603例医务人员血源性病原体职业接触调查  

Investigation of 603 medical staff occupational exposure with blood-borne pathogens

作　　者：宋小舟[1] 方旭[2] 丁洁 金林[4] 游晶[5] Song Xiaozhou;Fang Xu;Ding Jie;Jin Lin;You Jing(Department of Infection Control,The First People's Hospital of Yunnan Province,The NHC Key Laboratory of Drug Addiction Medicine and Department of Infectious Disease,Kunming 650032,China;Department of Infection Control,The First People's Hospital of Yunnan Province,Kunming 650032,China;Department of Liver Diseases,The Third People's Hospital of Kunming City,Kunming 650041,China;The First department of elderly respiration,The First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;The First Affiliated Hospital of Kunming Medical University,The NHC Key Laboratory of Drug Addiction Medicine and Department of Infectious Disease,Kunming 650032,China)

机构地区：[1]云南省第一人民医院感染管理科,国家卫生健康委员会委毒品依赖和戒治重点实验室,昆明650032 [2]云南省第一人民医院感染管理科,昆明650032 [3]昆明市第三人民医院肝病一科,650041 [4]昆明医科大学第一附属医院老年呼吸一科,650032 [5]昆明医科大学第一附属医院感染性疾病科,国家卫生健康委员会毒品依赖和戒治重点实验室,650032

出　　处：《中华劳动卫生职业病杂志》2020年第5期349-352,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：国家自然科学基金(81760111、81760617);中盖艾滋病项目(2010-11-G、2012-22-G)。

摘　　要：目的调查研究医务人员血源性病原体职业接触情况,探讨防护对策。方法于2019年4月,采用整群抽样法,调查某三级医院2014年7月至2018年7月登记的603例血源性病原体职业接触案例作为调查对象,分析其接触人群、接触方式、接触源及预防用药情况。结果603例职业接触事件中,<30岁的年轻医务人员更容易发生职业接触(70.98%,428/603);护士最多(48.92%,295/603);职业接触多发生在外科(35.16%,212/603);锐器伤为最主要接触方式(86.90%,524/603);手部为主要接触部位(90.38%,545/603);高发地点为病房(53.57%,323/603)和手术室(22.72%,137/603);易发生职业接触的操作是拔针(34.83%,210/603)、手术(20.89%,126/603)和整理/清洁物品(19.73%,119/603);致伤锐器中最主要物品为头皮针(34.73%,182/524);接触源以乙型肝炎为主(39.30%,237/603);接触源主要来自含有血液的医疗器械(81.92%,494/603));预防用药前后乙型肝炎表面抗体(hepatitis B surface antibody,HBsAb)分组例数比较,差异有统计学意义(χ^2=19.940,P<0.01);预防用药前后HBsAb滴度组间比较,差异有统计学意义(t=-8.592,P<0.01)。结论综合采取有针对性的职业接触的防护教育、操作规范、疫苗接种和监测管理是行之有效的降低医务人员血源性病原体职业接触的方法。Objective To investigate the occupational exposure with blood-borne pathogens of medical staff,and explore the protective strategy.Methods Using cluster sampling method,603 medical staff with occupational exposure with blood-borne pathogens were analyzed,from July 2014 to July 2018 in a tertiary hospital.Results In total of 603 occupational exposure incidents,70.98%(428/603)were freshmen younger than 30 years old.48.92%(295/603)nurses.The most cases of occupational exposure were in surgery(35.16%,212/603).Sharp injury was the major contact manner(86.90%,524/603).Hands were the main contact parts(90.38%,545/603).Ward(53.57%,323/603)and the operating room(22.72%,137/603)were the high-risk place.The most dangerous actions were needle injection(34.83%,210/603),surgery(20.89%,126/603)and finishing/cleaning items(19.73%,119/603).The main items lead to injuries were scalp needles(34.73%,182/524).The most exposure source was hepatitis B virus(HBV)which occupied 39.30%(237/603).Exposure source mainly comes from medical devices containing blood(81.92%,494/603).To compared the groups(χ^2=19.940,P<0.01)and titer(t=-8.592,P<0.01)of hepatitis B surface antibody(HBsAb)before and after used prophylactics,the differences were statistically significant.Conclusion Comprehensive strategies of occupational exposure protection education,operation norms and monitoring management were effective methods to reduce the occupational exposure in the medical staff with blood-borne pathogens.

关 键 词：医务人员 血源性病原体 职业接触 因素 防护 

分 类 号：R192[医药卫生—卫生事业管理]