2015—2018年成都市某三级甲等专科医院工作人员锐器伤发生状况调查

Investigation on occurrence of sharp injuries in staff of a grade-A tertiary hospital in Chengdu City from 2015 to 2018

目的了解成都市妇女儿童医院工作人员血源性病原体职业暴露中锐器伤发生现况及原因,为锐器伤的防控措施提供科学依据。方法查阅2015—2018年成都市某三级甲等妇女儿童专科医院发生的锐器伤记录资料,从发生锐器伤的工作人员职业类别、工龄、暴露地点、种类、原因、源患者病原种类等进行统计分析。结果 2015—2018年该院共发生锐器伤119例;实习进修和规培的人员锐器伤发生比例最高(32.8%),其次是工勤人员和护士(25.2%);工龄≤1年的占44.5%;锐器伤类型主要为注射器针头、头皮针、缝合穿刺针、手术刀等;发生锐器伤的主要环节是在手术中、操作后被不适当放置的锐器物刺伤、整理用毕的锐器物时。Fisher确切概率法结果显示,不同职业类别人员发生锐器伤类型不同,护士发生注射器针头伤的比例更高,医生发生缝合穿刺针伤比例更高,差异有统计学意义(P<0.01);对全部发生锐器伤职业暴露的人员均建立职业暴露健康档案,定期追踪随访,未发现因职业暴露而感染血源性疾病。结论该医院应加强对低年资医务人员及工勤人员职业防护的定期培训,需进一步完善血源性病原体职业暴露的监测和防护体系,强化标准预防和标准化操作,提供安全注射用具和场所,采取集束化综合性措施和方法来降低医院工作人员发生锐器伤的风险。

Objective To understand the current situation and causes of sharp injuries in occupational exposure of blood-borne pathogens of staff in women and children’s hospital of Chengdu City,provide scientific evidence for prevention and control measures of sharp injuries. Methods The records of sharp injuries occurred in a grade-A tertiary women and children’s hospital of Chengdu City from 2015 to 2018 were reviewed, to take the statistical analysis from the occupational categories, working years,exposure locations, types, causes, and source pathogens of the workers who suffered from sharp injuries. Results From 2015 to2018, there were 119 cases of sharp injuries in the hospital. The sharp injuries of internship trainees and trainers accounted for the highest proportion(32.8%), followed by workers and nurses(25.2%). The cases of staff with working age less than one year accounted for 44.5%. The main types of sharp injuries were syringe needles, scalp needles, suture needles, and scalpels. The main links of sharp injuries were being stabbed by improperly placed sharp objects during and after operation, and sorting out the used sharp objects. Fisher exact probability method showed that the different types of occupations had different types of sharp injuries, and the proportion of syringe needle injuries in nurses was higher, while the proportion of suture needle injuries in doctors was higher, and the difference was statistically significant(P<0.01). All occupational exposure workers with sharp injuries had the occupational exposure health files, and were followed up regularly,and no blood-borne diseases due to occupational exposure were found. Conclusion It is necessary to strengthen regular training of occupational protection among less-experienced medical personnel and workers, further improve the monitoring and protection system for occupational exposure of blood-borne pathogens, strengthen standard prevention and standardization operations, provide safe injection equipment and places, and adopt comprehensive measures and methods to reduce the risk of sharp injuries in hospital staff.