| ObjectiveTwo research methods are used in this study,which are the pooling analysis of domestic literature and the investigation of typical western hospital,to analyze the occurrence of occupational exposure to blood and body fluids and the implementation of protective measures for healthcare workers,and provide baseline data for further intervention measures and evaluation of' intervention effects.MethodsThrough collected the published articles on the status of sharp injuries in Chinese nurses,excerpted data on the status of sharp injuries and the implementation of protective measures.According to the time and level of the hospital,we analyzed the status of sharp injuries and implementation of protective measures,to understand the differences between different levels of hospitals at different times.A self-administered questionnaire was conducted in key departments in a general hospital and infectious disease specialist hospital,questionnaire for healthcare workers who have worked for more than one year as of June 30,2016.The contents of the questionnaire included the basic information,occupational exposure protection measures,occurrence of occupational exposure and collected occupational exposure registration data to determine the implementation of post-exposure prophylaxis(PEP).Data entry was performed using EpiData3.1 software,and statistical analysis was performed using SPSS 19.0 software.Results1.Pooling analysis1.1 Status of sharp injuriesThe pooled incidence of sharp injuries,needle stick and contaminated sharp injuries for all nurses were up to 81.93%?76.55%?61.14%,respectively.The pooled average number of episodes of sharp injuries,needle stick and contaminated sharp injuries were up to 3.14?3.00?2.02 episode per person per year,respectively.Compared with 2005-2009,the figures(the incidence of episodes of sharp injuries,needle stick and contaminated sharp injuries,the number of episodes of sharp injuries,needle stick and contaminated sharp injuries)for 2010-2016 are all significantly lower,but are still at a relatively high level.Among them,the incidence and number of contamination of sharp injuries were 48.52%and 1.03 times per person per year,respectively.There was no significant decreased in the incidence of sharp injuries,needle stick and the numbers of them among secondary hospitals,however,the incidence of contaminated sharp injuries and the number of it were increased.1.2 Implementation of prevention and control measuresThe percentage of the nurses accepted work safety and health training was 42.81%,52.05%of the nurses were immunized with Hepatitis B vaccine,23.67%of them wore gloves while doing procedures on patients,54.86%of the nurses who occurred the injury can handle the wound properly,only 14.00%of the episodes were reported.Compared with 2005-2009,the safety training rate,vaccination rate,wearing rate of gloves,correct treatment rate after injury,and post-injury reporting rate in 2010-2016 were significantly higher.2 Field investigation2.1 Occupational health training87.60%of the healthcare workers in the general hospital have received training of occupational health protection in their current units,85.30%of them received training about blood-borne pathogens.98.70%of the healthcare workers in the infectious diseases specialist hospital have received training about occupational health protection and blood-borne pathogens.The training rate in the infectious disease specialist hospital is higher than that of the general hospital.Personal score of knowledge about general precautions and standard precautions in the infectious diseases specialist hospital were higher than in the general hospital.2.2 Hepatitis B vaccinationThe rate of inoculation of hepatitis B vaccination among healthcare workers in the general hospital was 80.15%,and 81.15%in the infectious disease specialist hospital.The difference was not statistically significant.The positive rate of hepatitis B surface antibody among healthcare workers in the general hospital was 54.80%,and 61.66%in the infectious disease specialist hospital.The positive rate in the infectious disease specialist hospital is higher than that in the general hospital.2.3 Status of occupational exposureThe occupational exposure rate of healthcare workers in the general hospital was 14.98%,and in the infectious disease specialist hospital was 8.94%.The occupational exposure rate of healthcare workers in the general hospital is higher than that in the infectious disease specialist hospital.The largest proportion of exposure occurred in hospital wards.2.4 Self-reporting rateThe self-reporting rate of blood and body fluid occupational exposure among healthcare workers in the general hospital and the infectious disease specialist hospital were 29.17%and 33.33%,respectively.The reason why the healthcare workers of the two hospitals did not report after occupational exposure was mainly because the risk of infection caused by the injury was small,no time to report and the source patient had a low risk of infection.2.5 Preventive medication and laboratory inspectionIn the general hospital,after self-report occupational exposure,the baseline laboratory test rate was 90.48%,follow-up laboratory test rate was 9.52%,and the rate of preventive medication used was 33.33%.In the infectious disease specialist hospital,the baseline laboratory test rate was 100.00%,follow-up laboratory test rate was 93.75%,and the preventive medication used rate was 81.25%.The rate of preventive medication used and follow-up laboratory test in the infectious disease specialist hospital were higher than those in the general hospital,suggesting that post-contact preventive measures in the infectious disease specialist hospital work well.2.6 Logistic analysis of occupational exposure risk factorsIn the general hospital,the risk of occupational exposure to blood and body fluids in healthcare workers was related to the number of working days per week(OR=4.27,95%CI:2.71-6.72,P<0.001),the general prevention knowledge individual score(P=0.039)and whether or not to reflect problem about occupational health(OR=1.89,95%CI:1.24-1.95,P=0.003).In the infectious disease hospital,the risk of occupational exposure to blood and body fluids in healthcare workers was related to the number of working days per week(OR=6.54,95%CI:2.86-14.92,P<0.001)and the degree of satisfaction with protective equipment(P=0.007).ConclusionHealth care workers still face greater risk of exposure to blood and body fluids.The occupational exposure of blood and body fluids in the investigated hospitals is not optimistic.There are still problems in the protection situation.Comprehensive prevention and control measures should be adopted for weak point. |
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