手术室护士职业暴露分析与预警防范
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·论 著·手术室护士职业暴露分析与预警防范苏建萍,崔莉青,贾巍,张辉文(新疆医科大学附属肿瘤医院护理部,新疆乌鲁木齐830011)摘要:目的 探讨手术室护士职业暴露发生情况及危险因素,为手术室护士采取预警防范措施提供依据。
方法根据2010年1月-2013年1月医院手术室护士填报的医务人员职业暴露登记表,回顾性调查分析手术室护士职业暴露发生的详细情况及危险因素。
结果 手术室护士共45人,发生职业暴露24人,占53.33%;职业暴露方式以锐器伤为主占75.00%,暴露源均有血源性传疾病,主要为乙型肝炎占79.17%;暴露发生的主要环节:手术缝合针刺伤7名,注射针头刺伤及传递手术器械时刺伤4名,整理手术器械时刺伤、剪刀扎伤及手术刀坠下扎伤脚背各1名;发生职业暴露的手术室护士以职称低的护士和实习学生为主占91.67%;发生职业暴露的部位主要在手部占70.83%,其次在眼部占29.17%;发生职业暴露时,有6名未戴手套占25.00%,戴一层手套有17人占70.83%;发生职业暴露时注意力不集中的概率最高,共10人占41.67%;无人因职业暴露而感染。
结论 手术室护士职业暴露发生率高,标准预防有待于加强,应健全手术室护士的职业安全教育制度及培训,设立预防职业暴露的预警机制,保障手术室护士的职业安全。
关键词:手术室护士;职业暴露;预警措施中图分类号:R181.3+2 文献标识码:A 文章编号:1005-4529(2013)20-4982-03Risk factors for occupational exposures of operating room nurses and precautionsSU Jian-ping,CUI Li-qing,JIA Wei,ZHANG Hui-wen(Affiliated Tumor Hospital of Xinjiang Medical University,Urumqi,Xinjiang830011,China)Abstract:OBJECTIVE To investigate the incidence of occupational exposures of the operating room nurses andexplore the risk factors so as to provide guidance with respect to take precautions.METHODS According to theoccupational exposure registration tables filled out by the operating room medical staff from Jan 2010to Jan 2013,the incidence of occupational exposures and the risk factors were retrospectively analyzed.RESULTS Of totally 45operating room nurses investigated,the occupational exposure occurred in 24(53.3%),among which the nurseswith sharp instrument injuries accounted for 66.67%;the blood borne transitted diseases were involved in all theexposure sources,the hepstitis B accounted for 79.17%.For the main links during which the occupationalexposures occured,thre were 7nurses with needle injuries occuring during the surgery suture,4nurses withsyringe needles injuries occuring duirng passing the surgical instruments,1with neelde stick injuries and 1withscissor injuries when settling the instruments,and 1with ffotback injuries when the lancet fell down.As for thepopulation with occupational exposure,the nurses with low titles and interns were dominant,accounting for91.67%.Among the occutaional exposure sites,the hands accounted for 70.83%,followed by the eyes(29.17%).As the occupational exposures occured,6(25.0%)nurses were not wearing gloves,and 17(70.83%)were wearing one-layer gloves;there were 10(41.67%)nurses with the occupational exposures due tothe lack of concentration;no person was infected due to the occupational exposure.CONCLUSIONS The incidenceof occupational exposure is high in the operating room nurses,standard precautions need to be strengthened,it isnecessary to establish a sound occupational safety training system and set up a warning mechanism for preventionof occupational exposure so as to safeguard occupational safety of the operating room nurses.Key words:Operating room nurse;Occupational exposure;Precaution收稿日期:2013-08-10; 修回日期:2013-09-05基金项目:新疆医科大学科研创新基金(2013-028) 职业安全是近年来医护人员日益关注的重要问题,国内医务人员职业暴露率为62.80%~98.00%,而手术室护士职业暴露率位居榜首[1]。
笔者对2010年1月-2013年1月上报感染管理科职业暴露的手术室护士进行回顾性调查分析,了解手·2894·中华医院感染学杂志2013年第23卷第20期Chin J Nosocomiol Vol.23No.20 2013术室护士职业暴露的现状,结合医院实际制定出预警方案及防护措施。
1 对象与方法1.1 调查对象 医院2010年1月-2013年1月24名发生职业暴露的手术室护士。
1.2 方法 查阅《医务人员职业暴露登记》表,回顾性分析上报医院感染管理科职业暴露的24名手术室护士的相关资料,内容涉及职业暴露的时间、地点、方式、暴露源、原因、部位等,调查数据录入Excel建立数据库,并进行统计分析。
2 结 果2.1 职业暴露资料 手术室护士45人,发生职业暴露24人(53.33%)。
发生职业暴露后都能够按照职业暴露处理流程进行初步处理,于<24h上报医院感感染管理科,并及时得到个体化的指导和处理,24名手术室护士经随访均无感染发生。
2.2 职业暴露的种类及方式 发生职业暴露24人中锐器损伤18人,占75.00%;黏膜暴露6人,占25.00%,职业暴露的方式见表1。
表1 发生职业暴露的种类及暴露方式构成比(%)Table 1 Constituent ratios of the types of occupational exposures and the exposure approaches(%)项 目 人数构成比锐器伤手术缝合针刺伤7 29.17注射针头刺伤4 16.66整理手术器械刺伤1 4.17传递器械时刺伤4 16.66剪刀扎伤1 4.17手术刀坠下扎伤1 4.17黏膜暴露取标本时血液喷溅1 4.17术区血液喷溅4 16.66吸引接头分离血液喷溅1 4.17合 计24 100.002.3 职业暴露源 暴露源中血源性传播疾病乙型肝炎共19例,占79.17%,见表2。
表2 暴露源中血源性传播疾病分布及构成比(%)Table 2 Constituent ratios of the blood bornetransmitted diseases(%) 暴露源 例数构成比乙型肝炎19 79.17丙型肝炎1 4.17梅毒4 16.66合 计24 100.002.4 职业暴露手术室护士职称分布 发生职业暴露的手术室护士职称主要分布在护士和实习护士,具体见表3。
表3 职业暴露手术室护士的职称分布及构成比(%)Table 3 Constituent ratios of the operating room nurses with different titles(%)类 别 人数构成比护师2 8.33护士16 66.67实习护士6 25.00合 计24 100.002.5 职业暴露发生的部位分布 职业暴露部位主要发生在手部,占66.67%,见表4。
表4 暴露部位分布及构成比(%)Table 4 Constituent ratios of the exposure sites(%)暴露部位 人数构成比右手10 41.67左手6 25.00左脚1 4.17单侧眼部5 20.83双眼2 8.33合 计24 100.002.6 职业暴露发生时手术室护士戴手套情况 发生职业暴露时70.83%护士戴一层手套,25.00%护士未戴手套,仅有4.17%护士戴双层手套。
3 职业暴露相关因素分析3.1 锐器刺伤 调查资料显示,手术室护士职业暴露的类型主要是锐器伤,占暴露人数66.67%,与相关报道一致[2]。