| Objective:Medical and health institutions are high-risk workplaces for Occupational Bloodborne Pathogen Exposure(OBPE).The aim of this study is to analyze the current occupational exposure status of blood-borne pathogens,a typical biological hazard factor in medical and health institutions,as well as the current status of Occupational Safety and Health Management System(OSHMS)in such institutions.The study also eager to obtaining the viewpoints of health worker on the occupational safety and health status and management in this field,and to provide suggestions for the construction of the occupational safety and health management system in medical and health institutions.Methods:This study utilized a convergent parallel mixed-methods design in the selected sample hospital to investigate the occupational exposure status of bloodborne pathogens and the current state of OSHMS in it.The qualitative research component employed observation and interview methods,while the quantitative research component used a cross-sectional research design,collecting basic information on OBPE and the implementation of OSHMS through survey questionnaires,and evaluated institutional policies through quantitative assessment tools.Results:A questionnaire was distributed to 2181 health workers,with 984 responses received,yielding a response rate of 49.42%.The average score for the quantified assessment of occupational exposure protection intervention against bloodborne pathogens at the hospital was 720.33,which is below the good rating level of 800.There is still space for improvement in the existing system in terms of informing and communicating,cultivating a culture of occupational safety and health,taking preventive measures,following up and evaluating after occupational exposure to bloodborne pathogens,and auditing work.Regarding the evaluation of occupational safety and health culture,health workers are generally satisfied with the existing culture,but there are differences in the degree of recognition among health workers with different seniority,gender,and departments.Among the cultural construction evaluation sub-items,health workers had higher levels of recognition for "Participatory method action","Engineering preventive measures" and "Immediate response action" and lower levels of recognition for "Inclusion in performance evaluation," "Guaranteeing the accessibility of safety equipment," and"No-blame report." Regarding health workers’ knowledge of OBPE,the total score’s median was 8 points,with a median score of 7 points for the "Basic Knowledge" section,9 points for "Universal Precaution," and 8 points for "Standard Precaution." The knowledge scores with low correctness rates in "Basic Knowledge" were the "Hierarchy principle of risk control"(7.88%)and "Emergency handling measures after skin or mucous membrane exposure"(12.17%).The knowledge scores with low correctness rates in "Universal Precaution "were "prohibiting the mixing of infectious substances such as food and blood"(62.12%),"Prohibiting mouth-suction of blood and body fluids"(83.47%),and"Not handling contaminated sharp instruments without gloves"(82.08%).The knowledge scores with low correctness rates in " Standard Precaution" were "Placing contaminated sharp instrument boxes near the workstation"(6.44%)and "Daily cleaning and hygiene of the workplace are necessary to prevent bloodborne occupational exposure risks"(28.22%).Regarding OBPE incidents,the sample hospital’s OBPE incidence rate was 6.01%(9.55 times/100 person-year),with occupational exposure through needlestick and other sharp objects at 5.15%(6.87 times/100 person-year)and occupational exposure through damaged skin or mucous membranes at 2.36%(2.68 times/100 person-year).The incidence rate in outpatient and emergency departments(7.83%)was higher than that in other departments(5.75%),and there was no statistically significant difference between the two.Regarding the characteristics of OBPE,the main sites for needlestick injuries were hospital wards,operating rooms,and intensive care units.The main types of procedures were opening ampoules,recapping needles,and transporting sharps,and the types of sharps included ampoules,injection needles,and syringe needles.The main sites for percutaneous or mucous membrane exposure were inpatient wards and outpatient disposal rooms,and the main types of procedures were sorting,cleaning,transporting instruments,and opening veins.The risk resource were mainly blood or blood products,other liquids such as medications,rinses,and tissue fluids.When percutaneous or mucous membrane exposure occurred,58.33%of respondents wore single-layer gloves,29.17%wore non-protective clothing,and 16.67%did not wear any personal protective equipment.In terms of the causes of OBPE,they are mainly summarized as"Imbalance of consciousness,knowledge and behavior" "Inadequate accessibility,failure or new hazards of equipment and medical appliances" "Misuse of medical appliances" "Influence of psychosocial risk factors""Layout and Bad Ergonomics Design".As for prevention measures and services taking.the occupational health and safety knowledge training rate was higher with 96.03%.The hepatitis B vaccine coverage rate was 63.52%,suggesting more upside lies ahead.24.25%of health workers currently have no immunity to the hepatitis B virus,while 47.00%are unsure of their immune status.The hospital’s equipped personal protective equipment for all types had a rate of over 65%,and the rate of glove use during medical operations by health workers was 69.64%.while approximately 40%of health workers used inappropriate personal protective equipment,suggest more upside lies ahead of suitability.91.20%of the health worker thought that the head nurse or director of the department should be notified immediately after the occurrence of occupational exposure,and 44.55%thought that they should go to the designated infection specialist hospital for treatment after exposure.The Report and Record Rate for OBPE was only 16.85%.The main reasons for not reporting were fear of blame or criticism,occupational exposure caused by the worker’s own non-standard operations,not considering it necessary,negative results in patient serological tests,self-evaluation of low-level occupational exposure and risks,selfseeking treatment at another hospital,and the belief that reporting would lead to a series of troublesome processes.It was suggested that solving the reasons for underreporting and improve the reporting rate so as to provide a basis for taking targeted measures were necessary.Conclusion:The incidence of occupational bloodborne pathogen exposure in the hospital were low,but the underreporting rate was high,resulting in incomplete data and making it difficult to obtain an accurate understanding of the situation for targeted measures.It is urgent to establish an occupational safety and health management system in accordance with regulations and relevant technical guidelines.This system should implement risk management theories,advocate for a cultural value orientation that prioritizes the safety and health of workers,enhance the effectiveness of two-way communication of occupational safety and health information,further expand the scope and content of occupational safety and health knowledge training,and promote the effective operation and continuous improvement of the occupational safety and health management system. |
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