医护人员锐器伤调查分析

目的了解锐器伤的发生情况。方法对全院医护人员问卷调查，统计近一年中医护人员锐器伤的发生次数，主要致伤物，损伤的主要环节，不同专业科室年损伤率。结果近一年中锐器伤发生率为86．6％，累计发生次数4～6次最多，占35．77％，主要致伤物是针头，占44．24％，其次是玻璃，占27．49％，用手掰安瓿是最常见的致伤原因，占25．95％，其次是双手回套针帽，占12．75％。麻醉科、检验科、急诊科、妇产科损伤率均为100％，内科和门诊相对较低。结论锐器伤的发生率较高，应加强医护人员职业暴露和标准预防的知识宣教，规范操作流程，减少危险环节，加强损伤性医疗废物的规范化管理，改善医疗环境，增强职业防护设备等措施来减少锐器伤的发生。     

医务人员锐器伤基线调查分析

目的 了解医务人员锐器伤发生原因,并制定有效干预措施,保护医务人员职业健康.方法 于2011年9月采用回顾性调查方法,调查前1个月全院1498名可能接触锐器的医务人员、工勤人员.结果 调查1个月锐器伤的发生率为10.7％,月人均发生0.17次锐器伤,其中护士锐器伤发生次数最多,占74.1％;工作＜1年和1～5年是锐器伤高发期,分别占30.5％和30.9％;普通病房、手术室、补液室是发生锐器伤的高发场所;补液配置、肌内注射、拔动静脉针、回套针帽、抢救、手术操作均是发生锐器伤的危险因素.结论 医务人员是发生锐器伤的高发人群,提高医务人员自身防护意识,规范操作流程,健全锐器伤报告和处置制度,能有效降低医务人员锐器伤的发生.     

医务人员锐器伤职业暴露基线调查与分析

目的 了解医务人员锐器伤职业暴露的真实情况与特点,为完善职业防护措施提供科学依据.方法 对医院内有机会接触锐器的所有医务人员采用浙江省医院感染管理质控中心统一设计的调查问卷,调查2011年5月1-31日锐器伤职业暴露发生情况.结果 调查的1257名医务人员共发生锐器伤128人,锐器伤发生率10.18％,发生182人次,人均0.14次;护士发生最高,有106人次,占58.24％,其次为医师54人次,占29.67％;锐器伤发生地点主要在普通病房和手术室;导致锐器伤的锐器以注射器针头最多见,其次为真空采血针;发生锐器伤危险因素在医疗废物处置中最多,其次为抽血和补液配制;发生锐器损伤后报告医院感染管理科有3例.结论 医院感染管理部门应加强医务人员职业暴露相关知识培训,提高医务人员职业防护意识,针对高危人群、科室、环节等采取切实可行的预防措施,改进职业暴露报告监控系统,提高职业暴露后的上报率,降低职业暴露的发生.     

医护人员职业性伤害原因分析及防范管理对策

目的 了解医护人员职业性暴露和职业性伤害现状,分析原因,提出有效的防范管理对策.方法 整群抽取武汉市某三甲医院医护人员共792人进行问卷调查.结果 各种职业性伤害的发生率以锐器伤(49.61％)最高:各种职业性暴露的发生率以长期接触消毒灭菌剂(70.31％)最高:针刺伤发生人次占锐器伤的70.82％:针刺伤发生的原因以吸药、配药、加药和回套针帽最常见.多因素Logistic回归显示,职业性伤害与工龄、性格特征、工作紧张、经常性不规范操作、防护意识等有关.结论 医院管理层应提高对职业性伤害的重视程度,建立职业性伤害管理制度,加强职业安全教育,规范操作行为,提高防护意识和防护能力,完善防护设施,减少医护人员职业性伤害的发生.     

医护人员医疗锐器损伤情况调查分析

目的了解医护人员在临床工作中发生医疗锐器损伤情况,探讨预防对策. 方法对我市3所三级综合性医院临床一线的医生护士进行抽样问卷调查. 结果共调查179位医生和218位护士,在最近12个月内,有64.80%的医生和79.36%的护士发生过医疗锐器损伤;护士发生锐器损伤率要明显高于医生(χ2 =10.51,P<0.01);179位医生发生锐器损伤191次,平均每人被损伤1.07次,218位护士发生锐器损伤627次,平均每人损伤2.88次;医护人员锐器损伤种类依次为针刺伤54.16%、玻璃割伤33.25%、刀割伤6.36%、其他伤6.23%;医生、护士发生医疗锐器损伤率与其所进行的相关操作有关,医生以缝合、换药操作损伤率高于护士,护士以套针帽、采血、丢针头、收废物操作损伤率高于医生(χ2 =165.38,P<0.005);内、外、妇、儿科医生医疗锐器损伤率比较差异有显著性,外科、妇产科医生发生医疗锐器损伤率分别为73.91%和75.0%,要高于内科、儿科医生53.52%和54.55%的损伤率(χ2=8.26,P<0.05);内、外、妇、儿、门诊护士锐器损伤率分别为77.27%、83.33%、77.27%、81.82%、75.0%,其中外科、儿科护士损伤率略高于总体水平,但无显著意义(χ2=1.24,P>0.05). 结论医护人员锐器损伤较普遍,应提高医护人员安全防范意识,熟练规范操作,增加必要的设备,避免或尽量减少医疗锐器损伤.     

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。     

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.     

天津市黄河医院清洁工职业危害及防护意识

目的 了解医院清洁工职业防护知识的知晓情况及对职业危害产生因素进行调查,为降低医院清洁工职业危害、提高个人防护意识、预防医院感染的发生提供科学依据.方法 采用自行设计的问卷,对33名清洁工进行调查,现场发放问卷并收回.对采集的数据进行统计分析.结果 调查的33人中参加岗前培训的29人(88％),未参加过培训的4人(12％);调查显示清洁工中对含氯消毒剂的常用浓度及监测方法只有9％的人熟知;锐器损伤后的处理方法仅有21％的人知晓;六步洗手法的标准操作仅有12％的人熟练掌握;仅有27％的人每年进行常规健康检查;半年中23人发生锐器损伤(70％),未发生10人(30％);锐器损伤共发生48人次,人均受伤1.45次,受伤次数最多的1人发生5次;初中以下文化程度的17人中15人发生锐器伤(88％);初中毕业及以上文化程度的16人中8人发生锐器伤(50％);发生锐器伤的均为女性,占女性人数的79.31％;发生锐器伤者平均工龄3a,未发生者平均工龄8a.结论 目前医院不能做到对全体清洁工进行岗前培训,清洁工的个人卫生防护知识缺乏,清洁工锐器损伤发生率较高,医院清洁工是高风险职业.建议医疗管理部门应重视清洁工的医疗知识培训,强化其职业防护意识,降低职业暴露,预防院内感染的发生.     

口腔医护人员职业暴露与防护措施调查分析及对策

目的 了解口腔医护人员职业暴露与防护措施执行情况,探讨预防对策,为建立职业安全管理模式提供依据.方法 对石家庄市1所口腔专科医院及6所综合医院口腔科的临床医护人员进行问卷调查.结果 共调查医师149名、护士137名,1年内医师与护士皮肤锐器伤发生率分别为87.92％与85.40％,医师与护士黏膜暴露发生率分别为85.23％与68.61％;医师锐器伤种类占前3位的是注射器针头、钻针、扩大针和锉,分别占18.94％、16.71％、16.16％,护士锐器伤种类占前3位的是注射器针头、扩大针和锉、探针,分别占22.52％、13.74％、12.21％;乙型肝炎疫苗平均注射率为92.72％,注射后确定抗体阳性的占50.00％;临床上正确的防护措施执行率较低.结论 口腔医护人员职业暴露的发生率较高,职业防护知识缺乏,防护措施执行不到位,应加强职业安全教育,提高防护意识,规范操作技术,建立职业安全管理机制,减少职业暴露的发生.     

手术人员锐器损伤调查与对策

目的 了解手术医护人员锐器损伤现状,并探讨相关防护措施.方法 采用问卷调查对4所综合性医院手术人员锐器损伤进行调查.结果 共调查197人,其中医师115人、护士38人、护生44人;1年内医师、护士、护生锐器损伤发生率,分别为46.06％、78.95％、90.91％,护士、护生发生锐器损伤发生率明显高于医师(x2=32.73,P＜0.001);工龄＜1年的锐器损伤发生率为91.94％、1～5年为73.58％、＞5年为32.93％,工龄短者锐器损伤发生率明显高于工龄长者(x2 =56.26,P＜0.001);中专学历锐器伤发生率为70.00％、大专为79.41％、本科为52.10％,大、中专学历锐器损伤高于本科学历医护人员(x2=14.66,P＜0.005);初级职称锐器操作发生率86.96％、中级为34.69％、高级为18.18％,职称低者锐器损伤发生率明显高于职称高的医护人员(x2=102.20,P＜0.001).结论 手术医护人员是锐器损伤的高危人群,也是需要加强防范的重要人群,加强职业教育,规范操作可以预防和降低锐器损伤的发生.     

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.     

A review of sharps injuries and preventative strategies

Exposure to bloodborne pathogens from sharps injuries continues to pose a significant risk to healthcare workers (HCW). The number of sharps injuries sustained by HCW is still unclear, primarily due to under-reporting. In this review a mean rate of 4.0% (range 1.0-6.2%) sharps injuries per 10000 HCW was calculated from eight studies involving more than 7000 HCW. Nurses and doctors were most at risk of sharps injuries, frequently from hollow-bore needles. Approaches to reduce this risk have included education and training on the safe handling and disposal of sharp devices, awareness campaigns and legislative action. More recently, preventative strategies have focused on needle protective devices, which may reduce the rate of sharps injuries. Introducing needle protective devices should be considered particularly in high-risk areas, after training, education, evaluation and cost-benefit analysis.     

临床护士锐器伤调查与预防

目的探讨护士预防锐器伤的对策。方法对某所综合性医院193名护士在2004年1月~2005年6月发生的锐器伤进行问卷调查。结果46.1%护士发生锐器伤,人均1.6次;发生锐器伤的锐器主要是注射器针头(36.7%),其次是玻璃(32.4%);护士主要在掰安瓿(29.5%)、使用后处理锐器(22.3%)、安装调整针头(15.8%)、医护配合传递锐器(10.1%)等环节容易发生锐器伤;有79.1%护士发生锐器伤时未戴手套。结论护士面临锐器伤职业危险,各方应当采取对策,预防和控制锐器伤。     

379名护士针刺伤原因分析及对策

目的分析临床护士针刺伤的原因，探讨防护措施。方法对426名护士进行回顾性问卷调查。结果其中379名发生过针刺伤，发生率为88．97％；人均被刺伤4．75次／年、刺伤≥10次者占总人数的6．10%，刺伤最多1人1年被刺伤29次；针刺伤的主要原因有拔针、加药、回套针帽、分离针头等。结论护士针刺伤发生率很高，而防护意识淡漠，故应加强全面性防护概念的教育，预防针刺伤，减少经血液传播疾病的发生。     

Fatigue increases the risk of injury from sharp devices in medical trainees: results from a case-crossover study.

BACKGROUND: Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers. DESIGN: Case-crossover study. SETTING: Five academic medical centers in the United States and Canada. PARTICIPANTS: Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue. RESULTS: Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P<.001) and slept less the night before an injury (P<.001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P=.001).Conclusions. Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.     

广东省39所医院医务人员锐器伤调查

目的了解广东省医务人员血源性职业暴露的发生情况,为制定预防措施提供科学的依据。方法采用问卷调查方法,对广东省39所医院医务人员2011年6月锐器伤的发生情况进行横断面调查。结果发放调查表32 617份,回收32 297份,回收率为99.02%;实际有效问卷32 007份,有效率为99.10%。发生锐器伤1 460例,1 909例次,锐器伤发生率为4.56%,例次率为5.96%,平均月发生密度为0.06次/（人月）。发生污染锐器伤1 495例次,污染锐器伤例次发生率为4.67%（1 495/32 007）;污染锐器伤占锐器伤总例次的78.31%（1 495/1 909）,其中61.67%(922/1 495)能追踪到暴露源,38.33%（573/1 495）不能确定其是否具有传染性。血源性污染器械中,81.71%（67/82）为乙型肝炎暴露源,14.63%（12/82）为梅毒暴露源,3.66%（3/82）为丙型肝炎暴露源,无艾滋病暴露源。锐器伤发生的地点主要为普通病房（47.72%）与手术室(20.27%);频率最高的操作是加药(15.92%),其次为医疗废物处置(12.78%)和拔除动（静）脉针（12.21%）;主要医疗器具为一次性注射器 (35.99%)、头皮钢针 (19.43%)和手术缝针(13.41%)。医务人员职业暴露相关知识培训率为93.25%。结论锐器伤是导致血源性传播疾病感染的主要职业因素, 医疗机构应建立健全职业病防治组织机构和规章制度,规范医务人员的血源性职业暴露预防与控制行为,降低血源性职业暴露伤害风险。     

Needle-stick injuries in the National Health Service: a culture of silence

Injury by contaminated sharp instruments and needles constitutes a major occupational hazard for healthcare workers. In a confidential survey at a district general hospital, 300 healthcare professionals were asked about their personal experience of needle-stick injury and their attitudes to reporting. 279 individuals responded, of whom 38% had experienced at least one needle-stick (mean 1.8) in the past year and 74% had sustained such an injury during their careers (mean 3.0). Although 80% of respondents were aware that such incidents should be notified, only 51% of those affected had reported all needle-stick injuries. Doctors were less likely to report than nurses, despite a higher liability to injury. This survey adds to evidence of a culture of silence pertaining to needle-stick injuries. The consequent risks to health, and the ethical and financial implications, remain uncertain.     

卫生保健工作者安全注射的知识、态度和实践的快速评诂

目的　收集卫生机构卫生保健工作者中关于注射的知识、态度和实践方面的定性和半定量信息 ,估计各种注射者实施的对患者、提供者和社区无害的注射的百分比。方法　采用SIGN提供的标准化工具对卫生保健工作者进行访谈。采用直接观察法 ,标准化问卷和焦点组访谈在处方者、注射者和处理医疗废弃物的后勤人员中收集定性和半定量信息。结果　每个处方者平均每周要接待 87 9名患者 ,其中 35 2 %会开出注射处方。在调查的 935份有效处方中 ,4 7 8%至少包括 1次注射。访问的 10 0名护士中 ,平均每人每周要实施 90 9次注射 ,其中 12 1%的注射是用于免疫的。在这 10 0名护士中 ,有 75 %报告在过去 1年中受到过尖锐物刺伤。每名护士平均每天要给 32名患者分配药物 ,其中 73 4 %的患者会接受注射。结论　即使在目前对AIDS的认识不断提高的情况下 ,注射在上海的使用程度仍然很高 ;一些因素提示卫生保健者对过度使用注射起到了一些作用 ;虽然在上海已经建立了一套有效的注射提供、管理、监督和废弃物处理体系 ,但是在注射者和医疗废弃物处理人员中仍时常发生尖锐物刺伤 ;一次性注射器和针头已经完全被医疗人员和患者所接受     

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。     

Sharps disposal containers

Sharps disposal containers are specially designed containers into which used needles and other medical-waste sharps are discarded. They are intended to protect hospital employees--including sharps users and other workers downstream--from sharps injuries that result from contact with needles and other sharp devices. Since our last Evaluation of sharps containers in August-September 1993, manufacturers have introduced various new designs that may further reduce the risk of needlesticks and other sharp-object injuries (SOIs). These designs are intended to prevent users from overfilling the sharps container; they are also easier to use and better constructed. In this study, we evaluated eight models of sharps containers from four suppliers. None of the evaluated devices meet all our criteria; they all have disadvantages that could result in a needlestick. However, the devices that we rate Preferred or Acceptable meet our basic requirements for preventing SOIs and perform satisfactorily against most of our criteria. The eight evaluated models run the gamut: one is Preferred, four are Acceptable, two are Not Recommended, and one is Unacceptable.