医务人员感染性职业暴露风险及其影响因素研究  

Risk of infectious occupational exposure and its influencing factors among healthcare workers

作　　者：李圆圆 林陶玉 郭薇 郭晓颖 张亚桃 陈彦丽 LI Yuanyuan;LIN Taoyu;GUO Wei;GUO Xiaoying;ZHANG Yatao;CHEN Yanli(School of Medicine,Shihezi University,Shihezi,Xinjiang Uygur Autonomous Region,832000,China)

机构地区：[1]石河子大学医学院,新疆维吾尔自治区石河子市832000 [2]苏州高新区人民医院护理部

出　　处：《中国护理管理》2025年第2期261-266,共6页Chinese Nursing Management

基　　金：苏州市科技发展计划项目(SKYD2023087);苏州高新区人民医院科学创新基金项目(SGY2022D01)。

摘　　要：目的:调查医务人员感染性职业暴露风险现状,分析感染性职业暴露风险的影响因素,为感染性职业暴露防控的分层管理提供依据。方法:采用便利抽样法,选取石河子市和苏州市各2家三级公立医院2018年1月至2022年12月上报的感染性职业暴露相关数据进行回顾性研究,采用二阶聚类和决策树模型对职业暴露人群进行划分并形成感染性职业暴露风险判定标准,使用无序多分类Logistic回归分析其影响因素。结果:4家医院共上报637例次感染性职业暴露,暴露方式以锐器伤为主(87.6%),暴露源阳性占比为51.3%。二阶聚类将感染性职业暴露风险聚为3类,结合决策树模型结果将感染性职业暴露风险划分为高、中、低3个水平。无序多分类Logistic回归分析结果显示,相较于低水平风险,工作年限、工勤人员是中水平风险的危险因素,手术室、门/急诊是中水平风险的保护因素;护士、工勤人员、门/急诊、其他地点、手部是高水平风险的保护因素。结论:感染性职业暴露以锐器伤为主,感染性职业暴露风险处于较高水平,管理部门应推进感染性职业暴露监测和随访系统建设,识别医务人员感染性职业暴露风险并进行分层管理。Objective:To investigate the current situation of infectious disease risks associated with occupational exposure of healthcare workers,analyze its influencing factors,and provide a basis for hierarchical control and management of occupational infections.Methods:Using the convenience sampling method,4 tertiary public hospitals at the county level in Shihezi and Suzhou were selected as sample hospitals,and the data of occupational infections reported by them from January 2018 to December 2022 were adopted for retrospective study.The second-order clustering analysis and the decision tree model were employed to categorize the population with occupational exposure and form the criteria to decide their risk for occupational exposure.Disordered multiclassification logistic regression was utilized to analyze the influencing factors.Results:In the four hospitals,a total of 637 cases of occupational exposure were reported.Which were mainly caused by sharp instrument injuries(87.6%).As to the exposure sources of HBV,HCV,HIV and syphilis,51.3%were tested to be positive.According to the second-order clustering analysis,the risk of occupational exposure were classified into three categories ranging from high,medium to low in light with the results of the decision tree model.The results of Logistic regression showed that compared with low-level risk,length of service and being supporting staff were risk factors for medium-level risk,while working in the operating room,outpatient and emergency department were protective factors for medium-level risk,while being nurses,and supporting staff,working in outpatient and emergency department,other places,and hands were protective factors for high-level risk.Conclusion:Occupational exposure is mainly associated with sharp instrument injuries,and the risk is at a high level.Management departments should promote the construction of the monitoring and follow-up system for occupational exposure,identify the risk of of health workers and carry out hierarchical management.

关 键 词：医务人员 职业暴露 风险识别 影响因素 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]