某院医务人员锐器伤目标性监测

Targeted monitoring of sharp injuries among health care workers in a hospital

目的了解某院医务人员发生锐器伤的人群分布特征和风险环节,为制定有效防护措施提供依据。方法回顾性调查2014年1—12月该三级甲等医院医务人员上报医院感染管理科的职业暴露情况,分析发生锐器伤者的职业类别、暴露地点及环节、暴露源等情况。结果 2014年1—12月共监测医务人员2 643名,发生锐器伤61名,其中护士43名(占70.49%),医生13名(占21.31%)。医务人员锐器伤职业暴露科室主要为骨科(9名,占14.75%),致伤锐器主要为输液针(33名,占54.10%),发生的主要操作环节为拔针(21名,占34.43%);暴露源主要为乙型肝炎病毒(HBV),共36例(占59.01%);34名(占55.74%)锐器伤职业暴露医务人员在操作中均未戴手套。锐器伤职业暴露后进行局部处理者54名(占88.52%),进行药物治疗(含预防用药)者仅18名(占29.51%);追踪随访43名(占70.49%),均未因暴露而发生感染。结论医院应建立完善的锐器伤职业暴露监控体系,加强对发生锐器伤高危人群的培训,强化标准预防,对风险环节进行监控和干预,有效减少医务人员锐器伤的发生。

Objective To understand the population distribution characteristics and risk links of sharp injuries among health care workers （HCWs）in a hospital,and provide basis for making effective protection measures. Methods Occupational exposure of HCWs in a tertiary first class hospital between January and December 2014 were retrospectively surveyed.Occupations of HCWs sustained sharp injuries,exposure locations and links,expo-sure sources and so on were analyzed.Results A total of 2 643 HCWs were monitored in January-December 2014, 61 cases of sharp injuries occurred,43（70.49%）sharp injuries occurred in nurses,13 （21 .31 %）in doctors.Sharp injuries mainly occurred in HCWs in department of orthopedics（n=9,14.75%）,the major device causing sharp in-juries was transfusion needles （n = 33,54.10%）,the main manipulation was pulling out the needles （n = 21 , 34.43%）,the main exposure source was hepatitis B virus（n=36,59.01 %）;34（55.74%）HCWs with sharp inju-ries didn’t wear gloves during manipulation.54 （88.52%）HCWs performed local treatment following sharp inju-ries,only 18（29.51 %）HCWs received medication（including preventive medication）,43（70.49%）HCWs with oc-cupational exposure were followed up and didn’t develop infection.Conclusion Hospital should establish compre-hensive monitoring system for occupational exposure injuries,strengthen the training of sharp injuries among high risk population,improve standard prevention,monitor and intervene risk links,so as to effectively reduce the inci-dence of sharp injuries among HCWs.