收稿日期: 2024-01-22
网络出版日期: 2024-09-30
基金资助
广东省中医药局科研项目(20231149)
Analyzing the prevention strategies of accidental puncture in traditional Chinese medicine acupuncture based on occupational exposure data
Received date: 2024-01-22
Online published: 2024-09-30
目的 调查和分析从事中医针刺类操作的医务人员发生意外针刺伤的现状,提出预防刺伤策略,保障职业安全。 方法 通过回顾性分析方法,调查某三甲中医院在2020—2022年期间的职业暴露数据,收集整理暴露者的年龄、性别、工作年限、职业类别、岗前培训、使用针具类别、刺伤环节和暴露源等情况,分析刺伤发生风险点,并提出相应预防措施。 结果 本次调查共涉及12个临床科室5 069名医务人员,其中63名医务人员被刺伤,发生率为1.24%(63/5 069)。年龄25 ~ 30岁发生刺伤的概率比< 25岁人群高(OR = 18.556,P < 0.05);年龄> 30岁发生刺伤的概率比< 25岁人群高(OR = 14.311,P < 0.05)。工作年限≥ 3年发生刺伤的概率比< 3年人群低(OR = 0.025,P < 0.05)。实习医生发生刺伤的概率比医生高(OR = 2.212,P < 0.05)。刺伤环节方面,拔针时发生率最高58.73%(χ2 = 106.222,P < 0.05)。针具类型方面,针灸针发生率最高为41.27%(χ2 = 45.095,P < 0.05)。暴露源方面,“未知暴露源”最高42.86%(χ2 = 57.476,P < 0.05),“暴露源为乙肝患者”为20.63%(χ2 = 57.476,P < 0.05)。岗前培训方面,“接受过岗前培训”仍发生刺伤占比最高为69.84%(χ2 = 38.000,P < 0.05)。 结论 应提前获取患者的血清学状态,严格遵守“标准预防”和“接触隔离”等预防感染的控制措施,实施有效岗前培训,并关注特殊针具的刺伤风险,才能预防刺伤,保障职业安全。
蔡莉 , 陈惠超 , 李娅斐 , 罗丁 , 陈静薇 , 欧阳红莲 . 基于职业暴露数据对中医针刺操作意外刺伤的调查分析[J]. 实用医学杂志, 2024 , 40(18) : 2635 -2639 . DOI: 10.3969/j.issn.1006-5725.2024.18.022
Objectives To enhance occupational safety for medical practitioners involved in acupuncture procedures within the field of Chinese medicine, it is imperative to thoroughly investigate and analyze the current incidence of accidental punctures. Subsequently, effective strategies can be proposed to prevent such occurrences. Methods Through retrospective analysis, this study investigates the occupational exposure data of a tertiary hospital specializing in traditional Chinese medicine from 2020 to 2022. The demographic characteristics (age and gender), professional experience, occupational category, pre-service training, type of acupuncture tools used, puncture session details, and exposure sources of the individuals involved are collected and organized for analyzing the risk factors associated with accidental needlestick injuries. Corresponding preventive measures are proposed accordingly. Results In this survey, a total of 5 069 medical staff from 12 clinical departments were included, among whom 63 experienced accidental puncture with an incidence rate of 1.24% (63/5 069). The likelihood of puncture was found to be significantly higher in individuals aged between 25 ~ 30 years compared to those under the age of 25 (OR = 18.556, P < 0.05). Similarly, the probability of puncture was also higher in individuals aged over 30 years compared to those under the age of 25 (OR = 14.311, P < 0.05). Conversely, individuals with at least three years of experience had a lower probability of experiencing punctures compared to those with less than three years (OR = 0.025, P < 0.05). Furthermore, interns exhibited a higher likelihood of puncture incidents compared to physicians (OR = 2.212, P < 0.05). Regarding the puncture session, the highest probability of occurrence is 58.73% at the time of needle removal (χ2 = 106.222, P < 0.05). Regarding the type of acupuncture tools, acupuncture needles have the highest probability of occurrence at 41.27% (χ2 = 45.095, P < 0.05). Concerning the exposure source, "unknown exposure source" has the highest prevalence at 42.86% (χ2 = 57.476, P < 0.05), while "exposure source is hepatitis B patient" accounts for 20.63% (χ2 = 57.476, P < 0.05). Regarding pre-service training, individuals who have received pre-service training exhibit a higher likelihood of puncture incidents (69.84%) (χ2 = 38.000, P < 0.05). Conclusions The serological status of patients should be obtained in advance, and strict adherence to infection prevention control measures such as "standard precautions" and "contact isolation" is necessary. Effective pre-service training must be implemented, with particular attention given to the risk of puncture when using specialized acupuncture tools for occupational safety.
| 1 | 张根柱,毛亚娟,郭秀梅. 六西格玛联合护理风险管理预防护理实习生针刺伤的干预研究[J]. 护理研究,2024,38(7):1305-1307. |
| 2 | 国家中医药管理局. 中医医疗技术相关性感染预防与控制指南(试行)[EB/OL].(2017-07-06)[2023-01-10].. |
| 3 | 高丹. 某中医医院医务人员血源性职业暴露调查分析及预防对策[J]. 云南中医中药杂志,2023,44(7):98-101. |
| 4 | 黄慧敏,嵇小倩,李亚楠,等. 2012-2021年某医院医务人员血源性职业暴露调查分析[J]. 中华医院感染学杂志,2023,33(10):1569-1573. |
| 5 | 王春华,姑丽巴哈尔·吾布力,王燕. 近四年我院工作人员职业暴露因素分析与探讨[J]. 新疆中医药,2024,42(1):79-81. |
| 6 | FATHIZADEH H, ALIREZAIE Z, SAEED F, et al. Prevalence of needle stick and its related factors in Iranian health worker: an updated systematic review and meta-analysis [J]. Glob Health, 2023,13:04104. doi:10.7189/jogh.13.04104 |
| 7 | TONGHUI W, YING L, XIAOLU W, et al. A large-scale survey on epidemiology and underreporting of needlestick and sharp injuries among healthcare workers in China [J]. Front Public Health, 2023,11:1292906. doi:10.3389/fpubh.2023.1292906 |
| 8 | LEE J B, CHOI J S. Epidemiology of occupational exposure to blood-borne viruses, postexposure prophylaxis and seroconversion over 10 years among healthcare workers [J]. Hosp Infect, 2023,135:18-27. doi:10.1016/j.jhin.2023.02.003 |
| 9 | 吕建峰,贾丽燕,王清秀,等. 2014-2020年某三甲医院医务人员血源性职业暴露特点及防控费用[J]. 中华医院感染学杂志,2022,32(8):1243-1247. |
| 10 | STALLARD C, HEATON K, MONTGOMERY A P, et al. Identifying and Decreasing Sharps Injuries Through Root Cause Analysis in a Large Urban Hospital System.[J].Workplace Health Saf, 2023,71(6):268-274. doi:10.1177/21650799231156564 |
| 11 | LEE S H, YANG I S. Empowering hospital-associated infection prevention and control: A quasi-experimental study on the effect of scenario-based simulation training[J]. Nurse Educ Pract,2024,76:103936. doi:10.1016/j.nepr.2024.103936 |
| 12 | NAIDU R T, TOAL P, MISHRA S C,et al.Incidence of needlestick injury among healthcare workers in western India[J].Indian J Med Res,2023,158(5&6):552-558. doi:10.4103/ijmr.ijmr_892_23 |
| 13 | 张迎梅,田碧文,孙蕾,等. 六西格玛管理在预防中医诊疗操作针刺伤中的应用研究[J]. 医药高职教育与现代护理,2022,5(5):395-398. |
| 14 | 王芳,李阳洋,杜婕,等. 医院护理人员针刺伤现状及对策研究[J]. 成都医学院学报,2024,19(1):116-120. |
| 15 | MOHAMUD R Y H, MOHAMED N A, DO?AN A, et al.Needlestick and Sharps Injuries Among Healthcare Workers at a Tertiary Care Hospital: A Retrospective Single-Center Study[J].Risk Manag Healthc Policy, 2023,16:2281-2289. |
| 16 | JANIK-KARPINSKA E, BRANCALEONI R, NIEMCEWICZ M, et al. Healthcare Waste-A Serious Problem for Global Health. [J]. Health Care (Basel), 2023,11(2):242. |
| 17 | 王银花,廖健敏,蔡鹏,等. 2010年-2020年中国实习护生锐器伤发生率的Meta分析[J]. 循证护理,2022,8(9):1152-1159. |
| 18 | KASTELER S D, REID M, LEE P C, et al. Sharps Injuries Among Medical Trainees and Attending Physicians[J] .Acad Med, 2023,98(7):805-812. doi:10.1097/acm.0000000000005187 |
| 19 | TSEGA D, GINTAMO B, MEKURIA Z N, et al. Occupational exposure to AIDS and utilization of post-exposure prophylaxis among healthcare workers at St. Peter's specialized hospital in Addis Ababa, Ethiopia[J] . Sci Rep, 2023,13(1):7021. doi:10.1038/s41598-023-34250-4 |
| 20 | HESSELS A J, GUO J, JOHNSON C T, et al. Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes[J]. Am J Infect Control, 2023,51(5):482-489. doi:10.1016/j.ajic.2023.01.021 |
| 21 | 唐珍珍,张玉娟,郑蓉. 中国医务人员艾滋职业暴露情况的Meta分析[J]. 中华医院感染学杂志,2021,31(18):2842-2845. |
| 22 | 梁远俊,苏姗姗,陈宗梅,等. 医护实习生中医针具刺伤现状及影响因素分析[J]. 全科护理,2023,21(23):3291-3294. |
| 23 | DEBELU D, MENGISTU D A, TOLERA S T, et al. Occupational-Related Injuries and Associated Risk Factors Among Healthcare Workers Working in Developing Countries: A Systematic Review[J]. Health Serv Res Manag Epidemiol, 2023,10:23333928231192834. doi:10.1177/23333928231192834 |
| 24 | 王诚尧,周燕,朱洁妤,等. 针具变革推动下针刺技术体系的创新与发展[J]. 中医杂志,2021,62(5):375-380. |
| 25 | LEE J B, CHOI J S. Epidemiology of occupational exposure to blood-borne viruses, postexposure prophylaxis and seroconversion over 10 years among healthcare workers[J]. Hosp Infect,2023,135:18-27. doi:10.1016/j.jhin.2023.02.003 |
/
| 〈 |
|
〉 |