医务人员锐器伤现状调查与防护对策的研究

Investigation on the Current Situation of Sharp Instrument Injury of Medical Personnel and Research on Protective Countermeasures

目的探讨医务人员锐器伤发生的相关危险因素与相应的防护对策,为避免甚至杜绝此类事件发生提供理论依据。方法采用便利抽样选取医院工作的医务人员,自行设计问卷进行调查,问卷内容包括一般资料(年龄、工作年限、职称、学历、是否参加过职业教育、自身血液感染性标记物状态)、2021年3月1日—2022年3月1日期间职业相关锐器伤的发生情况(锐器伤发生次数、发生时机、源患者血液检测结果)、暴露后处理(采取报告行为与否及原因、报告的时间、接受专业评估、接受心理咨询、预防用药物、确认暴露源、血清抗体反转等)三部分。所有问卷均进行匿名填写,现场回收,并进行统计学分析。结果研究共发放调查问卷1535份,有39位医务人员在2021年3月1日—2022年3月1日期间发生过锐器伤,发生率为2.54%。其中男性16例,女性23例。医师17例,护士22例,技师0例。年龄范围21~54岁,平均(33.43±8.41)岁。20例为初级职称,12例为中级,7例为高级。教育程度本科以下者17例,本科及以上者22例,35例参加过职业安全知识培训,4例未参加。本科及以上医务人员的锐器伤发生率为3.84%,高于本科以下医务人员的锐器伤发生率1.58%,未参加职业安全知识培训医务人员的锐器伤发生率为18.18%,高于参加职业安全知识培训医务人员的锐器伤发生率2.31%,差异有统计学意义(P<0.05)。锐器伤发生时机分布情况显示,手术中是锐器伤发生最多的时机,构成比占38.46%,之后依次为回套针帽、拔针和拆卸器械的时机。结论职业安全知识培训在医务人员中已逐渐普及,医务人员普遍提升了锐器伤相关防护知识的认知和知晓情况。但由于传染性疾病、血液疾病近年来发病率的不断上升,在实际工作中医务人员,尤其是一线临床工作人员仍应该提升自我职业防护意识,加强重点环节培训,熟练掌握锐器操作方法及锐器伤的应急处理方法,尽量避免甚至杜绝锐器伤的发生。

Objective To explore the current situation investigation and protection countermeasures of sharp instrument injuries of medical personnel,so as to provide a theoretical basis for avoiding or even eliminating such incidents.Methods The medical staff working in the hospital were selected by convenient sampling,and the questionnaire was designed by themselves.The contents of the questionnaire included general information(age,working years,professional title,educational background,whether they had participated in vocational education,their own blood influenza infectious marker status),the occurrence of previous sharp instrument injuries from March 1,2021 to March 1,2022(sharp instrument injuries occurred during work,source patients,and the number of sharp instrument injuries occurred in the past 12months)post exposure treatment(whether or not to report behavior and reasons,time of report,professional evaluation,psychological counseling,preventive drugs,confirmation of exposure source,reversal of serum antibody,etc.).All questionnaires were filled in anonymously,collected on site,and statistically analyzed.Results A total of 1535 questionnaires were distributed in this study.39medical staff had sharp instrument injuries from March 1,2021 to March 1,2022,with an incidence of 2.54%.There were 16 males and 23 females.There were 17 doctors,22 nurses and 0 technicians.The age range was 21~54 years old,with an average of(33.43±8.41)years.20 cases were junior professional titles,12 cases were intermediate and 7 cases were senior.17 cases had a bachelor’s degree or below,22 cases had a bachelor’s degree or above,35 cases had participated in occupational safety knowledge training,and 4cases did not participate.The incidence of sharp instrument injury of medical personnel with bachelor degree or above was 3.84%,which was higher than that of medical personnel with bachelor degree or below by 1.58%.The incidence of sharp instrument injury of medical personnel without occupational safety knowledge training was 18.18%,which was higher than that of medical personnel with occupational safety knowledge training by 2.31%(P<0.05).The distribution of the occurrence time of sharp instrument injury shows that the operation is the most frequent time of sharp instrument injury,accounting for 38.46%,followed by the time of needle cap retraction,needle extraction and instrument disassembly.Conclusions Occupational safety knowledge training has been gradually popularized among medical personnel,and medical personnel have generally improved their cognition and awareness of sharp instrument injury related protection knowledge.However,due to the increasing incidence rate of infectious diseases and hematological diseases in recent years,medical workers,especially the first-line clinical workers,should still enhance their awareness of self-occupation protection,strengthen training in key links,master sharp operation methods and emergency treatment methods for sharp injuries,so as to avoid or even eliminate the occurrence of sharp injuries.