德宏傣族景颇族自治州2016-2020年医务人员和公安干警HIV职业暴露处置情况分析  

Occupational exposure to HIV infection among the medical staff and policemen between 2016 to 2020 in Dehong Prefecture,Yunnan Province

作　　者：王继宝 冯程 杨锦 高洁 叶润华 段星 王译葵 杨涛 杨跃诚 姚仕堂 何纳[2] 丁盈盈[2] 段松 WANG Jibao;FENG Cheng;YANG Jin;GAO Jie;YE Runhua;DUAN Xing;WANG Yikui;YANG Tao;YANG Yuecheng;YAO Shitang;HE Na;DING Yingying;DUAN Song(Department for STD and AIDS Prevention and Control,Dehong Prefecture Center for Disease Control and Prevention,Mangshi 678400,China;Department of Epidemiology,School of Public Health,Key Laboratory of Public Health Safety of Ministry of Education,Fudan University,Shanghai 200032)

机构地区：[1]德宏傣族景颇族自治州疾病预防控制中心艾滋病性病防制科,云南芒市678400 [2]复旦大学公共卫生学院流行病学教研室公共卫生安全教育部重点实验室,上海200032

出　　处：《中国艾滋病性病》2022年第1期87-91,共5页Chinese Journal of Aids & STD

基　　金：国家重点地区艾滋病防治项目(卫办疾控发[2004]49号);国家科技重大专项(2018ZX10721102-004)。

摘　　要：目的了解德宏傣族景颇族自治州(简称德宏州)医务人员、公安干警发生职业暴露,特别是HIV职业暴露的状况,为完善职业暴露后应急处理措施、避免HIV职业暴露提供科学依据。方法下载中国疾病预防控制系统全国艾滋病检测实验室信息管理系统职业暴露数据库中的德宏州2016-2020年报告的所有职业暴露者流行病学个案资料,并对相关信息进行描述性统计分析。结果共报告908例职业暴露事件。其中,护士550例(60.6%),医生183例(20.2%),公安干警13例(1.4%),其他162例(17.8%)。暴露方式为针刺或锐器割伤802例(88.3%);暴露地点为医疗机构877例(96.6%)。暴露后立即对皮肤、黏膜或伤口进行清洗和消毒906例(99.8%),2例未进行任何处理,均发生在乡镇医疗机构。暴露源为HIV阳性117例(12.9%),暴露源为HIV阴性683例(75.2%),暴露源不明108例(11.9%)。225例HIV职业暴露者中,175例采取了暴露后预防用药(PEP),其中118例(67.4%)在暴露后2 h内采取了PEP,医务人员2 h内实施PEP的比例(72.4%)明显高于非医务人员(55.8%),差异有统计学意义(P<0.05)。6个月随访检测无HIV抗体阳转者。结论坚持"普遍性防护原则"、暴露后立即采取应急措施、暴露评估后尽早接受PEP有益于避免和降低高危职业人员感染HIV的风险。Objective To investigate occupational exposure,especially HIV infection,among the medical staff and policemen in Dehong Prefecture in Yunnan Province;and provide practical support to improve the measures after exposure and avoid or decline the incidence of occupational exposure HIV.Methods Based on the Chinese National Occupational Exposure Database in AIDS Testing Laboratory Information Management System,the case reports of occupational exposure between 2016 to 2020 in Dehong Prefecture in Yunnan Province were included for the descriptive analysis.Results 908 occupational exposure events were reported.Among them,550 cases(60.6%)were nurses,183 cases(20.2%)were doctors,13 cases(1.4%)were policemen,162 cases(17.8%)were others.802(88.3%)cases were exposed by needlestick and sharp instrument cut,and 877 cases(96.6%)were exposed in medical institutions.In 906 cases(99.8%),the skin and mucous membranes were washed and disinfected immediately after exposure.However,2 cases in township medical institutions were not treated.The exposure sources of 117 cases were HIV positive,683 were HIV negative,and 108 were unknown.Among 225 cases of HIV occupational exposure,175 took post-exposure prophylaxis(PEP),of whom 118(67.4%)took PEP within 2 hours after exposure.The medical staff was more likely to take PEP within 2 hours than non-medical staff(72.4%vs.55.8%,P<0.05).No person was being HIV positive at the 6-month follow-up testing.Conclusion Adhering to the"Principles of universal precaution,"taking emergency measures immediately after exposure and accepting the PEP as soon as possible after exposure assessment is beneficial to avoid and reduce the risk of HIV infection among high-risk professionals.

关 键 词：艾滋病病毒 职业暴露 暴露后预防 

分 类 号：R373.9[医药卫生—病原生物学] R512.91[医药卫生—基础医学]