In-hospital contact investigation among health care workers after exposure to pulmonary tuberculosis in an intermediate tuberculosis prevalence area: A prospective study

We carried out in-hospital contact investigations of patients with pulmonary tuberculosis and analyzed the prevalence of latent tuberculosis infection (LTBI) among health care workers (HCWs) after TB exposure. A prospective study was conducted of 872 HCWs who were exposed to 55 index cases diagnosed with active pulmonary TB. HCWs after TB exposure were evaluated both TST and chest X-ray at the time of enrollment and 12 weeks after exposure; 625 HCWs (71.6%) underwent both initial assessments; 41 HCWs (6.6%) had a positive TST result. After 12 weeks, 71.1% of HCWs with initial negative TST (n = 415) underwent a second assessment. Ten HCWs had TST conversion. One HCW (0.2%) developed active pulmonary TB. In multivariable analysis, age over 30 years was associated with TST conversion (p = .02). Point prevalence of latent TB was 6.6%, and incidence of LTBI was estimated as 2.4 per 100 HCWs. Strict infection control measures should be emphasized in intermediate TB-burden, BCG-vaccinated countries, especially in HCWs with high risk for TB exposure.     

医务人员血源性病原体职业暴露调查

目的了解医务人员发生血源性病原体职业暴露的特点和危险因素,探讨防治对策。方法采用回顾性调查方法,运用《医务人员血源性职业暴露登记表》对某院2013年1月1日—2015年12月31日发生的血源性病原体职业暴露事件进行调查分析。结果共发生血液/体液职业暴露246例。职业暴露人群以在职护士为主(95例,占38.62%);职业暴露发生地点主要为病房(148例,60.16%);职业暴露方式以锐器伤为主(219例,占89.02%);医务人员发生职业暴露时的操作环节主要为手术意外(69例,占28.05%);暴露源主要为乙型肝炎病毒(HBV),共123例(占50.00%);暴露医务人员经局部处理和预防用药后,无1例发生感染。结论医疗机构应加强医务人员血源性病原体职业暴露相关培训,提高防护意识,规范操作行为,改善工作环境,最大限度地减少职业暴露的发生。     

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。     

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。     

一起医务人员聚集性肺炎查因病例的调查分析

目的查明一起医务人员院内感染不明原因肺炎的病因,评估控制措施效果。方法对聚集性肺炎查因病例及相关人群、相关场所进行流行病学调查和病原学检测。结果2004年9月10~16日深圳市罗湖区某医院共发生8例肺炎临床诊断病例和5例医学观察病例。8例临床诊断病例中,医生5例,护士3例。病原学检测(PCR)结果显示,病例衣原体阳性率达90%(9/10)。实施隔离与消毒防护等措施后疫情终止。结论该起聚集性肺炎可能为肺炎衣原体感染。隔离治疗、个人防护、消毒等是遏制疫情的有效措施。     

Facilitator report: Bloodborne pathogens exposure among health care workers

Several psychosocial and organizational factors have been identified as important correlates of compliance with safe work practices among health care workers. In particular, compliance with “universal precautions”—a set of work practices which were designed to minimize exposure to bloodborne pathogens—has been found to be associated with several potentially modifiable factors. The development of interventional strategies designed specifically to target these factors (e.g., HIV/AIDS attitudes, safety climate) are important objectives in the overall risk management approach to occupational exposure to bloodborne pathogens. © 1996 Wiley-Liss, Inc.     

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。     

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。     

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。     

医务人员血源性职业暴露的监测分析

目的探讨医务人员血源性职业暴露状况,为制定科学有效的管理、预防控制和监测处理办法提供依据。方法对某医院2015年1月-2017年1月发生职业暴露的87名医务人员的监测数据进行统计分析。结果发生血源性职业暴露的科室:手术系列科室最多,占62.07%,职业暴露人员中护士发生率最高为67.82%,医师为32.18%;职业暴露源前三位分别为乙型肝炎、梅毒、不明暴露源,分别占33.33%、28.74%和21.84%;发生职业暴露的方式主要是锐器伤;损伤锐器类型中针刺伤为主;锐器伤操作环节以操作完成后处理锐器发生率最高为31.03%,其次是输液拔针和回套针帽,分别占25.29%和16.09%;经过规范的处理和预防用药,随访6月(HIV随访1年)无医务人员因职业暴露发生血源性病原体感染。结论加强防护知识的培训是减少职业暴露最根本的途径,规范操作是避免失误发生的基本要求,标准预防是防止职业暴露的最佳方法,必要的防护用品配备是减少职业暴露发生的物质保证,采用安全注射系统切断了职业暴露发生的必要环节,完善报告流程是职业暴露后及时处理的重要保证,保护暴露者隐私和必要的心理疏导是帮助暴露者减轻精神压力和提高处置依从性的关键。     

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。     

医务人员职业暴露现状调查及对策

目的了解医务人员职业暴露现状和特点,为制定预防对策提供依据。方法自行设计职业暴露问卷调查表,调查2015年1—12月全院医务人员职业暴露情况,并进行统计分析。结果调查1 888名工作人员,发生职业暴露共304例,全院平均职业暴露发生率为16.10%;发生职业暴露370例次,职业暴露例次率为19.60%。医生、进修实习人员和工作年限≤1年的工作人员职业暴露相对较高,分别为23.18%(102/440)、17.88%(49/274)、18.34%(95/518)。锐器伤为主要的职业暴露方式,占83.24%(308例),发生环节以器械使用后处理前、器械使用中为主,分别占37.99%(117例)和36.69%(113例)。370例次职业暴露中,可追溯到暴露源的有315例次。已知暴露源中,血源性病原体职业暴露占24.13%(76例次)。370例次职业暴露中,仅59例次实施了完整的局部处理和上报程序,职业暴露上报率为15.95%。结论该院应采取综合措施最大程度地促进职业安全防护,降低职业暴露发生率。     

结核病专科医院医务人员结核感染风险研究

目的 探讨结核病专科医院医务人员职业暴露危险因素,以采取有效地预防控制措施降低结核感染风险.方法 采用整群抽样的方法,进行问卷调查,采集基本信息,对受试人群进行结核菌素试验(PPD)和T细胞斑点试验(T-SPOT.TB)检测.结果 共有符合条件的497人纳入本研究,98.59％认为自己在工作中有机会接触结核病患者,81.89％工作时佩戴口罩,82.70％接种过卡介苗;受试者中,PPD试验阳性率为66.60％,T-SPOT.TB试验阳性率较低,为10.87％,两种试验结果在医院内不同职业人群间差异无统计学意义,PPD试验阳性率与工作年限有相关性(x2=11.1936,P=0.0107),而T-SPOT.TB试验结果与工作年限无明显相关.结论 加强全体医务人员,特别是行政管理人员和新上岗医务人员的个人防护和健康教育有重要意义.     

医疗卫生机构医务人员结核病感染控制现状

目的分析我国医务人员结核感染和患病情况以及相应的危险因素,为加强医疗卫生机构医务人员的结核病感染预防控制工作提供理论依据。方法采取系统综述的方法,对1995-2010年关于医疗卫生机构中医务人员结核感染和患病情况及其影响因素的相关文献资料进行综合分析。结果我国关于医务人员结核感染预防控制方面的研究很欠缺。文献资料显示,我国医务人员的结核感染率明显高于普通人群,其PPD阳性率达60.4%～62.8%;医务人员的结核病患病率也比一般人群高,达6.7/1 000人年。对医务人员感染结核的危险因素分析显示,其结核感染和患病风险主要与在工作场所暴露和感染预防控制措施不足等有关。结论医务人员的结核感染控制工作十分薄弱,相关研究不足,目前已成为我国结核病控制面临的重要问题。     

某院医务人员血源性职业暴露的流行病学研究

目的掌握某院医务人员血源性职业暴露的流行病学特征。方法采用随机偶遇的方法对该院374名临床医务人员进行回顾性问卷调查。结果医务人员职业暴露后处理内容和处理流程正确率分别为54.81%（205/374）、89.84%（336/374）。 共发生血源性职业暴露174例、533例次,暴露率为46.52%(174/374)。不同科室、岗位医务人员职业暴露率比较,差异有统计学意义(P＜0.05);外科、儿科和内科的医务人员暴露率较高,分别为64.46%（78/121）、60.00%（18/30）和40.00%（50/125）;护士和医生暴露率较高,分别为51.52%（102/198）、47.27%（52/110）。医务人员血源性暴露时间主要集中在上午和晚上,穿刺、采血或处理物品为主要的暴露环节,暴露地点主要是病房和手术或换药室。结论该院医务人员血源性职业暴露率较高,应加强医院高危科室、人员和操作的血源性职业暴露防控措施的落实。     

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.     

The effect of work practices on personal exposure to glutaraldehyde among health care workers

Glutaraldehyde is a potential sensitizer and has been implicated in the literature as a cause of respiratory irritation and asthma among health care workers. In order to evaluate the effect of work practices and general ventilation system on employees' peak exposure to glutaraldehyde, 42 breathing zone personal air samples were taken in five hospitals. In addition, work practices were observed and recorded during the course of sampling and were classified into three categories. Presence of local or general ventilation system, air change per hour, and quantity of glutaraldehyde used were also recorded. Geometric mean concentration of all samples was 0.025 ppm (GSD=3.05). Statistical analysis indicated that work practice was the most important factor affecting the level of exposure to glutaraldehyde. In locations where "poor" or "unsafe" work practices were employed, the geometric mean concentrations were much higher (GM=0.05, GSD=2.11 and GM 0.08, GSD=1.52, respectively). The result has indicated higher prevalence of headache and itchy eyes among employees who worked where unsafe work practices were observed. Employing proper work practices can significantly reduce exposure to glutaraldehyde among health care workers. It has been recently proposed that the current occupational exposure limit of 0.2 ppm shall be reduced to either 0.1 or 0.05 ppm in the province of Québec (Canada). In this case, it is likely that concentration levels higher than these levels be experienced in some workplaces. Therefore, it is imperative that employers initiate necessary corrective action immediately.     

Accidental exposure to HIV infection by health care workers

The health care worker's exposure to HIV presents a cascade of real and potential problems. Medical, psychological, employment, and legal problems present ongoing challenges, often in uncharted territory. The references listed below provide additional information to help in both individual cases and in prospectively setting up programs and action plans for hospitals and offices.     

Preventing tuberculosis among health workers in Malawi

OBJECTIVE: Following the introduction of guidelines for the control of tuberculosis (TB) infection in all hospitals in Malawi, a study was carried out to determine whether the guidelines were being implemented, the time between admission to hospital and the diagnosis of pulmonary TB had been reduced, and the annual case notification rates among health workers had fallen and were comparable to those of primary-school teachers. METHODS: The study involved 40 district and mission hospitals. Staff and patients were interviewed in order to determine whether the guidelines had been adopted. In four hospitals the diagnostic process in patients with smear-positive pulmonary TB was evaluated before and after the introduction of the guidelines, with the aid of case notes and TB registers. In all hospitals the proportion of health workers registered with TB before and after the guidelines were introduced, in 1996 and 1999, respectively, was determined by conducting interviews and consulting staff lists and TB registers. A similar method was used to determine the proportion of primary-school teachers who were registered with TB in 1999. FINDINGS: The guidelines were not uniformly implemented. Only one hospital introduced voluntary counselling and testing for its staff. Most hospitals stated that they used rapid systems to diagnose pulmonary TB. However, there was no significant change in the interval between admission and diagnosis or between admission and treatment of patients with smear-positive pulmonary TB. The TB case notification rate for 2979 health workers in 1999 was 3.2%; this did not differ significantly from the value of 3.7% for 2697 health workers in 1996 but was significantly higher than that of 1.8% for 4367 primary-school teachers in 1999. CONCLUSION: The introduction of guidelines for the control of TB infection is an important intervention for reducing nosocomial transmission of the disease, but rigorous monitoring and follow-up are needed in order to ensure that they are implemented.