Merchant Roland C, Becker Bruce M, Mayer Kenneth H, Fuerch Janene, Schreck Barbara
Section of Emergency Medicine, Brown Medical School, Rhode Island Hospital, Providence 02903, USA.
Acad Emerg Med. 2003 Dec;10(12):1345-53. doi: 10.1111/j.1553-2712.2003.tb00009.x.
To determine the frequency and type of patient visits for blood or body fluid exposures to a large, urban emergency department (ED); to ascertain the frequency that human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) was prescribed for these exposures; and to compare HIV PEP usage by patient group, occupation, and exposure type.
Retrospective medical record review of ED patient visits (January 1, 1995, through June 30, 2001) extracted from two separate billing record computerized databases using 14 ICD-9 codes that defined blood or body fluid exposures.
Of the 1,436 visits, 22% were by health care workers (HCWs) and 78% by non-HCW adults, adolescents, or children. Sixty percent of the HCWs sustained needlestick or sharp injuries, 73% of non-HCW adults had human bites, and 81% of adolescents and children had sexual exposures. Nurses were the largest group of HCWs, whereas police, correction officers, and security guards were the largest group of non-HCWs exposed at work. HCWs and non-HCW adults who sustained nonsexual exposures were much more likely to present for an evaluation within 24 hours than adolescents or children who suffered sexual assault (p<0.001). HIV PEP was prescribed 143 times: 92 to HCWs and 51 to all other patients. HIV PEP was most often prescribed to HCWs sustaining needlestick injuries.
The majority of patients were not HCWs, which attests to the need for national, nonoccupational blood or body fluid management guidelines. There may be particular groups who would benefit from educational campaigns informing them of the need for early-intervention, postexposure measures to prevent an HIV infection.
确定一家大型城市急诊科（ED）因血液或体液暴露而就诊的患者的频率和类型；确定针对这些暴露开具人类免疫缺陷病毒（HIV）暴露后预防（PEP）的频率；并比较不同患者群体、职业和暴露类型的HIV PEP使用情况。
对1995年1月1日至2001年6月30日期间ED患者就诊情况进行回顾性病历审查，从两个单独的计费记录计算机数据库中提取数据，使用14个国际疾病分类第九版（ICD - 9）代码来定义血液或体液暴露。
在1436次就诊中，22%为医护人员（HCW），78%为非医护人员的成人、青少年或儿童。60%的医护人员遭受针刺或锐器伤，73%的非医护人员成人被人咬伤，81%的青少年和儿童有性暴露。护士是医护人员中最大的群体，而警察、惩教人员和保安是工作中暴露的非医护人员中最大的群体。遭受非性暴露的医护人员和非医护人员成人比遭受性侵犯的青少年或儿童更有可能在24小时内就诊进行评估（p<0.001）。共开具HIV PEP 143次：给医护人员92次，给所有其他患者51次。HIV PEP最常开给遭受针刺伤的医护人员。
大多数患者不是医护人员，这证明需要制定国家非职业性血液或体液管理指南。可能有特定群体将从教育活动中受益，这些活动告知他们早期干预、暴露后预防措施以预防HIV感染的必要性。
