手术室血源性职业暴露与防护现状分析
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摘要
目的:了解手术室血源性职业暴露及其防护情况,探讨减少手术室医务人员血源性职业暴露的措施。方法:选择24名手术室血源性职业暴露医务人员作为研究对象,分析其人群分布、发生环节、暴露源以及暴露后处理情况等。结果:手术室血源性职业暴露人群以医生为主(70.83%),年龄<40岁、工龄<3年和≥9年以及初级职称血源性职业暴露较多,分别占79.17%、37.50%、33.33%、54.17%。暴露部位以手为主,占91.67%,左手暴露部位拇指和中指较多,右手主要为示指。血源性职业暴露最主要的方式为锐器伤,占91.67%,手术中分合、传递、操作器械和手术缝针是主要环节,分别占45.83%和37.50%。暴露源病原体主要为乙型肝炎病毒,占83.33%。暴露后所有人员均立即作了局部处理,局部处理正确率为83.33%;暴露后18人(75.00%)接受预防用药处理,最主要的方式为乙型肝炎免疫球蛋白+乙型肝炎疫苗,其次为乙型肝炎免疫球蛋白治疗。结论:明确手术室血源性职业暴露的高危人群、主要环节和锐器物,通过规范操作流程、必要防护用品以及暴露后正确处理可减少血源性职业暴露和暴露后感染的风险。
Objective: To investigate the status of blood-borne occupational exposure and protection,and explore the measures to reduce the blood-borne occupational exposure of medical staff in operation room. Methods: Twenty-four medical staff with blood-borne occupational exposure in operation room were investigated,and the population distribution,generant step,exposure source and handle situation after exposure were analyzed. Results: Doctor was the main medical staff with blood-borne occupational exposure( 70. 83%),the ratios of blood-borne occupational exposure of medical staff with the age less than forty years,working year less than three years and more than or equal to nine years,and primary title were 79. 17%,37. 50%,33. 33% and 54. 17%,respectively. Hand was the main exposure part( 91. 67%),the thumb and middle fingers were more in the left hand,and the forefinger was more in right hand. The main way of blood-borne occupational exposure was sharp instrument injury( 91. 67%),and the ratios of the division,transfer and operation steps of surgical instrument during operation,and operation suture step were 45. 83% and 37. 50%,respectively. The HBV was the main pathogen of exposure( 83. 33%). All medical staff with blood-borne occupational exposure were immediately treated after exposure in local,the correct rate of local treatment was 83. 33%. Eighty medical staff were treated with preventive medication after exposure( 75. 00%),the main treatment way was the HBIG combined with hepatitis B vaccine,and second HBIG therapy. Conclusions:Definiting the high risk population,main step and sharp instrument of blood-borne occupational exposure in operation room,standardizing operating procedure,necessary protective equipment and right treatment after exposure can reduce the risk of blood-borne occupational exposure and infection after exposure.
Objective: To investigate the status of blood-borne occupational exposure and protection,and explore the measures to reduce the blood-borne occupational exposure of medical staff in operation room. Methods: Twenty-four medical staff with blood-borne occupational exposure in operation room were investigated,and the population distribution,generant step,exposure source and handle situation after exposure were analyzed. Results: Doctor was the main medical staff with blood-borne occupational exposure( 70. 83%),the ratios of blood-borne occupational exposure of medical staff with the age less than forty years,working year less than three years and more than or equal to nine years,and primary title were 79. 17%,37. 50%,33. 33% and 54. 17%,respectively. Hand was the main exposure part( 91. 67%),the thumb and middle fingers were more in the left hand,and the forefinger was more in right hand. The main way of blood-borne occupational exposure was sharp instrument injury( 91. 67%),and the ratios of the division,transfer and operation steps of surgical instrument during operation,and operation suture step were 45. 83% and 37. 50%,respectively. The HBV was the main pathogen of exposure( 83. 33%). All medical staff with blood-borne occupational exposure were immediately treated after exposure in local,the correct rate of local treatment was 83. 33%. Eighty medical staff were treated with preventive medication after exposure( 75. 00%),the main treatment way was the HBIG combined with hepatitis B vaccine,and second HBIG therapy. Conclusions:Definiting the high risk population,main step and sharp instrument of blood-borne occupational exposure in operation room,standardizing operating procedure,necessary protective equipment and right treatment after exposure can reduce the risk of blood-borne occupational exposure and infection after exposure.
引文
[1]黄淳茂,沈晓红,邓汉妹.基层医院手术室护士职业暴露的危险因素与防护对策[J].工业卫生与职业病,2015,41(2):155.
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[9]郭子君,勾健.手术室护士锐器伤的原因调查分析与防护措施[J].中华医院感染学杂志,2009,19(19):2592.
[10]NSUBUGA FM,JAAKKOLA MS.Needle stick injuries among in Sub Saharan Africa[J].Trop Med Int Health,2005,10(8):773.
[11]DEUFFIC-BURBAN S,DELAROCQUE-ASTAGNEAU E,ABITEBOUL D,et al.Blood-borne viruses in health care workers:prevention and management[J].J Clin Virol,2011,52(1):4.
[12]王根妹,陈少恋,陈晓丹.医务人员职业暴露的危险因素分析及管理措施[J].中国消毒学杂志,2015,32(8):826.
[13]DUNLEAVY K,TAYLOR A,GOW J,et al.Police officer anxiety after occupational blood and body fluid exposure[J].Occup Med,2012,62(5):382.
[14]彭凌,郑舟军,周月华.医务人员血源性传染病职业暴露后心理调查及对策[J].中华医院感染学杂志,2011,21(1):106.
[2]WINCHESTER SA,TOMKINS S,CLIFFE S,et al.Healthcare workers'perceptions of occupational exposure to blood-borne viruses and reporting barriers:a questionnaire-based study[J].J Hosp Infect,2012,82(1):36.
[3]许瑛,蒋维.SHEL模式在手术室护士职业暴露防范中的应用[J].中国消毒学杂志,2015,32(11):1165.
[4]韩光曙.医院的安全文化与医疗安全[J].中华医院感染学杂志,2004,20(3):129.
[5]DENIC LM,OSTRIC I,PAVLOVIC A,et al.Knowledge and occupational exposure to blood and body fluids among health care workers and medical students[J].Acta Chir Iugosl,2012,59(1):71.
[6]龚光明.手术室医护人员血源性感染职业暴露风险与防范[J].中华医院感染学杂志,2011,21(4):719.
[7]冯素萍,李文霞.临床护士锐器伤的安全防护状况调查[J].工业卫生与职业病,2009,35(2):106.
[8]王炜,孙迎红.手术室医护人员锐器伤现状调查及防护措施[J].齐鲁护理杂志,2011,17(32):33.
[9]郭子君,勾健.手术室护士锐器伤的原因调查分析与防护措施[J].中华医院感染学杂志,2009,19(19):2592.
[10]NSUBUGA FM,JAAKKOLA MS.Needle stick injuries among in Sub Saharan Africa[J].Trop Med Int Health,2005,10(8):773.
[11]DEUFFIC-BURBAN S,DELAROCQUE-ASTAGNEAU E,ABITEBOUL D,et al.Blood-borne viruses in health care workers:prevention and management[J].J Clin Virol,2011,52(1):4.
[12]王根妹,陈少恋,陈晓丹.医务人员职业暴露的危险因素分析及管理措施[J].中国消毒学杂志,2015,32(8):826.
[13]DUNLEAVY K,TAYLOR A,GOW J,et al.Police officer anxiety after occupational blood and body fluid exposure[J].Occup Med,2012,62(5):382.
[14]彭凌,郑舟军,周月华.医务人员血源性传染病职业暴露后心理调查及对策[J].中华医院感染学杂志,2011,21(1):106.