西南地区某医院2015—2019年血源性病原体职业暴露特点

目的 分析医务人员血源性病原体职业暴露特点,为制定有针对性的职业防护策略提供依据。方法 回顾性调查西南地区某医院2015-2019年医务人员上报的职业暴露资料,分析职业暴露的原因、类型、暴露源及处置随访等情况。结果 共上报411例次职业暴露。暴露者以护士为主（47.44%）,暴露科室主要为内科系统（39.41%）、外科系统（22.63%）和急诊科（12.41%）。暴露类型主要为锐器伤（78.10%,主要发生在整理诊疗器具/医疗废物、采血时）,皮肤黏膜接触（19.71%）和其他类型（2.19%,主要是抓伤、咬伤所致）。暴露源不明的职业暴露主要分布在急诊（33.38%）、门诊（13.89%）和后勤（8.33%）等科室,主要由于整理诊疗用物/医疗废物（44.44%）、门急诊注射输液（27.78%）、门诊采血（13.89%）等操作引起。血源性病原体暴露源以乙型肝炎病毒、人类免疫缺陷病毒和梅毒螺旋体为主,暴露后预防性用药率为70.67%。结论 预防医务人员职业暴露发生的工作中,应重点关注锐器伤,同时应加大职业防护培训和医疗废物处置管理力度。

Characteristics of occupational exposure to blood-borne pathogens in a hospital in Southwest China from 2015 to 2019

Objective To analyze the characteristics of occupational exposure to blood-borne pathogens among health care workers(HCWs), and provide basis for formulating targeted occupational protection strategies. Methods Data of occupational exposure reported by HCWs in a hospital in Southwest China from 2015 to 2019 were retrospectively investigated, the causes, types, sources, disposal and follow-up of occupational exposure were analyzed. Results A total of 411 cases of occupational exposure were reported. Most of the exposed persons were nurses (47.44%), the main exposure departments were internal medicine system (39.41%), surgical system (22.63%) and emergency department (12.41%). The main type of exposure was sharp injury (78.10%, mainly occurred during handling diagnosis and treatment device/medical waste, collecting blood), contacting with skin and mucosa (19.71%), and others (2.19%, mainly caused by scratch and bite). Occupational exposure with unknown source was mainly distributed in emergency department (33.38%), outpatient department (13.89%) and logistics department (8.33%), which was mainly caused during handling of diagnosis and treatment device/medical waste (44.44%), outpatient and emergency injection and transfusion (27.78%), and outpatient blood collection (13.89%). The main sources of blood-borne pathogens were hepatitis B virus, human immunodeficiency virus (HIV) and Treponema pallidum, 70.67% of exposure were treated with drug prophylaxis. Conclusion In the prevention of occupational exposure, more attention should be paid to sharp injury, and training of occupational protection and management of medical waste disposal should be strengthened.