Surgical Blood Exposures in Taiwan and in the US: Frequency and Prevention

台灣及美國外科手術血液曝觸的現況－頻率及預防

Patricia Lynch ； 王慧(H. Wang) ； Mary C. White

《護理研究》 3卷4期 (1995/12) Pp. 335-342

摘要

有過職業性血液接觸及曝觸經歷的醫護人員被B型、C型肝炎及愛滋病毒感染的危險性較高。過去的研究發現手術室的工作人員感染經由血液傳播的職業病的機率及危險性最高。
本次研究目的的是描述職業性血液接觸及曝觸的現況。研究的資料是由三所台北市大醫院的手術室流動護士負責收集的。研究的方法及定義均和在美國進行的研究(COBEX)相同。因此，我們可以將美國九所醫院及本次在台北三家醫院所俄結果作比較。
我們在這次研究中共發現246次血液接觸，其中包括46次穿刺傷，39次粘膜曝觸，及12次因皮膚破皮致血液曝觸。其他包括149次完整皮膚的血液接觸，這包括86次位於臉部皮膚，46次位於手指及手，及23次發生在身體其他部位。
台北的外科醫生在本次研究期間，其血液接觸的比例佔67%，但刷手護理人員卻受到較多的穿刺傷，且台北的刷手護理人員也較美國的刷手護理人員有較多的穿刺傷，粘膜及非完整皮膚的血液曝觸。
很多的血液接觸可以經由改變手術室的習慣或使用保護性的設備如戴面罩及雙層手套等來預防。手術室的護理人員在影響採取這些安全策略的過程中扮演重要的角色。在美國的研究中，手術室的護理人員收集血液接觸及曝觸的資料，然後將研究結果告知外科醫生及其他工作人員，並組織由各單位形成的委員會，以策劃改進措施。這些醫院在隨後的研究中都發現血液接觸的頻率有顯著的減少。

關鍵字

血液曝觸 ； 職業性感染 ； 血液

並列摘要

Personnel who experience occupational blood contacts and exposures have increased risk for developing infection with bloodborne pathogens: Hepatitis B and C, and HIV. Surgical personnel are among those identified as being at highest risk for occupationally-acquired disease transmitted by blood.
Circulating nurses in three large, urban hospital operating rooms in Taipei collected data for a study to describe occupational blood contacts and exposures. The study methods and definitions were the same as used for the Collaborative Operative Blood Exposure (COBEX) study, thus permitting comparisons between the nine US hospitals that participated in the COBEX study, and the three Taipei hospitals.
Personnel at the three hospitals experienced 246 blood contacts, including 46 punctures, 39 mucous membrane exposures, and 12 nonintact skin exposures. There were 149 contacts with intact skin, including 86 to facial skin, 46 to the fingers and hands and 23 to other parts of the body.
Although surgeons in Taipei experienced 67% of all blood contacts during the study period, scrub nurses experienced more punctures. Scrub nurses in Taipei had more exposures (punctures, mucous membrane and nonintact skin contact) than their counterparts in the US.
Many of the blood contacts could be prevented changes in operating room practices or use of protective equipment such as face shields and double gloves. Surgical nurses are in a unique position to influence adoption of these safer strategies. In the US COBEX study, operating room nurses collected data on blood contacts and exposures, disseminated the results to surgeons and other personnel, and formed multidisciplinary committees to plan interventions. These hospitals subsequently achieved a significant reduction in frequency of blood contacts.

並列關鍵字

blood exposure ； occupational infection ； blood