中国医务人员职业暴露与防护工作的调查分析

目的了解医务人员职业暴露与防护工作现状，为制定职业暴露防护措施提供依据。方法采用分层抽样方法于2016年4月6日—5月6日向全国13个省份158所不同级别医院发放调查问卷进行调查，分别调查各所医院开展职业暴露监测首年、2010年及2015年的职业暴露与防护管理及监测情况。结果81.65%（129/158）的医院医务人员职业暴露管理工作由医院感染管理部门负责；98.73%（156/158）的医院制定了相关规章制度；77.22%（122/158）的医院存在医务人员职业暴露漏报现象。共发生职业暴露事件11 116例，调查首年发生1 542例，2010年发生2 474例，2015年发生7 100例。锐器伤在各类职业暴露类型中占96.76%；职业暴露人员职业分布中，护理人员占53.90%；职业暴露人员科室来源主要为普通病房、手术室、重症监护病房等；引起医务人员职业暴露器具主要为注射器、头皮钢针、手术缝针等；静脉注射、针头丢入利器盒、手术缝针等是引起医务人员职业暴露的高危操作；在职业暴露源阳性分布中，以乙型肝炎病毒（HBV）为主，占58.69%。结论我国医务人员面临职业暴露的风险大，危害重，形势严峻，应通过政府立法、推广应用安全器具、规范医务人员操作行为、正确使用个人防护用品、强化医务人员教育与培训、建立健全职业暴露报告、评估和随访机制等措施，以切实减少职业暴露的发生。

Occupational exposure and protection among health care workers in China

ObjectiveTo understand the current situation of occupational exposure and protection among health care workers(HCWs), and provide evidence for formulating preventive measures of occupational exposure. MethodsFrom April 6, 2016 to May 6, 2016, questionnaire surveys were conducted in 158 different levels of hospitals in 13 provinces in China，occupational exposure, protection management, and monitoring of occupational exposure in the first year, 2010, and 2015 was surveyed by cluster random sampling method. ResultsOccupational exposure in 81.65%（129/158）of hospitals was responsible by healthcare associated infection management departments; 98.73%（156/158） of hospitals set up the relevant rules and regulations; 77.22%（122/158） of hospitals had missing report of occupational exposure. A total of 11 116 times of occupational exposure occurred (1 542 cases in the first year, 2 474 in 2010, and 7 100 in 2015). Of various types of occupational exposure, sharp injury accounted for 96.76%; among HCWs sustained occupational exposure, nursing staff accounted for 53.90%; the major department that HCWs who sustained occupational exposure were general wards, operating rooms, and intensive care units; the main medical appliances related to occupational exposure were syringes, scalp needles, and surgical suture needles; high risk behavior causing occupational exposure were intravenous injection, putting needles into the sharp containers, and surgical suturing; among occupational exposure sources, HBV accounted for 58.69%. ConclusionHCWs in China face a high risk of occupational exposure, occurrence of occupational exposure should be reduced through government legislation, application of safety appliances, standardizing behavior of HCWs, proper using of personal protective equipment, strengthening education and training of HCWs, and establishing a sound occupational exposure report, evaluation and follow up system.