摘要
目的研究血源性病原体职业暴露发生特点、应急处置、随访情况及防控费用,为医院职业暴露防控政策的制定提供依据。方法采用回顾性调查方法,收集及分析某三甲妇幼保健院2016年1月1日—2020年12月31日上报的血源性病原体职业暴露事件,对未完成全程检验追踪的暴露者进行电话回访。结果共收集149例次职业暴露,保洁员发生密度最高(0.036例次/人年),其次为护士(0.031例次/人年),高于医生(0.018例次/人年)和医技人员(0.005例次/人年)(P<0.001);初级及以下职称医务人员发生密度高于中、高级职称者(P<0.001)。手术室(25.50%)是最高发地点,锐器伤是最主要的暴露方式(85.23%),关联操作以发生于处理锐器时最多(34.90%),暴露病原体中以乙型肝炎病毒最多(20.81%),10~12点是一天中职业暴露发生的高峰时刻(28.86%),暴露部位以手部(82.55%)最多,暴露发生于非利手(46.98%)较利手(35.57%)多见,食指是手部最常见的受伤部位(42.28%)。发生原因居前三位者依次为自己操作不慎(48.99%)、意外或紧急情况(20.80%)、他人锐器处理不当(15.44%)。6.04%的暴露者存在局部应急处置不规范,20.13%的案例存在迟报,职业暴露后全程追踪落实率为41.89%。未落实全程追踪居前三位原因依次为:遗忘、未足够重视和错误认知。职业暴露后防控总费用20926.10元,平均每例140.44元,暴露源不明者平均费用最高(273.70元/例)。结论应针对血源性病原体职业暴露的高发人群、地点、环节、时间和部位等特点,以及存在的迟报率高、全程追踪落实率低等问题,进一步采取有效措施,减少职业暴露的发生,降低暴露后感染风险,保障医院工作人员职业安全。
Objective To study the occurrence characteristics,emergency response,follow-up information as well as prevention and control cost of occupational exposure to blood-borne pathogens,and provide reference to formulating prevention and control strategies of occupational exposure in hospital.Methods Occupational exposure events of blood-borne pathogens reported from January 1,2016 to December 31,2020 in a tertiary first-class maternal and child health hospital were collected and analyzed retrospectively.Exposed persons who didn’t complete the whole process of inspection and tracing were with telephone follow-up.Results There were 149 cases of occupational exposure to blood-borne pathogens.Incidence density of cleaning staff was the highest(0.036 cases/person/year),followed by nurses(0.031 cases/person/year),both were higher than that of doctors(0.018 cases/person/year)and medical technicians(0.005 cases/person/year)(P<0.001).Incidence density of occupational exposure of nurses and doctors with junior and lower professional titles were higher than those with intermediate and senior professional titles(P<0.001).Operating room was the location with the highest incidence(25.50%).Sharp instrument injury was the main exposure type(85.23%).Occupational exposure occurred most frequently during the disposal process of medical waste(34.90%).Hepatitis B virus is the most frequently exposed pathogen(20.81%).10am-12am was the peak time of occupational exposure(28.86%).Hand was the most exposed site(82.55%),and injuries occurred more often in non-dominant hand(46.98%)than in dominant hand(35.57%).Index finger was the most common site of hand injury(42.28%).The top three causes of occupational exposure were careless operation(48.99%),accident or emergency(20.80%),and improper handling of sharp instruments by others(15.44%).6.04%exposed persons had nonstandard emergency response,and 20.13%cases delayed reporting.The implementation rate of full tracing after occupational exposure was 41.89%,and the top three reasons for it were forg
作者
梁子东
郑光军
郭小铭
邹明艳
LIANG Zi-dong;ZHENG Guang-jun;GUO Xiao-ming;ZOU Ming-yan(Department of Healthcare-associated Infection Management,Dongguan Maternal and Child Health Hospital,Dongguan 523000,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2022年第12期1236-1242,共7页
Chinese Journal of Infection Control
关键词
血源性病原体
职业暴露
工作人员
追踪
防控费用
blood-borne pathogen
occupational exposure
hospital staff
trace
prevention and control cost
