使用真空採血器降低護理人員針扎及減少檢體溶血率之成效

Effects of Implementing the Vacutainer System on Reducing Needlestick Injuries in Nurses and Hemolysis during Blood Collection

尖銳物扎傷造成血液體液意外暴觸是護理人員常見的職業危險，而無針式醫療設備是目前醫院降低醫療人員意外暴觸的安全設備。本研究描述南部某醫學中 心護理人員2006～2009年發生針扎的情形，因2009年推行使用真空採血器抽血 介入措施，故比較介入措施前後護理人員針扎發生率及檢體溶血率的差異。結果發現977位護理人員因一般注射針頭發生扎傷共139人。依照單位護理人員使 用真空採血器的程度，分為未使用組、部分使用組以及完全使用組。發現完全使用真空採血器組的護理人員針扎發生率(0.00‰)顯著低於未使用(0.08‰)及部 分使用真空採血器組(0.15‰)(p<0.01)。完全使用真空採血器組的檢體溶血率 (0.23％)也顯著低於未使用(0.94％)及部分使用真空採血器組(0.62％) (P<0.01)。雖然在醫院推行真空採血器前後，護理人員整體的針扎發生率並無顯著差異，甚至整體的檢體溶血率反而有顯著上升的情形，但在推行使用真空採血器之後，使用真空採血器的頻率越高者，其護理人員的針扎發生率及單位的檢體溶血率越低。鑒於護理人員因針扎感染血液傳染性疾病，以及血液暴觸後人員遭受被感染的身心雙重壓力，加上安全針具的衛材成本較高，建議未來的研究能進一步評估使用無針式醫療設備的成本效益，以符合當前醫療機構的成本管理。

Needlestick and sharp injuries (NSI) are among the most significant occupational injuries for nurses. In the proposed study, the NSI incidents and events that occurred among nurses during the period from 2006-2009 were described, and the differences in the NSI incident and hemolysis rates after implementing Vacutainer systems were compared. A before-and-after intervention trial was conducted comparing the 3-year pre-intervention (2006-2008) period with the 1- year post-intervention (2009) period. The results showed 977 nurses with 139 events due to general needle stick injuries during 2006-2009. The units were divided into 3 groups according to the frequency of vacuum blood collection device use, no Vacutainer system use, partial Vacutainer system use, and full Vacutainer system use. The incidence of nurse needlestick injury with full Vacutainer system use (0.00‰) was significantly lower than both no (0.08‰) and partial Vacutainer system use (0.15‰) (χ2 = 15.23; p < 0.01). In addition, the hemolysis rate of blood samples with full Vacutainer system use (0.23%) was significantly lower than no use (0.94%), and partial Vacutainer system use (0.62%) (χ2 = 26.17; p < 0.01). The study found that both the incidence of nurse needle-stick injuries and the hemolysis rate of blood samples were reduced with full Vacutainer system use.