某三甲妇幼保健院血源性病原体职业暴露特点与随访研究

Characteristics and follow-up study of occupational exposure to blood-borne pathogens

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20 926.10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。

Abstract:

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 forgetting, not paying enough attention and wrong cognition. The total cost of the prevention and control after occupational exposure was 20 926.10 Yuan, with an average cost of 140.44 Yuan per case. The average cost of unknown exposure sources was the highest (273.70 Yuan per case). Conclusion Considering the characteristics of high-risk groups, locations, links, time and sites, as well as the high rate of delayed reporting and low implementation rate of full tracing of occupational exposure to blood-borne pathogens, it is necessary to take effective measures to reduce the occurrence of occupational exposure and decrease the risk of infection after exposure, thus ensure the occupational safety of hospital staff.