护理人员采血环节血源性病原体职业暴露监测

目的探讨护士采血过程发生血源性病原体职业暴露的具体环节,以及源患者感染状况,为制定职业暴露预防策略提供依据。方法对某院2011年8月-2013年9月护士采血环节血源性病原体职业暴露数据进行分析。结果共发生血源性病原体职业暴露89例次,包括静脉采血75例次,动脉采血14例次。采血操作环节职业暴露居前3位的是拔针后管塞穿刺针回弹（25例次,28.09%）、操作结束集中二次清理垃圾（18例次,20.22%）、血液体液皮肤黏膜接触（13例次,14.61%）。经检测,源患者确定感染43例次（48.31%）,感染包括乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、戊型肝炎病毒(HEV)、梅毒螺旋体（TP）、人免疫缺陷病毒（HIV）等血液接触感染病原体中的一项或多项;源患者未感染46例次（51.69%）。经科学处理,发生采血环节职业暴露的护士均未发生感染。结论开发安全型采血针,锐器使用后第一时间放入锐器盒,采血操作戴手套等防护用品,以及实施标准预防和加强职业防护知识培训是降低临床护理人员采血环节发生血源性病原体职业暴露的重要策略。     

Accidental blood and body fluid exposure among doctors

Aim To study the epidemiology and time trends of blood and bodyfluids (BBF) exposures among hospital doctors. Methods A 3-year study was carried out using data from the ExposurePrevention Information Network of four teaching hospitals inthe UK. Results One hundred and seventy-five cases of BBF exposuresin doctors were reported over the 3-year study period. Eighty-one(46%) occurred in senior doctors and 94 (54%) in junior doctors.Junior doctors had a higher rate of BBF exposures compared tosenior doctors: 13 versus 4 incidents per 100 person-years,respectively (relative risk 3, 95% confidence interval 2–4).The most frequent setting for BBF exposures among senior doctorswas the operating theatre/recovery (59%). Among junior doctors,it was the patient room (48%). The commonest original reasonfor use of sharps by junior doctors was the taking of bloodsamples (42%). Among senior doctors, it was suturing (41%). Conclusion While ongoing training efforts need to be directedtowards both junior and senior doctors, our data suggest thatjunior doctors are at higher risk of BBF exposures and may needparticular attention in prevention strategies. An improvementin the safety culture in teaching hospitals can be expectedto reduce the number of BBF exposures.     

Medical students' exposure to bloodborne pathogens in the operating room: 15 years later.

We compared the rates of exposure to blood in the operating room among third-year medical students during 2005-2006 with the rates reported in a study completed at the same institution during 1990-1991. The number of medical students exposed to blood decreased from 66 (68%) of 97 students during 1990-1991 to 8 (11%) of 75 students during 2005-2006 (P<.001).     

医务人员血源性病原体职业暴露危险因素分析及对策

目的对血源性病原体职业暴露案例进行总结、分析,提出预防对策。方法回顾性分析某院20032008年48例职业暴露案例资料。结果 48例血源性病原体职业暴露者中,人免疫缺陷病毒暴露19例,乙型肝炎病毒暴露18例,丙型肝炎病毒暴露6例,梅毒螺旋体暴露5例。手术科室医务人员发生职业暴露29例,非手术科室16例,其他科室3例。暴露途径以手术中各种锐器伤最多见,达16例。发生职业暴露最多者为医生24例(实习医生4例),其次为护理人员21例(实习护士8例),检验人员2例,助产人员1例。对职业暴露者均及时进行了预防性干预,经追踪随访,无一例发生感染。结论医务人员应增强职业防护意识,发生职业暴露后须及时进行干预以降低暴露后感染危险。     

Compliance with personal precautions against exposure to bloodborne pathogens among laboratory workers: a Canadian survey .

A survey was conducted in laboratories across Canada to determine rates of compliance with recommended safety precautions against exposure to bloodborne pathogens and the rationale for current behaviors. Laboratory workers reported high rates of exposure to bodily fluids and poor rates of compliance with personal protective behaviors. This national study has identified several deficiencies and strategies for improvement.     

某中医院血源性病原体职业暴露调查与对策

目的分析某中医院62例血源性病原体职业暴露个案,发现职业暴露预防的重点环节,探讨预防措施并拟定对策。方法设计《医务人员职业暴露调查表》,前瞻性调查2011-2015年间血源性病原体职业暴露个案,调查内容包括暴露者基本资料、暴露类型与程度、暴露的时机、患者感染状态与暴露者免疫状态。使用Epi Data 3.1软件整理数据。结果暴露者以护士居多,病房与手术室是高发部门。91.94%为锐器伤;被带血锐器刺伤、伴有出血的中等风险暴露占59.68%。58.06%的暴露发生于操作中,40.32%发生于操作后。75.81%的医务人员暴露于乙肝病毒,而29.03%的暴露者未注射过乙肝疫苗。结论监测职业暴露事件,针对工作人员的不同暴露风险进行强化培训,改进标准操作流程细节,提高医务人员免疫接种率,可减少医院内血源性职业暴露。     

医务人员血源性职业暴露调查及其对策

目的了解医务人员职业暴露现状,分析发生原因及危险因素,为采取有效防护措施提供依据。方法采用回顾性调查方法,对某院2013年1月1日—2016年12月31日发生的职业暴露事件进行调查分析。结果该院共发生职业暴露632例次。职业暴露发生以护士为主,共392例次,占62.02%;主要发生于工作年限不满2年的医务人员,共387例次,占61.23%。医务人员发生职业暴露的时机居前三位的分别是在输液完毕拔针、集中处置使用过的锐器物及针头以及手术缝合时,分别占15.19%、14.71%和12.18%。导致锐器伤发生的器械中,头皮钢针所占比例最大,共137例次,占23.42%;其次是缝合针,96例次,占16.41%。职业暴露血源性病原体以乙型肝炎病毒为主,占58.86%,其次是未知暴露源导致的职业暴露,占18.04%;职业暴露地点主要发生在普通病房(38.61%)。结论应加强职业安全防护教育,提高医务人员预防职业危害的能力,规范具有潜在危险的操作行为,加强医疗废物分类与管理,从而降低医务人员职业暴露所带来的危害。     

Occupational blood and body fluid exposure in an Australian teaching hospital

To examine work-related blood and body fluid exposure (BBFE) among health-care workers (HCWs), to explore potential risk factors and to provide policy suggestions, a 6-year retrospective study of all reported BBFE among HCWs (1998-2003) was conducted in a 430-bed teaching hospital in Australia. Results showed that BBFE reporting was consistent throughout the study period, with medical staff experiencing the highest rate of sharps injury (10.4%). Hollow-bore needles were implicated in 51.7% of all percutaneous injuries. Most incidents occurred during sharps use (40.4%) or after use but before disposal (27.1%). Nursing staff experienced 68.5% of reported mucocutaneous exposure. Many such exposures occurred in the absence of any protective attire (61.1%). This study indicated that emphasis on work practice, attire, disposal systems and education strategies, as well as the use of safety sharps should be employed to reduce work-related injuries among HCWs in Australia.     

OSHA's bloodborne pathogens standard: enforcement, compliance and comment

More than a year ago, federal OSHA's Bloodborne Pathogens standard, legislation designed to reduce worker exposure to bloodborne pathogens such as HIV and HBV, became law. Many healthcare facilities were using personal protective equipment (PPE) or had some form of Universal Precautions (which the law requires) in place before the law took effect. Healthcare providers interviewed said that the addition of the widespread use of water-retardant gowns formed the biggest change in their PPE program. Education and training on the standard lagged, and these provisions in the law were the ones most frequently cited by OSHA. Provisions for free hepatitis B vaccination and post-exposure follow-up were also found wanting during OSHA inspections. Opinion on the need for the law differs.     

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.     

The national study to prevent blood exposure in paramedics: rates of exposure to blood

Objective  

The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers.     

Unsafe injections in the developing world and transmission of bloodborne pathogens: a review

Unsafe injections are suspected to occur routinely in developing countries. We carried out a literature review to quantify the prevalence of unsafe injections and to assess the disease burden of bloodborne infections attributable to this practice. Quantitative information on injection use and unsafe injections (defined as the reuse of syringe or needle between patients without sterilization) was obtained by reviewing the published literature and unpublished WHO reports. The transmissibility of hepatitis B and C viruses and human immunodeficiency virus (HIV) was estimated using data from studies of needle-stick injuries. Finally, all epidemiological studies that linked unsafe injections and bloodborne infections were evaluated to assess the attributable burden of bloodborne infections. It was estimated that each person in the developing world receives 1.5 injections per year on average. However, institutionalized children, and children and adults who are ill or hospitalized, including those infected with HIV, are often exposed to 10-100 times as many injections. An average of 95% of all injections are therapeutic, the majority of which were judged to be unnecessary. At least 50% of injections were unsafe in 14 of 19 countries (representing five developing world regions) for which data were available. Eighteen studies reported a convincing link between unsafe injections and the transmission of hepatitis B and C, HIV, Ebola and Lassa virus infections and malaria. Five studies attributed 20-80% of all new hepatitis B infections to unsafe injections, while three implicated unsafe injections as a major mode of transmission of hepatitis C. In conclusion, unsafe injections occur routinely in most developing world regions, implying a significant potential for the transmission of any bloodborne pathogen. Unsafe injections currently account for a significant proportion of all new hepatitis B and C infections. This situation needs to be addressed immediately, as a political and policy issue, with responsibilities clearly defined at the global, country and community levels.     

Hospital nurses' occupational exposure to blood: prospective, retrospective, and institutional reports.

OBJECTIVES: This study examined nurses risk of exposure to blood resulting from injuries with needles and sharps, the methods of estimating those risks, and the factors affecting risks. METHODS: Nurses on 40 medical units in 20 hospitals in cities with a high incidence of AIDS were studied. Percutaneous injuries were documented for every shift during a 30-day period. These prospective reports were compared with retrospective and institutional reports. Factors affecting the likelihood of injuries were explored. RESULTS: Based on the prospective reports, the rate of injuries to staff nurses was 0.8 per nurse-year. Prospective and retrospective rates were similar, while institutional rates were significantly lower. Factors associated with increased injuries included recapping needles and temporary work assignments. Working in hospitals characterized by professional nurse practice models and taking precautions to avoid blood contact were associated with fewer injuries. CONCLUSIONS: Injuries from needlesticks are more common than institutional reports suggest and do not occur at random. Diminishing the frequency with which nurses recap needles, increasing precautions they take, reducing use of temporary nursing personnel, and implementing organizational changes may lower the odds of nurses being injured.     

Prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers.

OBJECTIVE: To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs).Design. Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000. SETTING: Correctional systems in 3 states. RESULTS: Among 310 participating CHCWs, the rate of percutaneous injury (PI) was 32 PIs per 100 person-years overall and 42 PIs per 100 person-years for CHCWs with clinical job duties. Underreporting was common, with only 25 (49%) of 51 PIs formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older (adjusted odds ratio [aOR], 2.41 [95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95% CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs (72%) reported having received a primary hepatitis B vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis B virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis C virus infection was 2% (n=7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only. CONCLUSION: Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting.     

Evaluation of a preclinical, educational and skills-training program to improve students' use of blood and body fluid precautions: one-year follow-up

BACKGROUND: Little is known about long-term improvements in medical students' knowledge, attitudes, and use of blood and body fluid precautions following preclinical training. METHODS: We evaluated an educational and skills-training program emphasizing double gloving for high-risk surgical procedures. Baseline surveys measuring knowledge, attitudes, and readiness to use specific precautions were completed by second-year (experimental) students before skills training and by third-year students (control) after their first clinical year. Follow-up surveys were completed 1 year later. Use of double gloves and protective eyewear during surgery clerkships was observed at baseline and follow-up. RESULTS: Of 149 students returning both surveys, the experimental group (n = 91) showed improvements in attitudes toward double gloving (P = 0.038) and use of double gloves during surgery at follow-up (relative risk = 1.95, 95% confidence interval = 1.06, 3.59). They expressed better attitudes toward (P = 0.003) and greater readiness to use (P = 0. 020) double gloves compared with controls at follow-up. They expressed better attitudes toward (P = 0.002) and greater readiness to use (P = 0.001) double gloves compared with controls when each had completed their first clinical year. CONCLUSION: The intervention was associated with improved attitudes toward and use of double gloves during surgery. The experimental group also expressed better attitudes and readiness to use double gloves compared with controls at follow-up.     

Usefulness of a rapid human immunodeficiency virus-1 antibody test for the management of occupational exposure to blood and body fluid.

OBJECTIVE: To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms. DESIGN: Before-and-after analysis. SETTING: A 269-bed, tertiary-care medical center with adjacent clinics. PARTICIPANTS: All source-patients and HCWs experiencing an occupational exposure during the study period. METHODS: Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms. RESULTS: After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of dollar 6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P = .049). CONCLUSION: Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HIV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.