目的 分析医院职业暴露工作人员特征、发生职业暴露环节、类型及处理方式,为医院制订干预措施提供理论基础。方法 回顾性分析玉溪市人民医院2018—2023年共301例发生职业暴露工作人员资料, 包括职业暴露时间、性别、年龄、科室、岗位类型、在院工作时间、职位、职业暴露发生环节、职业暴露类型、暴露源、职业暴露后是否需要用药等处置信息。结果 301例职业暴露工作人员平均年龄为（28.81±10.92）岁, 女性占比84.7%（255例）; 57.8%（174例）职业暴露发生在检查/穿刺/注射/采血/置管/治疗/手术等操作中, 38.9%（117例）发生在医疗废物处置环节;87.7%（264例）的暴露类型为针刺伤;45.5%（137例）接触暴露源为有血源性传播疾病的患者。发生职业暴露工作人员中, 不同岗位职业暴露者的暴露类型、职位、科室、是否需要药物干预及接触暴露源情况比较差异有统计学意义（P<0.05）。结论 应加强医务工作者职业暴露相关知识及应急处置培训, 对不同工龄、岗位医务工作者制定针对性培训方案, 加强医疗废物处置流程及临床操作技能规范等知识培训,预防医务工作者职业暴露的发生。
Objective To analyze the characteristics,occupational exposure links, types, and treatment methods of occupational exposure among healthcare staff hospital, providing a theoretical basis for the development of related intervention strategies for hospitals．Methods A retrospective study was conducted to explore 301 cases of occupational exposure among healthcare staff in The People’s Hospital of Yuxi City from 2018 to 2023．Data of 301 cases were collected, including information on gender, age,department,personnel category, length of service in the hospital, job title, and the circumstances of occupational exposures, which covered exposure links, type, source, and post-exposure medication treatment measures．Results Among the 301 healthcare staff experiencing occupational exposure, the average age was（28.81±10.92）years, with 84.7%（255 cases）being female．Occupational exposure most frequently occurred during procedures such as examination, puncture, injection, blood collection, catheterization, treatment, and surgery（57.8%,174 cases）, followed by the disposal of medical waste（38.9%, 117 cases）．The primary type of exposure was needle-stick injury（87.7%）．Contact with patients suffering from blood-borne infectious diseases accounted for 45.5%（137 cases）of the occupational exposure incidents．There were significant differences in exposure types, job positions, departments, sources of exposure, and post-exposure medication treatment measures among healthcare staff of different categories（P<0.05）．Conclusions To prevent the occurrence of occupational exposure among healthcare staff, it is necessary to enhance training on occupational exposure knowledge and emergency management, particularly improving the disposal of medical waste and clinical operational skills．Additionally, it is crucial to have personalized training programs tailored to healthcare staff based on their varying lengths of service and positions．
目的 观察失效模式与效应分析(FMEA)在医务人员血源性职业暴露监测分析及防护的应用。方法 采用FMEA回顾性分析2018年1月—2019年6月我院医务人员血源性职业暴露高危因素,计算风险指数(RPN),优先处理最高风险因素,制定改进措施,且于2019年7月—2020年12月采用改进后方案,对照分析方案实施前后失效模式RPN值、血源性职业暴露情况、医院安全氛围量表中文版。结果 采用FMEA后,RPN、权重系数(Wi)均降低,且RPN实施前为2 633分,实施后为853分,降幅为67.60%,Wi实施前为0.729 9,实施后为0.268 0,降幅为63.28%,均达到预定目标。采用FMEA前,血源性职业暴露率为28.74%,采用FMEA后,血源性职业暴露率为4.65%。实施整改方案后的安全工作阻碍(11.99±2.16)分、清洁度和整洁度(11.48±1.89)分、管理与支持(28.58±3.24)分、冲突与沟通(22.54±2.83)分、反馈和培训(13.82±2.55)分均高于实施前(10.67±2.68)分、(10.06±2.36)分、(26.80±3.86)分、(20.85±2.62)分、(12.52±1.19)分,P<0.05。结论 在医务人员血源性职业暴露管理中采用FMEA,可以细化高风险环节,提高改进措施的针对性,减少职业暴露。
Objective To observe the application of failure mode and effect analysis (FMEA) in monitoring analysis and protection countermeasures of blood-borne occupational exposure of medical personnel. Methods FMEA was used to retrospectively analyze the high risk factors of blood-borne occupational exposure of medical staff in our hospital from January 2018 to June 2019, to calculate the risk priority number (RPN), to give priority to the highest risk factor, to formulate improvement measures. The improved scheme was adopted from July 2019 to December 2020. The RPN value of failure mode, blood-borne occupational exposure and Chinese Hospital Safety Atmosphere Scale (C-HSCS) before and after the implementating of the scheme were compared and analyzed. Results After implementating FMEA, RPN and weight coefficient (Wi) decreased, and the RPN scores were 2 633 and 853 before and after implementation, with a decrease of 67.60%, Wi was 0.729 9 before implementation and 0.268 0 after implementation, with a decrease of 63.28%. Before FMEA, the blood-borne occupational exposure rate was 28.74%, and after FMEA, the rate was 4.65%. After the implementation, the scores of safety work obstruction was (11.99±2.16), cleanliness and tidiness was (11.48±1.89), management and support was (28.58±3.24), conflict and communication was (22.54±2.83), feedback and training was (13.82±2.55), which were higher than those before the implementation: (10.67±2.68), (10.06±2.36), (26.80±3.86), (20.85±2.62), (12.52±1.19), P<0.05. Conclusions Using FMEA in the management of blood-borne occupational exposure of medical personnel could refine high-risk steps, improve the pertinence of improvement measures and reduce occupational exposure.
目的 探讨医务人员血源性职业暴露情况,并且制定有效的防护对策,以保证医护人员的生命健康。方法 回归性分析2013年3月—2017年5月出现的51例出现血源性职业暴露的医务人员为研究对象,对医务人员的基本情况、职业暴露病种及类型、锐器致伤类型、暴露后预防用药及随访监测结果进行分析。结果 血源性职业暴露中,发生率最高的是护士,占62.75%;职业暴露来源上,主要来自外科科室,占50.98%;职业暴露病种以乙型肝炎最常见,暴露类型主要为锐器伤;锐器伤最主要原因为输血器针头;给予职业暴露者预防用药,随访监测职业暴露者的实际情况均得到有效改善。结论 医务人员在实际工作中,多种因素会引起职业暴露情况,因此需加强医务人员的培训教育,规范医护人员操作流程及完善暴露后的处理及干预,以降低职业暴露风险发生率。
目的 了解医务人员临床工作中血源性职业暴露的情况、暴露后的心理健康状况及其影响因素,采取干预措施,保障医务人员身心健康。方法 对医院2013年1月—2017年12月上报的79例血源性职业暴露者,在1个月内进行现状调查,同时采用自填式问卷症状自评量表(SCL-90)对调查对象进行调查,对其暴露后的心理影响程度进行评估。结果 医务人员在发生血源性职业暴露后其中躯体化因子、人际关系敏感因子、抑郁因子、焦虑因子在职业暴露前后的比较及与未发生职业暴露的医务人员相比较,均有不同程度的提高,差异均有统计学意义(P<0.001)。单因素分析显示影响血源性职业暴露后医务人员的心理健康状况的因素有年龄、职业、工龄、既往发生职业暴露史和患者患传染病种类(P<0.05)。其中年龄在21~25岁年龄的医务人员的得分较高,职业为医生和陪护工人的得分较高,工龄在1~5年的得分较高,既往发生过职业暴露的医务人员得分较高,患者患传染病类型为梅毒及暴露源不明的得分较高。结论 医务人员在发生血源性职业暴露后,其心理健康状态可受到较大影响;工龄、既往发生职业暴露史和患者患传染病种类是医务人员发生血源性职业暴露后心理状况健康的独立影响因素。医院管理者在重视预防及减少职业暴露的同时,更应关注血源性职业暴露后的心理变化,及时提供心理支持和医疗帮助。
目的 深入了解河源市某综合医院职业暴露的真实情况,评估健康风险,从而提出有效的控制措施,并提升医院员工的职业防护意识,以保障他们的健康和安全。方法 采用回顾性调查,从暴露类型、环节、病原体种类、职业类别、工龄等方面,对河源市某综合医院在2022—2023年所发生的职业暴露事件进行统计分析。结果 在2022—2023年期间,该综合医院共计发生了93例血源性病原体职业暴露事件,以锐器伤为主,共80例,占86.02%;职业暴露最多的是护理人员,共发生61例,占65.59%;工作人员中工龄≤2年的职业暴露比例最多,共有71例,占76.34%;职业暴露的发生环节主要集中在处理丢弃锐器物以及进行检查、治疗、护理操作的过程中,均为30例,占32.26%;发生职业暴露的原因主要是缺少防护,出现34例,占36.56%;职业暴露主要发生在普通病房,为37例,占39.78%;其次为门急诊,均为15例,占16.13%;职业暴露发生的暴露源传染病病原体种类以不明病原体为主,为36例,占38.70%;其次是乙型肝炎病毒,为32例,占34.40%;所有发生职业暴露的员工均接受了全面的暴露风险评估、合理的预防性用药措施以及定期的健康监测。结论 医院管理部门需加强职业安全培训,特别是针对护理人员和低年资员工,严格执行标准操作规程,提供充足防护用品,改进医疗设备设计,建立完善的监测报告和保障体系,并强化监督和管理,以降低职业暴露风险,保障员工职业安全。
Objective To gain a deep understanding of the actual situation of occupational exposure in a general hospital in Heyuan City, assess health risks, propose effective control measures,and enhance the awareness of occupational protection among hospital staff to safeguard their health and safety. Methods A retrospective study was conducted to statistically analyze the occupational exposure events that occurred in a general hospital in Heyuan City from 2022 to 2023, in terms of exposure types, links, types of pathogens, occupational categories, and years of service. Results During the period from 2022 to 2023, a total of 93 cases of occupational exposure to blood-borne pathogens occurred in the general hospital, with sharp instrument injuries being the most common, accounting for 80 cases（86. 02%）; nurses accounted for the majority of occupational exposures, with 61 cases（65. 59%）; among the staff, those with a service time ≤ two years had the highest proportion of occupational exposures, with 71 cases（76. 34%）; the main occurrence of occupational exposures was in the processes of disposing of discarded sharp instruments and conducting inspections, treatments, and nursing operations, both accounting for 30 cases（32. 26%）; the main reason for occupational exposures was lack of protection, with 34 cases（36. 56%）; occupational exposures occurred mainly in general wards, with 37 cases（39. 78%）, followed by outpatient and emergency departments, both with 15 cases（16. 13%）; the types of infectious pathogens exposed in occupational exposures were mainly unknown, with 36 cases（38. 70%）, followed by hepatitis B, with 32 cases（34. 40%）; all staff who experienced occupational exposures received comprehensive exposure risk assessments,reasonable preventive medication measures, and regular health monitoring. Conclusions Hospital management departments need to enhance occupational safety training, particularly for nursing staff and junior-level employees, strictly enforce standard operating procedures, provide adequate protective equipment, improve medical device design, establish a comprehensive monitoring and reporting system, strengthen supervision, and manage to reduce the risk of occupational exposure and ensure the occupational safety of employees.
