運用PRECEDE 模式降低護理人員尖銳物扎傷率之改善專案

The Improving Project ofUsing the PRECEDE Model to Lower Rates ofNursing Stick Injuries

尖銳物扎傷是醫療工作環境中最常見的職業傷害，護理人員亦是尖銳物扎傷之最高危險群。經調查某區域醫院護理人員2006-2008年度尖銳物扎傷率（扎傷率=針扎件數∕護理人員數×100%）為4.03-4.58%有升高的趨勢，且針扎的潛在危害主要來自血液或體液性病原菌的傳染，如：B型、C型肝炎、梅毒及愛滋病等高感染源，故引發成立改善小組的動機。現況分析發現護理人員防範尖銳物品扎傷認知不足、技術操作不正確、未依標準規範使用針頭即棄設備、因他人因素造成傷害，因此運用PRECEDE模式，改變護理人員正確使用尖銳物品的行為，經過宣導發放預防針扎手冊和電腦自我學習網教學、RCA案例分析與心得分享座談會、OSCE臨床技能檢核、行為操作的實地稽核，並設置獎勵辦法後，護理人員尖銳物品扎傷率降為1.43%，達本改善專案<3.36%的目標。本專案的實施不僅降低護理人員尖銳物扎傷率、改變尖銳物品使用遵從性，也提供安全的醫療工作環境。NSIs is one of the most common occupational injuries in the medical working environment. Nursing staff are under the highest risk of NSIs. An investigation of NSIs (The ratio of NSIs=Total events of NSIs/total number of nurses) in a regional hospital from 2006 to 2008 was 4.36~4.58%. This ratio tended to be high. The danger of the diseases mostly came from the B and C hepatitis and even AIDS carriers. In light of this, it triggered the establishment of a team to make improvement. The results of current analysis revealed that NSIs nurses lacked knowledge, performed technical operations incorrectly, did not follow standard norms to use disposable needles, and caused damages due to other human factors. The use of PRECEDE model changed the behavior of nurses in using the proper sharp objects. Through needle stick prevention propaganda issuing manuals and computer self-learning network teaching, RCA case studies and experience sharing forum, OSCE clinical skills check, conduct field audits of operations and set of incentives, the nursing staff ratio was reduced to 1.43% NSIs, reaching the target of <3.36% in this project. The implementation of this project not only reduced the rate of nursing NSIs to change the use in sharp objects, but also provided a safe environment for medical work.