McCarthy G M, Koval J J, MacDonald J K
School of Dentistry, Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Canada.
Infect Control Hosp Epidemiol. 1999 May;20(5):331-6. doi: 10.1086/501626.
To measure the frequency of occupational exposures reported by dentists in Canada and to identify factors associated with occupational exposure.
A national mailed survey of a stratified random sample of 6,444 dentists with three follow-up attempts. Weighted data were analyzed using t tests, analysis of variance, and multiple logistic regression.
The response rate was approximately 66%. Occupational exposures, percutaneous injuries, and mucous membrane exposures in the last year were reported by 67%, 62%, and 29% of respondents, respectively. Fewer than 1% reported exposure to human immunodeficiency virus or hepatitis B virus (HBV). Respondents reported means of 1.5 mucous membrane and 3.0 percutaneous exposures per year. HBV immunization was reported by 91% of dentists, but of these 28% reported no post-immunization serology. Other reports of suboptimal compliance included use of a postexposure protocol by only 41% and HBV vaccination of all assistants or of hygienists by 74% and 77% of respondents, respectively. Factors associated with percutaneous exposure included non-use of postexposure protocol or puncture-proof containers for sharps disposal, treating > or =20 patients per day, and male gender. Risk factors for mucous membrane exposure included non-use of eye protection or masks.
This study provides evidence of the protective effect of puncture-proof containers, eye protection, and masks and raises concerns related to HBV post-immunization serology and postexposure protocols. To reduce risk of infection, educational interventions are required to improve compliance with Universal Precautions, with emphasis on comprehensive HBV immunization and post-immunization serology, the use of barriers, puncture-proof containers for sharps disposal, and postexposure protocols.
测量加拿大牙医报告的职业暴露频率,并确定与职业暴露相关的因素。
对6444名牙医进行分层随机抽样的全国邮寄调查,并进行三次随访尝试。使用t检验、方差分析和多元逻辑回归对加权数据进行分析。
回复率约为66%。分别有67%、62%和29%的受访者报告了去年的职业暴露、经皮损伤和黏膜暴露。报告接触人类免疫缺陷病毒或乙型肝炎病毒(HBV)的受访者不到1%。受访者报告每年黏膜暴露的平均次数为1.5次,经皮暴露为3.0次。91%的牙医报告接种了HBV疫苗,但其中28%报告未进行接种后血清学检测。其他关于依从性欠佳的报告包括只有41%的人使用了暴露后处理方案,分别有74%和77%的受访者为所有助手或口腔保健员接种了HBV疫苗。与经皮暴露相关的因素包括未使用暴露后处理方案或用于锐器处理的防穿刺容器、每天治疗≥20名患者以及男性。黏膜暴露的危险因素包括未使用眼部防护用品或口罩。
本研究提供了防穿刺容器、眼部防护用品和口罩具有保护作用的证据,并引发了对HBV接种后血清学检测和暴露后处理方案的关注。为降低感染风险,需要开展教育干预措施,以提高对通用预防措施的依从性,重点是全面的HBV免疫接种和接种后血清学检测、使用屏障、用于锐器处理的防穿刺容器以及暴露后处理方案。