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在一家三级医疗中心减少针刺伤的干预措施。

Interventions to reduce needle stick injuries at a tertiary care centre.

作者信息

Mehta A, Rodrigues C, Singhal T, Lopes N, D'Souza N, Sathe K, Dastur F D

机构信息

Department of Microbiology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai - 400 016, India.

出版信息

Indian J Med Microbiol. 2010 Jan-Mar;28(1):17-20. doi: 10.4103/0255-0857.58722.

Abstract

BACKGROUND

Occupational exposure to blood/body fluids is associated with risk of infection with blood borne pathogens like human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV).

MATERIALS AND METHODS

We carefully document needle stick injuries (NSI) and implement post-exposure prophylaxis (PEP). We report a four-year continuing surveillance study where 342 healthcare workers (HCWs) sustained NSI. PEP was given to HCWs injured from seropositive sources. If the source was HbsAg positive, HCWs were given a hepatitis B immunization booster. If the HCW was antiHBs negative, both hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine were administered. For HCWs who sustained injuries from HIV positive sources, antiretroviral therapy was started. Follow-up was done after three and six months of exposure. Recent interventions by the infection control committee at our hospital reduced NSI considerably during intravenous line administration and glucose monitoring.

RESULTS AND DISCUSSION

Of 342 injuries, 254 were from known sources and 88 from unknown sources. From known sources, 37 were seropositive; 13 for HIV, 15 for HCV, nine for HBV. Sixty six sharp injuries were sustained through garbage bags, 43 during IV line administration, 41 during injection administration, 35 during needle recapping, 32 during blood collection, 27 during blood glucose monitoring, 24 from OT instruments, 17 during needle disposal, 16 while using surgical blade, 7 during suturing and 34 from miscellaneous sources.

CONCLUSION

No case of seroconversion has taken place, so far, as a result of needle stick injuries at our centre.

摘要

背景

职业性接触血液/体液与感染血源性病原体(如人类免疫缺陷病毒(HIV)、乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV))的风险相关。

材料与方法

我们仔细记录针刺伤(NSI)并实施暴露后预防(PEP)。我们报告了一项为期四年的持续监测研究,其中342名医护人员发生了针刺伤。对来自血清学阳性源受伤的医护人员给予暴露后预防。如果源为乙肝表面抗原(HbsAg)阳性,则给医护人员注射乙肝疫苗加强针。如果医护人员乙肝表面抗体(antiHBs)阴性,则同时给予乙肝免疫球蛋白(HBIG)和乙肝疫苗。对于来自HIV阳性源受伤的医护人员,开始抗逆转录病毒治疗。在暴露后三个月和六个月进行随访。我们医院感染控制委员会最近的干预措施在静脉输液和血糖监测期间显著减少了针刺伤。

结果与讨论

在342例损伤中,254例来自已知源,88例来自未知源。在已知源中,37例为血清学阳性;13例为HIV阳性,15例为HCV阳性,9例为HBV阳性。通过垃圾袋造成66例锐器伤,静脉输液期间43例,注射给药期间41例,针头回套期间35例,采血期间32例,血糖监测期间27例,手术室器械造成24例,针头处理期间17例,使用手术刀片时16例,缝合期间7例,其他来源34例。

结论

到目前为止,我们中心尚未发生因针刺伤导致血清转化的病例。

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