人群中重复使用注射器的风险：估计血源性疾病传播的概率。

Population risk of syringe reuse: estimating the probability of transmitting bloodborne disease.

机构信息

Community Medicine Residency Program, School of Public Health, University of Alberta, Edmonton, Canada.

出版信息

Infect Control Hosp Epidemiol. 2010 Jul;31(7):748-54. doi: 10.1086/653200.

DOI:10.1086/653200

PMID:20509761

Abstract

BACKGROUND

In 2008, the Medical Officer of Health at Alberta Health Services (Edmonton, Canada) was notified that, in some practice settings, a syringe was used to administer medication through the side port of an intravenous circuit and then the syringe, with residual drug, was used to administer medication to other patients in the same manner. This practice has been implicated in several outbreaks of bloodborne infection in hospital and clinic settings.

METHODS

A risk assessment model was developed to predict the risk of a patient contracting a bloodborne viral infection from the practice. The risk of transmission was defined as the product of 5 factors: (1) the population prevalence of a specific bloodborne pathogen, (2) the probability of finding a viral bloodborne pathogen in an intravenous circuit, (3) the rate of syringe reuse, (4) the probability of causing disease given a bloodborne pathogen exposure, and (5) the susceptibility of the exposed person.

RESULTS

The risk was modeled first with consistent use of the proximal port of the intravenous circuit. The risk of transmission of hepatitis B virus was approximately 12-53 transmission events per 1,000,000 exposure events for a range of practice probabilities (ie, frequency of the risk practice) from 20% to 80%, respectively. The risk of transmission of hepatitis C virus was approximately 1.0-4.3 transmission events per 1,000,000 exposure events for the same practice probability range, and the risk of transmission of human immunodeficiency virus was approximately 0.03-0.15 transmission events per 1,000,000 exposure events for the same practice probability range. The use of the distal port was associated with a 10-fold decrease in the risk.

CONCLUSIONS

Practitioners must practice safe, aseptic injection techniques. The model presented here can be used to estimate the risk of disease transmission in situations where reuse has occurred and can serve as a framework for informing public health action.

摘要

背景

2008 年，艾伯塔省卫生服务部（加拿大埃德蒙顿）的卫生官员接到通知，在某些医疗环境中，有一种做法是将注射器通过静脉输液回路的侧管给药，然后将残留药物的注射器用于以相同方式给其他患者用药。这种做法与医院和诊所环境中发生的几次血源性感染暴发有关。

方法

开发了一种风险评估模型来预测患者因这种做法而感染血源性病毒的风险。传播风险定义为 5 个因素的乘积：（1）特定血源性病原体的人群流行率，（2）静脉输液回路中发现病毒血源性病原体的概率，（3）注射器重复使用的比率，（4）血源性病原体暴露后致病的概率，以及（5）暴露者的易感性。

结果

首先在一致使用静脉输液回路近端管的情况下对风险进行建模。乙型肝炎病毒传播的风险大约为每 100 万次暴露事件有 12-53 次传播事件，对应的做法概率（即风险做法的频率）范围从 20%到 80%。丙型肝炎病毒传播的风险大约为每 100 万次暴露事件有 1.0-4.3 次传播事件，同一做法概率范围，而人类免疫缺陷病毒传播的风险大约为每 100 万次暴露事件有 0.03-0.15 次传播事件。使用远端管与风险降低 10 倍相关。