北京市三级甲等医院急诊科护士职业暴露与防护行为的现状调查

目的 了解北京市三级甲等医院急诊科护士锐器伤、血液暴露及工作场所暴力3种职业暴露的发生状况及防护行为现状。方法 便利抽取21所北京市三级甲等医院,依据每所医院急诊科排班整群抽取1组护士作为调查对象,采用自制问卷进行调查,问卷内容包括一般资料及锐器伤、采血过程中血液暴露、工作场所暴力的发生现状及防护行为,调查对象匿名填写问卷。结果 共收集问卷1 150份,有效问卷1 102份,有效回收率为95.83%。在过去1年中,急诊科护士至少经历过1次锐器伤、采血中的血液暴露、语言暴力、身体暴力及性骚扰的发生率分别为37.8%、36.4%、68%、12%和5.3%;急诊科不同的工作区域,锐器伤（χ ²=16.805,P=0.010）、语言暴力（χ ²=98.509,P<0.001）、身体暴力（χ ²=79.916,P<0.001）发生率不同。在发生职业暴露的护士中,92.8%的护士在发生锐器伤后能够挤血,同时用流动水冲洗并消毒;69.8%的护士在采血过程发生血液暴露后能够冲洗暴露部位并消毒;在工作场所暴力发生时,41.3%的护士耐心解释,30.0%的护士忍让回避。3种职业暴露的上报率均较低（<30%）。结论 急诊科职业暴露发生率相对较高,管理者需要重视急诊科的工作环境建设,加强采血过程和工作场所暴力的职业防护培训,同时增强对3种职业暴露的上报管理。

Investigation on occupational exposure and protective behaviors of nurses at emergency departments in tertiary hospitals in Beijing

Objective To understand the occurrence and protection status of three occupational exposures：needle-stick injury by nurses,blood exposure and workplace violence in the emergency department in tertiary hospitals in Beijing. Methods According to the schedule of the emergency department of each hospital,one group of nurses were selected from each hospital in 21 tertiary hospitals in Beijing to participate in the online survey. Self-designed online questionnaires were distributed and completed anonymously,including general information,the occurrence status and protective behaviors of needle-stick injury by nurses,blood exposure and workplace violence. Results A total of 1,150 questionnaires were collected,of which 1,102 were valid,with an effective rate of 95.83%. In the past year,the incidence rates of at least one needle-stick injury by emergency department nurses,blood exposure during blood collection,verbal violence,physical violence and sexual harassment were 37.8%,36.4%,68%,12%,and 5.3%,respectively. In different working areas at emergency department,the occurrence of needle-stick injury（χ ²=16.805,P=0.01）,verbal violence（χ ²=98.509,P<0.001） and physical violence（χ ²=79.916,P<0.001） were different. Among nurses with occupational exposure,92.8% were able to squeeze blood after needle-stick injury,flush with flowing water and disinfect;69.8% were able to flush and disinfect exposed parts after blood exposure in the process of blood drawing. Among nurses encountering workplace violence,41.3% explained patiently,and 30.0% adopted tolerance and avoidance. In addition,the reporting rate of all three types of occupational exposure was low（less than 30%）. Conclusion The incidence of occupational exposure in emergency department is relatively high. Nursing managers should attach importance to the construction of the work environment in emergency department,strengthen the training of pre-exposure protection in blood collection process and workplace violence,and strengthen the reporting and management of the three types of occupational exposure.