护理人员血源性职业暴露的调查研究_张光慧

目录符号说明..........................................................................................................................1中文摘要..........................................................................................................................2英文摘要..........................................................................................................................4论文正文：护理人员血源性职业暴露的调查研究......................................................7前言......................................................................................................................71对象与方法..........................................................................................................92结果....................................................................................................................133讨论....................................................................................................................254结论....................................................................................................................31参考文献........................................................................................................................34文献综述：护理人员职业暴露的研究进展................................................................37致谢............................................................................................................................45攻读学位期间发表论文情况........................................................................................461符号说明英文缩写英文全称中文全称CDCTheCentersforDiseaseControlandPrevention疾病预防控制中心OSHATheOccupationalSafetyandHealthAdministration美国职业安全健康署NPINETTheExposurePreventionInformationNetwork血液暴露通报网络系统WHOTheWorldHealthOrganization世界卫生组织HIVHumanImmunodeficiencyVirus人类免疫缺陷病毒HCVHepatitisCVirus丙肝HBVHepatitisBVirus乙肝AIDSAcquiredImmuneDeficiencySyndrome艾滋病SASSelf-ratingAnxietyScale焦虑量表CVIIndexofContentValidity内容效度NISNeedlestickinjury针刺伤2护理人员血源性职业暴露的调查研究摘要目的：调查重庆市护理人员血源性职业暴露现状。分析不同类别护理人员血源性职业暴露的认知水平、防护行为的差异性,探讨血源性职业暴露的影响因素，为提高护理人员血源性职业防护意识，规范操作行为，完善防护措施提供依据。方法：采用分层随机抽样方法选取重庆市20所医院的1270名护理人员为调查对象，用自行设计的问卷对他们的血源性职业暴露情况、防护知识和行为进行调查；所有数据采用SAS8.0软件进行分析。结果：1.护理人员血源性职业暴露知识平均答对率为57.85%;其中对有关血源性疾病种类、安全注射操作等的认识较好，但对感染途径、感染风险性及应急处理等认识较差；经方差分析发现，不同护龄、学历、职称、受聘形式及不同医院级别的护理人员血源性职业暴露的知识答对率差异具有统计学意义（p＜0.05）。2．防护行为的研究结果显示:护理人员防护行为得分昀低11分,昀高35分,平均得分23.70分（总分40分）;防护行为不规范，主要涉及双手回套针帽、污染锐器的回收处理等习惯性操作方面；不同类别护理人员在防护行为积分差别上没有统计学意义（p＞0.05）。3．本调查显示:1164名被调查对象中过去一年发生针刺伤1057名3（90.18%），体液暴露的857名（73.63%）,仅有166(15.70%)名护理人员上报针刺伤;经历针刺伤的护理人员中190名（17.96%）有明显焦虑症状；针刺伤发生的主要环节是：配药、双手回套针帽、拔针、毁形浸泡。4．个人防护知识与防护行为没有显著相关性(r=0.0199p=0.499)；而学历、职称、防护行为以及防护管理水平是影响护理人员针刺伤频率的重要因素。结论：1.护理人员血源性职业暴露的风险意识淡薄，防护认知不够，应加强对低年龄、低学历、低职称、编外护士、低级别医院的护理人员的职业防护教育培训。2.护理人员是针刺伤和体液暴露的高危群体，教育并督促护理人员改变固有的模式化错误行为，培养良好规范的操作习惯。3.建立并健全职业安全管理制度，作好护理人员血源性职业暴露的紧急处理及心理疏导工作。关键词：护理人员，血源性职业暴露，职业防护，针刺伤，焦虑4INVESTIGATIONBLOOD-OCCUPATIONALEXPOSUREAMONGNURSINGSTAFFABSTRACTOBJECTIVE:Toinvestigatethecurrentstatusofblood-occupationalexposureamongclinicalnursingstaffsinChongqingandtoexploredthedifferencesofknowledgeaswellasbehaviorsamongthem.Theinfluencingfactorsassociatedwithblood-occupationalexposurewerealsoanalyzed.Wehopethatourstudyconclusionscouldprovidethetheoreticalfoundationsthatcannotonlyimprovenurses’protectiveconsciousness,butstandardizetheoperationalconductandguidecorrespondingmeasures.METHODS:Collectingdatabythemeansoflayeringrandomsamplingmethod,1270nursesaresampledfrom20hospitalsinChongQing.andthestatusofblood-occupationalexposure，knowledge,behaviorinthesenurseswereinvestigatebySelf-designedquestionnaires.AlldatacollectedwereanalyzedbySAS8.0software.RESULTS:1.Theaveragerateofcorrectanswersaboutknowledgeofblood-occupationalexposurewas57.85%.ofthetotal,thekindsofthe5bloodtransmissiblediseasesandsafetyinjectionwasknownbetterthancognitiontotheriskinfection,routeofinfectionandtheabilitytodealingwithoccupationalexposure.Furthermore,thereweresignificantlydifferentintherateofthecorrectanswersamongnursestaffindifferentworkingage,academicqualification,professiontitle,employedway,gradehospital（p＜0.05）.2.Theaveragescoreofnurses’self-protectionis23.70oftotalscore40,thescorerangedfrom11to35.Thefactorsinfluencenurses’self-protectionwerehabituationmanipulations,suchasrecappingtheneedle,conductingtheabandonedsticks.Furthermore,therewerenotsignificantlydifferencesindifferentthescoresofself-protectionamongvarykindofnurses（p＞0.05）.3.Itrevealsthatamong1164nursestherewas73.63%(857)whoexperiencedbodyfluidexposure.90.18%(1057)nursesexperiencedneedlestickinjury(NIS),andonly166(15.70%)hadofficiallyreportedtheirNSItomanagementduringtheprevious12months.Inaddition190(17.96%)hadanxiety.Theneedlestickinjurytookplaceinworkingbehaviors,suchasdispensation,recappingtheneedle,pullingouttheneedles,conductingtheabandonedsticks..4.Therewasnosignificantcorrelationbetweenself-protectionknowledgeandbehaviors(r=0.0199p=0.499).Nurses’workingage,professiontitle，behaviorsandmanagementlevelofprotectionwerethe6mainfactorswhichinfluencetheincidenceofneedlestickinjury.CONCLUSION:1.Nursingsta