医护人员血源性传播疾病职业暴露的现况分析

目的 探讨医护人员血源性传播疾病职业暴露的特征及危险因素,为其预防和干预提供有效依据.方法 回顾性分析海军军医大学(第二军医大学)长海医院2006年4月至2021年1月登记上报的746例医护人员血源性传播疾病职业暴露案例的资料,包括性别、年龄、职业、工作科室、职业暴露发生时间、暴露源、暴露途径、处理措施等.结果 从性别上看,发生血源性传播疾病职业暴露的女性(540例,72.39％)较男性(206例,27.61％)多;从职业来看,发生血源性传播疾病职业暴露的人员以护士(师)(305例,40.88％)、医师(171例,22.92％)和实习护士(111例,14.88％)为主;从科室分布看,发生血源性传播疾病职业暴露的医护人员所在科室主要为急诊科(105例,14.08％)、普通外科(73例,9.79％)、麻醉科(67例,8.98％)、消化科(55例,7.37％)、胸心外科(54例,7.24％).暴露源以HBV为主,共有508例(68.10％);暴露途径以皮肤锐器伤为主,共有666例(89.28％).36例(4.83％)发生暴露后未进行任何紧急处理,但所有暴露者均接受了后续的预防性治疗及随访,且最终无一例发生职业暴露感染.结论 医护人员血源性传播疾病职业暴露不容忽视,应增强对血源性传播疾病的防范意识、强化职业防护培训、建立合理有效的防护制度、改善诊疗环境,以降低血源性传播疾病的发生率、保证医护人员的身心健康.

Analysis of current situation of blood-borne disease exposures among medical staffs

Purpose: To explore the characteristics and risk factors of blood-borne disease exposures in clinical work, so as to provide effective basis for prevention and intervention. Methods: Retrospective analysis was conducted on 746 cases of blood-borne disease exposures among medical staffs, which registered and reported in Changhai Hospital, Second Medical University from April 2006 to January 2021. Results: Among 746 patients with occupational exposure injury, nurses (305) accounted for 40.88%, constituting the majority and 191 doctors accounted for 25.60%. There were more females (540, 72.39%) than males (206, 27.61%). The top five department of the staff distribution were emergency department (105 cases), general surgery (73 cases), anesthesiology department (67 cases), digestive department (55 cases) and cardiothoracic surgery (54 cases), accounting for 14.08%, 9.79%, 8.98%, 7.37% and 7.24%, respectively. Needle stab injuries were the main cause (620 cases), accounting for 83.11% while hepatitis B (508, 68.10%) was the main disease type. After exposure to blood-borne diseases, 208 cases (27.88%) were treated inappropriate. Conclusion: To reduce the incidence of blood-borne diseases and ensure the physical and mental health of medical staffs, we should strengthen the awareness of prevention of blood-borne diseases, strengthen occupational protection training, establish reasonable and effective protection system, and improve the diagnosis and treatment environment.