McCormick R D, Meisch M G, Ircink F G, Maki D G
Infection Control Department, University of Wisconsin Hospitals, University of Wisconsin Medical School, Madison 53792.
Am J Med. 1991 Sep 16;91(3B):301S-307S. doi: 10.1016/0002-9343(91)90386-c.
The world pandemic of acquired immunodeficiency syndrome (AIDS) has focused enormous attention on the problem of accidental sharps injuries sustained by health care workers (HCWs) and the risk of occupationally acquired infection by human immunodeficiency virus (HIV). At the 1980 Conference, we reported a 4-year epidemiologic study (1975-1979) of sharps injuries in HCWs at our hospital. Using the same reporting system and analyses, we now report the epidemiology of sharps injuries in our center during the current AIDS era (1987-1988) and assess trends over the 14-year period. Despite greatly increased institutional efforts to prevent sharps injuries, the annual incidence has increased more than threefold (60.4 to 187.0/1,000 HCWs), reflecting better reporting and increased exposure. Reported injuries by house officers have increased ninefold. Adjusting for inflation, the direct costs of sharps injuries has increased sevenfold ($5,354 to $37,271/year). Environmental service HCWs (305.8 sharps injuries per 1,000 employees) now have the highest incidence in our center, followed by nursing personnel (196.5/1,000) and laboratory personnel (169.9/1,000), but as in 1975-1979, two thirds of all injuries occur in nursing personnel. Although phlebotomy team members have a very low risk per procedure (1/26,871 draws), their annual incidence is extraordinarily high, 407.0/1,000. Injuries continue to occur mainly during disposal of waste, linen, or used procedure trays (19.7% of all injuries), administration of parenteral injections or infusion therapy (15.7%), surgery (16.0%), blood drawing (13.3%), or recapping of used needles (10.1%). Making disposal units available at every bedside has reduced injuries from needle disposal two-fold since 1975-1979. With consistent application of a stringent postexposure protocol, and wide acceptance of the hepatitis B vaccine, we have had no sharps injury-related infections during the past 3 years. These data indicate the increasing risk, complexity and cost of sharps injuries in HCWs and the need for more innovative--ideally, technology-based--approaches to prevention. Certain groups of HCWs are at very high risk. Comprehensive postexposure protocols that are uniformly applied can provide substantial protection to exposed HCWs.
获得性免疫缺陷综合征（艾滋病）的全球大流行，已将极大的关注聚焦于医护人员意外锐器伤问题以及职业性感染人类免疫缺陷病毒（HIV）的风险。在1980年的会议上，我们报告了一项针对我院医护人员锐器伤的为期4年（1975 - 1979年）的流行病学研究。运用相同的报告系统和分析方法，我们现在报告当前艾滋病时代（1987 - 1988年）我院中心锐器伤的流行病学情况，并评估这14年期间的趋势。尽管机构在预防锐器伤方面付出了巨大努力，但年发病率仍增加了两倍多（从60.4/1000名医护人员增至187.0/1000名医护人员），这反映出报告情况有所改善以及暴露增加。住院医师报告的锐器伤增加了九倍。经通胀调整后，锐器伤的直接成本增加了七倍（从每年5354美元增至37271美元）。环境服务医护人员（每1000名员工中有305.8次锐器伤）现在在我院中心的发病率最高，其次是护理人员（196.5/1000）和实验室人员（169.9/1000），但与1975 - 1979年一样，所有损伤中有三分之二发生在护理人员身上。尽管静脉穿刺团队成员每次操作的风险很低（1/26871次采血），但其年发病率却异常高，为407.0/1000。损伤仍主要发生在处理废物、床单或用过的操作托盘期间（占所有损伤的19.7%）、进行皮下注射或输液治疗时（15.7%）、手术过程中（16.0%）、采血时（13.3%）或回套使用过的针头时（10.1%）。自1975 - 1979年以来，在每个床边配备处置装置已使针头处置导致的损伤减少了一半。通过持续应用严格的暴露后处理方案以及广泛接种乙肝疫苗，在过去3年中我们没有发生与锐器伤相关的感染。这些数据表明医护人员锐器伤的风险、复杂性和成本在增加，并且需要更多创新的——理想情况下是基于技术的——预防方法。某些医护人员群体处于非常高的风险中。统一应用的全面暴露后处理方案可为暴露的医护人员提供实质性保护。
