医务人员职业暴露风险分析与防控对策*

目的：了解医务人员职业暴露的现状及相关危险因素，为制定相应的防护措施和完善监测管理系统，减少职业暴露的发生提供有力的科学依据。方法：对南通大学附属医院2014年1月—2015年12月发生并登记职业暴露的医务人员，根据发生职业暴露的职业类别、暴露地点及类型、暴露发生的原因、暴露源及暴露后的处置情况进行统计分析。结果：医务人员发生职业暴露共191例，发生职业暴露人员的职别：护士、实习生、医师、工勤人员、技师分别占45.03%、25.65%、20.42%、6.28%、2.62%；暴露地点主要在病房(49.74%)，其次为手术室(28.80%)；暴露类型主要为锐器伤(94.76%)，以输液针头、注射针头等空心针为主；暴露原因以操作中意外损伤为主(29.84%)；暴露源以乙型肝炎为主(63.87%)，暴露后67.02%预防使用高效免疫球蛋白。结论：护理人员是职业暴露的高危人群，暴露方式以锐器伤为主。加强医务人员职业安全防护教育与培训，增强自我防护意识，规范操作流程，切实落实标准预防，完善报告流程，加强监管，是减少职业暴露发生的有效措施。

Analysis of risk and countermeasures of prevention in occupational exposure of medical staff*

Objective: To provide evidence for reducing occupational exposure and occupational infection, learn the situation about medical staffs'' occupational exposure and the prevention, and explore effective prevention and intervention. Methods: The occupation, exposure''s reasons, ways, places, treatment efficiency and so on according to registration form filled by medical staff in a basic hospital from Jan 2014 to Dec 2015 was analyzed statistically. Results: According to the medical staff, there were 191 occupational exposure cases. Classification by occupation: the rate of exposure of nurse was 45.03%, medical student was 25.65%, doctor was 20.42%, handymen were 6.28% and technician was 2.62%. Classification by the location, wards was 49.74% and operating room was 28.80%. Classification by the types of exposure: Sharp instrument injury was the most dangerous factor(94.76%). Operative sharp instrument(infusion needle, injection needles and etc) injury was the most common. The main causes for exposure were unexpected injury during a medical procedure(29.84%). The main exposure was Hepatitis B(63.87%). And the main prophylaxis for Post-Exposure was by using immunoglobulin(67.02%). Conclusions: Nursing staff was the high-risk group of people. Sharp instrument injury was the most dangerous factor. It is the crucial to cut down the risk of occupational exposure by enhancing the training of medical staffs, intensifying the professional safety consciousness, specifying the procedure, enforcing standard precautions.