手术相关梅毒职业暴露的预防研究

Prevention of occupational exposure to syphilis

目的:系统性分析一段时间内发生的手术相关梅毒职业暴露风险分析相关因素,并通过品管圈(Quality Control Circle,QCC)活动制定相应的对策,减少相关暴露风险。方法:选取2011年1月至2012年12月我院未实行品管圈干预期间收治的梅毒手术患者486例重症患者作为对照组;选取2013年1月至2016年9月我院实施品管圈活动后收治的梅毒手术患者576例作为观察组。详细分析对照组手术相关梅毒职业暴露相关原因,在术者心理准备、手术准备、物品准备以及污染处理方面制定相关的政策,并在观察组实施。分析干预前后,发生手术相关梅毒职业暴露的发生情况。结果:对照组486例手术中出现梅毒职业暴露有73例,占比15.02%。其中在所有的可能暴露的原因中,手术中出现的占比最高,达到31.51%;由于破损皮肤接触而导致的梅毒职业暴露占比也很高,达到27.40%,其他原因导致的梅毒职业暴露较为平均。在干预前,医生和护士发生手术相关梅毒职业暴露的占比分别为45.20%和54.79%;其中工龄在5年以下的人员占比最多,达到41.09%,工龄在15年医生的人员占比最少。观察组在采取相对应的干预措施后,手术相关梅毒职业暴露例数显著下降,与对照组相比有显著差异(P<0.01)。结论:通过品管圈活动制定详细的预防手术相关梅毒职业暴露的预防措施,能够显著降低相关的手术梅毒职业暴露,值得借鉴推广。

Objectives： To systematically analyze the risk factors related to the surgery related occupational exposure to syphilis during a period of time,and to formulate corresponding measures through Quality Control Circle（QCC） activities in order to reduce the risk of exposure. Methods： 486 severe syphilis patients in our hospital before the implementation of QCC intervention from January 2011 to December 2012 were selected as control group,and 576 syphilis patients in our hospital after the implementation of QCC from January 2013 to September 2016 were selected as the observation group. The related reasons of occupational exposure to syphilis were analyzed in the control group,and the related policies were formulated in the aspects of psychological preparation,surgical preparation,preparation of articles and pollution treatment. Analysis of the incidence of occupational exposure to syphilis before and after the intervention was conducted. Results： In the control group,there were 73 cases of occupational exposure to syphilis,accounting for 15. 02%. Among the possible reasons,surgery accounted for the highest proportion of 31. 51% and skin damage accounted for 27. 40%. Before intervention,the incidence of surgery related occupation exposure among doctors and nurses accounted for 45. 20% and 54. 79% respectively. Subjects with working age below 5 years accounted for the most（41. 09%） and that of those above 15 years was the least. In the observation group after taking corresponding intervention measures,the number of surgery related syphilis occupational exposure was significantly decreased,with significant difference compared with that in the control group（P 0. 01）.Conclusion： The risk of occupational exposure to syphilis can be significantly reduced through detailed preventive measures developed by QCC activities,which is worth clinical promotion.