標準防護與預防醫療職業的暴露－－以血液暴露為例

Standard Precautions and Exposure-A Case Study of Exposure to Blood

標準防護（Standard precautions）是健康照護者預防職業暴露（exposure）（因工作時被愛滋病毒、B型肝炎病毒、C型肝炎病毒和其他血液傳染性病原體的傳播）的最佳措施。健康照護者經由血液暴露或被體液污染的針頭扎傷，進而造成血源性病原體感染的風險度雖不一致，但健康照護者的任何損失均會造成負面影響。有很多因素使醫院工作者無法確實執行標準防護措施，包含硬體環境、醫院工作者人力不足、知識、態度、認知等，醫療單位提供足夠的人員和物資，以及各層級的醫務工作者採標準防護措施，措施包含：手部衛生、手套、臉部防護措施、隔離衣預防針扎和其他預防尖銳傷器具等。所有的醫護人員應接種B型肝炎疫苗，發生職業暴露後，應先評估傳播風險，並提供暴露後的預防策略。經歷過HIV職業暴露的人員應接受輔導，重點放在後續的照顧，提供職業暴露的醫療人員對感染的風險和暴露後的預防性投藥（Post-exposure prophylaxis, PEP）的風險和效益提問，不論何種方式的職業暴露所造成的心理影響是不可低估的，應提供心理諮詢。

Standard protection is the best measure for protecting healthcare providers from exposure to HIV, hepatitis B virus, hepatitis C virus, and other blood-borne pathogens. Healthcare providers who are exposed to blood or contaminated body fluids are easily infected by these pathogens. Although infection does not always occur, the medical care system is impacted if any healthcare provider is lost due to exposure. Many factors influence healthcare providers’ poor conformance with standard protective measures, including the hospital environment and worker knowledge, attitudes, and understanding. Medical units should provide adequate staff and supplies, and each healthcare worker should take appropriate precautions, including hand hygiene, glove use, face protection measures, gown use, and precautions to prevent needle and other sharp instrument injuries. All healthcare workers should also be vaccinated against hepatitis B virus. After exposure, we should estimate the risk of transmission and provide post-exposure transmission strategies. Individuals suffering from HIV exposure should receive counseling, with a focus on follow-up care. We can provide these individuals with risk data, information about the effect of PEP, and help to resolve their concerns. The psychological impact of exposure cannot be underestimated.