某三甲医院医务人员血源性职业暴露现状调查

Investigation and analysis of the status of blood-borne occupational exposure of medical staff in a top three hospital and intervention measures

目的分析某三甲医院医务人员血源性职业暴露现状及干预效果,为临床工作加强职业暴露管理提供依据.方法于2019年2月,调查2015~2018年某三甲医院所有医务人员血源性职业暴露情况,共调查433名医务人员;比较不同岗位、不同工龄医务人员血源性职业暴露情况;比较2018年该院开始使用PDCA法进行风险管理前后的血源性职业暴露情况,分析PDCA循环法实施效果.结果433名医务人员中发生血液职业暴露91例(PDCA循环法实施前82例,实施后9例),职业暴露发生率21.01%.与其他岗位比较,护士血源性职业暴露构成比(68.29%,56/82)较大,差异有统计学意义(P<0.05);与其他工龄比较,1~5年工龄者职业暴露构成比(62.20%,51/82)较大,差异有统计学意义(P<0.05).主要暴露源为乙型肝炎(34.15%,28/82)、丙型肝炎(26.83%,22/82);锐器伤主要发生在各个操作过程中(36.59%,30/82)、拔针时(14.63%,12/82)、针头入锐器盒时(14.63%,12/82)、手术中(13.41%,11/82).与PDCA循环法实施前比较,实施后疫苗接种率、规范化现场处理率、预防性用药率、检查率均提高,差异均有统计学意义(P<0.05);标准预防概念考核项目、标准暴露后处理措施考核项目、防护箱及应急箱配置考核项目考核合格率均提高,差异均有统计学意义(P<0.05).结论工作年限短的护士容易出现血源性职业暴露,暴露后处理存在不规范现象,通过PDCA管理进一步加强新入职人员、低工作年限人员培训,完善设备,规范流程,能明显提高医护人员血源性职业暴露预防和应激处理落实程度.

Objective To understand the current situation of blood-borne occupational exposure among health care workers and evaluate the intervention effect of PDCA. Methods Retrospective survey was adopted to investigate and analyze the blood-borne occupational exposure incidents in a hospital from January 2015 to December 2018, and to compare the intervention effects after PDCA management. Results A total of 82 cases of occupational exposure occurred from 2015 to 2017, and only 9 cases happened after the implementation of PDCA intervention. The exposed population was mainly consisted of nurses (59 cases, 64.83%), and mainly with low-working age (1-5 years)(56 cases, 61.54%), and the main source of exposure was hepatitis B (34 cases, 37.36%). In addition, after the implementation of PDCA, the vaccination rate of personnel was 77.78%, the standardized field treatment rate was 100%, the preventive drug use rate was 88.89%;The qualified rate of occupational protection assessment was higher than that before intervention, which all shows the difference was statistically significant (P<0.05). Conclusion With the guide of PDCA management, Strengthen the training of new employees or ones with low working years as well as their awareness of protection, and standardize the relevant operational procedures, which can significantly improve the prevention of blood-borne occupational exposure and stress management of medical staff.