Osborn E H, Papadakis M A, Gerberding J L
Palo Alto Medical Foundation, California 94301, USA.
Ann Intern Med. 1999 Jan 5;130(1):45-51. doi: 10.7326/0003-4819-130-1-199901050-00009.
Medical students may be at high risk for occupational exposures to blood.
To measure the frequency of medical students' exposure to infectious body substances, to identify factors that affect the probability of such exposure, and to suggest targets for the prevention of such exposure.
Review of all exposures reported by medical students at the University of California, San Francisco, School of Medicine.
Teaching hospitals affiliated with the University of California, San Francisco.
Third- and fourth-year medical students from the classes of 1990 through 1996 at the University of California, San Francisco, School of Medicine.
A needlestick hotline service was instituted at teaching hospitals affiliated with the University of California, San Francisco, and a required course was created to train students in universal precautions and clinical skills before the beginning of the third-year clerkship.
Reports of exposures made to the needlestick hotline service, including type of exposure, training site, clerkship, and time of year.
119 of 1022 medical students sustained 129 exposures. Of these exposures, 82% occurred on four services: obstetrics-gynecology, surgery, medicine, and emergency medicine. The probability of exposure was not related to graduation year, clerkship location, previous clerkship experience, or training site. Surveys of two graduating classes at the beginning and end of the study showed that the percentage of exposures reported increased from 45% to 65% over the 7-year study period. Thus, the reported injury rates represent minimum estimates of actual occurrences. Human immunodeficiency virus infection and hepatitis were not reported, although follow-up was limited.
Instruction in universal precautions and clinical procedures is not sufficient to prevent exposures to blood during medical training. Medical schools must assume greater responsibility for ensuring that students are proficient in the safe conduct of clinical procedures and must develop systems that protect students so that they can report and learn from their mistakes.
医学生职业暴露于血液的风险可能很高。
测定医学生接触传染性体液的频率，确定影响此类暴露可能性的因素，并提出预防此类暴露的目标。
回顾加利福尼亚大学旧金山分校医学院医学生报告的所有暴露情况。
加利福尼亚大学旧金山分校附属教学医院。
加利福尼亚大学旧金山分校医学院1990年至1996年班级的三、四年级医学生。
在加利福尼亚大学旧金山分校附属教学医院设立了针刺热线服务，并开设了一门必修课，在三年级实习开始前培训学生普遍预防措施和临床技能。
向针刺热线服务报告的暴露情况，包括暴露类型、培训地点、实习科室和年份。
1022名医学生中有119名发生了129次暴露。在这些暴露中，82%发生在四个科室：妇产科、外科、内科和急诊医学科。暴露的可能性与毕业年份、实习地点、以前的实习经验或培训地点无关。在研究开始和结束时对两个毕业班的调查显示，在7年的研究期间，报告的暴露百分比从45%增加到65%。因此，报告的受伤率只是实际发生情况的最低估计。尽管随访有限，但未报告有人类免疫缺陷病毒感染和肝炎病例。
普遍预防措施和临床程序方面的教学不足以防止医学培训期间暴露于血液。医学院校必须承担更大的责任，确保学生熟练掌握安全的临床操作程序，并必须建立保护学生的系统，以便他们能够报告错误并从中吸取教训。
