北部某醫學中心醫療尖銳物扎傷與血液體液暴觸事件之調查分析

Analysis of Needle-stick Injury and Blood and Body Fluid Exposure in a Medical Center in Northern Taiwan

針頭和尖銳物刺傷（Needle-stick/sharp injury；NSSI）是醫療工作者常見的職業傷害，本研究目的是就北部某醫學中心工作人員，於2005年1目至2007年12月通報之醫療尖銳物扎傷個案共241人次，與血液體液暴觸共22人次，分析扎傷物品種類、扎傷時的醫療行為、原因及扎傷人員之B型肝炎病毒、C型肝炎病毒、人類免疫缺乏病毒及梅毒螺旋體之血清學反應，並定期追蹤扎傷後血清學變化之結果。3年期間，依職別每百人扎傷次數高低排序為實習學生（9.92）、護理人員（7.04）、醫師（3.05）、醫事技術入員（1.08）及清潔人員（0.97）;以工作年資排名，扎傷人員年資一年以下者佔最多（51.9%），每百人扎傷次數以1-2年為最高（6.61）；最常發生的地點為一般病房（47.7%）。扎傷物品以一般丟棄式注射針頭最多（51.5%），扎傷時醫療行為最常發生在整理或清洗器械（23.3%）;扎傷的原因以他人因素扎傷佔最多（19.9%），依次為整理或清洗器械（12.9%）及回套（12.0%）。血清學方面，遭B型肝炎病毒、C型肝炎病毒、入類免疫缺乏病毒及梅毒螺旋體感染者的血液意外暴觸者分別有38例、26例、4例及8例，追蹤均無血清陽轉情形。藉由研究的分析，簡化該院扎傷後之通報系統，及修訂看診流程，並加強工作人員遵守標準防護措施之教育宣導，以強化員工之自我保護能力，進而減輕傷害的發生。

Needle-stick/sharp injury (NSSI) is one of the most common occupational injuries among health-care workers (HCWs). We retrospectively analyzed the data of patients with NSSI who were admitted in a tertiary care medical center at northern Taiwan between January 2005 and December 2007. Among these patients, 241 sustained NSSIs with contaminated needles and 22 were exposed to infectious blood and body fluids. We further analyzed the causative species, medical behavior, and etiologies of the NSSI cases and followed up the serologic conversion of pathogens, including those of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Treponema pallidum, in these cases. The incidence of NSSIs among HCWs was the highest in trainees (9.92) followed by nurses (7.04), doctors (3.05), technicians (1.08), and housekeepers (0.97). In the above population, employees who had worked for less than a year accounted for 51.9% of the total number of infected HCWs. The most common site of NSSI occurrence was the general ward (47.7%). The most common material responsible for NSSIs was the single-used needle-stick (51.5%). The most common occurrence of NSSI was during sorting or cleaning medical devices (23.3%).The causes of NSSIs included injury caused by another person (19.9%), injury incurred during sorting or cleaning objects (12.9%) and recapping the needles (12.0%), etc. None of the HCWs showed seroconversion in the serology test at 6 months after the injury. To ensure the HCWs, safety, we enforced education and training for them. We also simplified the NSSI reporting system, followed-up the patients post-exposure, and introduced prophylactic measures.