The Intervention and Surveillance Experience for Blood and Body Fluid Exposures at a Major Teaching Hospital in Taiwan

台灣某大型教學醫院對於血液與體液暴觸事件的介入與監控經驗

吳景義(Jing-Yi Wu)；陳宜君(Yee-Chun Chen)；石富元(Fuh-Yuan Shih)；簡淑芬(Shu-Fen Chien)；黃寶華(Bao-Hwa Huang)；杜宗禮(Chung-Li Du)

針扎 ； 經皮穿刺傷 ； 經黏膜表皮接觸 ； 血液與體液暴觸 ； Needlestick injury ； Percutaneous injury ； Mucocuatneous exposure ； Blood and body fluid exposure

勞工安全衛生研究季刊

22卷3期（2014 / 09 / 15）

276 - 288

英文

研究背景：減少醫療照護相關肝炎感染的最有效方式是預防血液與體液暴觸事件，然而醫療照護人員對於事件通報不足一直是職業防護上重要議題。因此許多研究文獻都建議醫療院所應當鼓勵常規通報機制、並且採取適當控制策略。本研究旨在瞭解大型教學醫院內事件發生率及其持續性介入措施的潛在效應。研究方法：我們在具有2,200住院病床的三級照護醫學中心，於西元2006年時成立工作小組，依據先前血液與體液暴觸事件根本原因分析結果，進行前瞻性介入研究，在推動各項防護措施過程中持續監控各種危險因素相關的事件，考量病人住院總日數、平均佔床數、或全時間作業員工等量數估算發生率，以卡方線性趨勢檢定確認於西元2004至2008年間的增減趨勢與工作小組介入前後的差異。研究結果：我們發現於西元2004年至2008年間在醫院共發生1,769件血液與體液暴觸事件，年度發生率介於每百床17.0至13.7件之間。若考量病人住院平均佔床數，事件發生率在整體上有明顯逐年降低趨勢、特別在護理人員上；若考量病人住院總日數，事件發生率在整體上於針器使用後而未棄置前、或棄置期間有明顯逐年降低趨勢；若考量全時間作業員工等量數，事件發生率在實習醫學生上有非顯著性逐年增高趨勢，但是在工作小組介入後，發生率於經皮注射相關處置、或針器使用後而未棄置前有大幅減少。研究結論：我們發現整合性團隊的努力在血液與體液暴觸事件的介入與監控上有正向效果，其中對於易感族群採取工程控制措施、進行特定職前與在職繼續教育訓練是非常重要的策略，但是爭取管理階層支持以不斷推動運作更是不可或缺的。

Background: The most effective means of reducing health care associated hepatitis infection is to prevent the blood and body fluid exposures (BBFE). However, under-reporting of accidents is evading the issue of occupational protection among health care workers. It is advised to encourage routine BBFE reporting program and to take control strategies accordingly. The study aimed to survey the levels of BBFE in the major teaching hospital, and to evaluate the potential effects of various ongoing measures during this intervention period of time. Methods: At a 2,200-bedded tertiary referral hospital center, we organized a task group in 2006, conducting a prospective interventional study based on the respectively causal analyses. We analyzed incidences by hospitalized inpatient days (IPD), full-time equivalent employees (FTE), and occupied beds (OB), and patterns of BBFE related to jobs, places, tasks, & steps involved with the device use, comparing the differences with Chi-square (x^2) for trend tests. Results: There were 1,769 BBFE in 5 years with the incidence of 17.0-13.7/ 100OB per annum overall, and the significantly decreasing trend overall (p=0.028) and especially noted among nurses (p=0.019). Using index of IPD, a significant reducing trend (p＜0.001) in the overall BBFE mostly appeared after the use or before the disposal (p=0.001), and during disposal of devices (p=0.017). A non-significantly increasing incidence trend of BBFE by index of FTE was observed among interns (p=0.484), but their incidence of BBFE due to percutaneous injection (-6.7/100FTE), and after use & before disposal of the device (-2.2/100FTE) were reduced. Conclusion: The team effort has monitored and controlled the BBFE effectively. Engineering control, pre & post occupational tailored trainings and on-site continuous education are most crucial, especially for the vulnerable subgroups. Continual collaborative promotion with authority supports and prudent interpretation of indices are also indispensable.

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