某大型综合医院血源性病原体职业接触干预研究

Study on intervention of bloodborne pathogen exposure in a general hospital

目的通过干预提高医院医护人员血源性病原体职业接触防护知识知晓率和接触后自我报告率，降低血源性病原体职业接触发生率；总结医院血源性病原体职业接触的有效防治和干预措施。方法在对1家大型综合医院既往调查工作的基础上，对干预前的727名和干预后的614名医护人员的人员结构和科室分希睛况进行对比，选定血源性病原体职业接触风险较高、2009年人员结构与本年度匹配的科室，对医院开展推动医院职业卫生体系建设、对医院相关文件制度进行更新、辅以知识培训、座谈和现场指导等综合性干预工作，在干预后对受干预人员进行调查，将干预前后的调查数据进行比较。结果对于本次干预培训时重点培训的14个方面的知识，干预后被调查人员的得分总数均明显高于干预前，干预前后的得分差异有统计学意义（P〈O．05）；干预前后调查人群血源性病原体职业接触总接触发生率由81．57人／100人·年降至43．81人／100人·年，干预前发生血源性病原体职业接触的危险度是干预后的1．86倍；所调查科室的医护人员自我报告发生率由干预前的2．06人／100人·年上升至干预后的9．45人／100人·年，接触后自我报告率由干预前的0．47％升至干预后的9．65％。结论对医护人员所采取的干预措施能使该医院医护人员对血源性病原体职业接触防护相关知识的知晓率明显提升，可有效降低该医院医护人员血源性病原体职业接触发生率，提高接触后自我报告率。

Objective To improve the awareness of bloodborne pathogen exposure protection knowledge, reduce the contact incidence （including sharp injuries, contacting with the broken skin and mucous membrane contact）, and increase the self-report incidence of bloodborne pathogen exposure in the healtheare workers of the investigated hospital after the intervention. To summarize effective prevention and intervention measures of occupational exposure to bloodborne pathogen. Methods The project was on the basis of previous investigations in a general hospital, after comparing the personnel structure and departments distribution of 727 HCWs before the intervention and 614 HCWs after the intervention, we selected several departments in which the heahhcare workers with a higher risk of occupational exposure to bloodbome pathogens. We promoted the hospital to set up occupational health prevention and control system, improved related files, supplemented by knowledge training, discussion and field guidance, such a comprehensive intervention in the hospital. After the intervention, we conducted an cross-sectional investigation, and compared the rate of protection knowledge awareness, self- reporting rate after exposure, occupational exposure to bloodbome pathogens （including sharp injuries, contacting with the broken skin and mucous membrane contact） incidence before and after the intervention. Results Before and after the intervention, the total score of the investigated population of 14 knowledge points that we focused on in training showed a significant difference （P〈0.05）, total contact incidence of bloodborne pathogen exposure reduced from 81.57 persons/100 persons per year to 43.81 persons/100 persons per year, the RR of bloodborne pathogen exposure in the former investigation was 1.86 times of that in the latter investigation, the self-reported incidence increased form 2.06 persons/100persons per year to 9.45 persons/100 persons per year, self-reporting rate after exposure increased form 0.47% to 9.65%. Conclusion The interventions significantly improved the awareness of bloodborne pathogen exposure protection knowledge, effectively reduced the contact incidence of bloodborne pathogen exposure, and increased the self-reported incidence in the healthcare workers of the investigated hospital.