综合医院医务人员结核分枝杆菌感染调查及风险分析

Investigation and analysis on risk factors of Mycobacterium tuberculosis infection among the medical staff in general hospital

目的：调查综合医院医务人员结核分枝杆菌感染状况，分析结核分枝杆菌感染的影响因素及有效措施以降低感染风险。方法采用整群抽样方法将湖北省宜昌市某医院1086名符合条件的医务人员纳入本研究，按照工作中是否曾接触过结核病患者或其分泌物划分为接触组与非接触组，按照不同的工作岗位划分为临床组、医技组及行政组。所有受试人群均进行结核T细胞斑点试验（T-SPOT.TB）检测，组间进行T-SPOT.TB试验阳性率比较。结果接触组与非接触组研究对象T-SPOT.TB阳性率分别为55.03%和40.29%，差异具有统计学意义（χ2=14.245、P =0.018）。行政组与医技组研究对象T-SPOT.TB阳性率分别为44.27%和62.28%（χ2=9.803、P =0.027），差异具有统计学意义；行政组与临床组研究对象T-SPOT.TB阳性率分别为44.27%和51.41%，差异无统计学意义（χ2=2.284、P =0.063）；临床组与医技组研究对象阳性率差异具有统计学意义（χ2=6.794，P =0.038）。针对不同工作年限段的临床组与医技组中医务人员进行T-SPOT.TB试验阳性率分层比较，工作年限＜5年群体中，医技组与临床组研究对象阳性率差异无统计学意义（χ2=0.015，P =0.489）；工作年限5～15年群体中，医技组研究对象的阳性率显著高于临床组（χ2=5.018，P =0.046）；工作年限＞15年群体中，医技组的阳性率显著高于临床组（χ2=7.320，P =0.031）。临床组研究对象中，结核专业组与非结核专业组T-SPOT.TB阳性率差异具有统计学意义（χ2=4.022、P =0.036）。结论医务人员结核分枝杆菌感染率与不同工种、工作年限以及与患者接触与否有关，应加强对医技人群和从事非结核病专业临床医务人群的个人防护和健康教育。

Objective To investigate the status of medical staff withMycobacterium tuberculosis infection in a general hospital, and to analyze the factors ofMycobacterium tuberculosis infection and the effective measures to reduce the risk of infection.Methods Total of 1 086 qualiifed medical staff in a hospital of Yichang, Hubei Province were collected by cluster sampling method. According to whether exposed to patients with tuberculosis or their secretions, the 1 086 medical staff were divided into the contacted group and the non-contacted group. According to different jobs, they were divided into clinical group, medical group and administration group. All the subjects were detected for tuberculosis T cell spot test (T-SPOT.TB), the positive rates of T-SPOT.TB test among the different groups were compared, respectively.Results The positive rates of T-SPOT.TB were 55.03% and 40.29% in the contacted group and the non-contacted group, respectively, with signiifcant difference (χ2= 14.245,P = 0.018). The positive rate of T-SPOT.TB in administration group and medical group were 44.27% and 62.28%, respectively, with signiifcant difference (χ2= 9.803,P = 0.027). The positive rates of T-SPOT.TB were 44.27% and 51.41% in the administration group and the clinical group, respectively, without signiifcant difference (χ2= 2.284,P = 0.063). The positive rates of T-SPOT.TB between the clinical group and medical group was not significantly different (χ2= 6.794,P = 0.038). The positive rate of T-SPOT.TB test of medical staff with different working years in clinical group and medical group were compared, respectively. Among the medical staff with working years < 5, the positive rate between&nbsp;the medical group and the clinical group was not signiifcantly different (χ2= 0.015,P = 0.489). Among the medical staff with working years of 5-15 years, the positive rate of medical group was signiifcantly higher than that of clinical group (χ2= 5.018,P = 0.046). Among the medical staff with working years of > 15 years, the positive rate of the medical group was signiifcantly higher than that of clinical group (χ2= 7.320, P = 0.031). In the clinical group, the positive rate of T-SPOT.TB test between the professional group and the non-tuberculosis group was signiifcantly different (χ2= 4.022,P = 0.036).Conclusions The infection rate ofMycobacterium tuberculosis was related to different careers, the working life and the contaction with the patients. It is important for medical staff and those who engaged in non-tuberculosis clinical medical professional groups to strengthen personal protection and health education.