基于职业暴露数据对中医针刺操作意外刺伤的调查分析

Analyzing the prevention strategies of accidental puncture in traditional Chinese medicine acupuncture based on occupational exposure data

目的调查和分析从事中医针刺类操作的医务人员发生意外针刺伤的现状,提出预防刺伤策略,保障职业安全。方法通过回顾性分析方法,调查某三甲中医院在2020—2022年期间的职业暴露数据,收集整理暴露者的年龄、性别、工作年限、职业类别、岗前培训、使用针具类别、刺伤环节和暴露源等情况,分析刺伤发生风险点,并提出相应预防措施。结果本次调查共涉及12个临床科室5069名医务人员,其中63名医务人员被刺伤,发生率为1.24%(63/5069)。年龄25~30岁发生刺伤的概率比<25岁人群高(OR=18.556,P<0.05);年龄>30岁发生刺伤的概率比<25岁人群高(OR=14.311,P<0.05)。工作年限≥3年发生刺伤的概率比<3年人群低(OR=0.025,P<0.05)。实习医生发生刺伤的概率比医生高(OR=2.212,P<0.05)。刺伤环节方面,拔针时发生率最高58.73%(χ^(2)=106.222,P<0.05)。针具类型方面,针灸针发生率最高为41.27%(χ^(2)=45.095,P<0.05)。暴露源方面,“未知暴露源”最高42.86%(χ^(2)=57.476,P<0.05),“暴露源为乙肝患者”为20.63%(χ^(2)=57.476,P<0.05)。岗前培训方面,“接受过岗前培训”仍发生刺伤占比最高为69.84%(χ^(2)=38.000,P<0.05)。结论应提前获取患者的血清学状态,严格遵守“标准预防”和“接触隔离”等预防感染的控制措施,实施有效岗前培训,并关注特殊针具的刺伤风险,才能预防刺伤,保障职业安全。

Objectives To enhance occupational safety for medical practitioners involved in acupuncture procedures within the field of Chinese medicine,it is imperative to thoroughly investigate and analyze the current incidence of accidental punctures.Subsequently,effective strategies can be proposed to prevent such occurrences.Methods Through retrospective analysis,this study investigates the occupational exposure data of a tertiary hospital specializing in traditional Chinese medicine from 2020 to 2022.The demographic characteristics(age and gender),professional experience,occupational category,pre-service training,type of acupuncture tools used,puncture session details,and exposure sources of the individuals involved are collected and organized for analyzing the risk factors asso⁃ciated with accidental needlestick injuries.Corresponding preventive measures are proposed accordingly.Results In this survey,a total of 5069 medical staff from 12 clinical departments were included,among whom 63 experienced accidental puncture with an incidence rate of 1.24%(63/5069).The likelihood of puncture was found to be signifi⁃cantly higher in individuals aged between 25~30 years compared to those under the age of 25(OR=18.556,P<0.05).Similarly,the probability of puncture was also higher in individuals aged over 30 years compared to those under the age of 25(OR=14.311,P<0.05).Conversely,individuals with at least three years of experience had a lower probability of experiencing punctures compared to those with less than three years(OR=0.025,P<0.05).Furthermore,interns exhibited a higher likelihood of puncture incidents compared to physicians(OR=2.212,P<0.05).Regarding the puncture session,the highest probability of occurrence is 58.73%at the time of needle removal(χ^(2)=106.222,P<0.05).Regarding the type of acupuncture tools,acupuncture needles have the highest probability of occurrence at 41.27%(χ^(2)=45.095,P<0.05).Concerning the exposure source,"unknown exposure source"has the highest preva⁃lence at 42.86%(χ^(2)=57.476,P<0.05),while"exposure source is hepatitis B patient"accounts for 20.63%(χ^(2)=57.476,P<0.05).Regarding pre-service training,individuals who have received pre-service training exhibit a higher likelihood of puncture incidents(69.84%)(χ^(2)=38.000,P<0.05).Conclusions The serological status of patients should be obtained in advance,and strict adherence to infection prevention control measures such as"standard precau⁃tions"and"contact isolation"is necessary.Effective pre-service training must be implemented,with particular atten⁃tion given to the risk of puncture when using specialized acupuncture tools for occupational safety.