Marini Michelle A, Giangregorio Maeve, Kraskinski Joanna C
*Emergency Services, Children's Hospital, Boston, MA; †Intravenous Therapy Team, Children's Hospital, Boston, MA; ‡Occupational Health Services, Children's Hospital, Boston, MA.
Pediatr Emerg Care. 2004 Mar;20(3):209-214. doi: 10.1097/01.pec.0000117932.65522.93.
Preventing the transmission of bloodborne pathogens to healthcare workers has been a mission and a challenge of the healthcare industry for over 20 years. The development of the Occupational Safety and Health Administration Bloodborne Pathogens Standard in 1991 and the passing of the Needlestick Safety Act in 2000 mandated hospitals to develop an Exposure Control Plan to protect workers from these pathogens. Children's Hospital Boston began implementation of a needleless system in 1993. Employees readily accepted these systems into practice, because they were convenient and easy to use. A marked decrease in exposures to bloodborne pathogens naturally followed, which is consistent with the national data. The transition to intravenous (i.v.) safety devices at Children's Hospital began in 2000 and proved to be more of a challenge. First, the clinicians must choose a safety product, which requires developing and implementing a trial plan with potential catheters. This selection process is especially difficult in pediatrics where successful placement of the smallest-gauge catheter, no. 24, is imperative. After choosing an i.v. safety product, successful transition is dependent upon the thoroughness of i.v. safety device training and a commitment by the clinicians to the use of these products. Although the number of needlestick injuries and subsequent transmission of bloodborne pathogens have been further reduced with the use of i.v. safety devices, needlestick injuries still occur. This results from a lack of familiarity with the engineering of the device and therefore poor technique or a failure to activate the safety mechanism. Staff resistance due to loss of expertise with the new device and patient care concerns are additional barriers to the use of these new products. Addressing these obstacles and providing adequate training for all clinicians were required for successful implementation of these i.v. safety devices.
二十多年来，防止血源性病原体传播给医护人员一直是医疗行业的一项使命和挑战。1991年职业安全与健康管理局的《血源性病原体标准》的制定以及2000年《针刺安全法案》的通过，要求医院制定暴露控制计划以保护工作人员免受这些病原体的侵害。波士顿儿童医院于1993年开始实施无针系统。员工们欣然接受并将这些系统应用于实践，因为它们方便易用。随之而来的是血源性病原体暴露的显著减少，这与全国数据一致。波士顿儿童医院向静脉（i.v.）安全装置的过渡始于2000年，事实证明这更具挑战性。首先，临床医生必须选择一种安全产品，这需要制定并实施一项针对潜在导管的试验计划。在儿科，这种选择过程尤其困难，因为成功插入最小规格的24号导管至关重要。选择静脉安全产品后，成功过渡取决于静脉安全装置培训的彻底性以及临床医生对使用这些产品的承诺。尽管使用静脉安全装置进一步减少了针刺伤的数量以及血源性病原体的后续传播，但针刺伤仍有发生。这是由于对该装置的设计缺乏了解，从而导致技术欠佳或未能启动安全机制。由于对新装置缺乏专业知识以及对患者护理的担忧而产生的员工抵触情绪，是使用这些新产品的额外障碍。要成功实施这些静脉安全装置，就需要克服这些障碍并为所有临床医生提供充分的培训。
