Wong E S, Stotka J L, Chinchilli V M, Williams D S, Stuart C G, Markowitz S M
Medical Service, Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, VA 23249.
JAMA. 1991 Mar 6;265(9):1123-8.
Using a daily questionnaire, we prospectively studied 277 physicians from two hospital medical services for incidents of exposure to blood and body fluids and barrier use before and after the implementation of universal precautions. We found that implementation significantly increased the frequency of barrier use during exposure incidents from 54% before implementation to 73% after implementation of universal precautions. Implementation led to a decrease in the number of exposure incidents that resulted in direct contact with blood and body fluids (actual exposures), from 5.07 to 2.66 exposures per physician per patient care month, and to an increase in averted exposures in which direct contact was prevented by the use of barrier devices, from 3.41 exposures per patient care month before implementation to 5.90 exposures per patient care month after implementation. Implementation affected neither the types of body fluid or procedures involved nor the overall rate of exposure incidents (8.5 per patient care month) but, through an increase in barrier use, it did prevent direct contact with blood and body fluids and thus converted what would have been an actual exposure into an averted one. We conclude that universal precautions were effective in reducing the risk of occupational exposures among physicians on a medical service.
我们使用每日问卷，对两家医院医疗服务部门的277名医生进行了前瞻性研究，以了解在实施普遍预防措施前后，他们接触血液和体液的事件以及屏障使用情况。我们发现，实施普遍预防措施后，暴露事件期间屏障的使用频率显著增加，从实施前的54%提高到实施后的73%。实施普遍预防措施导致直接接触血液和体液（实际暴露）的暴露事件数量减少，从每位医生每月每例患者护理中的5.07次暴露降至2.66次，同时通过使用屏障装置防止直接接触而避免的暴露事件增加，从实施前每位患者护理每月3.41次暴露增加到实施后5.90次。实施普遍预防措施既未影响所涉及的体液类型或操作，也未影响暴露事件的总体发生率（每位患者护理每月8.5次），但通过增加屏障的使用，确实防止了与血液和体液的直接接触，从而将原本会发生的实际暴露转化为可避免的暴露。我们得出结论，普遍预防措施在降低医疗服务部门医生职业暴露风险方面是有效的。
