CAJ | 학술논문

目的：调查医务人员发生血源性职业暴露的高危人群、科室及操作环节，并探讨发生血源性职业暴露高危险因素的防护策略。方法建立血源性职业暴露监测报告系统，医务人员发生职业暴露后填写“职业暴露个案登记表”，调查分析2012年6月－2013年5月所上报61名医务人员发生血源性职业暴露情况，采用SPSS 17．0软件进行统计处理。结果在上报的61名职业暴露人员中，以护士和护生人数最多，占80．33％；发生职业暴露较多的科室为普通病房、手术室和急诊室，分别占54．1％、19．67％和9．84％；发生较多的操作环节为输液完毕拔针及各种注射、穿刺、抽血拔针，手术缝合和集中分离针头，分别占39．34％及13．11％，11．48％和9．48％；暴露者未戴手套操作占86．89％，以接触不明源患者或病原体的后续预防最为棘手，暴露源中以携带乙型肝炎病毒最多，占54．10％。结论血源性职业暴露多发生于护士和护生，病房、手术室和急诊室是主要场所，某些不规范的临床操作为高发因素，对标准预防知识的掌握和应用态度、使用安全锐器或针具进行安全操作、及时接种乙型肝炎病毒疫苗以及发生职业暴露后主动上报，是医务人员血源性职业暴露的最佳防护策略。
목적：조사의무인원발생혈원성직업폭로적고위인군、과실급조작배절，병탐토발생혈원성직업폭로고위험인소적방호책략。방법건립혈원성직업폭로감측보고계통，의무인원발생직업폭로후전사“직업폭로개안등기표”，조사분석2012년6월－2013년5월소상보61명의무인원발생혈원성직업폭로정황，채용SPSS 17．0연건진행통계처리。결과재상보적61명직업폭로인원중，이호사화호생인수최다，점80．33％；발생직업폭로교다적과실위보통병방、수술실화급진실，분별점54．1％、19．67％화9．84％；발생교다적조작배절위수액완필발침급각충주사、천자、추혈발침，수술봉합화집중분리침두，분별점39．34％급13．11％，11．48％화9．48％；폭로자미대수투조작점86．89％，이접촉불명원환자혹병원체적후속예방최위극수，폭로원중이휴대을형간염병독최다，점54．10％。결론혈원성직업폭로다발생우호사화호생，병방、수술실화급진실시주요장소，모사불규범적림상조작위고발인소，대표준예방지식적장악화응용태도、사용안전예기혹침구진행안전조작、급시접충을형간염병독역묘이급발생직업폭로후주동상보，시의무인원혈원성직업폭로적최가방호책략。
OBJECTIVE To investigate the hign‐risk populations ,departments and operation activities associated with occupational exposure to blood borne pathogens among healthcare workers ,further discuss prevention strate‐gies for the hign‐risk factors .METHODS The monitoring report system for the occupational exposure to blood borne pathogens was established ,and the registration form of exposure cases was filled out by the healthcare workers after occurrence of exposure .The 61 reported cases were investigated from Jun .2012 to May 2013 .The software SPSS17 .0 was used for statistical analysis .RESULTS The majority of the 61 reported cases (80 .33% ) were junior nurses and student nurses . Occupational exposure more frequently occurred in general wards (54 .1% ) ,operating rooms (19 .67% ) and emergency rooms (9 .84% ) ,and was most frequently associated with clinical activities such as needle‐withdrawal after transfusion (39 .34% ) ,needle‐withdrawal after various injec‐tions ,punctures and blood drawing (13 .11% ) ,sutures during operation (11 .48% ) and centralized separation of needles (9 .48% ) .The reported cases in which operators did not wear gloves accounted for 86 .89% .It was the most difficult for post‐exposure prophylaxis after contact with unknown patients or unknown pathogens .Hepatitis B virus accounting for 54 .10% took the highest proportion among the sources of blood borne pathogens . CONCLUSION Occupational exposure to blood borne pathogens occurs most frequently in junior nurses and student nurses ,in general ward ,operating rooms and emergency rooms ,and is highly associated with certain unstandard‐ized clinical activities .The optimal prevention strategies for the exposure include well knowledge and concept of ap‐plication of standard precautions ,safely manipulation of safe sharp instruments and needles ,timely vaccination and active self‐report after occupational exposure .