医务人员锐器伤后乙型肝炎病毒感染调查

目的 了解医务人员职业暴露认识情况及医疗锐器伤后感染HBV情况,探讨防控对策.方法 自设知识问卷对焦作市821例医务人员进行调查,对其中154例锐器伤者进行监测.结果 锐器伤发生率18.76%.锐器伤发生后,按意外刺伤流程处理者82.47%;接种乙肝疫苗者24.03%;注射乙肝免疫球蛋白者46.10%;HBV感染者12.34%.结论 医务人员锐器伤后感染HBV的危险性较高,应加强职业防护教育及培训,严格执行正确处理流程.     

皮肤性病医院护士锐器伤分析及防护

目的了解皮肤性病医院护士锐器伤的发生率和刺伤原因等，提出护士职业暴露防护措施，维护护士身心健康。方法采取回顾性调查，对2004—2005年皮肤性病医院临床护士所发生的61人次锐器损伤原因进行分析。结果被调查13人中，13人均被锐器所刺伤，其刺伤率为100％。2年内发生锐器伤61例次，被调查者人均年刺伤2．6次，其中52．5％被传染病患者的血液、体液污染的针头所刺伤。结论树立职业防护管理理念，建立健全职业防护管理制度、防护流程，教育培训护士安全防护，严格遵守操作规程是防止护士发生锐器伤和减少感染血源性疾病的关键。     

121例医务人员锐器伤监测分析

目的：调查医护人员医疗锐器损伤的相关因素,探讨有效的职业防护管理措施。方法采用前瞻性研究方法,监测医务人员医疗锐器损伤发生情况。结果2012年1-12月医务人员发生职业暴露共130人其中发生医疗锐器损伤121名、占93．08％,皮肤黏膜接触8人、占6．15％,离体残肢端刺伤1人、占0．77％;内外科病房和门诊输液厅是锐器伤主要发生场所;各种诊疗穿刺和注射、采血操作是常见的锐器伤环节;暴露源为乙型肝炎者占首位为33．06％;一级暴露7人、占5．79％,二级暴露114人、占94．21％。所有医疗锐器损伤的医务人员经追踪观察,无一人发生血源传播性疾病。结论医疗锐器伤是医疗操作中常见的职业暴露,遵守操作规程,重视自身的防护是降低职业性感染的有效方法。     

医院职工锐器伤害的调查和预防

锐器伤害是导致医务人员感染血源性疾病最常见的原因，应引起医务人员的高度重视。为切实加强医院职工的自我防护意识，防止锐器伤害，预防血源性疾病的传播，笔者进行了本次调查。     

临床医务人员锐器伤现状调查分析

目的 了解临床医务人员锐器伤现状及相关影响因素,为进一步制定职业防护措施提供科学依据.方法 按照分层整群抽样抽取一定数量的医务人员,采用填写调查问卷的方式收集资料.结果 571名调查对象中,发生锐器伤者389人,锐器伤发生率为68.13％,共计发生1058人次,人均被刺伤2.72次;工作年限≤5、6～10、≥11年的医务人员锐器伤的发生率为78.73％、71.52％、46.05％,差异有统计学意义(x2=48.790,P＜0.01);318人被污染的锐器损伤,270人进行上报,上报率为84.91％,被HBV、HCV患者污染的锐器致伤的上报率均为100.00％,被其他不明感染患者污染的锐器致伤上报率为75.76％;医务人员锐器伤主要发生于操作前准备用物时及操作中,占33.18、35.35％.结论 临床医务人员锐器伤发生率较高,应加强对医务人员的职业防护教育,规范操作流程,实施标准预防,降低锐器伤的发生率.     

传染病医院医务人员血源性职业暴露原因及防护措施

目的：回顾分析苏州市传染病医院血源性疾病职业暴露原因,为及时采取有效应对措施、避免医务人员感染提供参考。方法对市传染病医院医务人员血源性职业暴露后的应急处置资料进行统计。结果2009－2014年,共发生医务人员血源性传染病职业暴露62人次。其中,医务人员针刺伤38人次（占61.29％）,实习医生锐器伤11人次（占17.74％）,实习护生锐器伤 8人次（占12.90％）,护工被排泄物污染皮肤黏膜3人次（占4.84％）,医技人员被患者的呕吐物喷脸或眼内2人次（占3.23％）。血源性职业暴露后经正确及时的应对处理及预防性治疗,无人感染血源性疾病。结论加强自我防护意识,一旦发生职业暴露准确及时评估,有效的局部处理及合理预防性用药,是避免感染血源性疾病的重要举措。     

机械热力清洗消毒技术与供应室人员的职业安全

医疗器械使用后，不仅污染了大量的细菌，带血的器械还可能污染大量的乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、输血性肝炎病毒（TTV）、人免疫缺陷病毒（HIV）等经血传播的病毒。医务人员血源感染的主要途径是感染性血液及体液进入其血液，进人方式包括被污染的锐器刺伤，破损的皮肤或黏膜接触污染的血液和体液等。殷小基收集了2001年6月1日-2002年5月31日东华医院24例锐器伤害员工资料，受伤人员中受伤率最高为护士，占54．2％.     

我院医护人员刺伤状况的调查分析

医疗锐器伤是医护人员在工作中最常见的职业性损伤，各种血源性疾病都可经医疗锐器伤传给医护人员。长期以来，大家非常关注血源性疾病在患者中传播，对医护人员因职业暴露感染血源性疾病危险的关注较少。因我院发现2例HIV患者后，医院领导非常重视医护人员的职业防护问题。为此，对我院医护人员刺伤状况进行调查，结果报告如下。     

2009年广东省部分地区基层医务人员乙型肝炎血清流行病学分析

目的了解广东省部分地区基层医务人员乙型病毒性肝炎（乙肝）流行现状,为制定乙肝高危人群的防制策略提供科学依据。方法2009年7月,在广东省韶关南雄市、汕尾海丰县和云浮新兴县采取分层比例随机抽样方法,抽取1243名基层医务人员作为样本,开展血清流行病学调查。采用雅培试剂化学发光法检测HBsAg、抗-HBs、抗-HBc,应用SPSS10．0软件对数据进行统计分析。结果共调查基层医务人员1243人,男性486人,女性757人。HBV感染率为69．03％（858／1243）,HBsAg阳性率为9．49％（118／1243）、抗-HBs阳性率为74．18％（922／1243）,抗-HBc阳性率为58．81％（731／1243）。不同调查地区基层医务人员HBV感染率、HBsAg和抗一HBc阳性率差异均有统计学意义（P〈0．05或P〈0．01）。男性的HBV感染率和抗-HBc阳性率（分别为75．31％、66．46％）高于女性（64．99％、53．90％）（P〈0．01）;HBV感染率和抗-HBc阳性率随着年龄的增长而升高（P〈0．01）。接种过乙肝疫苗的医务人员,HBV感染率、HBsAg和抗-HBc阳性率低于未接种过乙肝疫苗和接种史不详的医务人员（P〈0．01）,而抗-HBs阳性率则高于未接种过乙肝疫苗和接种史不详的医务人员（P〈0．01）。结论广东省受调查基层医务人员HBsAg阳性率高于全国一般人群水平,而低于省内一般人群水平,且该人群年龄越高感染的机会越高。要控制医务人员乙肝流行,应加强对医务人员的健康教育,并大力推行乙肝疫苗接种。     

新医护人员锐器伤调查及预防措施

目的了解新医护人员诊疗工作中发生锐器伤情况及其防护意识和处理措施。方法自行设计问卷，对某校3所附属医院工作3年以内的668名新医护人员进行回顾性调查。结果被调查的新医护人员中发生锐器伤人数为639人(95．66％)，共发生4476次，受伤2次以上者占90．87％。锐器伤种类以注射器针头刺伤为主，占63．43％，其次为手术时缝针刺伤和刀片划伤(32．77％)。发生锐器伤后上报者仅占7．67％。结论临床新医护人员锐器伤发生率高，受伤后汇报率低；加强全面性防护意识教育，建立并执行全面性防护措施，减少医护人员职业性、血源性疾病的传播是当前职业防护的重要课题。     

Needlestick injuries during medical training

Medical students are at risk of acquiring infections caused by needlestick injuries, although it is unknown when needlestick injuries are most likely to occur during medical training. The aim of this study was to define high-risk periods over the course of medical training. A cross-sectional study was conducted among medical students in the first, third, fourth and fifth years of training at two medical schools in Munich. Overall, 1317 (85%) students returned a questionnaire on demographic data, vaccination status against hepatitis B, lifetime prevalence of needlestick injuries, level of knowledge about measures after such accidents, and transmission risks. Lifetime prevalence of needlestick injuries was 23%, ranging from 12% in first year students to 41% in fourth year students. These accidents happened most commonly during medical internships, especially during blood-taking practices; an activity that usually starts during the third year of training. The frequency of respondents not vaccinated against hepatitis B also varied between first (21%) and fourth (6.6%) year students. Needlestick injuries occur frequently and early on in medical training. In order to decrease the risk of preventable infections, complete coverage of vaccination against hepatitis B should be achieved early in medical training.     

医务人员职业损伤的研究分析

目的：研究分析医务人员因针头或其他尖锐器具造成损伤的发生率及其原因。方法：对610名医务人员进行问卷调查，被调查人员包括医生，护士，技师和实验工作人员。被调查者通过回顾的方式，如实填写过去一年内皮肤损伤的原因，次数及所采取的预防措施，回收有效问卷581份（95％），结果：在581名被调查者中，共发生1811例次皮肤务污染事件，其中54％是被污染血液后的内孔针头引起的，医务人员清楚地了解，有13％的病人患有乙肝，丙肝，梅毒，艾滋病等可以通过血液传播的疾病，每名医师（技师）每年有2．85次皮肤损伤几率，每名护士每年有3．4次皮肤损伤几率,所有的损伤事故发生后，均采用强力碘等消毒伤口，并有针对性地采取大量盐水冲洗，注射乙肝疫苗，高效免疫球蛋白等措施，结论：医务人员的这种损伤与他们的特殊职业有密切的关联，54％的损伤是在内孔针头充满血液的情况下造成的，具有很高的传播疾病的危险性，因此，应采取针对性的防护安全教育，预防事故发生。     

Susceptibility of healthcare workers in Kenya to hepatitis B: new strategies for facilitating vaccination uptake

Hepatitis B virus (HBV) infection is preventable, yet many healthcare workers (HCWs) in resource-poor countries remain at risk. The aims of this study were to evaluate the susceptibility of HCWs in a Kenyan district to HBV infection, and the feasibility of expanding the Extended Programme of Immunization (EPI) for infants to incorporate hepatitis B vaccination of HCWs. HCWs in Thika district, Kenya were invited to complete an interviewer-administered questionnaire about their immunization status and exposure to blood or body fluids. Participants were asked to provide a blood sample to assess natural or vaccine-induced protection against HBV. All non-immune HCWs were offered hepatitis B vaccination. Thirty percent (168/554) of HCWs reported one or more needlestick injuries (NSIs) in the previous year, with an annual incidence of 0.97 NSIs/HCW/year. Only 12.8% (71/554) of HCWs had received vaccination previously and none had been screened for immunity or for hepatitis B surface antigen. In total, 407 staff provided blood samples; 41% were HBV core antibody, 4% expressed hepatitis B surface antibody from previous vaccination, and 55% were unprotected. Two hundred and twenty-two staff were eligible for vaccine delivered through the EPI infrastructure. Self-motivated uptake of a full course of vaccine was 92% in the smaller health centres and 44% in the district hospital. This study demonstrates the importance of hepatitis B vaccination of HCWs in parts of Africa where high exposure rates are combined with low levels of vaccine coverage. High rates of vaccination can be achieved using childhood immunization systems for the distribution of vaccine to HCWs.     

Needlestick injuries and hepatitis B virus vaccination in health care workers

An analysis of 2646 needlestick injuries in hospitals in the Greater Manchester area between April 1992 and April 1999 was carried out. Ten per cent of members of staff injured in these incidents had never been vaccinated against hepatitis B virus (HBV) and 27% of those who had been vaccinated had no anti-HBs (< 10 IU/L). Although few health care workers were at risk of transmission of HBV through needlestick incidents in this study (0.6% (12/2084) of all source patients were HBsAg positive; 9 HBeAg positive, 7 anti-HBe positive), the large number of members of staff who were not protected from HBV infection indicates a need for occupational health departments to reinforce HBV vaccination policies.     

Hepatitis B vaccination coverage levels among healthcare workers in the United States, 2002-2003.

BACKGROUND: Hepatitis B virus (HBV) infection is a well recognized risk for healthcare workers (HCWs), and routine vaccination of HCWs has been recommended since 1982. By 1995, the level of vaccination coverage among HCWs was only 67%. OBJECTIVE: To obtain an accurate estimate of hepatitis B vaccination coverage levels among HCWs and to describe the hospital characteristics and hepatitis B vaccination policies associated with various coverage levels. DESIGN: Cross-sectional survey. METHODS: A representative sample of 425 of 6,116 American Hospital Association member hospitals was selected to participate, using probability-proportional-to-size methods during 2002-2003. The data collected included information regarding each hospital's hepatitis B vaccination policies. Vaccination coverage levels were estimated from a systematic sample of 25 HCWs from each hospital whose medical records were reviewed for demographic and vaccination data. The main outcome measure was hepatitis B vaccination coverage levels. RESULTS: Among at-risk HCWs, 75% had received 3 or more doses of the hepatitis B vaccine, corresponding to an estimated 2.5 million vaccinated hospital-based HCWs. The coverage level was 81% among staff physicians and nurses. Compared with nurses, coverage was significantly lower among phlebotomists (71.1%) and nurses' aides and/or other patient care staff (70.9%; P<.05). Hepatitis B vaccination coverage was highest among white HCWs (79.5%) and lowest among black HCWs (67.6%; P<.05). Compared with HCWs who worked in hospitals that required vaccination only of HCWs with identified risk for exposure to blood or other potentially infectious material, hepatitis B vaccination coverage was significantly lower among HCWs who worked in hospitals that required vaccination of HCWs without identified risk for exposure to blood or other potentially infectious material (76.6% vs 62.4%; P<.05). CONCLUSIONS: In the United States, an estimated 75% of HCWs have been vaccinated against hepatitis B. Important differences in coverage levels exist among various demographic groups. Hospitals need to identify methods to improve hepatitis B vaccination coverage levels and should consider developing targeted vaccination programs directed at unvaccinated, at-risk HCWs who have frequent or potential exposure to blood or other potentially infectious material.     

Prevalence and prevention of needlestick injuries among health care workers in a German university hospital

Objective Health care workers (HCWs) are exposed to bloodborne pathogens, especially hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) through job-related risk factors like needlestick, stab, scratch, cut, or other bloody injuries. Needlestick injuries can be prevented by safer devices. Methods The purpose of this study was to investigate the frequency and causes of needlestick injuries in a German university hospital. Data were obtained by an anonymous, self-reporting questionnaire. We calculated the share of reported needlestick injuries, which could have been prevented by using safety devices. Results 31.4% (n = 226) of participant HCWs had sustained at least one needlestick injury in the last 12 months. A wide variation in the number of reported needlestick injuries was evident across disciplines, ranging from 46.9% (n = 91/194) among medical staff in surgery and 18.7% (n = 53/283) among HCWs in pediatrics. Of all occupational groups, physicians have the highest risk to experience needlestick injuries (55.1%—n = 129/234). Evaluating the kind of activity under which the needlestick injury occurred, on average 34% (n = 191/561) of all needlestick injuries could have been avoided by the use of safety devices. Taking all medical disciplines and procedures into consideration, safety devices are available for 35.1% (n = 197/561) of needlestick injuries sustained. However, there was a significant difference across various medical disciplines in the share of needlestick injuries which might have been avoidable: Pediatrics (83.7%), gynecology (83.7%), anesthesia (59.3%), dermatology (33.3%), and surgery (11.9%). In our study, only 13.2% (n = 74/561) of needlestick injuries could have been prevented by organizational measures. Conclusion There is a high rate of needlestick injuries in the daily routine of a hospital. The rate of such injuries depends on the medical discipline. Implementation of safety devices will lead to an improvement in medical staff’s health and safety.     

Blood borne viral infections among Danish Health Care Workers – frequent blood exposure but low prevalence of infection

Denmark is a country with low prevalence and incidence of blood borne viral infections. Among health care workers (HCWs) vaccination for hepatitis B is only offered to high-risk groups. The aims of this cross sectional survey were to determine the prevalence of hepatitis B, -C, and human immunodeficiency virus (HIV) among the staff at a Danish University hospital and to correlate this with risk factors for transmission. Additionally, we wanted to examine the current frequency of blood exposure, reporting habits and hepatitis B vaccination status in the staff. Of 1439 eligible hospital staffs included, 960 (67%) were HCWs. The overall human immunodeficiency virus (HIV)-, hepatitis C Virus (HCV)- and hepatitis B Virus (HBV)-prevalence was 0% (0/1439), 0.14% (2/1439) and 1.6% (23/1439), respectively. Twenty-three percent of HCWs were vaccinated against HBV. Age, blood transfusion and stay in endemic areas were associated independently to HBV infection as opposed to job-category, duration of employment, HBV vaccination status and blood exposure. Based on a 4-week recall period, the incidence of percutaneous blood exposure was 1.5/person-year. In conclusion the HIV and hepatitis prevalence was low despite frequent blood exposure and the principal risk factors were unrelated to work. Danish HCWs do not seem to be at increased risk of hepatitis B even though universal HBV vaccination has not been implemented.     

Needlestick and sharps injuries among health-care workers in Taiwan.

Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high.     

Prevalence of hepatitis C antibodies in a large sample of Belgian healthcare workers.

OBJECTIVE: To assess the risk of hepatitis C virus (HCV) infection among Belgian (Flemish) healthcare workers. DESIGN: A seroprevalence survey of HCV IgG antibodies. SETTING AND PARTICIPANTS: A systematic sample of 5,064 employees from 22 general hospitals in Flanders and Brussels, Belgium, was tested at the annual occupational medical examination. Together with demographic and occupational data, information was collected on the frequency of blood contact, needlestick injuries, and medical and surgical history. The blood samples were tested using the third-generation Abbott Screen Kit test, with confirmation by Matrix, LIA, and an in-house polymerase chain reaction and the Quantiplex-HCV b-DNA test. RESULTS: 21 persons were found to be positive for HCV markers. The overall prevalence was 0.41% (95% confidence interval [CI95], 0.24-0.59). A statistically significant association was found with a history of blood transfusion (odds ratio [OR], 4.14; CI95, 1.67-10.31) and with history of a clinically apparent hepatitis (OR, 3.98; CI95, 1.60-9.90). Although the ORs for the frequency of blood contact were slightly elevated (between 1.17 and 2.73), this association was not significant. Moreover, a history of needlestick injuries showed a nonsignificant OR of 1.28 (CI95, 0.53-3.09), and no statistically significant difference was found with a variety of duties and tasks. The ORs for potential occupational risk factors were adjusted according to age, gender, antecedents, and other confounders using a logistic regression analysis. Based on this procedure, the ORs decreased slightly. CONCLUSIONS: Flemish healthcare workers showed a lower HCV seropositivity than is seen in the general population; a history of blood transfusion and of clinically apparent hepatitis was most strongly associated with the presence of HCV markers. We concluded that employees in Flemish regional general hospitals are not at an overall increased risk for HCV infection, although occasional transmission through percutaneous injuries is possible, and prevention therefore remains imperative.     

重庆市流动农民工乙型病毒性肝炎感染现况研究

[目的]掌握流动农民工乙型肝炎感染状况,为制定预防控制策略提供信息和依据。[方法]抽样调查,酶联免疫吸附实验检测病原体。[结果]HBsAg总阳性率为8.6%,男性为10.0%,女性为7.0%,男女差别无统计学意义,各年龄组差别无统计学意义。HBsAg阳性人群中20.4%为HBsAg和HBeAg两项同时阳性。多因素非条件Logistic回归分析表明,输血、口腔疾病就医史、两个以上性伴侣等为该人群乙型肝炎感染的主要危险因素。[结论]重庆市流动农民工人群在乙型肝炎的传播流行上具有特殊的流行病学意义。加强乙型肝炎相关知识健康教育,提倡良好的生活卫生习惯和安全性生活,推行免疫接种,推广分餐制,严格献血员的筛选等,是预防乙型肝炎进一步在该人群间以及该人群与城市居民之间传播流行的必要和切实可行的措施。