| [Objectives]There are many kinds of damage factors that would result in physical and mental health injury of medical stuff in hospitals, including biological factors, chemical factors, physical factors and psychological factors. Along with the progress of the society and the improved people-oriented awareness, medical personnel occupation exposure and health has been paid more attention than before.By far, diseases spread via blood have become the biggest risk factor of occupational latent infection for medical staff. The great majority of medical personnel regularly contact with operations for blood and body fluids, such as injection, taking blood, blood transfusion, surgical operation, endoscope, dialysis and collection, delivery or inspection of all kinds of patients’specimens, which cause medical personnel a high risk group that can not be ignored for occupational blood exposures. Hematogenous occupation exposure brings lots of physiological and psychological harm to the medical staff. It also may cause harm to the whole society.It is necessary to strengthen the prophylaxis in medical staff against infection of hematogenous disease, because the medical staff occupation exposure infection has become a major occupation problem in medical field now.In this regard, international medical circles paid much attention to this issue in the early eighty’s, and they started a large number of related research. A new understanding of occupation risk on the medical staff has been gradually formed. SARS pandemic in2003had become a warning sign to the occupation safety and protection of medical staff in our country, occupation health and safety of medical personnel attracts much attention nowadays. Occupation safety is important in current medical personnel concerned.Infectious disease hospitals are special hospitals that receive and cure infectious diseases such as viral hepatitis, AIDS, tuberculosis and other contagious diseases. The medical staff of infectious disease hospitals is constantly in special working environment. The special occupation determines that he (she) who has relatively higher risk of blood-borne occupation exposure than general hospital medical staff. Therefore, the medical staff in infectious hospitals is facing more severe occupation risk.This study analyzed the main factors that influence the occurrence of blood-borne occupation exposure, practiced the protection measures of occupation exposure to blood, established an effective protection system of blood-borne occupation exposure, avoided or reduced furthest the medical staff of blood-borne occupation exposure occurs and ensured the occupation safety medical staff through occupation of blood-borne investigation of an infectious disease hospital exposure and protection status.[Methods]1. Literature reviewFocus on the key words of "occupation exposure","occupation safety" and "occupation protection", and search papers and data on domestic and international progress in the occupation exposure and occupation protection through different retrieval tools such as Pubmed, CNKI, and the library’s electronic resources. Summarize the previous investigation and conclusions.2. Retrospective reviewAnalyze the data of blood-occupational exposure registered by the hospital from January1,2006-December31,2010, including:exposure in general, occupation distribution, exposure, exposure through manner and location, caused by sharp instrument injury types, exposure to the source of disease, time and method, after the exposure processing post exposure prophylaxis drugs etc..3. Questionnaire surveyMake a questionnaire by consulting relevant literature and material. Each400questionnaires were delivered to participants proportional before and after intervention according to the actual number of doctors, nurses, technicians and logistics (90questionnaires for physicians,180for nurses,50for medical technicians,30for the auxiliary departments, and50for medical waste disposal personnel). According to the survey, explain the questions in the questionnaire fully to interviewees and make the respondents do the survey voluntarily and truthfully. Then the investigators establish a database with Epidata3.0software, and deal with the conclusion by the SPSS19.0statistical software.The questionnaire includes3aspects:①Basic information:including job number, sex, age, occupation, working life, job title and other information.②A survey of self-protection behavior against blood-occupational Exposure:In accordance with the Occupation Protection Guide of Pathogens in Blood issued by Hygienic standard of Occupation Health Ministry Committee, list all protection measures to blood-borne occupation exposure in every position of medical staff. Every question provides the same options:"always perform","perform most of the time","occasionally perform" and "not perform". Each of these options are assignment, positive entries for "3,2,1,0", the negative items reverse assignment. Higher scores indicate better protective action.③Survey on knowledge of blood-occupational exposure:From5aspects to evaluate medical staff cognition for blood-borne occupation exposure. Mainly includes the common types of blood-borne diseases, personal protective measures, the emergency treatment measures after blood-borne occupation exposure occurred, blood-borne occupation exposure judgment and the reporting process after blood-borne occupation exposure occurred.4. Statistical assumptionAll categories of personnel blood-occupational exposure status, risk factors and standard protection implementation are analyzed by statistical methods. T test and chi-square test were used to infer the differences various medical staff’s blood-borne occupation exposure and their cognition and protective behavior to blood-borne occupation exposure before and after the implementation of intervention measures.[Results]1. Nurses blood-borne occupation is at highest risk of exposure (59.32%). The primary title and the following personnel blood-borne occupation exposure is more easily than intermediate grade and above; Occurrence of multiple exposure duration of5years following the number than the working life of5years and above. Exposure to the mainly source of disease is HBV (55.93%), HIV/AIDS (30.51%), HCV (10.17%) and syphilis (3.39%) and other blood-borne diseases; Blood-borne occupation exposure distribution of departments in Department of internal medicine (59.32%); The main blood-borne occupation exposure is mainly caused by sharp instrument injury (88.14%), the most site of injury is hand (88.13%), especially the fingers. Sharp type infusion needle for the first (67.31%), injection, needle and needle is high-risk areas most prone to cause sharp instrument injury accounted for30.77%,21.15%, respectively. Exposure damage mostly is skin injury (51.92%), followed by epidermal injury (30.77%) and deep wounds (13.46%). Exposure occurs in busy work, poor mental state, the attention is not centralized, the operation is not standard, not wearing protective equipment and so on, also with the assistant with the unskilled, instrument design defects, patients do not match, etc..2. The sample hospital medical staff for blood-borne occupation exposure knowledge awareness rate is not high; those medical personnel for blood-borne occupation exposure cognition should be improved. Medical staff in sample hospital for protective measures of overall implementation of blood-borne occupation exposure is not ideal, the medical staff is generally "in the injection/rehydration wore gloves","in the injection/rehydration check before if there is hand skin damage"; but only a small part of people will "wear a hard surface and not easy leakage shoe for operation", most can not do the protective measures such as "do the injection/rehydration in a quiet and bright and the operation space is abundant environment","use safety injection/fluid infusion device","wear protective goggles in the injection/rehydration" and "wear protective goggles in the operation". The measure that inspection personnel do the best is "sample leakage according to SOP processing", the score of2.90points. The measure they do the worst is "the use of sharps box processing glass syringe", this score is1.84points. Auxiliary Department (B ultrasound, electrocardiogram, electroencephalogram room, Radiology, interventional radiology) personnel overall score is not high, which is doing relatively better is to "use the sharps box processing glass, syringe", the score is1.77points, and "operation completely wear personal protective supplies" is done worst, the score is only0.50points. Protective measure done the best in Workers is "use of sharps box processing glass syringe", the score of2.44points. The respectively worse doing are in the aspects of "confirm whether the specimens may contain blood-borne pathogens" and "operation completely wear personal protective supplies", the score is0.22points and0.48points. The rate of implementation requires effective intervention measures taken to correct and improve the medical staff in the daily operation of personal protective measures.3. After the implementation of interventions, medical personnel for blood-borne occupation exposure of cognition have been significantly improved, the execution rate of most protective measures were improved greatly. Especially the mandatory measures, medical personnel execution rate increased more significantly. And the disposal measures were improved after hematogenous occupation exposure occurred. The blood-borne occupation exposure rate in hospital thousands bed days was decreased from16.25%to9.96%after intervention, that shows the implementation of a series of interventions have effected.[Conclusion]1. Blood-borne occupation exposure risk groups is mainly in low seniority, title of the primary clinical front-line medical care personnel and workers; the main source of blood borne occupation exposure is sharp injuries caused by sharp instruments, type in the infusion needle occupies the first place, injection, puncture and pull the needle is most prone to high-risk areas of sharp instrument injury; occupation exposure risk factors for blood needle treatment is not correct, standard prevention measures are not in place.2. The cognitive for blood-borne occupation exposure and its protection status in medical staff is not ideal. The awareness rate for blood-borne occupation exposure and prevention standards implementation rate should be improved in medical personnel.3. The strengthening of the infectious disease hospitals of different levels in high-risk occupation protection training and barrier protection measures, after exposure to timely treatment and reasonable preventive medication, can effectively prevent blood-borne occupation exposure occurred infection and exposure. |
PDF Full Text Request