Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
PLoS One. 2007 Feb 7;2(2):e194. doi: 10.1371/journal.pone.0000194.
Percutaneous exposure incidents (PEIs) and blood splashes on the skin of health care workers are a major concern, since they expose susceptible employees to the risk of infectious diseases. We undertook this study in order to estimate the overall incidence of such injuries in a newly founded tertiary hospital, and to evaluate possible changes in their incidence over time.
METHODOLOGY/PRINCIPAL FINDINGS: We prospectively studied the PEIs and blood splashes on the skin of employees in a newly founded (October 2000) tertiary hospital in Athens, Greece, while a vaccination program against hepatitis B virus, as well as educational activities for avoidance of injuries, were taking place. The study period ranged from October 1, 2002 to February 28, 2005. Serologic studies for hepatitis B (HBV) and C virus (HCV) as well as human immunodeficiency virus (HIV) were performed in all injured employees and the source patients, when known. High-titer immunoglobulin (250 IU anti-HBs intramuscularly) and HBV vaccination were given to non-vaccinated or previously vaccinated but serologically non-responders after exposure. Statistical analysis of the data was performed using Mc Nemar's and Fisher's tests. 60 needlestick, 11 sharp injuries, and two splashes leading to exposure of the skin or mucosa to blood were reported during the study period in 71 nurses and two members of the cleaning staff. The overall incidence (percutaneous injuries and splashes) per 100 full-time employment-years (100 FTEYs) for high-risk personnel (nursing, medical, and cleaning staff) was 3.48, whereas the incidence of percutaneous injuries (needlestick and sharp injuries) alone per 100 FTEYs was 3.38. A higher incidence of injuries was noted during the first than in the second half of the study period (4.67 versus 2.29 per 100 FTEYs, p = 0.005). No source patient was found positive for HCV or HIV. The use of high-titer immunoglobulin after adjustment for the incidence of injuries was higher in the first than in the second half of the study period, although the difference was not statistically significant [9/49 (18.37%) vs 1/24 (4.17%), p = 0.15].
CONCLUSIONS/SIGNIFICANCE: Our data show that nurses are the healthcare worker group that reports most of PEIs. Doctors did not report such injuries during the study period in our setting. However, the possibility of even relatively frequent PEIs in doctors cannot be excluded. This is due to underreporting of such events that has been previously described for physicians and surgeons. A decrease of the incidence of PEIs occurred during the operation of this newly founded hospital.
经皮暴露事件（PEI）和医护人员皮肤上的血液飞溅是一个主要关注点，因为它们使易感员工面临传染病的风险。我们进行这项研究是为了估计在一家新成立的三级医院中此类伤害的总体发生率，并评估其随时间变化的发生率。
方法/主要发现：我们在希腊雅典的一家新成立的（2000 年 10 月）三级医院前瞻性研究了员工的 PEI 和皮肤血液飞溅，同时进行了乙型肝炎病毒（HBV）疫苗接种计划和避免受伤的教育活动。研究期间为 2002 年 10 月 1 日至 2005 年 2 月 28 日。对所有受伤员工和已知来源患者进行了乙型肝炎（HBV）和丙型肝炎（HCV）病毒以及人类免疫缺陷病毒（HIV）的血清学研究。对未接种疫苗或以前接种过疫苗但血清学无反应的暴露后人员，给予高滴度免疫球蛋白（250 IU 肌肉内抗-HBs）和 HBV 疫苗接种。使用 McNemar 和 Fisher 检验对数据进行统计分析。在研究期间，71 名护士和两名清洁人员报告了 60 次针刺伤、11 次锐器伤和两次飞溅，导致皮肤或黏膜暴露于血液。高风险人员（护理、医疗和清洁人员）每 100 个全职工作年（100 FTEY）的总体（经皮损伤和飞溅）发生率为 3.48，而每 100 FTEY 的经皮损伤（针刺伤和锐器伤）发生率为 3.38。与研究的后半段相比，前半段受伤的发生率更高（每 100 FTEY 分别为 4.67 和 2.29，p=0.005）。未发现来源患者 HCV 或 HIV 阳性。尽管差异无统计学意义[9/49（18.37%）与 1/24（4.17%），p=0.15]，但在研究的前半段，受伤后使用高滴度免疫球蛋白的情况高于后半段。
结论/意义：我们的数据表明，护士是报告经皮暴露事件最多的医护人员群体。在我们的研究环境中，医生在研究期间没有报告此类伤害。然而，不能排除医生中也存在相对频繁的经皮暴露事件的可能性。这是由于之前描述的医生和外科医生对此类事件的报告不足。在这家新成立的医院运营期间，经皮暴露事件的发生率有所下降。
