醫院安全氣候與醫療工作人員對於扎傷、血液體液暴觸的知識、態度、行為之關連

Association between hospital safety climate and health care workers’ knowledge, attitude, and practice toward sharps injuries, and blood and body fluid exposure.

鍾春花(Chun-Hua Chung)

指導教授 ： 許玫玲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00005

摘要

本研究目的在瞭解醫院安全氣候與醫療工作人員對於扎傷及血液、體液暴觸之知識、態度與行為現況與其關連。為一橫斷性研究（cross-setional study），以立意取樣方式選取北部地區級以上七家醫院之有扎傷及血液體液暴觸風險之員工；以自填式結構性問卷為主要研究工具，共發出問卷1465份，回收有效問卷996份，有效問卷回收率為67.9﹪，所得資料以SPSS 12.0版之統計套裝軟體為分析工具。研究結果如下：
一、醫療工作人員最近一年內有過醫療銳物扎傷及血液或體液暴觸者佔33.3﹪。發生扎傷及血液、體液暴觸事件時向院方專責單位通報比率為67.5％，有時通報有時未通報佔19.9％，完全未通報者佔12.6％；未進行通報的原因包括，認為病人沒有血液傳染疾病，覺得通報程序麻煩及沒有時間。二、醫療工作人員醫療銳物扎傷及血液、體液暴觸知識平均答對率為 79﹪，清潔人員平均答對率為67.3 ﹪。以「可能感染愛滋病毒的認知」、「應向相關單位通報」及「立即就醫且定期追蹤」答對率最高；「可能感染肺結核的認知」答對率最低。多因子分析結果顯示與扎傷及血液體液暴觸知識相關影響因素包括醫院層級、年齡、工作職稱、教育程度、年資、血液體液暴觸經驗及任職單位。三、醫療工作人員對醫院安全氣候的感受，相關影響因素包括醫院層級、年齡、教育程度及工作職稱。四、醫療工作人員扎傷及血液、體液暴觸知識與態度、行為與態度、行為與安全氣候的感受、安全氣候的感受與態度互有關聯及影響性。當扎傷及血液、體液暴觸知識得分愈高時，則「通報重要性」與「警覺性」也愈高。扎傷及血液、體液暴觸之困難度感受愈高，行為與安全氣候的感受均較為負向。安全氣候的感受愈好，態度及行為則愈正向。五、醫療工作人員之個人特質對扎傷及血液、體液暴觸之知識、態度、行為具有顯著的預測力，安全氣候對態度及行為具顯著的預測力。預測變項中以安全氣候對醫療工作人員扎傷及血液、體液暴觸之行為的預測力最高，安全氣候之於扎傷及血液、體液暴觸防治中的角色最為重要。根據上述結果，提出以下建議：1.評鑑單位制定評鑑標準時勿以扎傷率的下降做為醫院對於扎傷及血液、體液暴觸事件防治的優劣評斷。2.醫院管理者應該展現營造安全文化的態度，宣示對安全的重視與承諾。3.後續的研究宜針對此議題作更深入的探討，並擴大醫院層級的研究樣本。

關鍵字

針扎 ； 扎傷及血液體液暴觸 ； 安全氣候 ； 知識、態度、行為

並列摘要

The purpose of this research is to understand the situation of and association between hospital climate and the knowledge, attitude, and handling of piercing injuries and blood and bodily fluid exposure by health care staff. A cross-sectional study used sampling to select staff from seven regional or higher level hospitals in northern Taiwan who were at risk from sharps injuries or exposure to blood/bodily fluids. Research was primarily conducted through self-administered surveys, with a total of 1465 issued and 996 received, recovery rate was 67.9%. Data was analyzed using SPSS 12.0, a statistics software program, and the research findings were as follows:
1. 33.3% of health care staff were pierced by sharp medical objects or exposed to blood/bodily fluids in the last year. 67.5% of these incidents were always reported to the responsible hospital section, 19.9% were sometimes reported, and 12.6% were never reported. Reasons for failing to report included believing that the patient was not contagious or feeling that the reporting process was too troublesome or time-consuming.
2. Health care staff correctly answered an average of 79% of the survey questions pertaining to piercing injuries from sharp medical objects and blood/bodily fluid exposure, while cleaning staff correctly answered an average of 67.3%. Questions most frequently answered correctly concerned potential HIV infection, reporting to the proper unit, and immediate hospitalization/periodic follow-up services, while the question least frequently answered correctly concerned potential tuberculosis infection. Multi-factor analysis showed that knowledge of piercing injuries and blood/bodily fluid exposure was influenced by factors such as hospital level, age, job title, educational level, seniority, experience being exposed to blood/bodily fluids, and position held.
3. Health care staff’s feeling about hospital safety was affected by factors such as hospital level, age, educational level, and job title.
4. Knowledge, attitude, and handling of piercing injuries and exposure to blood/bodily fluids among health care workers is associated with and influenced by how they feel about hospital safety. A better knowledge of piercing injuries and blood/bodily fluid exposure corresponded to higher awareness of the importance of reporting incidents and staying alert. On the other hand, those who had trouble with these questions were more likely to display negative handling behavior and have negative feelings about hospital safety. Finally, staff members who felt better about hospital safety were more likely to display positive attitudes and handling behavior.
5. Personal characteristics are a reliable way to predict health care staff’s knowledge, attitude, and handling of piercing injuries and blood/bodily fluid exposure. Hospital safety is also a reliable predictor of attitude and behavior. Hospital safety is the most reliable variable for predicting health care staff’s handling of piercing injuries, and it is the most important factor for preventing piercing injuries and exposure to blood/bodily fluids.
In consideration of these conclusions, the following measures are proposed: 1. Assessment standards established by the responsible section should not take a reduction in the number of piercing injuries as an indication that the hospital is necessarily doing a better job of preventing piercing injuries and exposure to blood/bodily fluid. 2. Hospital administrators need to be concerned about safety and should express their commitment to doing so. 3. Follow-up research should examine this topic in more depth and include data from more hospitals of different levels.

並列關鍵字

Needle-stick injury ； Sharps injuries, ； Safety climate, ； knowledge, attitude, and Practice model

參考文獻

行政院衛生署疾病管制局，扎傷及血液、體液暴觸之感染控制措施指引（2008）。http://www.cdc.gov.tw

李璧伊、黃建元、王建楠（2008）。南部某醫學中心尖銳物品扎傷發生率及其相關因素之探討。中華職業醫學雜誌，15（1），43-53。

吳聰智(2000)。工作場所安全氣候。工業安全衛生月刊，37（1），13-25。

吳聰智、李金泉〈2003〉。大專院校實驗室等場所安全氣候量表之發展。勞工安全衛生研究季刊，11（1），19-34。

林永崇、羅美惠、顧淑芳、葉國明、彭銘業、張峰義（2000）。職業性針扎事件原因探討及預防成效的分析。中華職業醫學雜誌，7（2），95-102。