某三甲医院血源性职业暴露流行病学及伦理问题分析
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摘要
目的了解某三甲医院血源性职业暴露的流行病学特点,探讨相关伦理问题,为制定防护措施和管理制度提供参考。方法采用横断面调查研究,对该院2013年1月—2016年12月上报的304例职业暴露资料进行统计分析。结果暴露者中护士、工龄5年以下人员占比最高,分别为71. 05%、53. 95%;主要暴露源为乙肝,占59. 21%;主要暴露方式为锐器伤,占91. 45%;主要暴露环节为整理废弃物时,占23. 18%;主要暴露场所为病房,占58. 22%。结论医务人员职业暴露风险高,加强职业安全培训,进行免疫接种,对锐器使用、废弃物整理等高危环节加强管理,正确处理职业暴露中的伦理问题,对于降低职业暴露发生率和暴露后感染的风险,保护暴露人员的身心健康具有重要意义。
Objective: To understand the epidemiological characteristics of blood-borne occupational exposure in an Three-A hospital,and to explore relevant ethical issues,so as to provide reference for the formulation of protective measures and management system. Methods: A cross-sectional study was conducted to analyze 304 cases of occupational exposure reported in this hospital from January 2013 to December 2016. Results: Among all the staff who had hematogenous occupational exposure,most of them were nurses and medical staffs under 5 years of service accounted for 71. 05% and 53. 95% respectively. The main source of exposure was hepatitis B,accounting for 59. 21%. The main exposure mode was sharp instrument injury,accounting for 91. 45%. The main exposure link was waste disposal,accounting for 23. 18%. The main exposure sites were wards,accounting for58. 22%. Conclusion: Medical staff are at high risk of occupational exposure. It should strengthen occupational safety training,carry out immunization,strengthen management of high-risk links such as sharp instrument use and waste disposal,and properly handle ethical issues in occupational exposure. It is of great significance to reduce the incidence of occupational exposure and the risk of post-exposure infection and to protect the physical and mental health of exposed persons.
Objective: To understand the epidemiological characteristics of blood-borne occupational exposure in an Three-A hospital,and to explore relevant ethical issues,so as to provide reference for the formulation of protective measures and management system. Methods: A cross-sectional study was conducted to analyze 304 cases of occupational exposure reported in this hospital from January 2013 to December 2016. Results: Among all the staff who had hematogenous occupational exposure,most of them were nurses and medical staffs under 5 years of service accounted for 71. 05% and 53. 95% respectively. The main source of exposure was hepatitis B,accounting for 59. 21%. The main exposure mode was sharp instrument injury,accounting for 91. 45%. The main exposure link was waste disposal,accounting for 23. 18%. The main exposure sites were wards,accounting for58. 22%. Conclusion: Medical staff are at high risk of occupational exposure. It should strengthen occupational safety training,carry out immunization,strengthen management of high-risk links such as sharp instrument use and waste disposal,and properly handle ethical issues in occupational exposure. It is of great significance to reduce the incidence of occupational exposure and the risk of post-exposure infection and to protect the physical and mental health of exposed persons.
引文
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[10]冯玲,杨蓉蓉,桂希恩,等.护理人员HIV职业暴露及感染HIV原因分析[J].中国感染控制杂志,2017,16(8):752-756.
[11]王渊,刘永杰,付强,等. 1例出入境医务人员职业暴露感染HIV的调查报告[J].口岸卫生控制,2016,21(3):31-32.
[12] Kuhar D T,Henderson D K,Struble K A,et al.Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis[J]. Infect Control Hosp Epidemiol,2013,34(9):875-892.
[2]王晓艳,平宝华,林永杰,等.关于综合医院医务人员血源性职业暴露现状调查及伦理对策探讨[J].中国医学伦理学,2015,28(3):308-311.
[3]白雪,杨莉莉,窦学梅.某综合医院医务人员血源性病原体职业暴露情况[J].中国感染控制杂志,2017,16(2):176-178.
[4]陈丽丽,严艳清,陈芙蓉,等.医务人员血源性职业暴露调查[J].解放军医院管理杂志,2016,23(1):19-21.
[5]胡必杰,高晓东,索瑶,等.医务人员血源性病原体职业暴露预防与控制最佳实践[M].上海:上海科学技术出版社,2012.
[6]冼俊芳,陈祖辉.广州市某综合医院锐器伤现状分析及防治对策[J].职业与健康,2016,32(13):1866-1869.
[7]李冬梅,高燕,王守军,等.某三甲医院临床医务人员锐器伤流行病学特点[J].中华医院感染学杂志,2016,26(12):2865-2866.
[8] Naghavi S H,Shabestari O,Alcolado J. Posttraumatic stress disorder in trainee doctors with previous needlestick injuries[J]. Occup Med(Lond),2013,63(4):260-265.
[9]孙继伟,韩瑜,白华羽,等.医务人员血源性传染病职业暴露后心理应激反应的纵向研究[J].中国心理卫生杂志,2017,31(3):190-194.
[10]冯玲,杨蓉蓉,桂希恩,等.护理人员HIV职业暴露及感染HIV原因分析[J].中国感染控制杂志,2017,16(8):752-756.
[11]王渊,刘永杰,付强,等. 1例出入境医务人员职业暴露感染HIV的调查报告[J].口岸卫生控制,2016,21(3):31-32.
[12] Kuhar D T,Henderson D K,Struble K A,et al.Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis[J]. Infect Control Hosp Epidemiol,2013,34(9):875-892.