Burnout as a clinical entity--its importance in health care workers

Burnout, viewed as the exhaustion of physical or emotional strengthas a result of prolonged stress or frustration, was added tothe mental health lexicon in the 1970s, and has been detectedin a wide variety of health care providers. A study of 600 Americanworkers indicated that burnout resulted in lowered production,and increases in absenteeism, health care costs, and personnelturnover. Many employees are vulnerable, particularly as theAmerican job scene changes through industrial downsizing, corporatebuyouts and mergers, and lengthened work time, Burnout producesboth physical and behavioural changes, in some instances leadingto chemical abuse. The health professionals at risk includephysicians, nurses, social workers, dentists, care providersin oncology and AIDS-patient care personnel, emergency servicestaff members, mental health workers, and speech and languagepathologists, among others. Early identification of this emotionalslippage is needed to prevent the depersonalization of the provider-patientrelationship. Prevention and treatment are essentially parallelefforts, including greater job control by the individual worker,group meetings, better up-and-down communication, more recognitionof individual worth, job redesign, flexible work hours, fullorientation to job requirements, available employee assistanceprogrammes, and adjuvant activity. Burnout is a health careprofessional's occupational disease which must be recognizedearly and treated.     

Tuberculosis among health care workers

To assess the annual risk for latent tuberculosis infection (LTBI) among health care workers (HCWs), the incidence rate ratio for tuberculosis (TB) among HCWs worldwide, and the population-attributable fraction of TB to exposure of HCWs in their work settings, we reviewed the literature. Stratified pooled estimates for the LTBI rate for countries with low (<50 cases/100,000 population), intermediate (50-100/100,000 population), and high (>100/100,000 population) TB incidence were 3.8% (95% confidence interval [CI] 3.0%-4.6%), 6.9% (95% CI 3.4%-10.3%), and 8.4% (95% CI 2.7%-14.0%), respectively. For TB, estimated incident rate ratios were 2.4 (95% CI 1.2-3.6), 2.4 (95% CI 1.0-3.8), and 3.7 (95% CI 2.9-4.5), respectively. Median estimated population-attributable fraction for TB was as high as 0.4%. HCWs are at higher than average risk for TB. Sound TB infection control measures should be implemented in all health care facilities with patients suspected of having infectious TB.     

某院医务人员职业暴露监测

目的了解医务人员发生职业暴露人群的分布特征、危险因素与风险环节。方法对某院所有医务人员2011年1月—2014年6月发生的职业暴露进行风险监控,分别从发生职业暴露者的职业类别,暴露的地点、环节以及方式进行数据统计。结果 286例次职业暴露者中,男性63例(22.03%),女性223例(77.97%);2011年111例次(38.81%),2012年75例次(26.22%),2013年67例次(23.43%),2014年1—6月份33例次(11.54%);对不同人群发生职业暴露者统计数据显示,各年度不同人群发生职业暴露所占百分比相似,由高到低依次为护士(31.97)%、医师(19.90%)、护工(15.79%)、技师(7.64%)、护师(4.17%)和保洁员(2.84%);整理废物、拔针或更换针头、丢弃锐器入利器盒、手术缝合或器械传递、各种穿刺(含抽血)操作时的锐器伤是医务人员发生职业暴露损伤的主要风险环节,其构成比分别为22.38%、19.58%、14.34%、12.94%和11.19%;各年度职业暴露发生地点相似,主要是病房、手术室和注射(治疗)室,其构成比分别为51.40%、19.58%和11.54%。结论医院应建立完善的职业暴露监控与风险管理体系,强化标准预防,加强对职业暴露高危人群的培训,对风险环节及危险因素进行监控和干预,以有效降低医务人员职业暴露发生率。     

Burnout and use of HIV services among health care workers in Lusaka District, Zambia: a cross-sectional study

Background  

Well-documented shortages of health care workers in sub-Saharan Africa are exacerbated by the increased human resource demands of rapidly expanding HIV care and treatment programmes. The successful continuation of existing programmes is threatened by health care worker burnout and HIV-related illness.     

Prevalence of cytomegalovirus infection among health care workers in pediatric and immunosuppressed adult units

The prevalence of cytomegalovirus (CMV) infection varies not only from one country to another, but also with social, economic, and environmental conditions and with professional activity. Health care workers in contact with the main vectors of the CMV (i.e., children and immunosuppressed patients) are particularly exposed to the infection. We assessed the prevalence of the virus among health care personnel in light of CMV epidemiology and the recent shift in living conditions and family size. Our study was included in a broader program evaluating the risk of infection among female hospital workers of childbearing age. The goal of the program was to implement appropriate preventive measures for personnel who were not immune to the infection. Consequently, we included only female caregivers who worked with children or immunosuppressed patients. The study was based on a clinical examination, a medical and occupational questionnaire, the assessment of tasks performed; and CMV serologic testing. The overall seroprevalence was 44.25% in our population (n = 400) and was comparable regardless of the place of work. Prevalence differed significantly with age and parity, and we also found that it was higher among personnel who worked in closer contact with the patients (nurse's aides, pediatric nurse's aides) than among those whose tasks required more technical skills (nurses, pediatric nurses) (57.3% vs 34.5%, P < 0.01). The logistic regression analysis between prevalence of CMV antibodies, age, parity, and type of job showed that "contact job" was as significant a factor as parity to explain immunization in our population (odds ratio, 2.2). We also determined a correlation between the prevalence of CMV antibodies and tasks performed. In addition, we found a non-negligible group of non-immune personnel (55.75%) and young workers (mean age: 33.4) who were potentially exposed to infection. This points to the need to establish a prevention program.     

某医院医护人员手卫生依从性调查

目的了解医护人员手卫生状况,为进一步提高手卫生依从性提供依据。方法 2012—2014年某院采取多项手卫生干预措施,对每年8月1—31日医护人员手卫生依从性和各年度医院感染情况进行调查统计。结果 2012—2014年医护人员手卫生依从率分别为59.55%、62.13%和65.16%,呈增高趋势,(χ2=10.018,P=0.002);医院感染率分别为2.13%、1.48%和1.06%,呈降低趋势(χ2=82.377,P0.001);医生手卫生依从率(57.97%)低于护士(65.97%);不同手卫生时刻中接触患者前的手卫生依从率最低(41.32%),而接触患者体液后依从率最高(76.47%)。结论该院手卫生综合干预措施已初见成效,完善并提高医护人员手卫生依从性有利于预防医院感染。     

211例医务人员锐器伤监测结果分析

目的分析医务人员锐器伤发生情况,为持续改进锐器伤安全管理工作提出建议。方法回顾性分析某院2006年8月—2015年7月上报的《锐器伤登记表》,分析统计相关资料。结果共上报211例锐器伤,主要人群为护士(118例,55.92%)和医生(83例,39.34%);工龄主要为5年及以下者(117例,55.45%);发生地点主要为外科病房(67例,31.75%)、内科病房(65例,30.81%)及门急诊(33例,15.64%);致伤物主要为注射器针头(91例,43.13%)、缝合针(34例,16.11%)和头皮针/输液器针头(27例,12.80%);主要致伤操作为各种注射(40例,18.95%)、静脉输液(38例,18.00%)、手术缝合/剪断(36例,17.06%)。主要致伤环节为操作中(治疗、检查、手术),共109例(51.66%)。血源性病原体污染的器械中,HBV污染95例(76.61%),HCV污染25例(20.16%),HIV污染4例(3.23%)。无血源性病原体感染病例发生。211例医务人员接种乙肝疫苗者155例(73.46%)。结论应重点针对工作时间≤5年的护士和医生,外科病房、内科病房及门急诊的医务人员,注射、静脉输液、缝合/剪断等操作时做好锐器伤防护工作。医院相关部门完善上报流程,加强追踪。     

徐州地区医务人员锐器伤现状调查分析

目的调查徐州地区各级医院医务人员锐器伤发生及上报情况,为制定本地区锐器伤防护措施、完善上报制度提供依据。方法 2016年7—8月,采用多阶段分层随机抽样方法随机抽取徐州市13所不同级别医院的医务人员,对其一般资料、锐器伤发生及上报情况等进行问卷调查。结果共收集2 694份有效问卷,医务人员锐器伤发生率为10.32%,例次发生率为12.84%,上报率为30.64%。医务人员锐器伤例次发生率一级医院为44.83%,二级医院为11.53%,三级医院为12.52%,不同级别医院锐器伤例次发生率比较,差异具有统计学意义(χ~2=55.148,P0.001)。锐器伤发生时机主要为医务人员在回套针帽时(79例次,22.83%),器具种类主要为中空针类(297例次,85.84%)。参加培训情况不同的医务人员锐器伤发生率比较,差异具有统计学意义(χ~2=66.760,P0.001)。结论本地区医务人员的锐器伤现状不容乐观,存在培训效果欠佳,上报率较低且安全器具使用率不高等问题,应进一步采取有效措施,建立有效的锐器伤监测追踪系统以减少锐器伤的发生。     

Nudging influenza vaccination among health care workers

Our online randomized controlled trial on 6230 healthcare workers (HCWs) tests the impact that three nudges – social norms, reminding the impact on beneficiaries, and defaults – have on the intention to vaccinate against seasonal influenza across job families. Willingness to get a flu shot was higher among subjects invited to imagine themselves working at the local health authority (LHA) with the greatest immunization coverage within their region relative to their counterparts prompted to imagine working at the LHA with the lowest coverage. Reminding the impact of flu vaccination on beneficiaries had different effects across job families, with physicians caring more benefits for themselves, nurses about patients’ benefits, and technicians about family and friends. Default responses anchoring toward a high rather than a low vaccination intention increased the willingness to immunize among all HCW except physicians. Targeted nudges can be considered in developing interventions to promote influenza vaccination among HCWs.     

Latex allergy symptoms among health care workers: results from a university health and safety surveillance system

We sought to describe risk factors for latex glove allergy symptoms among health care workers by combining data from an active clinical surveillance program and a comprehensive occupational health surveillance system. A total of 4,584 employers completed a latex allergy questionnaire. Six percent (n = 276) of subjects reported symptoms consistent with latex allergy. Years of latex glove use was a significant risk factor for latex allergy symptoms even after controlling for the effects of atopy, gender, age, race, fruit, and other allergies. Nurses, medical or lab technicians, physician's assistants, other clinical professionals, and housekeepers had the highest prevalence of latex glove allergy symptoms. Forty subjects (0.87%) who were confirmed as having latex sensitization. Sensitizsation may have been underestimated due to use of specific IgE antibody, less sensitive than skin-prick testing, and tiered design leading to laboratory assessment on a subset of the cohort. This surveillance program identified risk factors for latex allergy symptoms. Our findings provide a basis for tailoring future prevention strategies.     

Hepatitis B vaccination among primary health care workers

Health care workers' immunization against hepatitis B is an essential measure to avoid occupational transmission of hepatitis B virus at primary health care centers. The aims of this study were to investigate the prevalence of complete-series vaccination against hepatitis B, estimate the prevalence of confirmed immunity, and verify the factors associated with complete-series vaccination among primary health care workers in Florianópolis, Santa Catarina State, Southern Brazil. A total of 1,249 primary health care workers participated in this study. The prevalence of complete hepatitis B vaccination was 64.61%, and 29.82% of workers indicated knowing they were immunized after taking a serological test to confirm immunity. In the adjusted analysis, complete-series vaccination was positively associated with higher level of schooling and contact with potentially infectious materials or sharps, and negatively associated with precarious employment status and current smoking. Educational measures are recommended to achieve vaccination of health workers who have not been vaccinated or have not completed the series and to inform on the need for vaccine response monitoring.     

Improving motivation among primary health care workers in Tanzania: a health worker perspective

In Tanzania access to urban and rural primary health care is relatively widespread, yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality.     

某院医务人员锐器伤目标性监测

目的了解某院医务人员发生锐器伤的人群分布特征和风险环节,为制定有效防护措施提供依据。方法回顾性调查2014年1-12月该三级甲等医院医务人员上报医院感染管理科的职业暴露情况,分析发生锐器伤者的职业类别、暴露地点及环节、暴露源等情况。结果2014年1-12月共监测医务人员2 643名,发生锐器伤61名,其中护士43名（占70.49%）,医生13名（占21.31%）。医务人员锐器伤职业暴露科室主要为骨科（9名,占14.75%）,致伤锐器主要为输液针（33名,占54.10%）,发生的主要操作环节为拔针（21名,占34.43%）;暴露源主要为乙型肝炎病毒（HBV）,共36例（占59.01%）;34名（占55.74%）锐器伤职业暴露医务人员在操作中均未戴手套。锐器伤职业暴露后进行局部处理者54名（占88.52%）,进行药物治疗（含预防用药）者仅18名（占29.51%）;追踪随访43名（占70.49%）,均未因暴露而发生感染。结论医院应建立完善的锐器伤职业暴露监控体系,加强对发生锐器伤高危人群的培训,强化标准预防,对风险环节进行监控和干预,有效减少医务人员锐器伤的发生。     

医务人员职业暴露监测分析

目的探讨医务人员职业暴露人群分布、高危环节以及暴露源等,为制定职业防护措施、预防职业暴露后感染提供依据。方法利用湘雅感染监测管理系统开展监测,分析2011年8月-2013年8月上报的医务人员发生职业暴露数据。结果两年上报254人次职业暴露事件,职业暴露人群以临床护士最高,200人次占78.74%,工龄≤6年人员发生职业暴露达208人次占81.90%,针刺伤是职业暴露最主要方式,达213人次占83.86%,暴露源确定感染乙型肝炎病毒、丙型肝炎病毒、戊型肝炎病毒、苍白密螺旋体、人类免疫缺陷病毒等血源性病原体达121人次占47.64%,确认职业暴露后发生丙型肺炎病毒感染两人,感染率为8.70%,坚持完成1年聚乙二醇干扰素联合利巴韦林抗病毒治疗获得痊愈。结论落实标准预防、推广无针注射和无针输液,是降低医务人员职业暴露有效措施;暴露后遵医嘱及时预防性用药,追踪监测、尽早诊断急性感染、积极抗病毒治疗,是预防暴露后感染以及感染后发展为慢性病的有力保障。     

医务人员手卫生依从性调查

目的对某院医务人员手卫生采取综合干预措施,比较干预前后医务人员手卫生执行情况,评价干预效果。方法2013年4-6月为该院医务人员手卫生基线调查阶段,2013年7月开始实施干预,2013年10-12月为干预后效果评价阶段。调查人员利用调查表,隐蔽观察医务人员手卫生执行情况。 结果通过多种干预措施,医务人员手卫生依从率为53.86%,显著高于干预前的38.02%,差异有统计学意义（χ2=181.82,P＜0.05）;内科、外科、重症监护室手卫生依从率均高于干预前（均P＜0.05）。干预后,不同操作时机医务人员整体手卫生依从率为53.45%(2 044/3 824),显著高于干预前的41.87%(1 740/4 156)（χ2=107.2,P＜0.05）;除无菌操作,其余4个操作时机医务人员手卫生依从率均高于干预前（均P＜0.05）;不同岗位医务人员手卫生依从率均高于干预前（均P＜0.05）。结论采取积极的手卫生干预措施,可有效提高医务人员手卫生依从性。     

Implementing participatory ergonomics teams among health care workers

Three participatory ergonomics teams have been established among healthcare workers in a metropolitan medical center. Three teams, consisting of orderlies, intensive care unit nurses, and laboratory workers, were selected to provide a diversity of work activities and educational backgrounds. The effectiveness of these teams was assessed by observations of team interactions, by team members' perceptions of their effectiveness, and by the teams' success in identifying problems and implementing solutions. After 1 year, one of the three groups has been highly effective by these measures. To varying degrees, the groups encountered competing time demands and obstacles in implementing solutions within current administrative structures. For some groups of health care workers, participatory ergonomics teams seem to be an effective strategy to improve health and safety. This approach may not be feasible in all areas of health care, especially in high-demand clinical areas where patient needs may take precedence over the safety of health care workers. Am. J. Ind. Med. 32:190-196. © 1997 Wiley-Liss, Inc.     

某三级综合医院医务人员职业暴露调查

目的了解某三级综合医院医务人员职业暴露情况,分析职业暴露发生原因及预防对策。方法对某院2010年1月—2013年12月134例发生职业暴露的医务人员进行调查。结果暴露人群中,护士所占比率最高(59.70%),其次是医生(19.40%)、医技人员(9.70%)。职业暴露主要原因为锐器管理不规范(占46.27%,62例),其次为操作意外(占42.54%,57例)、防护措施不足所致(占11.19%,15例);暴露方式以锐器伤为主(占94.78%,127例),黏膜接触暴露占5.22%(7例),暴露源不明确者占42.54%,暴露源明确者占57.46%,其中乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒螺旋体(TP)、人类免疫缺陷病毒(HIV)分别占35.82%、12.69%、3.73%、2.24%;HBV、HCV合并感染占2.24%(3例);HIV、HBV、HCV、TP合并感染占0.74%(1例)。职业暴露后正确处理率为95.52%。结论护士是职业暴露高危群体,做好职业防护,并规范锐器管理,可以减少医务人员职业暴露发生。     

基层口腔医务人员职业暴露防护现况调查

目的探讨基层口腔医务人员职业暴露情况,制定有效的干预措施。方法应用分层随机整群方法抽取商丘市县级以下口腔医疗机构临床一线工作人员385名进行统一问卷调查,调查内容包括一般情况、口腔职业暴露的相关知识、防护行为,防护管理措施。结果 374名基层口腔医护人员职业暴露基础知识认知,知晓率在20.9%⁷2.7%,平均得分(5.1±1.1)分;职业暴露防护行为认知,知晓率在9.4%72.7%,平均得分(5.1±1.1)分;职业暴露防护行为认知,知晓率在9.4%⁹8.4%,平均得分(6.7±1.2)分;职业暴露防护行为不同职称间比较差异有统计学意义(P<0.05);手机一人一用一灭菌,县、乡两级医院与口腔诊所比较差异有统计学意义(P<0.05);医师在使用手机前后踩脚闸情况,县级医院与口腔诊所比较差异有统计学意义(P<0.05);手机采样监控乡级医院与口腔诊所之间差异有统计学意义(P<0.05)。结论基层口腔医务人员职业暴露相关知识严重缺乏,职业暴露的防护行为不规范,基层医院口腔职业暴露安全防护措施管理存在问题,应加强基层口腔医务人员的持续培训,对诊疗过程中的防护行为进行规范、督导,建立基层医院安全防护机制。     

中国医务人员职业暴露与防护工作的调查分析

目的了解医务人员职业暴露与防护工作现状,为制定职业暴露防护措施提供依据。方法采用分层抽样方法于2016年4月6日—5月6日向全国13个省份158所不同级别医院发放调查问卷进行调查,分别调查各所医院开展职业暴露监测首年、2010年及2015年的职业暴露与防护管理及监测情况。结果81.65%（129/158）的医院医务人员职业暴露管理工作由医院感染管理部门负责;98.73%（156/158）的医院制定了相关规章制度;77.22%（122/158）的医院存在医务人员职业暴露漏报现象。共发生职业暴露事件11 116例,调查首年发生1 542例,2010年发生2 474例,2015年发生7 100例。锐器伤在各类职业暴露类型中占96.76%;职业暴露人员职业分布中,护理人员占53.90%;职业暴露人员科室来源主要为普通病房、手术室、重症监护病房等;引起医务人员职业暴露器具主要为注射器、头皮钢针、手术缝针等;静脉注射、针头丢入利器盒、手术缝针等是引起医务人员职业暴露的高危操作;在职业暴露源阳性分布中,以乙型肝炎病毒（HBV）为主,占58.69%。结论我国医务人员面临职业暴露的风险大,危害重,形势严峻,应通过政府立法、推广应用安全器具、规范医务人员操作行为、正确使用个人防护用品、强化医务人员教育与培训、建立健全职业暴露报告、评估和随访机制等措施,以切实减少职业暴露的发生。