况。结果共有56人次发生血源性传染病职业暴露,其中护理人员41人次,占73.21%;临床医师8人次,占14.29%;非医护人员7人次,占12.50%。暴露者年龄30岁以下43人次,占76.79%。暴露科室以手术室最高,为20人次(占35.71%),外科14人次(占25%),消化内科10人次(占17.86%),内镜中心7人次(占12.50%),检验科5人次(占8.93%)。暴露方式主要为锐器损伤和接触暴露,分别为38人次(占67.86%)和18人次(占32.14%)。暴露部位以拇指为主,为20人次,占35.71%。暴露源以慢性乙肝居多,为34人次(占60.71%),其次为丙肝和梅毒,分别为5人次(占8.93%)和12人次(占21.43%)。暴露者发生职业暴露后均能正确进行局部消毒处理,根据暴露者暴露情况及对源患者病原体自身免疫情况给于相应干预,随访6个月,无感染病例发生。结论医务人员尤其是护理人员,是血源性传染病职业暴露的高危人群,应建立健全工作制度,加强职业防护知识培训,规范操作流程,配备防护用品、暴露后采取有效干预等措施以防止感染的发生。

Objective To ascertain the current state of occupational exposure of medical personnel to blood-borne infectious diseases and factors influencing that exposure in order to increase awareness of steps to prevent exposure,to standardize procedures and behavior,and to provide a scientific basis for development of protective measures. Methods Data on medical personnel at this Hospital who were occupationally exposed to a blood-borne infectious disease were collected from January 2012 to December 2014.Incidents in which medical personnel were occupationally exposed to a blood-borne infectious disease at work were analyzed. Results A total of 56 medical personnel were occupationally exposed to a blood-borne infectious disease,including 41nurses（73.21%）,8clinicians（14.29%）,and 7non-medical personnel（12.50%）.Of the personnel who were occupationally exposed,43（76.79%）were under the age of 30.The most frequent site of exposure was in the operating room in 20instances（35.71%）,followed by Surgery in 14（25%）,Gastroenterology in 10（17.86%）,the Endoscopy Center in 7（12.50%）,and the Clinical Laboratory in 5（8.93%）.Exposure occurred mainly via a sharps injury in 38instances（67.86%）or contact with infected blood in 18（32.14%）.The part of the body that was exposed was most often the thumb in 20instances（35.71%）.The most disease personnel were most often exposed to was chronic hepatitis B in 34instances（60.71%）,followed by hepatitis C infection in 5（8.93%）and syphilis in 12（21.43%）.The 56 incidents of occupational exposure were correctly treated.An appropriate intervention was implemented based on the conditions of exposure and the immune status of personnel who were exposed to a pathogen.A follow-up at 6 months revealed that none of the personnel had been infected. Conclusion Medical personnel,and especially nurses,are at risk of occupational exposure to a blood-borne infectious disease.A sound protocol should be devised,knowledge of and training in protection from occupational exposure should be enhanced,procedures should be standardized,protective equipment should be provided,and effective interventions should be implemented after exposure to reduce the occupational exposure of medical personnel to blood-borne infections.