Investigation On Blood-borne Occupational Exposure And Protective System Of Emergency Medical Staff

ObjectiveTo understand the current situation of blood-borne occupational exposure and protection system of emergency medical staff in the tertiary hospitals in China,and to provide objective evidence for improving occupational exposure of emergency medical staff in the future,and to provide reference for the future formulation and perfection of emergency occupational protection standards.Method1.Investigation of blood-borne occupational exposure in emergency medical staffFrom March to May in 2016,using the convenience sampling method,a retrospective questionnaire survey was conducted on 1212 emergency medical staff in 114 hospitals in 29 provinces,municipalities and autonomous regions in China.The survey tool was "Questionnaire on blood-borne occupational exposure status of emergency medical staff in the tertiary hospitals in China" and "Hospital safety climate scale."2.Status of emerency medical staff blood-borne occupational protection researchUsing qualitative interviews and on-site observation of a combination of methods,comprehensive and meticulous understanding the implementation status of the protective system and emergency medical staff protective behavior of the tertiary hospitals in China.Result1.Status of blood-borne occupational exposure in emergency medical staff1.1 The prevelance status of blood-borne occupational exposure among emergency medical staffOver the past 12 months,the emergency medical staff occupational exposure to blood-borne overall incidence rate was 37.3%,the incidence of sharp injuries,non-intact skin exposure,mucosal exposure was 31.6%,8.9%,6.3%,respectively,the frequency of occurrence were:0.88time(person-year),0.38(person·year),0.43(person·year),the reporting rate was 2.8%,12.9%,3.1%;Ampoules,scalp steel needles,syringe needles,and blood collection needles were the main equipment causing the sharp injuries,accounted for 51.3%,49.5%,33.8%and 25.4%respectively;Break ampoules,pull out needles or needlecaps,patients do not cooperate with infusion or blood,separate the needles were the main operation causing the sharp injuries,accounted for 51.3%,29.5%,28.7%and 24.3%respectively;After sharp injury,94.3%of medical staff correctly completes the real-time processing measures,23.6%(suspected)contamination of the sharp exposure source is not retrospective;Among the injured staff,25.6%of thestaff has not been vaccinated against hepatitis B before exposure.The patient's blood or body fluids encountered during operation is the main cause of the occurrence of the emergency medical staff exposed to direct blood body fluids(non-sharps injuries),accounting for 39.8%,Of which 34.8%of the sources of exposure were not retrospective;32.1%of thestaff has not been vaccinated against hepatitis B before exposure.1.2 The current situation of the hospital safety climateHospital safety climate average score is 3.98±0.62,from high to low scores of each dimension:conflict and communication(4.28±0.64),management and support(4.21 ± 0.69),feedback and training(4.16±0.64),safety work hinder(3.43 ± 1.03),cleanliness and cleanliness(3.41±1.01).Hospital safety climate and emergency medical workers occupational exposure to blood-borne occurrence was negatively correlated(P = 0.000,r =-0.20).2.The status of blood-borne occupational protection in emergency medical staff2.1 The status of implementation of the emergency occupational protection systemThe tertiary hospitals have established basic occupational protection system,including institutional system,protective system,and occupational exposure tracking system,but there is a gap between the occupational protection system of each hospital and the actual implementation of clinical medical personnel,the implementation to the emergency staff of each hospital systems varies,as well as the degree of implementation of different hospital systems are not the same.2.2 The status of protective equipment and implementation of the protective behavior of medical staff65 tertiary hospital emergency departments,of which 55 were equipped with safe needle,28 were equipped with no-needle connector,36 were equipped with a screw-type infusion,7 were equipped with eye wash equipment;The hand hygiene compliance rates of doctors,nurses,interns,training nurses and nursing workers were 57.7%,59.0%,57.3%,63.3%,46.4%,respectively;The compliance rate of wearing gloves for nurse,nurse,interns was 19.9%,14.5%,9.1%of intravenous infusion,while 39.9%,36.7%37.9%of blood collection.The incidence of recapping,separate needle and syringe by hand and the sharps are not immediately thrown into the sharps box was 24.6%,43.2%and 20.9%,respectively.ConclusionAlthough the current tertiatry hospital occupational protection system has been basically established,but there is a gap between the occupational protection system of each hospital and the actual implementation of clinical medical staff,the tertiatry hospital emergency medical staff still face a greater risk of blood-borne occupational exposure.Hospitals should be based on the clinical situation of their own,to refine and improve occupational protection system,construct a good hospital safety atmosphere,so as to improve the protection of emergency medical staff awareness and protective behavior.On the one hand,optimize reporting processes,establish the education training feedback system,increase the investment in protective equipment,and actively promote the safety injection to prevent the occurrence of exposure,On the other hand,strengthen the construction of occupational exposure tracking system to achieve real-time monitoring of medical staff after exposure,improve the compliance of follow-up exposure,and improve the hepatitis B vaccination rate of emergency medical staff,so as to to reduce the risk of infection after occupational exposure,ensure the occupational safety of medicalstaff.