2014-2020年某三甲医院医务人员血源性职业暴露特点及防控费用

Blood borne occupational exposure and expenditure of prevention and control of blood borne occupational exposure in health care workers of a three-A hospital from 2014 to 2020

目的 探讨医务人员血源性职业暴露发生特点,分析相关影响因素及防控费用,探讨防控措施,为医务人员职业防护提供科学有效的依据。方法 采用回顾性研究方法调查某三甲综合性教学医院2014年-2020年发生血源性职业暴露的医务人员114例,收集上报随访数据。结果 工龄<5年的医务人员最易发生职业暴露(45.61%)。暴露人员以手术科室为主(73.69%),前3位的分别是手术室、关节外科、产科;暴露源以乙型肝炎病毒为主(75.44%);锐器伤是主要暴露环节(88.60%)。护士暴露最多的地点为病房,主要时机是注射及拔针操作时;医生暴露最多的地点为手术室,主要时机是器械使用中,暴露场所及时机差异有统计学意义(P<0.05)。2014-2020年血源性职业暴露发生率呈下降趋势(P<0.05);暴露发生月份中,7、8月高发,其次是3、4月。血源性职业暴露防控费用平均每例392.22元,HCV、HBV、梅毒职业暴露平均费用分别为684.43元、388.09元、335.57元,其中HBV暴露者抗体滴度≥10 mIU/ml,平均每例95.70元,与无表面抗体或抗体滴度不足时(平均每例502.51元),同比降低80.95%。结论 应重点加强对职业暴露高危人群、高危科室、高危环节和高危时刻的防控,践行长效防控机制,有效预防血源性职业暴露的发生,降低其卫生经济负担。

OBJECTIVE To explore the characteristics of blood borne occupational exposure and the expenditure of prevention and control, and to analyze the effective measures to provide scientific evidence for further occupational protection for health care workers. METHODS A retrospective study was applied to investigate health care workers with blood borne occupational exposure from 2014 to 2020. All patients were followed up and data were collected. RESULTS Medical personnel with less than 5 years of service were most likely to have occupational exposure(45.61%). Occupational exposure occurred mainly in surgical departments, accounting for 73.69%. The top three departments prone to occupational exposure were operation theatre, joint surgery department and obstetric ward. The main pathogen of exposure was hepatitis B virus(75.44%), and sharp injury was the main process causing blood borne exposure(88.60%). The occupational exposure of nurses mainly occurred in the ward when injection and accidental withdrawal of needles happened. The The occupational exposure of doctors mainly occurred in the operating room, and the main time was in using surgical instruments. There was a significant difference in incidence and opportunity between doctors and nurses(P<0.05). From 2014 to 2020, the overall incidence of blood borne occupational exposure decreased(P<0.05). Occupational exposure occurred mainly in July and August, followed by March and April. The average cost of prevention and control for occupational exposure was 392.22 yuan, and the average cost of occupational exposure to HCV, HBV and syphilis per case was 684.43, 388.09 and 335.57 yuan, respectively. The average cost per case was 95.70 yuan for those with antibody titer ≥10 mIU/ml. Compared with those without surface antibody or with insufficient titer(502.51 yuan per case), it decreased by 80.95% year-on-year. CONCLUSION It′s necessary to strengthen the prevention and control of blood borne occupational exposure in high-risk population and departments and at high-risk of opportunity by practicing long-term occupational prevention and control mechanism, which can reduce the incidence of occupational exposure of health care workers and high expenditure effectively.