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手术程序特征与锐器相关血液和体液暴露风险

Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure.

作者信息

Myers Douglas J, Lipscomb Hester J, Epling Carol, Hunt Debra, Richardson William, Smith-Lovin Lynn, Dement John M

机构信息

1Occupational and Environmental Medicine Division,Department of Community and Family Medicine,Duke University Medical Center,Durham,North Carolina.

3Division of Biological Safety,Duke University Medical Center,Durham,North Carolina.

出版信息

Infect Control Hosp Epidemiol. 2016 Jan;37(1):80-7. doi: 10.1017/ice.2015.233. Epub 2015 Oct 5.

Abstract

OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87.

摘要

目的 利用在一家大型学术教学医院收集的独特多成分管理数据集,研究手术室中发生经皮血液和体液(BBF)暴露的风险。设计 一项为期10年的回顾性队列研究设计。地点 一家大型学术教学医院。参与者 分析了2001年至2010年期间进行的所有外科手术(n = 333,073)以及报告的2113例BBF暴露事件。方法 计算粗暴露率;采用泊松回归分析风险因素并考虑手术持续时间。将涉及缝合针的BBF暴露与涉及其他器械类型的暴露分开进行检查,以研究风险因素的可能差异。结果 报告的BBF暴露总体发生率为每1000例外科手术6.3例(每1000个手术小时2.9例)。BBF暴露率随估计的患者失血量增加而升高(每1000例手术中失血量为501 - 1000 cc时暴露17.7例,每1000例手术中失血量>1000 cc时暴露26.4例)、手术过程中手术区域内工作人员数量(每1000例手术中有≥15名工作人员进入过手术区域时暴露34.4例)以及手术持续时间(每1000例持续4至<6小时的手术暴露14.3例,每1000例持续≥6小时的手术暴露27.1例)而增加。回归结果显示,与缝合针相关的暴露关联通常更强。结论 结果在很大程度上支持了文献中其他研究的发现。然而,进一步的研究应调查与缝合针相关的BBF暴露和与所有其他器械类型相关的BBF暴露在风险因素方面的差异。《感染控制与医院流行病学》2015年;37(1):80 - 87。

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