Nelsing S, Nielsen T L, Nielsen J O
Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Denmark.
Eur J Epidemiol. 1997 Jun;13(4):387-93. doi: 10.1023/a:1007369016717.
The objective of this study was to describe the mechanisms of percutaneous blood exposure (PCE) among doctors and discuss rational strategies for prevention. Data were obtained as part of a nation-wide questionnaire survey of occupational blood exposure among hospital employed doctors in Denmark. The doctors were asked to describe their most recent PCE, if any, within the previous 3 months. Detailed information on the instruments, procedures, circumstances and mechanisms that caused the PCE was obtained. Of 9375 doctors, 6256 (67%) responded, and 6005 questionnaires were eligible for analysis. Of 971 described PCE the majority were caused by suture needles (n = 483), i.v.-catheter-stylets (n = 94), injection needles (n = 75), phlebotomy needles (n = 53), scalpels (n = 45), arterial blood sample needles (n = 41) and bone fragments (n = 23). Inattentiveness was the most common cause, contributing to 30.5% of all PCE. Use of fingers rather than instruments was a major cause of injury in surgical specialities and was a contributing cause of 36.9% PCE on suture needles. Common contributing causes when fingers were used (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. It was often argued that instruments were not practical to use or might harm the tissue. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines like recapping only, but other mechanisms like sudden patient movements and 'acute situation' were common, especially in the case of PCE on i.v.-catheter-stylets. It is concluded that the exposure mechanisms of PCE reflect both unsafe routines, difficult working conditions and unsafe devices. Education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.
本研究的目的是描述医生经皮血液暴露（PCE）的机制，并探讨合理的预防策略。数据是作为丹麦医院在职医生职业血液暴露全国问卷调查的一部分获得的。要求医生描述他们在过去3个月内最近一次的PCE（如有）。获取了有关导致PCE的器械、操作程序、情况和机制的详细信息。在9375名医生中，6256名（67%）做出了回应，6005份问卷符合分析条件。在971起描述的PCE中，大多数是由缝合针（n = 483）、静脉导管芯（n = 94）、注射针（n = 75）、静脉穿刺针（n = 53）、手术刀（n = 45）、动脉血采样针（n = 41）和骨碎片（n = 23）引起的。注意力不集中是最常见的原因，占所有PCE的30.5%。在外科专业中，用手指而非器械是受伤的主要原因，是缝合针PCE的36.9%的促成原因。使用手指时（n = 199）常见的促成原因是手术区域空间狭小（30.2%）或视野不佳（18.6%）。人们经常认为器械使用起来不方便或可能会损伤组织。在外科专业的689起PCE中，17.4%是由同事造成的。高达53.3%的空心针PCE可归因于仅重新盖帽等不安全操作，但其他机制如患者突然移动和“紧急情况”也很常见，尤其是在静脉导管芯PCE的情况下。结论是，PCE的暴露机制既反映了不安全操作、工作条件困难，也反映了不安全器械。所有专业都需要进行更安全工作操作的教育。在外科专业中，引入更安全的器械应具有高度优先性，在非外科专业中也应予以考虑。
