哈尔滨市239名医护人员HBV职业暴露现况及原因分析

Analysis of occupational exposure status and causes of HBV among 239 medical workers in Harbin

目的探讨医护人员HBV职业暴露原因和采取的主动免疫和被动免疫措施,为HBV职业暴露后采取的预防措施提供依据。方法通过收集门诊病历资料和询问调查的方式,运用统计学方法回顾性分析239例医护人员HBV职业暴露原因和采取的防护措施。结果239例HBV职业暴露者均为临床一线医护人员,暴露源均为乙肝患者的血液或体液。其中医生61名,护士178名,二者占比差异有统计学意义(χ^2=6.70,P<0.05)。男性59例,年龄28~50岁;女性180例,年龄20~42岁,二者占比差异有统计学意义(χ^2=6.47,P<0.05)。暴露者中175例为血液感染,占比73.22%;64例为体液感染,占比26.78%(均为手术室医务人员),二者差异有统计学意义(χ^2=6.38,P<0.05)。暴露者中有76人明确知晓自己的乙肝五项情况,知晓率31.80%;101人对自己是否接种过乙肝疫苗不清楚;177例暴露者主动注射乙肝免疫球蛋白和接种乙肝疫苗,62例暴露者在其他医务人员提醒下注射乙肝免疫球蛋白和接种乙肝疫苗;239例暴露者均能在暴露后正确处置伤口。结论发生的职业暴露以护理人员和低年资医生为主,原因为防护意识淡薄,知识缺乏。在乙肝职业暴露发生前主动检测乙肝五项和接种乙肝疫苗,是减少医源感染HBV的有效方法。

Objective To explore the causes of occupational exposure to HBV in medical and nursing staffs and the active and passive immunization measures,provide evidence for the preventive measures for occupational exposure to HBV.Methods Through the collection of outpatient medical records and investigation,the causes of occupational exposure of HBV and the protective measures taken by 239 cases of medical and nursing staffs were analyzed by retrospective analysis.Results All the 239 patients with HBV occupational exposure were the first-line medical staff,and the source of exposure was the blood or body fluid of the patients with hepatitis B.Among them,there were 61 doctors and 178 nurses,and there was the significant difference between them(χ^2=6.70,P<0.05).There were 59 males,aged between 28 and 50,and 180 females,aged between 20 and 42,with the statistically significant difference(χ^2=6.47,P<0.05).One hundred and seventy-five cases of exposure were blood infection,accounting for 73.22%,64 cases of humoral infection,accounting for 26.78%(all of them were medical staffs in operating room).There was significant difference between the two groups(χ^2=6.38,P<0.05).Seventy-six of the exposed persons the own situation of the 5 items of hepatitis B,and the awareness rate was 31.80%;101 were not clear about whether they had been vaccinated against the hepatitis B vaccine;177 exposed subjects received hepatitis B immunoglobulin and hepatitis B vaccine;62 of the exposed subjects were reminded by other medical personnel to inject hepatitis B immunoglobulin and hepatitis B vaccine;239 of the exposed patients were able to properly dispose of the wound after exposure.Conclusion Most of the occupational exposure occurred in nurses and junior doctors,which was due to the weak sense of protection,and lack of knowledge.The active detection of hepatitis B two-to-half and the inoculation of hepatitis B vaccine before the occurrence of hepatitis B occupational exposure is an effective method to reduce the infection of HBV in the medical source.