降低血液透析室尖銳物品扎傷發生率之改善專案

Improvement Project to Reduce Sharps Injury Rate in the Hemodialysis Unit

透析室為與血液接觸頻繁之單位，有鑑於護理人員佔尖銳物品扎傷發生率首位，且本單位2010年1月至12月針扎發生率居護理部之冠16.6%（5/30），因此成立專案小組主要以降低針扎發生率為目標，避免因扎傷感染B、C型肝炎、梅毒等傳染病。運用查檢表實地觀察及特性要因圖，確定發生原因為環境中危險因子多、針扎防治認知不足、作業標準不實用，經由決策矩陣分析表擬訂去除環境中危險因子、提升護理人員對針扎防治之認知、修訂「血液透析動靜脈穿刺及移除穿刺針作業」之具體對策方案，在跨團隊的協助下逐一改善，使針扎發生率降至0.0%。建議在繁忙的工作中，技術標準可採多元化的圖示、口訣等協助護理人員記憶，鼓勵參與安全工作環境的建置，提高警覺性以降低職業傷害。

The complex environment of the hemodialysis unit provides multiple opportunities for health care workers to sustain sharps injuries. Research showed that nurses sustained the highest number of sharps injuries among all health workers. The sharps injury rate in the hemodialysis unit was 16.6% (5/30) in 2010, higher than other units of nursing department at Hsinchu Branch of the National Taiwan University Hospital. An ad hoc group was therefore established with the goal of reducing the rate of sharps injuries and preventing blood-borne diseases related to sharps injury such as Hepatitis B, Hepatitis C and Syphilis. Using the observation checklist and cause-and-effect diagram, the main causes of sharps injuries were determined to be due to the high number of environmental risk factors, lack of awareness on sharps injury prevention, and impractical standard operating procedures for needle puncture and removal. Preventive strategies made by decision matrix analysis included elimination of environmental hazards, improving awareness on sharps injury prevention among nurses, and revising standard operating procedures for arteriovenous shunt puncture and needle removal. After these strategies were implemented, sharps injury rate was decreased to 0.00%. The policies recommended for reducing occupational injuries are illustrations and mnemonics for improving memory of standard techniques, encouraging health care workers to participate in the creation of a safe work environment, and improved awareness.