综合医院护士某些职业暴露及其干预效果评价的初步研究

发布时间：2018-09-12 07:19

【摘要】：医务人员职业暴露指其在诊疗、护理过程中接触含有毒、有害或病原体等损害健康甚至危及生命的物质。护士工作在临床第一线，与患者接触最密切，面临生物、物理、化学、心理等多种危害因素，为职业暴露中的高危人群。医务人员职业暴露常见的有血源性和呼吸道传染病病原体，一些物理（锐器、放射线、噪声）和化学（化学消毒剂、麻醉气体）因素以及其伴随的心理压力等。其中，锐器伤是医务人员职业暴露感染血源性传播疾病的主要途径。据美国疾病控制中心统计，全国每年发生锐器伤约60万～80万例，护士约占80%。在职业生涯中，护士几乎人人均有锐器伤的经历。近年来随着肿瘤患病率的升高和抗肿瘤药物的不断开发，此类药物的暴露已逐渐成为一种危害较大的因素。抗肿瘤药物大多是细胞毒制剂，具致突变、致癌和致畸性。杀伤癌细胞的同时，对正常细胞也具杀伤作用或损害。配制和使用时，长期低剂量接触，若防护不当则会对自身健康造成一定危害。护士对职业安全防护知识的掌握情况、防护技能水平的高低，不仅直接影响自身健康，也影响患者的安全。故本研究旨在，通过对西安市某三级甲等综合医院护士进行血源性和抗肿瘤药物职业暴露流行病学研究，了解其主要危险因素、引起的损伤及其分布状况，分析暴露的程度和防护知识的普及水平；同时通过职业防护培训、考核等措施进行干预，，分析干预效果，以探索护士血源性和抗肿瘤药物职业暴露的某些规律以及有效的干预模式，为进一步提高职业防护水平提供科学依据。第一部分护士血源性职业暴露及其防护的调查和干预研究目的：了解某综合医院护士血源性职业暴露危险因素、暴露的程度、引起的损伤及其分布状况，以及防护知识的普及水平，并初步评价干预效果。方法：采取整群抽样的方式，于2011年3月对某三级甲等综合医院护士进行问卷调查，内容主要包括洗手、戴手套，锐器伤的发生情况和标准预防内容知晓及其执行情况等。随后实施干预措施，包括职业防护知识培训、考核以及调整人力资源配置等。于干预后6个月，再进行一次同样的调查。比较分析两次调查结果，评价其暴露状况和后果，防护水平以及干预效果。结果： 1、锐器伤发生率和职称、工作年限有关，初级职称、工作年限短的护士锐器伤发生率高于中高级职称及工作年限较长者（P0.01）。提示职称、工作年限少是其危险因素。 2、锐器伤的种类，居首位是玻璃划伤，其他依次为：注射器针头刺伤、缝针刺伤、输液器针头刺伤、手术刀片划伤。 3、干预后锐器伤发生率31.3%，较干预前（52.2%）降低非常明显（P0.01）。对标准预防的了解，干预后较干预前有非常明显提高（P0.01）。接触患者戴手套、接触后洗手，在干预后较干预前非常明显提高（P0.01）。锐器伤种类的构成比在干预前后无明显变化。结论：初级职称、工作年限少是锐器伤的危险因素，玻璃划伤居锐器伤种类的首位；干预后锐器伤发生率明显降低，标准预防知晓率明显提高。提示通过上述干预，可有效地降低血源性职业暴露。第二部分护士抗肿瘤药物职业暴露及其防护调查和干预研究目的：了解某综合医院护士抗肿瘤药物职业暴露危险因素、暴露的程度和防护现状，并初步评价干预效果。方法：采用整群抽样的方式，于2011年3月对某三级甲等综合医院护士进行问卷调查，内容主要包括一般资料、对抗肿瘤药物的职业防护认知情况、工作时防护措施和防护管理情况等。随后实施干预措施，包括职业防护教育培训和行政干预。于干预后6个月，再进行一次同样的调查。比较分析两次调查结果，评价其暴露状况，防护水平和干预效果。结果： 1、防护知识知晓状况：56.5%掌握抗肿瘤药物进入人体的吸收途径，57.7%掌握药物外溅后污染处理方法，66.7%掌握药物不慎接触皮肤、粘膜后的处理方法，60.7%掌握正确的配置方法。 2、防护措施执行状况：89.3%配制抗肿瘤药物时从不戴防护目镜，86.9%从不穿防护衣,87.5%从不戴防护帽。 3、干预效果：干预后对相关防护知识知晓率有非常明显或明显提高（P0.01，P0.05）；配制抗肿瘤药物时戴防护目镜、穿防护衣和戴防护帽的比例非常明显提高（P0.01），洗手的依从性也有改善。结论：某院护士对抗肿瘤药物的职业防护的认知能力、配制抗肿瘤药物时防护行为均较差；干预后均有非常明显或明显地改善。提示，职业防护教育和行政干预等方式行之有效。
[Abstract]:Occupational exposure of medical staff refers to their exposure to toxic, harmful or pathogenic substances which damage health or even endanger life in the process of diagnosis and treatment.
Occupational exposure to blood-borne and respiratory pathogens, some physical (sharp instruments, radiation, noise) and chemical (chemical disinfectants, anaesthetic gases) factors, as well as the accompanying psychological stresses, is common among medical staff. Sharp instrument injuries are the main route of occupational exposure to blood-borne infectious diseases, according to the United States Disease Control. About 600,000 to 800,000 sharp injuries occur annually in China, accounting for 80% of the total number of nurses. Almost all nurses have experienced sharp injuries in their careers.
In recent years, with the increasing incidence of cancer and the continuous development of antineoplastic drugs, the exposure of these drugs has gradually become a more harmful factor. Antineoplastic drugs are mostly cytotoxic agents, with mutagenicity, carcinogenesis and teratogenesis. Low dose exposure may cause some harm to our health if it is not properly protected.
Nurses'mastery of occupational safety and protection knowledge and their level of protection skills not only have a direct impact on their own health, but also on the safety of patients. At the same time, through occupational protection training, assessment and other measures to intervene and analyze the effect of intervention, in order to explore some rules of nurses'blood-borne and anti-tumor drug occupational exposure and effective intervention model, in order to further improve the level of occupational protection. For scientific basis.
Part one investigation and intervention study on occupational exposure to blood and protection of nurses
Objective: To understand the risk factors of blood-borne occupational exposure, the degree of exposure, the injury and its distribution, and the popularization level of protective knowledge among nurses in a general hospital, and to evaluate the effect of intervention.
Methods: Cluster sampling was used to conduct a questionnaire survey among nurses in a tertiary general hospital in March 2011. The questionnaire included washing hands, wearing gloves, knowing the occurrence of sharp injuries and the content of standard prevention and its implementation. Interventions were then implemented, including training of occupational protection knowledge, assessment and adjustment of human resources. Source allocation and so on. Six months after intervention, the same survey was conducted again. The results of the two surveys were compared and analyzed to evaluate the exposure status and consequences, protection level and intervention effect.
Result:
1. The incidences of sharp instrument injuries were related to professional titles and working years. The incidences of sharp instrument injuries in nurses with junior professional titles and short working years were higher than those with middle or senior professional titles and longer working years (P 0.01).
2. The most common type of sharp instrument injury is glass scratch. The others are needle scratch, needle scratch, transfusion needle scratch and surgical blade scratch.
3. The incidence of sharp instrument injury was 31.3% after intervention, which was significantly lower than that before intervention (52.2%) (P 0.01). The understanding of standard prevention was significantly improved after intervention (P 0.01). Change.
Conclusion: The risk factors of sharp instrument injuries are less years of work, and glass scratches rank first in the category of sharp instrument injuries.
The second part is investigation and intervention on occupational exposure and protection of nurses' antineoplastic drugs.
OBJECTIVE: To investigate the risk factors of occupational exposure to antineoplastic drugs in nurses of a general hospital, the degree of exposure and the present situation of protection, and to evaluate the effect of intervention.
METHODS: A questionnaire survey was conducted among nurses in a tertiary A general hospital in March 2011. The questionnaire included general information, cognition of occupational protection of antineoplastic drugs, protective measures and management of protection at work, etc. Six months after the intervention, the same survey was conducted again. The results of the two surveys were compared and analyzed to evaluate the exposure, protection level and intervention effect.
Result:
1. Knowledge of protection: 56.5% mastered the absorption pathway of antineoplastic drugs into the human body, 57.7% mastered the method of contamination treatment after drug splashing, 66.7% mastered the method of inadvertent contact with skin and mucosa, 60.7% mastered the correct configuration method.
2. Execution of protective measures: 89.3% never wore protective eyeglasses when preparing antineoplastic drugs, 86.9% never wore protective clothing, 87.5% never wore protective caps.
3. Intervention effect: After the intervention, the awareness rate of related protection knowledge was significantly improved (P 0.01, P 0.05); the proportion of wearing protective eyeglasses, protective clothing and protective cap was significantly increased (P 0.01), and the compliance of hand washing was also improved.
CONCLUSION: Nurses in a hospital have poor cognitive ability in occupational protection of antineoplastic drugs and poor protective behavior when preparing antineoplastic drugs. After intervention, the occupational protection education and administrative intervention are effective.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R13

【相似文献】