医务人员职业暴露情况调查分析

目的 加强职业暴露管理，完善职业暴露保障体系。方法 采用医院感染科自制调查表于2005年2月至2006年3月对全院在岗人员进行调查，了解其职业暴露情况。结果 共发生职业暴露93人，其中护士60人（64．51％）、医生24人（25．81％）、其他人员9人（9．68％）；20-30岁年龄段发生职业暴露最多共67人（72．04％）；93人中针刺和锐器伤75人（80．65％）；暴露时最常见的血源传播性疾病为乙型肝炎，共37人（39．78％）；暴露后能正确处理伤口61人（65．59％）。结论 增强各级人员职业暴露防范意识，强化职能部门管理工作是医务人员职业安全的保证。     

医务人员职业暴露情况调查分析

目的 加强职业暴露管理,完善职业暴露保障体系.方法 采用医院感染科自制调查表于2005年2月至2006年3月对全院在岗人员进行调查,了解其职业暴露情况.结果 共发生职业暴露93人,其中护士60人(64.51%)、医生24人(25.81%)、其他人员9人(9.68%);20～30岁年龄段发生职业暴露最多共67人(72.04%);93人中针刺和锐器伤75人(80.65%);暴露时最常见的血源传播性疾病为乙型肝炎,共37人(39.78%);暴露后能正确处理伤口61人(65.59%).结论 增强各级人员职业暴露防范意识,强化职能部门管理工作是医务人员职业安全的保证.     

城乡医务人员HIV/AIDS职业暴露防护知识调查分析

目的了解城乡医务人员HIV/AIDS职业暴露和防护知识的知晓情况,为防护知识培训提供依据.方法自行设计问卷对湖北省某县7个乡镇及某市的医务人员338名(乡镇180名、城市158名)进行HIV/AIDS职业暴露及防护知识调查.结果城乡医务人员对HIV/AIDS职业暴露及防护知识的知晓率偏低;乡镇医务人员在部分防护能力及暴露后的应对知识方面与城市医务人员比较,差异有显著性意义(P<0.05, P<0.01).结论加强城乡医务人员HIV/ALDS职业暴露及防护知识的培训,扩展乡镇医务人员培训面,以提高基层卫生工作者HIV/AIDS职业暴露的防护能力和暴露后的及时应对,减少HIV/AIDS感染的发生是目前迫切的任务.     

医务人员职业暴露管理手册的设计与应用

医务人员职业暴露管理重在做好预防、落实防护措施,对于不幸发生职业暴露者,则以预防用药和追踪监测为重心,及时采取有效的干预措施降低职业暴露后发生职业感染的风险。但在医务人员职业暴露管理工作中发现,有部分医务人     

基层医院医务人员血源性职业暴露情况的调查分析

目的了解基层医院医务人员血源性职业暴露现状,减少其血源性职业暴露的发生。方法依据医务人员职业暴露登记表,对32例职业暴露者进行回顾性调查。结果经过6～24个月随访及跟踪监测,31例检测阴性,1例单纯HBsAg阳性。结论血源性职业暴露后规范及时的应急处理,是降低医务人员血源性职业暴露后发生感染的关键。     

护士职业暴露漏报原因分析及对策

目的 了解临床护士职业暴露漏报率及其原因，以寻求降低护理人员职业感染危险性的有效方法。方法 要求102名轮中夜班的临床护士按常规上报2006年1～6月的职业暴露情况，6个月后由专人采用自制问卷及面对面访谈的方式向102名护士了解实际职业暴露漏报率及共原因。结果 102名护士中发生职业暴露74名（72．5％），124人次漏报48人次，漏报率为38．7％。漏报原因依次为患者的检验结果正常，无需上报；暴露较轻，已经过消毒处理；工作繁忙，忘了上报；认为上报对已发生的暴露无帮助而未上报。结论 护士职业暴露漏报率较高，应采取针对性干预措施提高护士职业暴露防护意识井采取积极防护措施。     

医务人员狂犬病职业暴露原因分析及建议

3名医务人员(1名医生,2名护士)在为兴奋期狂犬病患者诊疗过程中分别被患者抓伤、喷吐唾液至眼部及干扰操作致针刺伤,经及时冲洗消毒处理,注射狂犬病疫苗及狂犬病免疫球蛋白。结果狂犬病抗体检测3人均呈阳性,均未发病。提出对兴奋期狂犬病患者评估不足、防护不到位(均未佩戴面罩、防护眼镜,未穿隔离衣;未固定患者肢体)是本次职业暴露的主要原因,应加强职业暴露知识培训,强化防范措施,尽量减少职业暴露。     

检验科职业暴露原因和类型及防护分析

<正>检验科是医院的重要医技科室之一,检验科人员工作中经常要搅拌,震荡,离心,灼烧接种杯具,均可产生大量微生物气溶胶。同时长期与患者的血液,体液,排泄物等各种传染源密切接触,并频繁使用针头,刀,剪等锐器操作,导致皮肤,手部锐器被刺伤。试管发生破裂,标本溅撒到皮肤、黏膜甚至眼部等,职业暴露危险性高[1]。回顾性分析2010-01—2013-01间我科在     

护士职业暴露漏报原因分析及对策

目的 了解临床护士职业暴露漏报率及其原因,以寻求降低护理人员职业感染危险性的有效方法.方法 要求102名轮中夜班的临床护士按常规上报2006年1～6月的职业暴露情况,6个月后由专人采用自制问卷及面对面访谈的方式向102名护士了解实际职业暴露漏报率及其原因.结果 102名护士中发生职业暴露74名(72.5%),124人次漏报48人次,漏报率为38.7%.漏报原因依次为患者的检验结果正常,无需上报;暴露较轻,已经过消毒处理;工作繁忙,忘了上报;认为上报对已发生的暴露无帮助而未上报.结论 护士职业暴露漏报率较高,应采取针对性干预措施提高护士职业暴露防护意识并采取积极防护措施.     

ICU医护人员艾滋病职业暴露的预防干预研究

目的探讨重症监护病房（ICU）内人类免疫缺陷病毒（HIV）职业暴露的原因和综合预防干预的疗效。方法选择2009年1月至2010年12月本院ICU发生HIV职业暴露的患者为对照组（25例）,自2011年1月至2012年12月采用综合预防干预措施的患者作为干预组（53例）。对照组采用口罩、手套、隔离服等防护措施;综合干预组在对照组防护措施的基础上,采取AIDS患者进入ICU后常规在日间放置深静脉置管、动脉置管、密闭式吸痰管和防护面罩,由高年资、心理素质好的医护人员进行有创操作等综合预防措施。比较两组HIV职业暴露人数/收治获得性免疫缺陷综合征（AIDS）病例数比值的差异。结果 4年间本院ICU共收治AIDS危重患者78例,发生HIV职业暴露共7例,采取综合干预措施使HIV职业暴露人数/收治AIDS病例数的比值由20%减低至4%（χ^2=13.2,P〈0.05）。结论 ICU内收治AIDS患者发生HIV职业暴露的风险较高,采取综合干预措施能够降低ICU内HIV职业暴露的风险。     

2007年至2018年某传染病医院医护人员血源性职业暴露状况分析与管理策略

目的分析2007年至2018年某传染病专科医院医护人员血源性职业暴露状况的队列资料，并总结医护人员血源性职业暴露发生特点及趋势。 方法利用首都医科大学附属北京地坛医院2007年1月至2018年12月医护人员职业暴露登记数据，对399例医护人员血源性职业暴露的队列进行分析。 结果暴露人数与暴露率总体呈下降趋势[17（1.88%）]；暴露部位以锐器伤与黏膜接触暴露为主[288（72.18%）和82（20.55%）]；暴露部位以手指为主[305（76.44%）]；黏膜暴露以眼部为主[82（20.55%）]；暴露源以乙型肝炎病毒（HBV）暴露为主[203（50.88%）]。医生和护士的暴露方式（χ² = 26.59、P < 0.001）、暴露部位（χ² = 12.00、P = 0.002）、HBV（χ² = 17.90、P < 0.001）、丙型肝炎病毒（HCV）（χ² = 4.18、P = 0.041）、人类免疫缺陷病毒（HIV）（χ² = 8.31、P = 0.004）暴露源种类差异均有统计学意义；其中护士锐器伤暴露率显著高医生[218（79.56%） vs. 70（56.00%）（χ² = 23.73、P < 0.001）。卡方检验显示，不同年龄段医护人员暴露方式（χ² = 27.88、P < 0.001）、暴露部位（χ² = 0.00、P = 0.008）及暴露源HBV（χ² = 14.84、P = 0.005）、HIV（χ² = 8.47、P = 0.076）、梅毒螺旋体（χ² = 0.000、P = 0.016）和狂犬病毒（χ² = 0.02、P = 0.047）差异均有统计学意义。399例暴露者均于暴露后1、2、3和6个月接受随访监测，无1例发生暴露后感染。 结论随着职业暴露防护政策的加强，暴露率总体呈下降趋势，但锐器伤仍是导致医护人员发生职业暴露的主要因素，推广安全针的使用、规范操作行为、落实标准预防可有效地降低职业暴露的发生；完善的职业暴露管理体系可提高职业暴露预防的成功率。     

上海地区医务人员对激素替代治疗知晓率及现状调查

目的 了解上海地区医务人员对围绝经期综合征的激素替代治疗（HRT）的认知及对相关知识需求情况,为提高医务人员对HRT的知识,并为提高中老年妇女保健工作质量提供依据.方法 对上海市12所医院480名在职医务人员进行HRT相关知识的问卷调查.采用自行设计的调查问卷对HRT的认知度、基本知识、知识需求等方面进行调查.结果 认为绝经期应用HRT有必要者占35.81%（169/472）;16.10%（76/472）的医务人员对HRT知识了解;43.22%（204/472）的医务人员有对HRT知识有培训需求;14.19%（67/472）医务人员对更年期对象询问是否用HRT,并会推荐使用;不推荐应用HRT的原因中对副作用的担心占52.41%（76/145）.结论 上海地区部分医务人员对激素治疗的知晓率较低,医务人员对HRT的推荐率低;主要原因是对激素治疗知识的不掌握和对副反应的担心.医生和护士对HRT的认识上存在差异.     

Post‐traumatic reactions among rescue personnel 96 hours after the Hilton Hotel bombing in Sinai: The effect of previous exposure

This paper considers the immediate post‐traumatic reactions of rescue personnel who were exposed to the Hilton Hotel bombing in Sinai. The entire rescue personnel (n = 26) were assessed and separated into two groups on the basis of previous exposure to the same type of trauma. The results suggest that among rescue personnel, those with previous exposure had a lower level of post‐traumatic symptoms than those who were being exposed for the first time. This supports the hypothesis that previous exposure to the same type of trauma has an immunizing effect for subsequent same type of traumatic event among rescue personnel. Copyright © 2005 John Wiley & Sons, Ltd.     

根本原因分析法用于艾滋病病区护理人员锐器操作职业暴露管理

目的降低艾滋病病区护理人员锐器操作职业暴露发生率。方法运用根本原因分析法剖析导致护理人员锐器操作职业暴露事件的近端原因和根本原因,对护理人员加强针对性职业暴露防护培训,建立健全职业暴露防护管理制度。结果2013年、2014年(实施培训管理前)职业暴露发生率分别为6.25%、10.42%,2015年、2016年(实施培训管理后)发生率分别为0、2.08%。结论根本原因分析法对预防护理人员锐器操作职业暴露管理有很好的导向作用,可有效降低相关职业暴露发生率,有利于职业安全目标的实现。     

Low flow anaesthesia reduces occupational exposure to inhalation anaesthetics Environmental and biological measurements in operating room personnel

In the present study we evaluated the occupational exposure to N₂O and isoflurane during open circuit (OC) (fresh gas flow ≥ minute volume) and low flow (LF) (fresh gas flow=1.5 1/min) anaesthesia. The effects of active scavenging and of a charcoal filter positioned on the exhausting branch of the ventilator on environmental and urinary concentrations of inhalation anaesthetics were also investigated. The study was carried out in the same operating room provided with non-recirculating air changes (10 per hour). It involved anaesthetists and nurses during routine activity. N₂O and isoflurane concentrations (time-weighted average) were measured after 3-hour continuous exposure: 1) in the environment at the level of the personnel's breathing zone (Ci); 2) in the environment at the ventilator zone (C); 3) in urine (Cu). During OC anaesthesia without active scavenging the breathing zone concentration of both N₂O and isoflurane was very high (194.6±15.2 and 5.0±0.4 ppm, respectively). The activation of the scavenging greatly reduced the breathing zone concentration of N₂O (31.6±4.1 ppm) and isoflurane (1.7±0.2 ppm). LF anaesthesia (with active scavenging) significantly reduced the environmental concentration of both anaesthetics (Ci N₂O and isoflurane 22.7±1.8 and 0.6±0.04 ppm, respectively). During LF anaesthesia the breathing zone concentration of N₂O remained low, even without scavenging (22.7 ±1.8 ppm). Similar results were obtained by measuring N₂O and isoflurane concentrations at the ventilator zone and in urine. The application of a charcoal filter to the exhausting branch of the ventilator during LF anaesthesia without active scavenging reduced the environmental concentration of isoflurane to a lower value than that obtained with OC anaesthesia with active scavenging (Ci 0.88±0.1 vs 1.7±0.2 ppm). A linear correlation was found between environmental (Ci) and urinary concentrations of N₂O and isoflurane. Our data show that LF anaesthesia reduces the exposure of the operating room personnel to inhalation anaesthetics. A charcoal filter positioned on the exhausting branch of the ventilator in substitution of the active scavenging is very effective in reducing isoflurane pollution. The evaluation of the urinary concentration of inhalation anaesthetics is a simple and reliable method of monitoring occupationally exposed personnel.     

医疗纠纷对医院及医务人员产生的负面影响

目的:探讨医疗纠纷所导致医院及医务人员的负面影响.方法:分析患者家属在医疗纠纷中的过激的、不合理的、甚至违法的行为,对医院及医务人员各方面的影响.结果:不合理的维权行为严重干扰医院的正常秩序.结论:医疗纠纷会限制医疗创新发展,不利于医疗技术的提高.     

Tobacco use and occupational exposure to carcinogens, but not N-acetyltransferase 2 genotypes are major risk factors for bladder cancer in the Japanese

Our study investigated the risks of genotypes of N-acetyltransferase 2 (NAT2), tobacco use and/or occupational exposure to carcinogens in patients with bladder cancer and in age- and sex-matched controls in Japanese. NAT2 genotypes were categorized into two groups, homozygous mutant (slow acetylator genotype) and homozygous and heterozygous wild type (fast acetylator genotype). The percentage of NAT2 slow acetylator types was 6.7% in the bladder cancer patients, close to the value for controls (6.1%). There was no association between NAT2 slow acetylator genotype and the risk of bladder cancer. This association was also insignificant when subjects were restricted to those who used tobacco or those occupationally exposed to carcinogens. In contrast, tobacco use in combination with exposure to carcinogens was a significant risk factor, as based on the odds ratio and chi-square test. The combination of both factors should be an additive risk factor for bladder cancer. In this study, we demonstrated that the environmental factors of smoking habit and occupational exposure for carcinogenicity are much more important than genetic factors in bladder cancer. Received: 28 August 2000 / Accepted: 9 February 2001     

Occupational exposure to inhaled anaesthetics: a follow-up study on anaesthetists of an eastern European university hospital

BACKGROUND: Although no dose-response relationship for the health risks associated with the occupational exposure to inhaled anaesthetics exists, public health authorities recommend threshold values. The aim of the present study was to assess if and to what extent these threshold values are exceeded in an eastern European university hospital before and after measures had been taken to reduce occupational exposure. METHODS: At nine workplaces occupational exposure of anaesthetists to nitrous oxide and halothane or isoflurane was measured by means of photoacoustic infrared spectrometry. The measurements were carried out in 1996 and were repeated in 1997 after the installation of active scavenging devices at five workplaces and an air-conditioning system at one workplace. RESULTS: Occupational exposure to nitrous oxide and halothane or isoflurane was lower in 1997 compared to 1996. In 1997 most of the nitrous oxide values still exceeded the threshold value of 100 ppm, whereas most of the halothane and isoflurane values were already below the threshold values of 5 ppm and 10 ppm in 1996. CONCLUSION: The measures taken were effective in reducing waste gas exposure. Nevertheless, further efforts are necessary, especially for nitrous oxide, to reach western European standards. These efforts comprise structural measures such as active scavenging devices and air-conditioning systems at all workplaces, the use of total intravenous anaesthesia, low-flow anaesthesia and an appropriate working technique.     

Effect of male occupational heat exposure on time to pregnancy

The relationship between male occupational heat exposure and the time required to achieve a pregnancy [TTP] was studied in a retrospective survey of 402 fertile couples. The TTP for t he subgroups 'exposure t o heat' (median = 4 .0 months; mean 11.8; SD = 13.3) and 'professional driver >3 h/day' (median = 4.5; mean = 14.4; SD = 28.5) was significantly longer (both p < 0.05) than for the controls (median = 2.8; mean = 7.8; SD = 13.3). Bakers and welders showed comparable results: only 14% of the bakers' partners became pregnant within 3 months (cf. 55% of controls, p < 0.05) and only 29% became pregnant within 6 months (cf. 74% of controls, p < 0.02). This study suggests that occupational exposure to heat is a 'weak' risk factor for male subfertility.