護理人員輪班工作與經皮割刺傷之相關性

The Association between Rotating Shift Work and Percutaneous Injuries in Nurses

江婉婷(Woan-Tyng Jiang)

指導教授 ： 蕭淑銖

國立臺灣大學/醫學院/護理學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.10244

摘要

目的: 探討護理人員輪班、工時與經皮割刺傷之相關性。
方法: 研究對象為中文版EPINet 通報系統(Exposure Prevention Information Network; EPINet)於100 年度中曾經發生經皮割刺傷事件之護理人員。透過EPINet 取得100 年度發生經皮割刺傷事件護理人員的通報資料，並且連絡通報醫院收集發生事件護理人員於發生日起前後60 天的班表，再採用case-crossover研究設計方法，以SAS9.2 統計軟體進行資料分析。
結果: 連絡121 家醫院(1,432 人次護理人員發生經皮割刺傷事件)，自57 家(499人次)回收318 人次的班表，扣除固定白班(n=34)、現職醫院工作年資小於六個月(n=63)、事件發生前兩個月內曾休假大於或等於一個月(n=7)、事件發生後未滿28 天離職(n=13)、事件發生前後兩個月內有單位異動(n=5)及職業別非本研究所定義之護理人員(實習護士、專科護理師，n=12)，最後剩餘184 人次的班表進入分析(回收率36.9%)。現職醫院年資小於五年的佔63.59%，病房為最常見的發
生地點佔58.15%，最常發生在白班佔56.52%，發生當天平均工作累積4.36 小時發生事件，連續(successive)工作天數小於兩天即發生事件佔55.98%。控制逆時針輪班(班別轉換方向:大夜班->小夜班->白班->大夜班)次數、班別及休假日數後，有逆時針輪班一次、白班及休假日數愈多時，在統計上呈現顯著地增加經皮割刺傷風險，尤其是在加護病房及地區醫院以逆時針方向輪班一次的經皮割刺傷風險分別高於病房及區域醫院。
結論:逆時針輪班、白班及休假日數較多時可能會增加經皮割刺傷的風險，建議避免以逆時針方向輪班，並且進一步瞭解白班、休假日數愈多時、加護病房及地區醫院具有較高經皮割刺傷風險的相關因素。建議配合醫療法第56 條，逐年替換安全針具使用比例，五年內全面使用安全針具，以降低經皮割刺傷事件發生的風險。

關鍵字

輪班 ； 工時 ； 疲勞 ； 經皮割刺傷

並列摘要

Objective: To understand the association between rotating shifts, work hours and percutaneous injuries in nurses.
Method: The study population was nurses who had ever sustained percutaneous injuries in Chinese version EPINet (Exposure Prevention Information Network;EPINet) in 2011. We obtained the percutaneous injury reports of 2011 from EPINet and contacted with 121 hospitals to collect work schedules which were before and after 60 days of the injury day. We used case-crossover study design and SAS9.2 statistics sofeware to analysis the data.
Rusult: A total of 318 work schedules was provided from 57 hospitals (499 percutaneous injury nurse-times) after contacting with 121 hospitals (1,432 percutaneous injury nurse-times). Excluding the data of nurses who had fixed day shift (n=34), had currently working years that were within 6 months (n=63), were on leave for 1 month or over within the preceding 2 months of the injury day (n=7), left the job within 28 days after the injure day (n=13), had job exchange of the work unit in the preceding 2 months of the injury day (n=5), and had the occupational titles that did not correspond to this study’s definition of nurse (student nurses, nurse practitioners, n=12),184 work schedules were eligible for final analyses (response rate 36.9%). The majority of work experiences in current hospitals was less than 5 years(63.59%). Wards were the most common place occurring percutaneous injuries (58.15%). 56.52% percutaneous injury was happened in day shift. Averagely, nurses sustained percutaneous injuries after cumulated 4.36 work hours in injury day. 56% injury was happened within 2 successive work day. Frequency of backward rotation (direction of rotation:night shift→evening shift→day shift→night shift),day shift and more off days would statisticly siginificantly increase the risk of percutaneous injuries, especially in intensive care units and local hospitals.
Conclusion: According to the results, frequency of backward rotation, day shift and more off days would increase the risk of percutaneous injuries;therefore, we suggested that: (1) avoid backward rotation；(2) further investigation to understand factors of day shift, more off days, intensive care units and local hospitals which showed higher risk of percutaneous injuries. Moreover, it is imperative to follow 56 provision of Medical Care Act, replace safety devices by degrees each year, and utilize safety devices entirely within 5 years, with the aim to decrease the risk of percutaneous injuries.

並列關鍵字

rotating shift ； work hour ； fatigue ； percutaneous injury

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