应对医疗保健中的针刺伤和锐器伤：一所大学教学医院十年的抗争与进步

Confronting needlestick and sharp injuries in healthcare: a decade of struggle and progress in a university teaching hospital.

作者信息

Wong Shuk-Ching, Yuen Lithia Lai-Ha, Lam Germaine Kit-Ming, Kwok Monica Oi-Tung, Siu Crystal Yuen-Ki, Li Bella Hong-Yan, Chen Jonathan Hon-Kwan, So Simon Yung-Chun, Chiu Kelvin Hei-Yeung, Cheng Vincent Chi-Chung

机构信息

Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Pokfulam, Hong Kong Special Administrative Region, China.

Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.

出版信息

BMC Health Serv Res. 2025 Feb 1;25(1):195. doi: 10.1186/s12913-025-12345-0.

DOI:10.1186/s12913-025-12345-0

PMID:39893447

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11787756/

Abstract

BACKGROUND

Needlestick and sharp injuries (NSIs) among healthcare workers (HCWs) are a significant concern in infection prevention. This study analyzes the incidence and characteristics of NSIs at Queen Mary Hospital and assesses the effectiveness of targeted training programs for interns.

METHODS

A retrospective analysis was conducted on NSI reports from 2014 to 2023, focusing on episodes involving medical, nursing, allied health, and other staff. Personal coaching training programs for newly recruited interns were implemented in 2019 to enhance safety practices. NSI episodes were analyzed in relation to patient days and full-time equivalents (FTE).

RESULTS

During the study period, there was a mean of 464,118 patient days per year, with an average of 5,928 HCWs per year. A total of 1,076 NSI episodes were reported, resulting in a mean of 2.31 episodes per 10,000 patient days and 1.82 episodes per 100 FTE. Medical staff accounted for 502 episodes (47%), while nursing staff had 339 episodes (32%). The mean NSI episodes among medical staff were significantly higher than nursing staff per year, measured per 10,000 patient days (1.08 ± 0.21 vs. 0.73 ± 0.16, p = 0.001) and per 100 FTE (8.46 ± 1.95 vs. 1.62 ± 0.40, p < 0.001). Of the 1,076 episodes, 430 (40%) occurred in HCWs with less than 1 year of experience, with 278 (65%) attributed to interns, contributing to 26% of the overall NSI burden. Most incidents among interns occurred in wards (95%, 264/278), with 95% (252/264) involving hollow needles. Notably, 54% (149/278) involved safety-equipped devices, yet 94% (140/149) of these were not activated properly. Following targeted training, NSI rates among interns significantly decreased from 0.82 to 0.46 per 10,000 patient days (R = 0.977, p = 0.001) and from 6.84 to 3.40 per 100 FTE (R = 0.874, p = 0.020) from 2019 to 2023.

CONCLUSIONS

The study highlights the ongoing issue of NSIs among HCWs, especially inexperienced interns. While training programs have shown promise in reducing NSI rates, the high incidence of safety devices not being effectively utilized underscores the need for continuous education and hands-on training to enhance safety practices and prevent NSIs in healthcare settings.

摘要

背景

医护人员的针刺伤和锐器伤是感染预防中的一个重大问题。本研究分析了玛丽医院针刺伤和锐器伤的发生率及特征，并评估了针对实习生的定向培训计划的效果。

方法

对2014年至2023年的针刺伤和锐器伤报告进行回顾性分析，重点关注涉及医疗、护理、专职医疗及其他工作人员的事件。2019年为新入职实习生实施了个人辅导培训计划，以加强安全操作。针刺伤和锐器伤事件根据患者住院天数和全职等效人员（FTE）进行分析。

结果

在研究期间，每年平均有464,118个患者住院日，每年平均有5928名医护人员。共报告了1076起针刺伤和锐器伤事件，平均每10000个患者住院日发生2.31起，每100个FTE发生1.82起。医务人员占502起事件（47%），而护理人员有339起事件（32%）。按每10000个患者住院日计算，每年医务人员的针刺伤和锐器伤事件平均发生率显著高于护理人员（1.08±0.21对0.73±0.16，p = 0.001），按每100个FTE计算也是如此（8.46±1.95对1.62±0.40，p < 0.001）。在1076起事件中，430起（40%）发生在经验不足1年的医护人员中，其中278起（65%）归因于实习生，占针刺伤和锐器伤总负担的26%。实习生中的大多数事件发生在病房（95%，264/278），其中95%（252/264）涉及空心针。值得注意的是，54%（149/278）涉及配备安全装置的器械，但其中94%（140/149）未正确启动。经过定向培训后，实习生的针刺伤和锐器伤发生率从每10000个患者住院日的0.82显著降至0.46（R = 0.977，p = 0.001），从每100个FTE的6.84降至3.40（R = 0.874，p = 0.020），从2019年到2023年。