臺灣醫療工作者發生高感染風險經皮穿刺傷之現況分析

Abstract

研究目的： 一、 辨識不同醫療工作者發生高感染風險經皮穿刺傷的地點、情境及常見之尖銳物種類及原始用途之分布。 二、 計算不同醫療工作者高感染風險經皮穿刺傷之發生率及推估其陽轉人數。 研究方法： 本研究以「中文版EPINet針扎通報系統」2014年1月1日至2013年3月31日通報資料為主，進行次級資料之分析。統計分析包括：高感染風險經皮穿刺傷之流行病學及計算2012年高感染風險經皮穿刺傷之發生率及及其陽轉人數推估。 研究結果： 本研究結果發現高感染風險經皮穿刺傷的分佈以區域醫院(53.3%)最多、且以護理人員佔最多數(63.7%)；最常見的發生地點依序為病房(34.6%)，開刀房(22.7%)及加護病房(13.1%)；發生情境則以「治療過程中某項步驟」(24.6%)占最多；尖銳物種類以拋棄式注射器最多占39.3%。尖銳物原始用途則以「肌肉/皮下注射或其他侵入性注射」居高20.0%。高感染風險經皮穿刺傷與各人員發生地點有顯著差異，其中醫師以「產房」、護理人員以「血液透析室」、醫技人員以「加護病房」、支援人員則以「病房」最高。全部醫療工作者高感染風險經皮穿刺傷發生率為0.77件/100FTEs，全臺經調整未通報率後，每年預估有90~227位醫療人員感染HBV，383~934位感染HCV及約1位到5位發生HIV感染。 結論及建議： 本研究結果顯示注射器是高感染風險經皮穿刺傷最常見的尖銳物，故建議醫療院所應盡快全面替換為安全注射器，尤其是發生頻率最高的血液透析室、加護病房、病房及抽血中心等場所。藉由陽轉人數的推估，期望再次提醒醫療工作者陽轉的可能性及通報的重要性。

Objective To identify the area, mechanism, device and its original purpose of use in high infection risk percutaneous injuries (PIs) in different type of health care workers (HCWs) in Taiwan. Further, to estimate the risk to seroconvert HBV, HCV and HIV after having a high infection risk PI. Method Data from Chinease EPINet between Janunary 2004 and March 2013 wer analyzed to identify the frequency and comparsion of proportions for location, mechanism, device and its orginal purpose of use in high infection risk PIs. The statistical package JMP 10.0. was. Incidence rate was calculated by using the number of the full-time equivalent healthcare workers in the hosptials which contributed the high infection risk PIs. Estimation of seroconversion after high infection PIs was also performed. Result The hosptial which had high infection risk PIs rate was “Metropolitan Hospital”(53.3%), and “nurse”(63.7%) accounted for the most high infection risk PIs. The locationwhere high infection risk PIs occurred most frequently was “patient rooms”(34.6%). The mechanism which caused high infection risk PIs most frequently were “between steps of a multi-step procedure” (24.6%). The most commonly seen device caused high infection risk PIs was “disposable(?) syringes”(39.3%).The original purpose of use of the device were”injection, followed by IM/subcutaneous and other”(20.0%). There are disparities of high infection risk PIs in different job categories and at different health care settings. “Delivery rooms”, “dialysis units”, “intensive care units”, and “patient rooms” were areas where the most High infection risk PIs occurred. The incidence rate of high infection risk PIs is 0.77/100 FTEs in all HCWs. After adjusting the reporting rate, the estimation of HBV seroconversion is 90~227 persons annually, 383~934 persons for HCV seroconversion, and 1-56 persons for HIV seroconversion. Conclusion The most common device caused high infection risk PIs was syringe needles. This study conluded that “dialysis rooms”, “intensive care units”,”patient rooms”and “blood collection centers” had the highest chance for high infection risk PIs. This study intends to increase the safety awareness of the HCWs in medical devices use, and to urge hospital to replace all medical devices to the ones with safety features if the 2011 National Needlestick Safety and Prevention Act and health care workers’ occupational safety are warranted.