Brasel Karen J, Mol Christopher, Kolker Alex, Weigelt John A
Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
J Surg Educ. 2007 Nov-Dec;64(6):395-8. doi: 10.1016/j.jsurg.2007.04.003.
Exposure to blood-borne diseases remains an occupational risk. Mandates have improved training in how to report exposures for all health-care workers. How exposure rates of surgical residents correlate with experience and mandatory training to reduce risk is not known. It was hypothesized that enhanced training would result in an increased reporting of exposures by surgical trainees and that risk would be greater in the first years of training.
Retrospective review of occupational health records and operative case logs, prospective survey.
Occupational Health Services provides both initial and annual training to General Surgery house staff at the Medical College of Wisconsin. Initial training consists of a blood-borne pathogen review and a detailed explanation of exposure reporting. Mandatory annual training is provided during Surgical Grand Rounds. Training was enhanced beginning June 2005 using a videotape outlining surgical risks and specific countermeasures. The numbers of reported exposures per year before and after enhanced training were compared. Exposures were self-reported. As most exposures occurred in the operating room, rate of exposure was calculated for each year of training using the total number of cases done each year reported by the general surgical residents.
Surgical residents reported 118 needlestick injuries over 6 years. Senior and chief residents demonstrated a significantly lower exposure rate than junior residents (nonparametric Mood's median test, p < 0.0001). No significant difference in the injury rate was found per 1000 cases after enhanced training.
Increasing surgical experience lowered the needlestick injury rate. Assuming no change in self-reporting rates by year, enhanced training and reporting guidelines did not seem to change risk. More specific training for junior residents, as well as passive prevention solutions, may be necessary to positively impact their exposure risk.
接触血源性病原体仍然是一种职业风险。相关规定已改善了针对所有医护人员的暴露报告培训。外科住院医师的暴露率与经验以及降低风险的强制培训之间的关联尚不清楚。研究假设强化培训将导致外科实习医生报告的暴露事件增加，且在培训的头几年风险会更高。
对职业健康记录和手术病例日志进行回顾性审查，开展前瞻性调查。
职业健康服务部门为威斯康星医学院普通外科住院医师提供初始培训和年度培训。初始培训包括血源性病原体复习以及暴露报告的详细解释。在外科大查房期间提供年度强制培训。从2005年6月开始，使用一盘概述手术风险和具体应对措施的录像带强化培训。比较强化培训前后每年报告的暴露事件数量。暴露事件由自我报告。由于大多数暴露事件发生在手术室，使用普通外科住院医师报告的每年完成的病例总数计算每年培训期间的暴露率。
外科住院医师在6年期间报告了118起针刺伤事件。高级和主治住院医师的暴露率明显低于初级住院医师（非参数Mood中位数检验，p<0.0001）。强化培训后每1000例病例的损伤率未发现显著差异。
增加手术经验可降低针刺伤率。假设每年自我报告率不变，强化培训和报告指南似乎并未改变风险。可能需要为初级住院医师提供更具体的培训以及被动预防措施，以切实影响他们的暴露风险。
