Risks of Bloodborne Diseases to Emergency Personnel in Traumatic Wound Management

急診醫師處理創傷傷口時的血液傳染病危險性

黃英傑(Ying C. Huang) ； 林志隆(Chih-Lung Lin) ； 張進富(Chin-Fu Chang) ； 王正信(Jeng-Shing Wang) ； 柯成國(Chen-Guo Ker)

《The Kaohsiung Journal of Medical Sciences》 10卷2期 (1994/02) Pp. 63-67

https://doi.org/10.6452/KJMS.199402.0063

摘要

多種疾病可經由被感染者的血液傳染，這包括了EB病毒，巨細胞病毒，泡疹，瘧疾，梅毒以及國內有高盛行率的病毒性肝炎與逐日增加的愛滋病等等。醫護人員因職業上的需要，常有與這些疾病息者接觸的機會，如果對這些疾病的傳染危險沒有了解，或是處理病患時自己沒有採取適當的保護措施，被感染的機會就會顯著地增加。

急診的病患因為病情緊急，醫療人員所能掌握的資訊就相對地有限，雖然曾有多位學者研究，嘗試找出足以發現高危險病患的方法，然而直到今日並未有準確可信的方法可供遵循，因此美國疾病管制中心乃建議：在情況無法完全被掌握的急診，病患的任何體液都應被視為可能傳染疾病而警戒。
反觀我國的急診醫療服務，大部份的醫療人員只穿個手套，甚至沒戴口罩，就對病情尚未被完全掌握的病患提供醫療。他們曝露在這些血液性傳染病的危險程度到底嚴重到那一種地步呢？因此我們前瞻性地收集了107位急診病患11針固創傷傷口，當這些傷患的病情已經穩定下來，再送到急診的手術室裹接受標準的傷口處理與縫合，每當處理完一個傷口，醫師將所戴的眼鏡與口罩取下，在良好的照明下看看有沒有血漬。在這115個創傷處理過程後，居然有46次（40.0 %）可在眼鏡或口罩上發現有血點。在這些已屬於較能控制的情況下，尚有如此的暴露率，當處於更緊急的情況或是需要執行更侵略性檢查治療時，更高的暴露率將可預期。
針對血液性傳染病的存在，急診病患情況的難以完全掌握，以及急診檢查治療所存在的暴露機會，適當且週全的保護是不可或缺的。手套、口罩、眼罩或是面罩，不透水的工作服是面對這些傳染病最基本的防護。加上正確的操作方式，廢棄物處理流程，感染控制計畫，以及不幸暴露後的補救與追蹤，才能提供醫療工作人員一個完整的防護。

並列摘要

High prevalence of viral hepatitis, increasing HIV infection and other bloodborne diseases in Taiwan have made the health care provider exposed to an increased risk of disease transmission unless adequate precautions and protections have been undertaken. Furthermore, emergency personnel must face the patient with limited information, and neither a reliable predictor nor appropriate tools have been found to assist in identifying emergency patients who pose a risk. The Centers for Disease Control (CDC) in the United States thus issued a specific caveat advocating all body fluids should be treated as potentially infectious under uncontrolled emergency circumstances.
Unfortunately, in Taiwan, personnel in emergency service practice with limited protection, often without mask and only gloves as the oniy barrier device used. We tried to determine the risk of facial exposure during traumatic wound management. One hundred and fifteen wounds of 107 patients were enrolled. Most of them were not life-threatening and thus could be managed under more controlled conditions. Standard procedures of wound management were applied and facial exposure was assessed after each wound closure. Positive exposure rate in such controlled conditions remained as high as 46/115 (40%). Exposure rate in uncontrolled conditions should be, therefore, much more significant. Therefore, we should put more emphasis on adequate precaution and protection against bloodborne diseases.

並列關鍵字

Bloodborne pathogens ； Traumatic wound management