台灣安全針具法實施五年後安全針具替換率與針扎率的變化

Changes in safety needle replacement rate and needlestick injury rate five years after the implementation of Taiwan's Safety Needle Act

目標：了解台灣醫療法第56條修正實施五年後，醫療院所之安全針具替換與醫療人員針扎率變化趨勢，並分析其相關性。方法：本研究方法為次級資料分析，取得健保署所提供之2011－2016年醫療機構之針具申報數量，及中文版EPINet資料庫擷取2011－2016年針扎通報事件資料中，符合「醫院層級、2011年之前加入通報之醫院及2011至2016年每年皆有持續通報者」，共得36家通報醫院資料，並進一步以全國醫療人員數標準化後推估出全國醫療人員之針扎發生率，進行分析。結果：台灣醫院機構在安全針具立法五年後，安全針具的替換率以靜脈留置針最高達93.7%，但空心針及胰島素針的替換率則只有23.7%與31.0%。推估各年度全國各類針具針扎發生率，其中「所有針具」與「靜脈留置針」的針扎率顯示有逐年下降，但「空心針注射器」、「胰島素注射針」則呈現波動。相關性分析顯示安全針具替換率越高，針扎率越下降；其中靜脈留置針達顯著負相關（r=-0.99，p＜.001）。結論：雖然醫療法規定五年內醫療院所須全面提供安全針具，但事實上安全針具的使用雖有增加但部分類別卻仍然有限。安全針具替換率愈好與針扎率降低有關，未來應進一步了解未確實落實安全針具全面替換的原因，以利於政策的落實與進一步檢討。 Objectives: Analyse the correlation between changes in medical institutions' safety needle replacement rate and needlestick injury rate five years after the implementation of Article 56 of Taiwan's Medical Care Act. Methods: Using secondary data analysis, this study obtained needle usage data from the National Health Insurance Administration, Ministry of Health and Welfare during 2011-2016. Over the same period, needlestick injury incident data meeting inclusion criteria were sourced from the Chinese version of the Exposure Prevention Information Network database for analysis; the criteria are those data from hospital level institutions, those institutions which have reported data since 2011 and those institutions which persistently reported data during 2011-2016. With data from 36 institutions, it went further to estimate the needlestick injury rate among healthcare workers. Results: Five years after legislation was passed requiring hospitals to replace safety needles, the replacement rate for peripheral venous catheters reached 93.7%, whereas those for hollow needles and insulin injection needles were only 23.7% and 31.0%. Annual estimation of needlestick injury rates for various needle types in Taiwan indicated that needlestick rates for all needles and peripheral venous catheters have been declining but those rates for hollow needles and insulin injection needles are fluctuating. Correlation analysis revealed that higher safety needle replacement rates correspond to lower needlestick injury rates; notably, the peripheral venous catheter exhibited a significant negative correlation (r=-0.99, p＜.001). Conclusions: Although the Medical Care Act requires medical institutions to replace a full range of safety needles within five years of the implementation and the use of safety needles has indeed increased, their use in some categories remains limited. Better replacement rate of safety device was related to lowered injuries. Factors for incomplete implementation should be investigated in the future to facilitate further policy implementation and review.