安全針具導入對醫療人員尖銳物傷害之影響分析

Effect of safety-engineered device implementation on the risk of sharps injuries among health-care workers

目標：尖銳物傷害對醫療人員不僅帶來感染風險（如B型肝炎、C型肝炎、HIV等），也增加工作時的心理壓力，因此成為醫療院所職安管理的重要指標。為了降低尖銳物所造成的傷害並提供醫療人員更安全的工作環境，台北市某醫學中心自2012年起依衛福部規定分階段導入安全針具，本研究旨在評估導入安全針具後對醫療人員尖銳物扎傷樣態的影響。方法：本研究採回溯性分析，統計2012年1月至2023年12月某醫學中心員工尖銳物扎傷案件，並分析比較安全針具全面導入前後之差異，探討安全針具導入對扎傷事件之影響。結果：針對2012至2023年間共2,695件尖銳物扎傷事件的分析結果，導入安全針具後，整體扎傷率由2012年的3.18%降至2023年的1.59%，尤以年資未滿兩年人員下降幅度最為顯著。此外，針對特定醫療行為如注射及抽血的扎傷事件亦有明顯改善。然而，手術過程中扎傷事件佔總數比例逐年增加，使得開刀房成為主要發生地點，反映手術器械尚未安全化之現況。研究同時發現錯誤使用安全針具可能產生反效果，突顯持續教育訓練的重要性。結論：安全針具有效降低尖銳物傷害風險，未來應強化使用普及率及教育訓練，並聚焦於提高手術器械安全化與提升住院醫師於手術過程的防護能力，進一步降低醫療院所整體風險。

Objectives: Health-care workers are at a high risk of sharps injuries, which expose them to not only bloodborne diseases such as hepatitis B, hepatitis C, and HIV but also psychological stress at work. Thus, sharps injuries safety is a key indicator of occupational safety management in health-care facilities. To reduce sharps injuries and enhance workplace safety, since 2012, a medical center in Taipei has implemented safety-engineered devices, adhering to the regulations of Taiwan’s Ministry of Health and Welfare. This study investigated the effect of safety-engineered device implementation on the patterns of sharps injuries among health-care workers. Methods: This retrospective study analyzed sharps injuries among health-care workers at a medical center between January 2012 and December 2023. To evaluate the effect of safety-engineered device implementation on sharps injuries by comparing data before and after full adoption. Results: During the study period, 2,695 incidents of sharps injury were reported. The incidence of sharps injuries decreased from 3.18% in 2012 to 1.59% in 2023. Implementation of safety-engineered devices significantly reduced sharps injuries, particularly among health-care workers with less than two years of experience. In addition, sharps injuries related to specific medical procedures, including injections and blood collection showed notable improvement. However, the proportion of sharps injuries occurring during surgical procedures increased annually, identifying operating rooms as the leading locations of occurrence. This finding indicates that surgical instruments remain to be fully adapted for safety. Furthermore, improper use of safety-engineered devices led to adverse outcomes, highlighting a need for ongoing training and education. Conclusions: The implementation of safety-engineered devices effectively reduced the incidence of sharps injuries. To further reduce sharps injuries in health-care facilities, efforts should focus on increasing the adoption of safety-engineered devices, enhancing training, expanding the use of safe surgical instruments, and strengthening intraoperative protective measures for resident physicians.