外科病房护士经皮锐器伤调查分析

Investigation and Analysis of Percutaneous Sharp Injuries in Surgical Ward Nurses

目的调查分析外科护理人员锐器伤现状,探讨预防锐器伤管理措施。方法采用问卷方式对外科病房发生经皮锐器伤的39名护士进行调查分析。结果被刺伤前39名护士均接种过乙型肝炎疫苗,注射间隔大于5年11例。导致伤害的锐器物种类包括头皮针22例、注射器针头13例、输液器针头2例、外周静脉留置针枕芯和采血针针头各1例。伤害发生的操作环节包括输液/采血/换液/拔针46.16%、拔针后剪掉针头时扎伤2.56%、拔针后往塑料输液袋回插头皮针刺伤占7.69%、回套针帽占17.95%、处理锐器盒的过程中占12.82%、锐器盒过满针头外露致伤占12.82%;经皮锐器伤发生部位包括左手占56.41%、右手占33.33%、其他占10.26%;经皮锐器伤的严重程度包括表面伤害占53.85%、中等程度伤害占46.15%;被血污染的锐器物刺伤共有22人(56.41%),暴露源包括梅毒、乙型肝炎、丙型肝炎、怀疑乙型肝炎合并丙型肝炎等。护理人员受伤时戴一层手套占46.15%、双层手套占28.21%、没戴手套占25.64%;受伤后处理伤口规范者占82.05%、不规范者占17.95%;受伤前知晓患者有无经血液传播疾病者占66.67%、不知晓者占33.33%,受伤后主动查看患者有无经血液传播疾病者占87.18%、经提醒后查看者占12.50%。结论护理人员不了解、不遵从标准预防是发生锐器伤的主要原因,从管理层面完善监督机制非常重要,管理者要定期开展相关培训教育,在日常工作中起到监督作用,使临床护理人员提高职业防护意识,规范操作,保障广大护理人员的职业安全。

Objective To investigate and analyze the situation of sharp injuries in surgical ward nurses,and to explore the prevention and control measures of sharp injuries.Methods Thirtynine surgical ward nurses with sharp injuries were investigated using questionnaires.Results All the 39 nurses received Hepatitis B vaccination before injury.Among them,the injection interval was greater than 5years in 11 nurses.The injuries were caused by scalp needle in 22 nurses,by syringe needle in 13 nurses,by infusion needle in 2nurses,and by peripheral venous indwelling needle pillow in 1nurse.The procedures causing injury included transfusion/blood collection/solution change/needle withdrawal（46.16%）,needle cutting（2.56%）,insertion of scalp needle into plastic infusion bag（7.69%）,needle capping（17.95%）,sharp box handling（12.82%）,and needle exposure due to overfull sharp box（12.82%）.Injuries occurred in left hand,right hand and other body parts in 56.41%,33.33% and 10.26% of these nurses,respectively.Superficial injury and moderate injury accounted for 53.85% and 46.15%,respectively.Twenty-two nurses（56.41%）were stabbed by contaminated sharps.The exposure sources included syphilis,hepatitis B,hepatitis C,and suspected hepatitis B with hepatitis C.When nurses were injured,46.15% wore one pair of gloves,28.21% wore two pairs of gloves,and 25.64% wore no gloves.After injury,82.05% of these nurses received standard would treatment and 17.95%received non-standard treatment.Before injury,66.67% of these nurses knew the presence of patients＇ blood-transmitted diseases,and 33.33% did not know.After injury,87.18% of these nurses take the initiative to examine whether patients had blood-transmitted diseases,and 12.50%examined patients＇ blood-transmitted diseases after they were reminded.Conclusion The incomprehension and non-observance of standard prevention are the main reasons for sharp injuries in surgical ward nurses.It is very important to perfect the supervision mechanism from the aspect of management.Managers should regularly carry out the relevant training and education and play a supervisory role to improve the protection awareness and standard operation of clinical nurses and to guarantee the occupational safety of nurse staff.