醫院工作人員尖銳物品扎傷之綜論

Review and Analysis of Literature Related to Needlestick and Sharps Injuries among Hospital Staff

回顧國內外尖銳物品扎傷相關文獻發現，扎傷對象以醫師及護理人員為最常見二大族群，其中醫師又以外科系醫師最常見。醫療人員不當處理尖銳廢棄物易導致洗衣工、清潔員扎傷的機率增加。尖銳物扎傷時機常見於執行侵入性治療，其他如針頭回套、以手──手傳遞手術刀或縫合針、隨手棄置尖銳廢棄物造成其他人員的誤觸。近年醫院努力推動針頭不回套及教育訓練，使該原因發生之扎傷事件已有顯著下降，反而人員處理已用畢之針頭被扎傷的現象逐漸浮出抬面，針扎防治重點開始轉變為針具安全性等議題。此外，醫療照護人員對於暴露於針扎後血（體）液傳染風險警覺性不足，書於通報及暴露後追蹤，且暴露後B型肝炎疫苗完注率偏低，容易導致醫療照護人員與病人之間交互感染。臨床實務上，學者專家提出預防尖銳物扎傷方法包括，1.定期教育，工作人員操作尖銳物品應該保持高度警覺心，集中注意力直到治療結束、處理完尖銳廢棄物；2.嚴格執行全面性防護措施，藉由落實人員遵從標準作業程序，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；3.提供隨手可得的尖銳物回收盒、提供安全設備及環境；4.重視針頭不回套或單手套針，醫療機構應主動提供安全針具朝向無針式，或回收容器應輕巧易攜帶的方向改善；5.簡化針扎通報及處理流程，提升針扎者通報意願及強化接受追蹤行為，增加暴露血（體）液後防範之完成率。

Needlestick and sharps injury among healthcare workers is a public health issue that cannot be neglected. The purpose of this study was to understand the causes of needlestick and sharps injuries among healthcare workers by analyzing the timing of these events and affected persons. A review of the relevant literature on needlestick and sharps injuries from domestic and foreign sources revealed that physicians and nursing staff are the two major groups that are vulnerable to needlestick and sharps injuries. Further, surgeons are the most susceptible sub-group among physicians. The occurrences of needlestick and sharps injuries are often observed during the performance of invasive treatments. Other incidents include needle recapping, hand-to-hand passing of scalpels or suture needles, and accidental stabbing of other personnel by improperly disposed sharps wastes. Needlestick and sharps injuries triggered by these causes have decreased significantly owing to institutional efforts to discourage needle recapping and augment staff training. However, the phenomenon of sharps injuries from used needles handled by staff began to surface, leading to shifts in needlestick injury prevention to emphasize sharps-related safety. Furthermore, the lack of awareness in postexposure risks to infection from blood and body fluids after needlestick pricks, neglect in reporting and postexposure follow up, and lower postexposure hepatitis B vaccination by the healthcare personnel can easily cause cross-contamination between the medical staff and patients.