护理人员采血环节血源性病原体职业暴露监测

Monitoring on nurses’ occupational exposure to bloodborne pathogens during blood collection process

摘要:

目的探讨护士采血过程发生血源性病原体职业暴露的具体环节，以及源患者感染状况，为制定职业暴露预防策略提供依据。方法对某院2011年8月—2013年9月护士采血环节血源性病原体职业暴露数据进行分析。结果共发生血源性病原体职业暴露89例次，包括静脉采血75例次，动脉采血14例次。采血操作环节职业暴露居前3位的是拔针后管塞穿刺针回弹（25例次，28.09%）、操作结束集中二次清理垃圾（18例次，20.22%）、血液体液皮肤黏膜接触（13例次，14.61%）。经检测，源患者确定感染43例次（48.31%），感染包括乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、戊型肝炎病毒(HEV)、梅毒螺旋体（TP）、人免疫缺陷病毒（HIV）等血液接触感染病原体中的一项或多项；源患者未感染46例次（51.69%）。经科学处理，发生采血环节职业暴露的护士均未发生感染。结论开发安全型采血针，锐器使用后第一时间放入锐器盒，采血操作戴手套等防护用品，以及实施标准预防和加强职业防护知识培训是降低临床护理人员采血环节发生血源性病原体职业暴露的重要策略。

Abstract:

ObjectiveTo investigate the activities associated with nurses’ occupational exposure to bloodborne pathogens and the source patients’infection status during blood collection process, so as to provide a basis for developing occupational exposure prevention strategies.MethodsData about occupational exposure to bloodborne pathogens during blood collection process in a hospital from August 2011 to September 2013 were monitored. ResultsA total of 89 times of bloodborne exposure occurred among HCWs, including 75 times of arterial blood collection and 14 venous blood collection. The top three procedures of occupational exposures were rebounding of needles after needles were pulled out (28.09%,n=25)， concentrated cleaning up of rubbish at the end of blood collection  (20.22%,n=18)，and  touching blood and body fluids by skin and mucous membrane （14.61%,n=13）. 48.31% (n=43) source patients infected with at least hepatitis B virus， hepatitis C virus , hepatitis E virus， Treponema pallidum，and human immunodeficiency virus , 51.69%(n=46）source patients were not infected ,after proper handling, none of nurses were infected during blood collection . ConclusionDeveloping safe bloodwithdraw needle，putting sharp instrument into sharp instrument container，wearing gloves, and intensifying training of  standard and occupational precaution are important strategies for the reducing of the occurrence of bloodborne exposure of clinical nurses during  blood collection process .