北京市三级甲等医院急诊科护士职业暴露与防护行为的现状调查

doi:10.3761/j.issn.0254-1769.2020.01.018

摘要/Abstract

摘要：

目的了解北京市三级甲等医院急诊科护士锐器伤、血液暴露及工作场所暴力3种职业暴露的发生状况及防护行为现状。方法便利抽取21所北京市三级甲等医院,依据每所医院急诊科排班整群抽取1组护士作为调查对象,采用自制问卷进行调查,问卷内容包括一般资料及锐器伤、采血过程中血液暴露、工作场所暴力的发生现状及防护行为,调查对象匿名填写问卷。结果共收集问卷1 150份,有效问卷1 102份,有效回收率为95.83%。在过去1年中,急诊科护士至少经历过1次锐器伤、采血中的血液暴露、语言暴力、身体暴力及性骚扰的发生率分别为37.8%、36.4%、68%、12%和5.3%;急诊科不同的工作区域,锐器伤（χ ²=16.805,P=0.010）、语言暴力（χ ²=98.509,P<0.001）、身体暴力（χ ²=79.916,P<0.001）发生率不同。在发生职业暴露的护士中,92.8%的护士在发生锐器伤后能够挤血,同时用流动水冲洗并消毒;69.8%的护士在采血过程发生血液暴露后能够冲洗暴露部位并消毒;在工作场所暴力发生时,41.3%的护士耐心解释,30.0%的护士忍让回避。3种职业暴露的上报率均较低（<30%）。结论急诊科职业暴露发生率相对较高,管理者需要重视急诊科的工作环境建设,加强采血过程和工作场所暴力的职业防护培训,同时增强对3种职业暴露的上报管理。

关键词: 职业暴露, 防护行为, 锐器伤, 血液暴露, 工作场所暴力, 急诊科, 横断面研究, 护理管理研究

Abstract:

Objective To understand the occurrence and protection status of three occupational exposures：needle-stick injury by nurses,blood exposure and workplace violence in the emergency department in tertiary hospitals in Beijing. Methods According to the schedule of the emergency department of each hospital,one group of nurses were selected from each hospital in 21 tertiary hospitals in Beijing to participate in the online survey. Self-designed online questionnaires were distributed and completed anonymously,including general information,the occurrence status and protective behaviors of needle-stick injury by nurses,blood exposure and workplace violence. Results A total of 1,150 questionnaires were collected,of which 1,102 were valid,with an effective rate of 95.83%. In the past year,the incidence rates of at least one needle-stick injury by emergency department nurses,blood exposure during blood collection,verbal violence,physical violence and sexual harassment were 37.8%,36.4%,68%,12%,and 5.3%,respectively. In different working areas at emergency department,the occurrence of needle-stick injury（χ ²=16.805,P=0.01）,verbal violence（χ ²=98.509,P<0.001） and physical violence（χ ²=79.916,P<0.001） were different. Among nurses with occupational exposure,92.8% were able to squeeze blood after needle-stick injury,flush with flowing water and disinfect;69.8% were able to flush and disinfect exposed parts after blood exposure in the process of blood drawing. Among nurses encountering workplace violence,41.3% explained patiently,and 30.0% adopted tolerance and avoidance. In addition,the reporting rate of all three types of occupational exposure was low（less than 30%）. Conclusion The incidence of occupational exposure in emergency department is relatively high. Nursing managers should attach importance to the construction of the work environment in emergency department,strengthen the training of pre-exposure protection in blood collection process and workplace violence,and strengthen the reporting and management of the three types of occupational exposure.

Key words: Occupational Exposure, Occupational Protection, Needle-Stick Injury, Blood Exposure, Workplace Violence, Emergency Department, Cross-Sectional Studies, Nursing Administration Research

郭金玉, 孙红, 刘颖青, 周文华, 葛宝兰, 王蕾. 北京市三级甲等医院急诊科护士职业暴露与防护行为的现状调查[J]. 中华护理杂志, 2020, 55(1): 107-112.

GUO Jinyu, SUN Hong, LIU Yingqing, ZHOU Wenhua, GE Baolan, WANG Lei. Investigation on occupational exposure and protective behaviors of nurses at emergency departments in tertiary hospitals in Beijing[J]. Chinese Journal of Nursing, 2020, 55(1): 107-112.

图/表 4

表1 急诊科各工作区域护士3种职业暴露发生情况比较[n=1 102,名（百分率,%）]

表2 锐器伤暴露特点及防护现状（n=417）

表3 采血中的血液暴露特点及防护现状（n=390）

表4 工作场所暴力暴露特点及防护现状（n=568）

参考文献 18

[1]	Gao XD, Hu BJ, Suo Y , et al. A large-scale survey on sharp injuries among hospital-based healthcare workers in China[J]. Sci Rep, 2017,7:42620.
[2]	Denis MA, Ecochard R, Bernadet A , et al. Risk of occupational blood exposure in a cohort of 24,000 hospital healthcare workers:position and environment analysis over three years[J]. J Occup Environ Med, 2003,45(3):283-288.
[3]	Wei CY, Chiou ST, Chien LY , et al. Workplace violence against nurses:prevalence and association with hospital organizational characteristics and health-promotion efforts:cross-sectional study[J]. Int J Nurs Stud, 2016,56:63-70.
[4]	Cho E, Lee H, Choi M , et al. Factors associated with need-lestick and sharp injuries among hospital nurses:a cross-sectional questionnaire survey[J]. Int J Nurs Stud, 2013,50(8):1025-1032.
[5]	Lo WY, Chiou, Huang N , et al. Long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan:a national survey[J]. Int J Nurs Stud, 2016,64:130-136.
[6]	封秀琴, 方萍萍, 张波 , 等. 我国三级甲等医院急诊医务人员锐器伤发生现状与对策分析[J]. 中华医院感染学杂志, 2017,27(14):3335-3338.
[7]	陈瑜, 许妹仔, 张珊 . 综合性医院护士遭受工作场所暴力的现状调查[J]. 解放军护理杂志, 2018,35(10):15-19.
[8]	Bennett NT, Howard RJ . Quantity of blood inoculated in a need-lestick injury from suture needles[J]. J Am Coll Surg, 1994,178(2):107-110.
[9]	顾莺, 胡雁, 张凤 . 安全型静脉留置针对医务人员防护效果的meta分析[J]. 中华护理杂志, 2015,50(4):394-399.
[10]	Hassankhani H, Parizad N, Gacki-Smith J , et al. The conse-quences of violence against nurses working in the emergency department:a qualitative study[J]. Int Emerg Nurs, 2018,39:20-25.
[11]	Howerton Child RJ, Sussman EJ . Occupational disappointment:why did I even become a nurse?[J]. J Emerg Nurs, 2017,43(6):545-552.
[12]	姜永梅, 许永进, 商玲 , 等. 急诊护士血源性职业暴露状况及风险防范[J]. 中华医院感染学杂志, 2013,23(11):2714-2716.
[13]	张艳霞, 毕岐勇 . 采血护士标准预防认知和行为依从性分析[J]. 北京医学, 2018,40(6):582-585.
[14]	邸红军, 施月仙, 臧红新 , 等. 医务人员针刺伤预防策略的最佳证据总结[J]. 中华护理杂志, 2017,52(1):93-98.
[15]	黄菲菲, 陈欣彦, 蔡红 , 等. 合作性学习案例在护理本科生安全与职业防护课程中的应用[J]. 中华护理教育, 2019,16(8):598-602.
[16]	聂圣肖 . 北京市三级综合医院病房护士针刺伤发生现状及其影响因素的研究[D]. 北京:北京协和医学院, 2012.
[17]	马冬梅, 周杏仙, 王芳 . 助产士职业暴露调查中低报告现象分析[J]. 中华护理杂志, 2006,41(4):328-329.
[18]	徐敏, 熊薇, 赖晓全 , 等. PDCA降低医务人员血源性职业暴露发生率的效果研究[J]. 中华医院感染学杂志, 2018,28(18):2861-2864.