某三级甲等中医医院2014—2023年血源性职业暴露监测与防护策略研究

Monitoring and protection strategies for blood-borne occupational exposure in a tertiary traditional Chinese medicine hospital from 2014 to 2023

摘要:

目的 分析某三级甲等中医医院医务人员血源性职业暴露的流行病学特征、原因与处置情况,为降低暴露风险提供参考。方法 采用回顾性研究方法,收集2014年1月—2023年12月某中医医院血源性职业暴露上报资料,并进行描述性分析。结果 2014—2023年医务人员血源性职业暴露报告发生率为3.08%(527/17 098)。其中破损皮肤或黏膜暴露55例次,发生率为0.32%;锐器伤472例次,发生率为2.76%,两者比较差异有统计学意义(χ²=335.125,P＜0.001)。血源性职业暴露中主要为锐器伤(89.56%)、女性(83.49%)、工龄<5年(42.69%)、中级职称(67.93%)的医务人员。破损皮肤或黏膜暴露以医生为主(58.18%), 锐器伤以护士为主(73.73%)。内科锐器伤暴露最高(42.80%),手术室破损皮肤或黏膜暴露最高(47.27%)。锐器伤发生环节主要为拔针(21.82%)、 处置使用过的锐器物与随意放置锐器(20.34%)和注射、穿刺、针灸、封管或采血(19.49%)。71.73%的暴露来源明确,检出经血传播病原体前三位分别为乙型肝炎病毒(70.86%)、丙型肝炎病毒(11.92%)和梅毒螺旋体(9.27%),暴露后正确处置率为88.05%。结论 2014—2023年该中医医院血源性职业暴露以锐器伤为主,护士在拔针、处置使用过的锐器物等过程中发生较多,破损皮肤或黏膜暴露主要为医生在手术过程中患者血液喷溅至眼睛。

Abstract:

Objective To analyze the epidemiological characteristics, causes and disposal of blood-borne occupational exposure of health care workers (HCWs) in a tertiary traditional Chinese medicine hospital, and provide reference for reducing exposure risks. Methods Data on blood-borne occupational exposure reported by a traditional Chinese medicine hospital from January 2014 to December 2023 were collected retrospectively, and analyzed descriptively. Results The reported incidence of blood-borne occupational exposure among HCWs from 2014 to 2023 was 3.08% (527/17 098). Among them, 55 cases had damaged skin or mucous membrane exposure, with an incidence of 0.32%; 472 cases had sharp device injuries, with an incidence of 2.76%. Difference between the two was statistically significant (χ²=335.125, P＜0.001). The main characteristcs of blood-borne occupational exposures were sharp device injuries (89.56%), female (83.49%) , HCWs with less than 5 years of service (42.69%) and intermediate professional titles (67.93%). Damaged skin or mucous membrane exposure mainly occurred in doctors (58.18%), while sharp device injury occurred mainly in nurses (73.73%). Department of internal medicine had the highest exposure to sharp device injuries (42.80%), and operating room had the highest damaged skin or mucous membranes exposure (47.27%). The main occurrence timing of sharp device injuries were needle pulling (21.82%), disposal of used sharp devices and randomly placed sharp devices (20.34%), as well as injection, puncture, acupuncture, tube sealing or blood collection (19.49%). 71.73% exposure sources were clear, and the top three detected blood-borne pathogens were hepatitis B virus (70.86%), hepatitis C virus (11.92%), and Treponema pallidum (9.27%). The correct disposal rate after exposure was 88.05%. Conclusion From 2014 to 2023, blood-borne occupational exposure in this traditional Chinese medicine hospital was mainly caused by sharp device injuries. Nurses experienced more incidents during needle pulling and sharp device handling. Damaged skin or mucous membrane exposure was mainly due to splashing patient’s blood into the eyes of doctors during surgery.