臺灣地區醫療院所針扎傷害回顧

Overview of Needlestick Injuries in Taiwan Medical Facilities

針扎與尖銳割刺傷是㊩院中主要職業性危害，可能導致血液或體液性病原的傳染。根據國內1990 至1997年所發表的針扎調查顯示，護理人員每人每年發生1.2-2.8次針扎，為針扎之高危險群，其中污染性針扎則介於0.7-0.9 次/年；實習者又較在職㊩護人員為高。技工工友污染性針扎的發生率僅次於護理人員，且其污染性針扎佔所有針扎事件的96％。最常發生的地點為一般病房，又以一般內科病房為最；其他高針扎發生地點尚包括：手術室、加護病房、治療室與急診室。不論是污染性或非污染性針扎，「套回針頭蓋」是最易發生扎傷的動作，佔所有針扎事件的23％—53％；單手回套則可顯著減少針扎。六成的針扎係發生在使用「一般丟棄式注射用針」時，應與該類針器使用頻繁有關；其次為留置針，佔6-26％的針扎事件。僅7-14%的針扎事件曾向上級主管單位通報，通報率普遍偏低，而其中僅護理人員的通報情形較佳；員工對針扎的後續處理認知不足，尤以技工工友為最。在針扎的預防上，建議加強不回套或單手回套針頭蓋的推廣，並應提供防穿刺的針器收集筒；另外，亦應要求使用者立即處理用過的針器，選擇適當的安全針器，加強教育訓練，落實員工健康檢查，並建立針扎通報制度與針扎處理流程及後續追蹤。

Needlestick injuries(NIs)have been documented as one of the major occupational hazards in hospitals, which may lead to exposure to bloodborne pathogens for healthcare workers(HCWs). In Taiwan, literature shows that the annual incidence of NIs for nursing personnel was 1.2-2.8/person from 1990-1997. And the incidence of contaminated blood or body fluids was 0.7-0.9/person. The risk to nurses in training was even higher. The highest incidence of contaminated NIs was found among nurses, followed by the housekeepers and laundry workers. Among housekeepers and laundry workers needlestick and sharp injuries with contaminated blood or body fluids accounted for 96% of their NIs. Most NIs occurred in general wards, especially internal medicine wards. Operating rooms, intensive care units, therapy rooms and emergency rooms were also the common areas where NIs took place. Recapping was identified as the most dangerous operation and accounted for 23-53% of NIs. One-hand recapping was shown effective in reducing the occurrence of NIs. Sixty percent of NIs were associated with disposable needles, probably due to their common use in hospitals. On average, only 7-14% of NIs were reported to hospital authorities. Nursing personnel were more likely to report an incident than other HCWs. However, medical treatment and follow-up of NIs were not well performed, especially for housekeepers and laundry workers. In terms of prevention strategies, it is recommended that used needles should not be recapped. If they must be recapped they should be recapped with one hand. HCWs should be trained to dispose of needles immediately after use. Puncture-resistant disposal containers should be made available. Hospital authorities should take safety needle devices into account to prevent NIs. The training and periodical health surveillance of HCWs should be implemented. A reporting system for NIs should be established. And standard procedures for the medical treatment and follow-up of needlestick injuries should also be established.