探討護理人員遵從標準作業與尖銳物品扎傷之風險

A Preliminary Study of Estimated Needlestick and Sharps Injuries (NSI) and Compliance with standard operating in a Teaching Hospital

目的：旨在探討尖銳物品扎傷之護理人員的特質、發生時機、常見尖銳物種類與相關因素，及探討扎傷與遵從標準作業之風險比。方法：採橫斷式回溯性研究設計，利用針扎通報系統分析100年1月至101年12月8家院區、護理人員通報之針扎事件。資料分析包括第一部份針扎者基本特性、工作年資、專業能力進階、班別；第二部份事件發生之時機與醫療行為、針扎物品類別；第三部份標準作業程序之遵從度、有無使用防護設備。統計方法包括percentage、chisquare 、correlation、odd ratio。結果：1.尖銳物品扎傷發生時機以抽血、執行醫療過程居多（67.12%）、針扎者多為資淺、工作年資≦1年者；2.未遵從使用針頭收集盒之規定者其針扎風險機率為有遵從使用針頭收集盒者的5.067倍（OR=5.067; 95% CI=1.840-13.955; p=.001）；3.未遵守使用工作車之規定者其針扎風險機率為有遵守使用工作車者2.800倍（OR=2.800; 95% CI=1.062-7.385; p=.035）。結論：藉由遵從標準作業程序，及使用防護設備可以有效移除工作場所不安全動作之骨牌效應、降低尖銳物品扎傷風險。而如何落實護理人員遵從標準作業程序，及執行醫療過程全面使用防護設備，降低人為的針扎風險成為今後醫院努力的課題。

Objective: 1. to understand the sharp injuries incidence among nursing staff and the associated factors; 2. to investigate the associated factors for polluted sharp injuries; 3. to study the polluted sharp injuries risk ratio. Method: the cross-sectional retrospective study design was adopted. The needlestick reporting system was used to analyze the reported needlestick events of the nursing staff in 8 branch of Taipei City hospitals from January 2011 to December 2012. The data collected included the basic characteristics of sharp injuries subjects, years of work experience, advanced professional skills and courses as part 1; the timing and medical conduct of sharp injuries events, sharp injuries object classification as part 2; the adherence to standard operating procedure, use of protective equipment, operation accuracy as part 3. The statistical methods used involved percentage, chi-squire, correlation, and Odds ratio. Results: 1. The sharp injuries events occurred mostly during blood withdrawal and medical practices (67.12%) among junior nursing staff with no more than 1 year of work experience; 2. the sharp injuries risk ratio of those who did not follow the instructions of the use of needle collectors was 5.067 times higher than those who did (OR=5.067, 95% CI=1.840-13.955; p=.001); 3. The sharp injuries risk ratio of those who did not comply with the instructions of the use of trolleys was 2.800 times higher than those who did (OR=2.800; 95% CI=1.062-7.385; p=.035). Conclusion: Compliance with the standard operating procedure and the use of protective equipment were able to eliminate the hurdle of unsafe behaviors in the work place and therefore reduce the sharp injuries risks. However, how to ascertain the adherence to the standard operating procedure among nursing staff, the full use of protective equipment during medical practices, and the reduction of anthropogenic sharp injuries risks were the major goals that the hospitals should attempt to achieve.