医疗机构辐射安全管理中放射工作人员职业健康风险因素的识别与应对  

Identification and response of occupational health risk factors for radiation workers in radiation safety management of medical institutions

作　　者：李莉珊 张静[1] 黄艾弥 于佳 纪灏 LI Lishan;ZHANG Jing;HUANG Aimi;YU Jia;JI Hao(Hospital Infection Management Office,Shanghai Chest Hospital(School of Medicine,Shanghai Jiao Tong University),Shanghai 200030,China)

机构地区：[1]上海市胸科医院(上海交通大学医学院附属胸科医院)医院感染管理办公室,上海200030

出　　处：《环境与职业医学》2025年第1期69-74,共6页Journal of Environmental and Occupational Medicine

摘　　要：[背景]医疗机构是健康中国战略的重要关口,如何在放射诊疗工作中加强辐射安全管理与防护,已经成为放射卫生工作的重点领域。[目的]通过识别、分析、评价辐射安全管理过程中的风险因素和危急程度,提出降低辐射安全管理过程中风险的策略。[方法]根据失效模式与效应分析(FMEA)模型,确定11名专家组成员,通过问卷调查与头脑风暴法制定辐射安全管理重点内容,以失效风险指数≥9.5和失效风险危急值(RPN)>80为基准评估风险因素,并进行潜在失效原因分析,拟定辐射安全管理策略。[结果]医疗机构辐射安全管理过程中的风险因素包括主风险3个,子风险7个,共32项风险内容,并根据失效风险指数提出12个关键环节,根据RPN对10个风险环节进行潜在失效原因分析并提出管理策略。辐射安全管理过程中的关键环节主要为放射工作人员辐射安全管理依从性低,防护意识不足,职业压力导致职业倦怠,放射性废物处置不当等。辐射安全管理主要策略包括对联合管理部门、设备供应部门等人员进行持续动态辐射安全教育培训,强化放射工作人员心理干预与辐射认知,提升辐射防护安全设施与设备质量,加强个人剂量计佩戴管理与反馈,规定给药后患者流动路线,针对放射性废物加强独立通风与过滤装置管理。[结论]通过分析辐射安全管理过程的主要风险因素,提出具有可操作性和实用性的管理策略,包括应针对性开展职业健康培训,加强职业健康监护与辐射防护,加强对放射源和放射性废物的管理,可为医疗机构辐射安全管理工作提供建议和指导,研究具有实践意义。[Background]Medical institutions are an important gateway to the Healthy China strategy,how to strengthen radiation safety management and protection in radiation diagnosis and treatment is a key area in the work of radiation health.[Objective]By identifying,analyzing,and evaluating the risk factors and degree of danger in ra-diation safety management process,to propose strategies for reducing these risks.[Methods]Using failure mode and effect analysis(FMEA),11 experts were selected to develop radiation safety management strategies through questionnaire surveys and brainstorming.Risk factors were evaluated based on a failure risk index≥9.5 and risk priority number(RPN)>80 as benchmarks,potential failure causes were analyzed to develop radiation safety management strategies.[Results]The proposed risk factors in the radiation safety management process of medical insti-tutions included 3 main risks,7 sub-risks,and 32 risk items.Based on the failure risk index,12 key links were proposed,and potential failure causes were analyzed by RPN for 10 risk links,and management strategies were proposed.The key links in the process of radiation safety manage-ment mainly included low compliance with radiation safety management by radiation workers,insufficient awareness of protection,occupational burnout induced by occupational stress,and improper disposal of radioactive waste.The proposed main strategies were radiation safety education and training by joint management departments and equipment supply departments,strengthening psychological intervention and radiation awareness of radiation workers,improving quality of radiation protection safety facilities and equipment,enhancing personal dosimeter wearing management and feedback,regulating patient movement after administration,and strengthening independent venti-lation and filtration device management for radioactive waste.[Conclusion]A set of feasible and practical management strategies are proposed after analyzing main risk factors for radiation safety management in medical

关 键 词：辐射安全 失效模式与效应分析 医疗机构 防护 风险因素管理 

分 类 号：R146[医药卫生—公共卫生与预防医学]