| Objective:To explore the epidemiological characteristics and related factors of needle stick injury based on the hospital reported sharp injury data of medical staff from Hospital infection monitoring system,in combination with the epidemiological investigation of regional clinical medical personnel,so as to provide relevant basis for the prevention and control of clinical sharp instrument injury.Methods:1.Based on the sharp injury data of medical staff reported by the hospital's hospital infection monitoring system,we analyzed 2246 cases of sharp injury from a third-grade hospital in Qingdao from January 1,2012 to December 31.2.By convenient sampling,a questionnaire survey was conducted among the various departments'medical staff who have contact with the sharp operation in the daily operation,including medical,nursing,and technical personnel(including interns and committee students).Epidata was used to create a database and double entry was used to ensure data accuracy.Descriptive analysis was used to describe the basic information of medical staff,the occurrence of sharp injuries,the department and the main instruments causing sharp injuries,the degree of sharp injury and the outcome,and the prevention and control costs after blood-based occupational exposure.The numerical variables were expressed as meanąstandard deviation,and the categorical variables were expressed as frequency and percentage.The high risk factors of needle stick injury were analyzed by?~2 test and multivariate logistic regression.P<0.05 was considered statistically significant.Statistical analysis was performed by SPSS 17.0software.Results:(1)HIS system sharp injury report cases from 2012-2017:Medical staff sharp injury exposure occurs mainly in arteriovenous needle removal(24.31%),needle into the sharps box(18.57%),surgical needle(13.40%),During drug preparation(9.14%),intravenous injection(7.79%),etc.(2)Medical staff with the highest frequency of sharp injury occurred in the general ward(44.35%),followed by emergency room(16.65%),static matching center(3.38%),infusion room(3.34%),specimen collection department(2.80%).(3)Infusion set steel needle(44.84%),surgical needle(10.51%),intravenous indwelling needle(8.59%),vacuum blood collection needle(8.33%),glass fragments(2.54%)are the main medical instruments causing sharp injuries to medical staff.(4)The injuries caused by sharp instruments were mainly mild cases,which accounted for 95.09%of the total cases;flowed by moderate cases(3.47%)and severe cases(0.53%).(5)The incidence of sharp injury in different professional titles was significantly different.The people with higher titles paid more attention to the prevention of sharp injury,the more difficult to occur sharp injury.Among them,the incidence of sharp instrument injury was 30.94%in primary title;10.90%in intermediate title;3.70%in deputy senior title;5.13%in high title.(6)The incidence of sharp instrument injury is not the same in different working years.Medical staff with short working years are more likely to have sharp instrument injury than those with long working years.The incidence of sharp injury was 8.62%for 20 working years;8.15%for 15-20 working years;19.54%for 10-15 working years and 19.77%for 5-10working years.For those with less than 5 years of service,the incidence of sharp injury was31.86%.(7)Medical workers with less education are more likely to have sharp instrument injury.Among them,the incidence of sharp instrument injury was 34.05%for junior college degree and below,18.38%for bachelor degree,12.74%for master degree and 4.82%for doctor degree.(8)The working environment has a great impact on the sharp instrument injury.The sharp instrument injury is not easy to occur under the condition of spacious and bright working environment,and the incidence rate of that condition is 11.46%.Under the condition of moderate operating environment,the incidence of sharp instrument injury was18.06%.The incidence of sharp instrument injury was 34.67%when the operating environment was not bright.There were statistically significant differences in the incidence of sharp instrument injuries in different operating environments under crowded operating environments.(9)The wearing of gloves had no significant effect on the occurrence of sharp instrument injury.Without gloves,the incidence of sharp instrument injury was 20.96%.Wearing single layer gloves,the incidence of sharp instrument injury was 22.22%.Wearing double gloves,the incidence of acute injury was 29.69%.(10)Occupational protection knowledge has a great influence on the occurrence of sharp instrument injury.The incidence rate of sharp instrument injury was 12.27%for medical staff who participated training on knowledge of hospital infection and was able to master relevant knowledge.The incidence of sharp instrument injury was 33.02%for those with basic knowledge of occupational protection and other knowledge training.The sharp instrument injury occurred in 37.72%of those who had little or no occupational protection knowledge training and had not mastered relevant knowledge.(11)Multi-factor logistic regression analysis was carried out to analyze the incidence of sharp instrument injury in medical staff.Statistical significance is testified in the following independent variables:Nurses are more susceptible to sharp injuries than other occupational categories(OR=0.53,95%CI:0.35-0.82),Women are more susceptible to sharp injuries than men(OR=0.31,95%CI:0.22-0.45),staff with low-ranking titles are more likely to get sharp injuries than their senior professional colleagues(primary:OR=2.34,95%CI:1.19-4.63;middle:OR=1.87,95%CI:1.21-2.86;secondary senior:OR=1.57,95%CI:0.70-3.50),staff with shorter working time are more likely to get sharp injuries than those working for>20years,(<5 years:OR=10.05,95%CI:2.70-38.80;5-10 years:OR=6.52,95%CI:2.24-19.01;10-20 years:OR=2.62,95%CI:1.30-5.29),increased risk of sharpness in the bad operating environment(moderate:OR=2.68,95%CI:0.53-13.70;not brightly:OR=7.07,95%CI:1.59-31.42;crowded:OR=8.93,95%CI:2.96-26.91),medical staff lack of occupational exposure protection knowledge are more likely to get sharp injuries(basically known:OR=2.04,95%CI:1.13-3.68;basically unknown:OR=7.50,95%C:1.13-20.50).(12)The prevention and control costs of occupational exposure of blood-borne pathogens were analyzed.A total of 65 people were tested and treated.The cost of prevention and control(laboratory inspection fee add.treatment fee)totaled26702.57 Yuan,with an average cost of 410.81 Yuan per case.Among them,the average cost after HIV exposure was 907 Yuan;average cost after HCV exposure was 264.25 Yuan;HBV exposures were the most frequent with 32 cases,and the average cost was 453.03 Yuan;after syphilis exposure,the average cost per case was 289.83 Yuan;the average cost after unknown exposure is 341.67 Yuan.(13)Questionnaire survey showed that the main causes of sharp instrument injury were:unskilled operation,stress and other reasons of medical personnel(37%);failure to operate according to the operation rules(25%);others(13%);rescue of patients(12%);patients do not cooperate(7%);Poor medical cooperation(6%).(14)Field questionnaire survey showed that medical staff did not report the sharp instrument injury according to the requirements mainly as follows:the safety awareness was not enough(37%);Uncontaminated appliances(25%);Have the fluke psychology that the degree of injury is light;or think oneself has antibody,which has less probability to cause cross infection(19%);report procedure is troublesome(9%);Lack of identification of source of infection,and low awareness of prevention(6%);others(4%)Conclusion:The results of this study show that there are differences in the occurrence of sharp injuries in different categories of medical practitioners,and the economic burden of exposure to blood-borne pathogens should not be underestimated.Risk factors for sharp injuries include occupational category,job title,gender,working years,operating environment and protection training.Hospitals should take prevention and control measures for medical staff,especially for high-risk groups,including a sound management system,strengthen safety supervision and environmental management,rational allocation of human resources;strengthen occupational safety training,improve prevention awareness;standardize operational behavior,improve protective skills Create a blood-borne pathogen occupational exposure protection culture. |
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