龙岩市部分医护（技）人员艾滋病职业暴露与防护情况

目的了解综合性医院医护（技）人员对艾滋病防治知识和职业暴露因素以及防护的认知情况，为有针对性地开展医护（技）人员艾滋病诊疗技术和职业防护培训工作提供依据。方法采用随机抽样方法，对2家市级综合医院的相关医护（技）人员进行问卷调查。结果大多数医护（技）人员对艾滋病的基本防治知识掌握较好，但对一些较专业的知识掌握不全面，存在认识误区，对艾滋病防治的专业知识掌握程度及职业防护意识存在差异。结论应针对不同专业、不同岗位的医护（技）人员进行全面、系统、深入地强化培训，提高对不同暴露环节和暴露因素的个人职业防护意识，以减少艾滋病职业暴露事故的发生和医源性传播的机会。     

Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India

Background:

Because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI).

Objective:

To study prevalence and response to needle stick injuries among health care workers.

Materials and Methods:

Study Design: Cross-sectional study. Setting: A tertiary care hospital in Delhi. Participants: 322 resident doctors, interns, nursing staff, nursing students, and technicians. Statistical Analysis: Proportions and Chi-square test.

Results:

A large percentage (79.5%) of HCWs reported having had one or more NSIs in their career. The average number of NSIs ever was found to be 3.85 per HCW (range 0-20). 72 (22.4%) reported having received a NSI within the last month. More than half (50.4%) ascribed fatigue as a cause in their injury. Most of the injuries (34.0%) occurred during recapping. In response to their most recent NSI, 60.9% washed the site of injury with water and soap while 38 (14.8%) did nothing. Only 20 (7.8%) of the HCWs took post-exposure prophylaxis (PEP) against HIV/AIDS after their injury.

Conclusions:

The occurrence of NSI was found to be quite common. Avoidable practices like recapping of needles were contributing to the injuries. Prevention of NSI is an integral part of prevention programs in the work place, and training of HCWs regarding safety practices indispensably needs to be an ongoing activity at a hospital.     

某医院医务人员血源性职业伤害目标性监测及管理

[目的]了解医疗职业伤害的危险因素,预防和减少医务人员血源性感染的发生。[方法]采用目标性监测的方法,对苏州大学附属第一医院1255名医务人员,在一年中发生职业伤害的47人进行登记处理及血清学检测。[结果]医务人员职业伤害发生率为3.75%,47人中发生锐器伤42人,其他职业伤害为5人,分别占89.4%和10.6%,但无一人感染血源性疾病。[结论]通过监测、管理,增强了医务人员主动防护意识。     

Occupational exposures to blood and risk of HIV transmission in a General Hospital (1986-88)

We conducted a study on occupational exposure to blood in a 1500-bed General Hospital in order to define incidence, type and circumstance of each exposure and to asses the risk of HIV transmission. From 1986 to 1988 a total of 548 cases of accidental blood exposure were reported, with an average of 15 accidents/month. The health care workers exposed included 376 nurses (68.6%), 91 manual workers (16.6%), 54 surgeons (9.8%), 14 physicians (2.5%) and 13 laboratory technicians (2.4%). There were 206 (37.6%) incidents related to recapping of needles. Other types of needle-stick injuries accounted for 191 cases (34.8%), cuts with sharp objects for 110 (20%) and skin or mucous membrane exposure for 41(7.5%). The highest incidence of exposure per month of work (in a total of 85,932 persons/month of work) and employment category was observed in nurses (.008) and the lowest in physicians (.001). Fifty-three (9.7%) employees were exposed to blood from patients with HIV infection: 36 nurses, 16 surgeons and 1 physician. No cases of seroconversion have been observed after a mean follow-up of 9 months (range: 2 – 18). The highest rate of HIV at-risk exposure per month of work was observed in surgeons (.001) and the lowest in physicians (.00008). Careful adherence to the universal infection-control guidelines published by international health authorities (W.H.O., C.D.C.) is recommended to prevent most at-risk incidents in health-care settings.Corresponding author.     

Reducing Occupational Risk for Blood and Body Fluid Exposure Among Home Care Aides: An Intervention Effectiveness Study

The purpose of this quasi-experimental pretest/posttest research study was to examine the effectiveness of an intervention designed through a participatory process to reduce blood and body fluid exposure among home care aides. Employer A, the intervention site, was a large agency with approximately 1,200 unionized home care aides. Employer B, the comparison group, was a medium-sized agency with approximately 200 home care aides. The intervention was developed in partnership with labor and management and included a 1-day educational session utilizing peer educators and active learning methods to increase awareness about the risks for occupational exposure to blood and body fluids among home care aides and a follow-up session introducing materials to facilitate communication with clients about safe sharps disposal. Self-administered preintervention and postintervention questionnaires identifying knowledge about and self-reported practices to reduce bloodborne pathogen exposure were completed in person during mandatory training sessions 18 months apart. Home care aides in the intervention group for whom the preintervention and postintervention questionnaires could be directly matched reported an increase in their clients’ use of proper sharps containers (31.9% pre to 52.2% post; p = .033). At follow-up, the intervention group as a whole also reported increased use of sharps containers among their clients when compared to controls (p = .041).     

2013年山东省某三甲医院医务人员艾滋病职业暴露及防护情况调查

目的了解山东省某三甲医院医务人员艾滋病职业暴露防护知识、暴露行为及培训现况。方法2013年7月,采用方便抽样的方法,对山东省某三甲医院296名医务人员进行艾滋病职业暴露及防护情况问卷调查。结果调查296人,7道艾滋病基础知识题目全部答对的占16．22％,各项艾滋病基础知识正确率为39．53％～96．28％,8道职业暴露相关知识全部答对的占0．34％,各项职业暴露知识正确率为15．54％～69．26％。有72．97％的人曾发生过职业暴露,其中18．24％的人明确知道自己曾经接触过HIV阳性病人。发生职业暴露时刺破（伤）皮肤的锐器主要是注射器针头、输液器针头和静脉采血针,占74．2l％;职业暴露部位主要是手上破损皮肤和眼睛黏膜,占9l_18％;职业暴露发生的环节主要是处置废物时、采血时和回套针帽时,占74．84％;41．22％的医务人员曾经接受过艾滋病职业暴露防护培训,97．97％的人希望得到相关培训。结论医务人员存在艾滋病职业暴露风险,防护知识缺乏,培训需求高。     

Occupational Risk Factors for Blood and Body Fluid Exposure Among Home Care Aides

This cross-sectional study of home care aides examines self-reported occupational exposure to blood and body fluids to determine if factors that place these workers at risk can be identified. Home care aides working for two agencies in the Chicagoland area were surveyed. A total of 62 (6.3%) of the home care aides reported instances of blood and body fluid exposure either via sharps or mucous membrane contact. Although few aides reported performing health care-related tasks such as colostomy care, caring for a urinary catheter, or bowel stimulation (which were outside their scope of duties), those who did were significantly more likely to experience blood and body fluid exposure (p ≤ .01). Level of assistance needed by clients in tasks such as feeding, laundry, and transportation was also found to be significantly associated with blood and body fluid exposure (p ≤ .01). These data highlight the importance of, and need for, home care aid training in the use of universal precautions.     

医务人员职业暴露的危害及其防护

对医院中医务人员的职业暴露进行了全面识别，阐述了物理性、化学性、生物性职业暴露及心理和暴力对医护人员的伤害。提出了相应的管理及防护措施。     

2009年成都市职业人群健康监护评价

目的了解成都市职业人群的健康状况,确定职业卫生工作防治的重点。方法收集2009年度本市职业人群的职业健康监护资料,并进行统计分析。结果苯作业人员的血常规异常、噪声作业人员的听力下降、电离辐射作业人员的晶体混浊及硫化氢、氨作业人员的鼻炎、咽炎等检出率最高,全年职业禁忌证检出率为4.02%,检出慢性职业性苯中毒5例,矽肺1例。结论本市2009年度职业人群的健康状况大部分良好（85%左右）,但部分苯、粉尘、噪声以及刺激性气体等职业病危害因素作业人员职业健康状况不容乐观,应将其职业健康监护作为成都市职业病防治工作的重点。     

氯乙烯作业工人职业接触评定与健康危害调查

[目的]评估氯乙烯累积接触剂量和氯乙烯职业危害的关系。[方法]选取某厂238名职业接触氯乙烯人群和212名非接触人群,登记该厂历年氯乙烯浓度监测资料,以及工人健康监护资料,将暴露人群按累积接触剂量分为未接触组和低、中、高接触组,比较接触组间和接触组与对照组间工人的症状和体征方面的差异。[结果]神经症、肝B超异常及咽部刺激症状随氯乙烯累积接触剂量的升高,发生率有升高的趋势（P＜0．01）,与对照组比较也有显著性差异。[结论]咽部刺激症状和肝脏的损害均与接触氯乙烯有明显的关系。提示在我国的卫生标准范围内,氯乙烯仍可能产生一定的健康危害。     

放射工作人员职业健康监护管理概述

我国卫生部于2007年6月30日发布的《放射工作人员职业健康管理办法》是《中华人民共和国职业病防治法》关于职业健康监护制度中放射工作从业人员健康监护的具体实施办法，具有法律意义。为了使该管理办法得以及时切实有效地贯彻实施，本文对该管理办法做了重点解读，系统诠释放射工作者职业健康监护的目的意义；放射性职业健康检查机构的职责与必备条件；职业医师的必备资质；从业者上岗前、在岗期间、离岗时、应急或事故照射、医学追踪观察等健康检查和检查结果的报告与通知及受检者放射工作适任性评估；并对放射性职业健康监护档案的建立与管理的重要性作必要阐述，以利放射工作者、患者和公众的健康权益得到保障。     

硝基胍对作业工人健康的影响

目的研究硝基胍对作业工人的健康影响,为制订卫生标准提供依据.方法对某厂硝基胍生产车间进行了劳动卫生学调查,并对55名硝基胍作业工人(接触组)和40名不接触硝基胍的教师(对照组)进行了健康体检.结果硝基胍作业现场监测结果显示,转晶、胶化、烘干、搓胍4个作业点硝基胍浓度分别为(0.15±0.09),(3.12±4.27),(4.95±2.01),(5.63±4.12)mg/m3.健康体检结果表明,搓胍组工人血清免疫球蛋白IgG含量明显比对照组高(P＜0.05), 搓胍组和烘干组工人血清丙二醛含量明显比对照组高(P＜0.05).结论硝基胍对作业工人的健康有一定影响.     

北京市大兴区2009年职业卫生检测及职工健康监护分析

目的了解北京市大兴区职工接触职业病危害因素情况和用人单位职业病危害现状。方法对2009年72家企业作业场所的职业病危害因素检测情况及233家用人单位的7735名职工职业健康检查结果进行分析。结果按企业所属性质分类,联营企业样品合格率低于其余经济类型企业的样品合格率。按职业病危害因素性质分类,物理因素、粉尘因素样品合格率远低于化学因素样品合格率。检出听力损失296人,发生率为13.5%(296/2200);白细胞低于正常值216人,发生率为7.42%(216/2910),二者发生率差异有统计学意义(χ2=50.56,P0.01)。结论受检单位职业病危害因素以噪声为主,加强对噪声的治理和加强职业健康监护是今后职业卫生工作的重点。同时应加大对联营企业存在的职业病危害因素的检测力度,加强对物理因素、粉尘职业病危害因素的检测。     

广东地区制造业工人职业安全态度与安全生产行为

[目的]了解广东地区制造业生产工人职业安全态度与安全生产行为之间的关系,为促进工人安全生产行为和健康提供科学依据。[方法]对广东地区46家制造业企业10585名一线生产工人进行问卷调查,问卷内容包括社会人口学特征、职业安全态度和安全生产行为,其中职业安全态度包括＂消极态度＂、＂对安全政策的态度＂、＂对管理者支持的态度＂和＂乐观态度＂等4个维度,安全生产行为包括＂工作姿势＂、＂操作安全＂、＂个人防护＂和＂工作卫生习惯＂4个方面。采用线性回归分析职业安全态度与安全生产行为的关系。[结果]回收问卷9020份（应答率为85.22%）,合格问卷7906份（合格率为87.65%）。参与调查的工人平均年龄为（30.45±8.63）岁,平均工龄为（6.99±6.52）年,男性占52.5%。多因素线性回归分析结果发现,＂消极态度＂与各安全生产行为有统计学负关联,＂对管理者支持的态度＂、＂乐观态度＂与＂个人防护＂安全生产行为的关联无统计学意义,职业安全态度的其它各维度与安全生产行为各维度均呈统计学正关联。[结论]工人的职业安全态度与安全生产行为有关,不同的职业安全态度对安全生产行为的影响存在区别。应在促进职业安全与健康的工作中注重改善工人的职业安全态度,以提高工作场所中安全生产行为。     

医务人员鼻前庭机会致病菌携带的调查

目的了解重症监护病房（ICU）医务人员鼻前庭带菌情况,以加强ICU医务人员医院感染的预防与控制。方法采用常规方法对ICU工作的93名医务人员和对照组的98名医务人员的鼻前庭拭子进行培养和菌种鉴定。结果从191名医务人员的鼻拭子中分离到214株机会致病菌,其中金黄色葡萄球菌8株,携带率4.19%,均为甲氧西林敏感金黄色葡萄球菌（MSSA）,凝固酶阴性葡萄球菌131株,携带率93.71%,主要是表皮葡萄球菌和溶血葡萄球菌,其中耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占50.3%,革兰阴性杆菌27株,携带率14.14%,主要是肺炎克雷伯菌和阴沟肠杆菌,未发现产超广谱β-内酰胺酶（ESBLs）细菌;ICU医务人员鼻前庭金黄色葡萄球菌携带率（6.5%）、MRCNS的携带率（60.2%）、革兰阴性杆菌的携带率（26.9%）均明显高于普通科室（P〈0.05）。结论医院内医务人员间鼻前庭机会致病菌携带率较高,不同科室医务人员之间的机会致病菌的携带存在明显差异,应加强医院医务人员自身感染的预防与控制,特别是长期在ICU工作的医务人员。     

The Effects of Occupational Stress,Work-Centrality,Self-Efficacy,and Job Satisfaction on Intent to Quit Among Long-Term Care Workers in Korea

ABSTRACT

A large and growing population of elderly Koreans with chronic conditions necessitates an increase in long-term care. This study is aimed at investigating the effects of occupational stress, work-centrality, self-efficacy, and job satisfaction on intent to leave among long-term care workers in Korea. We tested the hypothesized structural equation model predicting the intention to quit among long-term care workers in Korea. Survey data were collected from 532 long-term care workers in Seoul, Korea. Results showed that occupational stress was positively associated with intention to leave the job. The study also identified several possible mediators (self-efficacy, work-centrality, job satisfaction) in the relationship between stress and intent to quit. Evidence-based stress management interventions are suggested to help the workers better cope with stressors. Mentoring programs should also be considered for new workers.     

Burnout and Associated Factors Among Health Care Workers in Singapore During the COVID-19 Pandemic

ObjectivesThe strain on health care systems due to the COVID-19 pandemic has led to increased psychological distress among health care workers (HCWs). As this global crisis continues with little signs of abatement, we examine burnout and associated factors among HCWs.DesignCross-sectional survey study.Setting and ParticipantsDoctors, nurses, allied health professionals, administrative, and support staff in 4 public hospitals and 1 primary care service in Singapore 3 months after COVID-19 was declared a global pandemic.MethodsStudy questionnaire captured demographic and workplace environment information and comprised 3 validated instruments, namely the Oldenburg Burnout Inventory (OLBI), Safety Attitudes Questionnaire (SAQ), and Hospital Anxiety and Depression Scale (HADS). Multivariate mixed model regression analyses were used to evaluate independent associations of mean OLBI-Disengagement and -Exhaustion scores. Further subgroup analysis was performed among redeployed HCWs.ResultsAmong 11,286 invited HCWs, 3075 valid responses were received, giving an overall response rate of 27.2%. Mean OLBI scores were 2.38 and 2.50 for Disengagement and Exhaustion, respectively. Burnout thresholds in Disengagement and Exhaustion were met by 79.7% and 75.3% of respondents, respectively. On multivariate regression analysis, Chinese or Malay ethnicity, HADS anxiety or depression scores ≥8, shifts lasting ≥8 hours, and being redeployed were significantly associated with higher OLBI mean scores, whereas high SAQ scores were significantly associated with lower scores. Among redeployed HCWs, those redeployed to high-risk areas in a different facility (offsite) had lower burnout scores than those redeployed within their own work facility (onsite). A higher proportion of HCWs redeployed offsite assessed their training to be good or better compared with those redeployed onsite.Conclusions and ImplicationsEvery level of the health care workforce is susceptible to high levels of burnout during this pandemic. Modifiable workplace factors include adequate training, avoiding prolonged shifts ≥8 hours, and promoting safe working environments. Mitigating strategies should target every level of the health care workforce, including frontline and nonfrontline staff. Addressing and ameliorating burnout among HCWs should be a key priority for the sustainment of efforts to care for patients in the face of a prolonged pandemic.     

我国农民工职业安全卫生问题现状与思考

根据国外的经验,结合我国的实际情况,分析现阶段国内外农民工的特点、常见的职业病、职业性伤害事故以及农民工的职业安全卫生现状,提出了尽快建立职业安全卫生体系,全面提高农民工自身素质和安全意识,改善农民工的就业环境等预防措施,为保障农民工的健康提供科学依据。