2015—2018年某三级综合医院医护人员血源性职业暴露情况调查及安全防控体系构建

Blood-borne occupational exposure and its countermeasures among medical staff in a tertiary general hospital,2015-2018:a retrospective study

目的调查2015—2018年三级综合医院医护人员血源性职业暴露情况,并构建安全防控体系。方法采用回顾性分析方法对某综合医院2015—2018年医护人员血源性职业暴露情况进行调查,构建安全防控体系。结果2015—2018年某三级综合医院248人次发生血源性职业暴露,发生率为8.71%;护士血源性暴露发生率10.22%高于医生6.47%,女性9.56%高于男性6.28%,工作年限越长发生率越低,外科为高发科室,2015—2018年发生率总体呈下降趋势;血源性职业暴露发生率最高时间段为8:00~12:00(39.11%),其次为13:00~17:00(29.03%),暴露方式主要为针刺或锐器伤(65.32%),主要发生于注射结束拔针或采血环节(25.40%),手指为主要暴露部位(79.03%),多数未戴手套或眼罩(52.42%);锐器管理不规范为主要暴露原因(52.02%);其次为操作意外(31.45%)。主要暴露源为乙型肝炎病毒(28.63%),其次为丙型肝炎病毒(25.00%)。结论2015—2018年某三级综合医院医护人员血源性职业暴露高危人群为护士、女性、工作年限短、外科人员;主要暴露源为乙型肝炎病毒。

Objective To examine the situation of blood-borne occupational exposure and measures to prevent and control the exposure among medical staff in a tertiary general hospital from 2015 to 2018.Methods We collected all case reports of medical staff on blood-borne occupational exposure events registered from 2015 through 2018 in the management information system of a tertiary general hospital in Chongqing city and analyzed the data with descriptive statistics retrospectively.Results During the 4-year period,totally 248 person-times of blood-borne occupational exposure were reported among the staff,with an accumulated incidence rate of 8.71%and downward trend in yearly incidence rate.The reported incidence rate of blood-borne occupational exposure was higher among the nurses than among the doctors(10.22%vs.6.47%)and higher among the female staff than among the male staff(9.56%vs.6.28%);the reported incidence rate of blood-borne occupational exposure was inversely correlated with the years of professional work among the staff;and higher incidence rate of blood-borne occupational exposure was reported by the staff working in surgery department.For all the reported blood-borne occupational exposures,more than one-third(39.11%)occurred between 8:00–12:00 in the morning of a day and nearly one-third(29.03%)occurred between 13:00–17:00 in the afternoon of a day.The majority(65.32%)of the reported blood-borne occupational exposures were due to needle or sharp instrument injury and 25.40% of the exposures occurred during injection or blood sampling operations.Finger was the most frequently reported body part injured in 79.03%of the blood-borne occupational exposures.More than a half(52.42%)of the staff with blood-borne occupational exposures did not wear gloves or goggles when the exposures occurred;52.02% and 31.45% of the staff reporting the exposures attributed the exposures to the lack of standardized management on sharp instruments and accidental operations.Of all the reported blood-borne occupational exposures,28.63% and 25.00% were involved in probable infection of hepatitis B and C virus;91.53%were immediately dealt with local disinfection and 78.23% with follow-up detection for potential infections.Conclusion In a tertiary general hospital,nurses,female staff,the staff with short working years and working in surgery department are at a high risk of blood-borne occupational exposure and the main potential hazard of the exposures occurred is hepatitis B virus infection.