一项关于住院医师、医学生和护理人员在急症综合内科病房所遭受的血液和体液暴露情况的分析：一项前瞻性研究。

An analysis of blood and body fluid exposures sustained by house officers, medical students, and nursing personnel on acute-care general medical wards: a prospective study.

作者信息

Stotka J L, Wong E S, Williams D S, Stuart C G, Markowitz S M

机构信息

Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond.

出版信息

Infect Control Hosp Epidemiol. 1991 Oct;12(10):583-90. doi: 10.1086/646246.

DOI:10.1086/646246

PMID:1787308

Abstract

OBJECTIVE

To prospectively examine the epidemiology of blood and body fluid exposures sustained by medicine housestaff, medical school students, registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides (NAs) on general medicine wards and to define problem areas that may be amenable to change.

DESIGN

Daily data collection during 9 months using a self-reporting questionnaire.

SETTING

General medical wards in 2 tertiary referral hospitals.

PARTICIPANTS

Medicine housestaff/students and nursing personnel.

RESULTS

Physicians reported 644 exposures, of which 98 (15.2%), 296 (46.0%), and 250 (38.8%) were sustained by medicine residents, interns, and students, respectively. Blood contact occurred with 591 (91.8%) exposures. For physicians, 575 (89.3%) exposures occurred during venipuncture, intravenous catheter manipulation, and arterial punctures. Interns and students most commonly incurred exposures during venipunctures and intravenous manipulations; residents commonly were exposed during emergent intravenous catheter placements. Five-hundred-twenty-two (81%) exposures occurred between 7 A.M. and 7 P.M. During 524 (81.4%) exposures, physicians were not using barrier devices. Nurses reported 235 exposures, of which 140 (59.6%), 23 (9.8%), and 72 (30.6%) were sustained by RNs, LPNs, and NAs, respectively. RN exposures commonly occurred during intravenous manipulations and glucometer fingersticks. LPNs and NAs incurred a higher percentage of exposures during nonprocedural patient care. Blood contact and wound drainage accounted for 167 (71.1%) and 31 (13.2%) exposures, respectively.

CONCLUSIONS

Exposures to blood and body fluids frequently are incurred by healthcare workers on general medical wards. Efforts to reduce these exposures should be directed not only at improving procedural skills of healthcare workers for venipunctures, intravenous catheter insertions, and glucometer fingersticks, but also in increasing barrier use during procedural and nonprocedural tasks.

摘要

目的

前瞻性研究内科住院医师、医学院学生、注册护士（RN）、执业护士（LPN）和护士助理（NA）在内科普通病房所遭受的血液和体液暴露的流行病学情况，并确定可能需要改进的问题领域。

设计

采用自填问卷，在9个月内每日收集数据。

地点

2家三级转诊医院的内科普通病房。

参与者

内科住院医师/学生和护理人员。

结果

医生报告了644次暴露事件，其中住院医师、实习医师和学生分别占98次（15.2%）、296次（46.0%）和250次（38.8%）。591次（91.8%）暴露事件发生了血液接触。对于医生而言，575次（89.3%）暴露事件发生在静脉穿刺、静脉导管操作和动脉穿刺过程中。实习医师和学生最常在内科住院医师、实习医师和学生分别占98次（15.2%）、296次（46.0%）和250次（38.8%）。591次（91.8%）暴露事件发生了血液接触。对于医生而言，575次（89.3%）暴露事件发生在静脉穿刺、静脉导管操作和动脉穿刺过程中。实习医师和学生最常在静脉穿刺和静脉操作过程中发生暴露；住院医师通常在紧急静脉导管置入过程中发生暴露。522次（81%）暴露事件发生在上午7点至晚上7点之间。在524次（81.4%）暴露事件中，医生未使用防护设备。护士报告了235次暴露事件，其中RN、LPN和NA分别占140次（59.6%）、23次（9.8%）和72次（30.6%）。RN暴露事件通常发生在静脉操作和血糖仪指尖采血过程中。LPN和NA在非程序性患者护理过程中发生暴露的比例较高。血液接触和伤口引流分别占167次（71.1%）和31次（13.2%）暴露事件。