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麻醉医生感染乙型肝炎病毒:风险与预防

Anesthesiologists' acquisition of hepatitis B virus infection: Risk and prevention.

作者信息

Tian Jingling, Tan Fang, Lai Lifei, Deng Yingqing, Chi Xinjin, Geng Hongfang, Zhu Qianqian

机构信息

Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City.

Department of Anesthesiology, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou City, China.

出版信息

Medicine (Baltimore). 2019 Jul;98(29):e16416. doi: 10.1097/MD.0000000000016416.

Abstract

Occupational exposure remains a serious problem for medical staff, especially those working in operation rooms. Hepatitis B virus (HBV) is prevalent in patients undergoing surgery, and anesthesiologists are at risk of occupational acquisition of blood-borne HBV infection. To the best of our knowledge, there are no data about HBV prevalence and vaccinations, as well as attitudes toward sharp injuries and gloving among anesthesiologists in China, where the HBV prevalence is high. To clarify these, the present study was conducted.An electronic questionnaire including HBV markers, gloving during practice, and reporting patterns of sharp injuries was created and sent to anesthesiologists.After excluding 10 uncompleted questionnaires, 1739 questionnaires were included in the final analysis. Of all analyzed anesthesiologists, 1599 (91.9%) had experienced sharp injuries, and 1313 (75.5%) had experienced >1 sharp injury. Considering HBV vaccination histories, 1381 anesthesiologists (79.4%) received 3 vaccination doses, and only half of the immunized anesthesiologists received reminder HBV vaccination doses after work before exposure. There were 696 anesthesiologists (40.0% of all participants) who were ever exposed to HBV, and nearly two-thirds of them (440) were exposed to HBV more than once. There was a more positive attitude toward gloving and double-gloving to reduce HBV exposure.The incidence of occupational HBV exposure among anesthesiologists is high, and its threat should be considered. HBV vaccinations and adherence to postexposure guidelines are recommended. The high prevalence of sharp injuries during anesthesia practice highlights the importance of safe anesthesia practices, such as gloving or double-gloving, especially when in contact with high-risk body fluids.

摘要

职业暴露对医务人员来说仍然是一个严重问题,尤其是那些在手术室工作的人员。乙肝病毒(HBV)在接受手术的患者中很普遍,麻醉医生有职业性感染血源性HBV的风险。据我们所知,在中国这个HBV流行率较高的国家,尚无关于麻醉医生中HBV流行率、疫苗接种情况以及对锐器伤和戴手套态度的数据。为了阐明这些情况,开展了本研究。设计了一份包括HBV标志物、执业期间戴手套情况以及锐器伤报告模式的电子调查问卷,并发送给麻醉医生。在排除10份未完成的问卷后,最终分析纳入了1739份问卷。在所有分析的麻醉医生中,1599人(91.9%)曾经历过锐器伤,1313人(75.5%)经历过1次以上锐器伤。考虑到HBV疫苗接种史,1381名麻醉医生(79.4%)接种了3剂疫苗,而在工作且暴露前,只有一半的已接种疫苗的麻醉医生接受了HBV疫苗补种提醒。有696名麻醉医生(占所有参与者的40.0%)曾接触过HBV,其中近三分之二(440人)不止一次接触过HBV。对于戴手套和双层戴手套以减少HBV暴露,态度更为积极。麻醉医生职业性HBV暴露的发生率很高,应考虑其威胁。建议进行HBV疫苗接种并遵守暴露后指南。麻醉操作过程中锐器伤的高发生率凸显了安全麻醉操作的重要性,如戴手套或双层戴手套,尤其是在接触高危体液时。

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