医务人员职业暴露调查分析及防控措施

Investigation and Analysis of Occupational Exposure of Medical Staff and Prevention and Control Measures

目的:了解医务人员职业暴露现状并分析其危险因素,制定相关防控措施及应急处置预案,降低医务人员职业暴露风险。方法:采用回顾性调查的方法对2017年1月1日~2019年1月31日某三级甲等医院发生职业暴露的156名医务人员进行监测分析。结果:156名发生职业暴露的医务人员中,以护士、实习护士和医生为主,分别占比39.7%、34.0%和20.5%;最主要的暴露方式是锐器伤,占92.9%,其中静脉输液、各种经皮注射和动静脉抽血是最主要环节,分别占比36.5%、21.1%和12.1%;整理用毕锐物、丢弃锐物、被不当放置锐物刺伤和双手回套针帽是暴露发生的主要时机,分别占比19.9%、19.9%、12.2%和12.8%;暴露发生地点主要是病房内,共76名,占比48.7%;暴露源以乙型肝炎病毒为主,占28.8%。随访均未发现职业暴露后感染。结论:医务人员是发生职业暴露的高危群体,但部分医务人员防护意识薄弱、安全教育欠缺,加强培训、完善制度、建立健全职业暴露报告是减少医务人员职业暴露风险,维护其身心健康的根本途径。

Objective:To understand the status of occupational exposure of medical staff and analyze its risk factors,formulate relevant prevention and control measures and emergency response plans,and reduce the occupational exposure risk of medical staff.Methods:A retrospective investigation was conducted to monitor and analyze 156 medical staff who were exposed to occupational exposure from January 1,2017 to January 31,2019 in a Grade 3 Class A hospital.Results:Nurses,intern nurses and doctors accounted for 39.7%,34.0%and 20.5%,respectively,among 156 medical staff with occupational exposure.The most important exposure method was sharp instrument injury,accounting for 92.9%,among which intravenous infusion,various percutaneous injection and arteriovenous blood drawing were the most important links,accounting for 36.5%,21.1%and 12.1%respectively.The main opportunities of exposure were finishing with sharp objects,discarding sharp objects,being stabbed by improperly placed sharp objects and double-handed needle cap,which accounted for 19.9%,19.9%,12.2%and 12.8%respectively.The exposure occurred mainly in the ward with 76 cases(48.7%).The main source of exposure was hepatitis B virus(HBV),accounting for 28.8%.No post-exposure infections were found during follow-up.Conclusion:Medical personnel are the high-risk group of occupational exposure,but some medical personnel have weak protection awareness and are lack of safety education.Strengthening training,perfecting system and establishing and perfecting occupational exposure report are the fundamental ways to reduce occupational exposure risk and maintain physical and mental health of medical personnel.