Investigation And Intervention On The Occupational Injuries Of Midwives In Guangdong Province

BackgroundOccupational injuries of medical staff are an important global public health problem all over the world. A large number of researches show that hospital staff’s occupational hazards cover long-term impact of chronic, acute and unexpected hazards. Under the special medical environment, occupational injuries including injuries that leaded by occupational hazard factors and work related diseases. Midwives are at high risk for occupational injury. The special nature of the work and work environment determines that they often exposed to blood, amniotic fluid, secretion, sharp instrument injury and other dangerous factors, which causing both chronic long-term effects and acute paroxysmal harm. Furthermore, with the development of modern medicine, the medical model has been changed from the traditional biological one to the modern biological-psychological-social one, maternal physical and psychological needs are getting higher and higher. In this case, midwives face significant pressure that makes them be placed in the high and nervous appearance over a long period of time. As a result, they suffer health consequences. Studies abroad show that delivery room ranked second on occupational hazards.Because of the high-intensity, high-stakes, high stress, high investment, low-productivity nature of the work, midwives can be prone to stay away from job, midwife shortage will become more serious. China health statistics year book of2010told us that we had3.9nurses and midwives per1000people, if refer to the standard of neighboring Asian countries that proportion of midmives per1000population is0.2, the shortage of midwives in our country is227,000. Preventing and controlling occupational injuries of midwivies is an imminent problem to us.By recent years, the researches of occupational injury both domestic and abroad have got some achievements and established three-tier system of preventive measures. But there are still many works worth to be considerate. Yet it is still unclear the relationship between occupational post and occupational injury. At the moment, the large number of existing related research is limited to the risk factors of occupational injuries to midwives, a deeper level of organizational management factors, individual characteristics and other factors on the impact of occupational injuries has rarely reported.The purpose of this study is to understand the current situation of occupational injuries among midwives in Guangdong Province, and to analyse the corresponding risk factors of these injuries. Then give intervention to blood-occupational exposure which was common and frequently occurred, aiming at exploring the effect of intervention. In this way, we can promote occupational health of midwives and provide valuable references for hospital leaders in making plans and decisions.ObjectivesTo understand the prevalence of occupational injuries among midwives in hospitals in Guangdong province.To investigate the influencing factors of common occupational injuries among midwives, and to provide a reference for proposing more effective injury management measures.To evaluate the effect of intervention in prevention and control of blood-occupational exposure. MethodsPart Ⅰ1092midwives were investigated by a questionnaire from March2012to July2012. The questionnaire included basic document, organizational environment administration of hospital occupational exposure, social and personal factors. The main goals are to understand the prevalence of occupational injuries among midwives in hospitals in Guangdong Province, to investigate the influencing factors of common occupational injuries among midwives,and to provide a reference for proposing more effective injury management measures.Study subject:This research aimed on midwives from110different health faclities located in Guangdong Province. Every employee is eligible to this survey following the atatistic method of cluster sampling amd sratified sampling at the same time.Inclusion criteriaMother&infant health care service qualification holder;At least six months of work experience and on the job;Understand the content of the study, and voluntarily joined this research project. Exclusion criteriaLess than six months of work experience;Being absent as long as a week or more;With mental disorders;Failed to cooperate.Research methodquestionnaire and interview method. The questionnaire included: General data Including gender, the level of hospital, the nature of hospital, age, work experience, title, education background, marital status, and monthly income. Organizational environment administration data Including4layers26items, there are allocation of human resource (4items、security facilities provided (6items)、 organizational care (10items)、safe operation (6items).Occupational exposure Including exposure to maternal blood, amniotic fluid, or other high risk body fluid; exposure to chemical substances (such as various disinfectants, drugs, etc) and so on.Personal factors Including mental state, regulation of mood, deal with the complicated human relation and so on.Social factorOccupational injuries in the past six months including work related injury and work related disease.Part ⅡStudy subject:Interventions were given to46midwives that were enrolled in December2012to February2013by cluster sampling from four general hospitals in Guangzhou City. Inclusion criteriaThe same as part one. Exclusion criteriaThe same as part one. The research contentCharge nurse in delivery room together with me to complete the research.The research object will be intervented within a continuous three months. Specific forms of intervention including teaching lectures, demonstrations, thematic, consulting interaction and other means. The evaluation indexcomparison of frequencies of blood-occupational exposure after the intervention; comparison of awareness of blood-occupational exposure knowledge after the intervention;comparison of midwives’ satisfaction on organizational enviromment administration after the intervention;comparison of occupational protection of blood-occupational exposure after the intervention.Data analysisAll statistical data were analyzed by using statistical software SPSS13.0. Measurement Data was expressed as Mean±S.D. Chi-square test was used to compare ratio or percentage in different groups. Univariate analysis and two Logistic Regression Logistic Regression models were used to analyse factors of occupational injuries. After the intervention, we adopted analysis of paired-t test to compare cognitive scores about blood-occupational exposure. The occurrence of blood-occupational exposure, satisfaction of organizational environment, occupational protection were compared by using Wilcoxon one-sample test. P value<0.05was considered to be significant.ResultsA total of1092questionnaires were issued,1036were recovered, and the recovery rate was94.9%, filling out the questionnaire without missing entries was valid, valid questionnaires1018, and the effective rate was93.2%.The overall incidence of occupational injuries among midwives was24.2%.The occurrence rate of work-related injury was33.1%. The top five work-related injuries, in order, were workplace psychological violence (83.8%), mucocutaneous exposure (79.3%), insomnia (60.4%), impact injury (42.3%), needlestick injuries (38.4%).The occurrence rate of work-related disease was14.6%. The top five work-related idiseases, in order, were varicose veins of lower extremity (30.2%), cervical spine disease (25.8%), lumbar disease (25.5%), neurasthenia (23.0%), scapulohumeral periarthritis (19.1%), chronic pharyngitis (19.1%).The medical risk factors lead to different degrees of occupational injuries among midwives including demographic of midwives, organizational environment occupational exposure, personal factors. Specifically as follows:age, levels or nature of hospitals, work load, social evaluation of midwives and so on.After the intervention, aggregate cognitive score of blood-occupational exposure improved. So were the four dimensions of cognitive score. By the method of Paired-sample T test, we found that there were significant difference in the cognitive scores before and after intervention (P<0.001). Wilcoxon one-sample test results showed that the occurrence of blood-occupational exposure, satisfaction of organizational environment, occupational protection had statistically differences before and after intervention. While the reporting rate of occupational injury, wearing protective goggles had statistically significant differences (P<0.001).ConclusionsThe present situation of occupational injuries of midwives in Guangdong Province is not optimistic. The incident rate of work-related injury as well as work-related disease is high.Causes of occupational injury factors for midwives are complex and multifaceted. They are intertwined with each other, the combined effect, eventually causing the occurrence of occupational injury. The risk factors of occupational injury including:demographic of midwives (levels of hospitals, title, work experience, academic qualifications and so on), organizational environment, occupational exposure, personal factors. It’s very important to reduce all the risk factors.Midwives take the responsibility to bring new lives. Management should approach occupational health and safety of midwives from a strategic height., it’s essential to take effective measures such as creating good working environment, provision of adequate personal protective equipment, strengthening training and education, raising awareness of self-protection, etc.To some extent, interventions were at work on cognitive enhancement of blood-occupational exposure as well as compliance of self protection. But we need to increase sample size in the future to verify the results.