云南省医务人员职业暴露及其规范化管理路径的多中心研究

A multi-center study on exploration of standardized management pathways for occupational exposures among health care workers in Yunnan Province

  • 摘要: 目的 调查医务人员职业暴露的现状、处置管理及心理应激变化,探讨建立医务人员职业暴露规范化管理路径,尝试引入心理干预的必要性及可行性。方法 采用整群抽样法,选取2023年1月-2024年9月云南省9家各级医疗机构代表医院的540名职业暴露医务人员为调查对象,分析职业暴露发生情况、暴露特征及暴露时心理评估情况,并将广泛性焦虑障碍-7(GAD-7)和患者健康问卷-9(PHQ-9)总分≥10分的106名职业暴露人员分层随机为心理干预组和对照组各53人,分析两组人员干预前后的心理变化。结果 医务人员职业暴露发生于省级三甲医院的最多(74.26%); 以<30岁(67.96%)、女性(77.04%)、本科学历(67.22%)及本院职工(58.33%)为主; 护士比例最高(36.67%); 外科(37.41%)和病房(52.04%)最高发; 锐器伤(80.37%)最多; 手部暴露(82.22%)及拔针操作(34.26%)最常见; 暴露源以乙型肝炎病毒(HBV)为主(36.30%); 暴露前大部分人员接受过≥3次相关培训(61.48%),并且能够完全掌握相应处置方法(53.33%); 暴露后出现少许焦虑的人最多(46.48%); 并且觉得有必要进行适当心理干预(35.00%)。职业暴露人员心理干预结果显示,干预组在暴露后1周和3个月的心理状态评分均优于对照组(P<0.05)。结论 采用规范化管理路径进行医务人员职业暴露处置及监测管理是可行且有效的,同时将个性化心理干预纳入规范化管理路径可有效改善医务人员因职业暴露而产生的不良心理反应。

     

    Abstract: OBJECTIVE To investigate the current status,management practices and change of psychological stress of the health care workers with occupational exposures, explore standardized management pathways for occupational exposures and evaluate the necessity and feasibility of introducing psychological interventions. METHODS A total of 540 health care workers with occupational exposures who represented 9 various grades of metical institutions of Yunnan Province were recruited as the research subjects by using cluster sampling method from Jan. 2023 to Sep. 2024. The incidence of occupational exposures, features of exposures and psychological assessment were observed. The 106 health care workers with generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) total score no less than 10 points were stratified randomly as the intervention group with 53 cases and the control group with 53 cases. The psychological changes of the two groups of subjects were analyzed before and after the intervention. RESULTS There were most occupational exposures among the health care workers of the three-A hospitals (74.26%). The health care workers aged less than 30 years old(67.96%), female health care workers(77.04%), the health care workers with bachelor degree(67.22%) and workers of the hospital (58.33%) were dominant among the health care workers with occupational exposures. The proportion of nurses was highest(36.67%). The occupational exposures were most prevalent in surgery department(37.41%) and wards(52.04%). The sharp instrument injuries were dominant. The exposure to hands(82.22%) and withdrawal of needles (34.26%) were most common. The exposure source was dominated by hepatitis B virus (HBV)(36.30%). Most of the health care workers (61.48%)accepted no less than 3 times of trainings before the exposures and completely mastered the corresponding disposal measures(53.33%). The health care workers who had a little anxiety after the exposure were the most(46.48%), and 35.00% thought that appropriate psychological interventions were necessary(35.00%). The result of the psychological intervention to the health care workers with occupational exposures showed that the psychological state score of the intervention group was better than that of the control group after the exposure for 1 week and 3 months (P<0.05). CONCLUSIONS It is feasible and effective to adopt standardized management pathways for the disposal and surveillance management of occupational exposures in the health care workers. Integrating the standardized management pathways with individualized psychological intervention can effectively improve the adverse psychological reactions of the health care workers due to occupational exposure.

     

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