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。     

The epidemiology and surveillance of blood lead in Taiwan (R.O.C.): A report on the PRESS-BLL project

 To monitor the lead hazards in industries and to investigate the prevalence of elevated blood lead levels (BLLs) in lead-exposed workers, a lead surveillance system (PRESS-BLLs) has been established and operated in Taiwan, Republic of China, since July 1993. A cohort of lead-exposed workers who received a periodic annual health examination at 55 accredited hospital laboratories was constructed. A total of 9807 separate BLL measurements were reported to the system in 1994. The mean BLL was 15.8 μg/dl in male workers and 11.6 μg/dl in female workers. The mean BLL of lead-exposed workers was significantly (P<0.05, z-test) higher than that of the general Taiwanese population (8.6 μg/dl for males and 6.7 μg/dl for females). In addition, the BLLs of 983 (10.0%) workers exceeded the regulatory action level (40 μg/dl for males; 30 μg/dl for females). The workplaces and homes of 57% of the workers with elevated BLLs were thoroughly investigated to determine the sources of lead contamination. These actions identified the causes of elevated BLLs and set up strategies to reduce workers’ lead exposure. The establishment of this occupational lead surveillance system represents a method for monitoring of lead hazards from occupational and environmental settings to prevent lead poisoning. The information acquired from the system can help in the setting up of a priority of prevention and the development of control measures. It is also useful for further monitoring of changes in the BLLs of the lead-exposed-worker cohort. The Health Department of Taiwan can use this information to evaluate the effectiveness of current industrial hygiene practice. Subjects with elevated BLLs have been medically treated and placed on long-term follow-up for sequelae. Received: 2 September 1996/Accepted: 29 November 1996     

Thioether excretion of workers exposed to bitumen fumes

Summary The excretion of thioethers was determined in the urine of workers involved in road paving operations and in the preparation of asphalt mixing in an asphalt plant. An occupationally nonexposed group served as control. From the results it was observed that there was no significant difference in urinary thioether levels between the exposed and nonexposed groups, however, smokers of both exposed groups had significantly higher urinary thioether levels than the nonexposed smoking workers. These results suggested that higher urinary thioether excretion could be only due to a difference in smoking behaviour. There were also significant differences in urinary thioether levels between the exposed smoking and nonsmoking workers. The authors suggest that these workers have a low mutagenic/carcinogenic risk and smoking is responsible for the majority of thioether excretion, as has been found by other investigators.     

护理人员的职业损伤因素及健康维护

作者指出临床一线的护理人员是发生职业损伤的高危群体。产生职业损伤的危险因素包括基础教育和继续教育缺乏职业损伤及其防范知识；影响护理人员身体健康的诸因素，如化疗专用的溶药设备、洁净操作台或相对密闭的溶药环境不健全；乙型肝炎等医院内易感性等疾病增加，被血液、体液等污染的医疗锐器刺伤是护理人员职业感染的主要途径；护理人员工作职业特点对健康不利的影响，护理人员心理压力大。为维护护理人员身心健康，应加入医院感染、职业损伤和健康维护的在校理论教育内容，加强护理人员职业安全教育，采取防范职业损伤的措施，如化疗药物中心配药、使用一次性手套等措施。     

日晒海盐工人机体内高镁反应

报道福建某盐场从事日晒海盐生产人工机体内高镁对心血管系统的影响，通过现场空气、饮水、主良的镁含量测定，并对进入机体途径进行分析，得出空气、卤水接触、饮水为机体镁增高的主要来源。不同对象头发镁含量测定结果显示，以接触卤水、劳动强度大的盐工最高，并随机体内镁含量增高，出现血压偏低、心率减慢、心电图Ｐ－Ｒ间期延长、ＱＲＳ波增宽、Ｔ波高尖等机体高镁反应，与临床高镁血症相似。     

某钢铁厂工艺改进前后金属酸洗岗位职业危害的对比

目的了解工艺改进后金属酸洗岗位职业危害因素及浓度降低效果，控制岗位人员职业危害因素接受量，预防职业病的发生。方法通过对某钢铁厂金属酸洗车间工艺改进前后酸洗和天车操作两个岗位职业危害因素监测结果进行对比、分析，确定工艺改进对控制岗位职业危害的效果。结果天车操作室：硫酸雾合格率由60．2％上升到88．9％，盐酸雾合格率由63.0％提高到100％；酸洗操作岗位：硫酸雾合格率由37．0％上升到87．9％，盐酸雾合格率由49．0％提高到99．1％。经统计学分析，工艺改进前与工艺改进后硫酸雾、盐酸雾总体合格率差异均有显著性（P〈0．05），说明工艺改进后主要岗位职业危害因素减低的合格率均有较大提升。结论工艺改进对控制酸洗岗位职业危害效果明显。     

护理人员工作中被针刺伤调查及对策

目的：了解护理人员被针刺伤的情况，为采取职业防护措施提供科学依据。方法：采用问卷调查法调查护理人员被针头伤的有关情况。结果：不同职称护理人员被针刺伤的情况存在差异高度显著性，P＜0．01；不同科室护理人员被针刺伤的操作环节比较均存在差异高度显著性，P＜0．01，绝大多数护理人员对针刺伤后的处理不规范。结论：护理人员应主动增强职业防护意识，加强职业防护管理；改进废弃的一次性医疗用品管理方法和尽快采用防刺性护理用具。     

某电厂25 MW煤气发电工程职业病危害因素水平调查

目的 了解该项目主要职业病危害因素的种类、分布以及浓度和强度，提出防护措施，以达到减少职业病危害因素对人体健康的影响。方法 通过职业卫生学调查和现场测试对该项目职业病危害控制效果进行评价。结果 噪声、粉尘、一氧化碳、二氧化碳及二氧化硫化学毒物合格率为100％。结论 该建设项目生产工艺与设备先进，自动化程度较高，职业卫生防护设施基本齐全，防毒、防噪和防高温效果好，是优质环保工程。     

How to confirm occupational asthma

A methodological overview is provided on the important question of how to confirm occupational asthma in routine work. Recent knowledge gained in immunology and occupational allergy has been utilized, supplemented by an overview of recent publications on the diagnosis and pathophysiology of occupational asthma. The aim of the paper is to facilitate decision making for an investigator dealing with individual cases of occupational asthma. Moreover, by presenting stepping-stones in the diagnostic cascade, the author hopes to encourage the less experienced to conduct a comprehensive and cause-oriented diagnostic procedure. Methods which are being worked on at present (standardization) are discussed in more detail. Finally, the research goals in the understanding, confirmation, and prevention of occupational asthma are listed.     

Mortality study of asbestos cement workers

The present study describes cause-specific mortality of asbestos cement workers in the Emilia Romagna region of Italy. The cohort included workers in ten factories, most of which started operating between 1955 and 1965. Asbestos, mainly chrysotile, constituted 10%–20% of the dry component of the mixture. Crocidolite range between 5% and 50% of total asbestos. Asbestos concentrations up to 44 ff/cc were reported prior to 1975, while in recent years they have usually been below 0–1 ff/cc. The cohort included 3341 workers who had at some time been employed in the ten factories under study. Their mortality experience was compared with that of the population resident in Emilia Romagna. Vital status was ascertained at 1989. Seventy-three subjects were lost to followup (2.2%). Mortality from all causes and from all types of cancer was increased in the cohort. Malignant neoplasms of the respiratory tract showed a significant increase (SMR: 134; 90% confidence interval: 101–175; 40 observed) due to lung cancer (SMR: 124; 90% confidence interval: 91–166; 33 observed) and neoplasms of the pleura, mediastinum, and other parts of the respiratory tract (SMR: 602; 90% confidence interval 237–1267; 5 observed). The discrepancy between observed and expected mortality mainly concerned subjects with at least 20 years of employment in the factories. Five more cases of histologically confirmed mesothelioma occurred after the end of follow-up.