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国际安全中心警示医务人员面临的病原体暴露风险
检索丨刘金淑濮阳市油田总医院 翻译丨孔晓明溧阳市人民医院 审核丨刘金淑 濮阳市油田总医院 陈志锦 东莞市厚街医院 国际安全中心是全球职业研究和倡导安全工作场所的领导者，近期发布了防疫信息网络（EPINet）2015美国医院监测数据。EPINet为医疗保健机构提供了一个标准化系统，用于追踪将医务人员置于危险中的职业暴露。该中心还发布了一份新的共识声明和行动呼吁，其中记录了传统医务人员制服在病原体传播中的作用，并强调了需要解决医务人员遇到的高暴露风险和疾病。 EPINet监控系统包括针刺伤、锐器伤及血液和体液暴露的职业暴露报告。与2014年相比显示，2015年参与的医院中，伴随着安全器具的使用意外减少，培训医生（正式和实习生）的针刺伤和锐器伤明显增加，其中手术室受伤总体持续增加。 2015年的数据显示，患者和检查室发生血液和体液喷溅、飞溅的比例大于过去几年，近三分之二喷溅到医务人员的的眼睛。更令人震惊的是，当中只有不到7％的暴露者佩戴了防护镜。 该中心首席信息官兼副主任Ginger Parker说：“虽然2015年EPINet数据表明，医务人员的病原体暴露风险正在上升，但也表明医务人员越来越意识到这些风险是可以预防的。2014年，受伤或暴露的医务人员中，只有约30％的人认为技术装备控制、其他技术或改变行政工作做法能防止伤害。然而，2015年几乎有一半（48.7％）的锐器伤暴露者和超过三分之二（68.6％）的血液体液飞溅暴露者认为暴露是可以预防的。” 国际安全中心总裁兼执行董事Amber Mitchell博士说：“这些EPINet的结果应该能唤醒许多关心医务人员和患者安全的医疗机构。因为这些数据显示了锐器伤和体液暴露风险的增加，可能会将病原体传播给医务人员，潜在危及医务人员本身、患者及医务人员的家属。影响造成广大公众的血源性传播病原体的流行率越来越高，突显了保护医务人员在提供日常治疗时避免意外暴露的加重要，如丙型肝炎和新兴传染病寨卡。好的一面则是，医务人员对器具保护和工作场所保护措施的认识逐渐提高，并寻求管理层进行必要的调整，以帮助他们拥有更安全的工作环境。” 美国职业安全与健康管理局（OSHA）医疗办公室前主任Elise Handelman，目前是中心的一名教员，他指出：“25年前，当我们第一次开始考虑减少血源性传播病原体时，我们知道问题超出了艾滋病毒和慢性肝炎感染范畴。我们现在比以往任何时候都清楚，暴露风险正在不断转换和变化。只有减少血液暴露的方法普及了，包括使用更安全的医疗设备和个人防护装备（PPE），才能应对我们在埃博拉、疟疾、寨卡和其他血源性疾病方面面临的挑战。EPINet的数据帮助我们了解最大风险在哪些地方，并让我们将资源集中在最有效之处。” 这份关于改善有血液、体液和其他生物危害暴露风险工作人员工作服的共识声明和行动呼吁，强调需要解决医务人员遇到的高风险伤害和疾病。它提供的数据记录了传统医务人员制服在病原体传播中的作用，并提出了采取行动的呼吁，以提高对医务人员暴露于危险体液的国家紧迫感。它还力求确定实施PPE和主动屏障服装等新技术的一致性操作标准的最佳途径。 《共识声明》指出，2010年-2014年的EPINet数据显示，涉及体液喷溅、飞溅的职业暴露，大约70％被血液污染。然而，超过40％的暴露者表示，他们在暴露时穿着日常服装、非防护服或普通制服，只有17％穿着防护服。《共识声明》还指出，这些数据为实施创新性方法留下了很大的空间，以减少可能导致的风险及任何损害。 Mitchell补充说：“该中心的一个关键目标是将不同的利益相关者聚集在一起，以确定和记录可行的医务人员安全问题，并利用他们的专长、领导力和影响力来实现积极的变化。该《共识声明》工作组做了大量的工作，旨在更好地保护工作人员免受疗环境中无处不在的血液和体液意外暴露。保护工作人员免受意外暴露的改进措施和新技术越来越多，我们期待与其他组织合作，支持医疗机构解决这一重要问题。” 原文 InternationalSafety Center Highlights Pathogen Exposure Risks Faced by Healthcare Workers The International Safety Center, aglobal leader in occupational research and advocacy for safer workplaces, todayannounced the release of EPINet 2015 U.S. hospital surveillance data. EPINet®(the Exposure Prevention Information Network) provides healthcare facilitieswith a standardized system for tracking the occupational exposures that puthealthcare staff at risk. The Center also announced availability of a new Consensus Statementand Call to Action, which documents the role conventional healthcare workeruniforms play in the spread of pathogens and highlights the need to address thehigh rate of exposures and illness experienced by healthcare workers.
The EPINet surveillance system includes employee incident reports onNeedlestick and Sharp Object Injuries and on Blood and Body Fluid Exposures.Compared to 2014, in 2015 participating hospitals reported a marked increase ininjuries from sharps and needlesticks to training physicians (residents andinterns) and an overall increase in injuries sustained in the operating room,along with an unexpected decrease in the use of safety-engineered medicaldevices.
For blood and body fluid splashes and splatters, the 2015 data show that agreater proportion are occurring in patient and exam rooms than in years pastand almost two-thirds involved workers’ eyes. These data are especially alarmingbecause fewer than 7% of the workers involved with those exposures reportedthat they were wearing eye protection.
“Whilethe 2015 EPINet data suggest that pathogen exposure risks to healthcare workersare on the rise, they also indicate that workers are increasingly aware thatthese exposures are preventable,” said Ginger Parker,the Center’s chief information officer and deputydirector. In 2014, only about 30% of injured or exposed healthcare workers saidthat they felt the injury could have been prevented by engineering controls orother technologies, or by changes in administrative work practices. Incontrast, in 2015 almost half (48.7%) of workers reporting sharps injuries andmore than two-thirds (68.6%) exposed to blood and body fluid splashes indicatedthat they thought the exposures were preventable.
“TheseEPINet results should be a wake-up call to the many healthcare institutionsconcerned about worker and patient safety. The data show rising exposures tosharps and body fluids that can transmit pathogens to healthcare workers,potentially endangering them, their patients and their families,” said Dr. Amber Mitchell, president and executive director of theInternational Safety Center. “The growing prevalence offluid-borne infectious organisms affecting the general public, such ashepatitis C and emerging infectious diseases like Zika, highlights theimportance of protecting workers from the unanticipated exposures theyencounter while providing routine care. The good news is that workers aredemonstrating a high degree of awareness of the value of protective productsand workplace measures, and are looking to management to make the changesnecessary to help them achieve a safer working environment.”
Elise Handelman, former director of the Office of Nursing at the U.S.Occupational Safety and Health Administration (OSHA) and currently a Centerfaculty member, notes, “When we first began looking atreducing the transmission of bloodborne pathogens 25 years ago, we knew theproblem went beyond HIV and chronic hepatitis infections. We are aware now,more than ever, that exposure risks are continually shifting and changing. Onlya universal approach to reducing blood exposures, including the use of safermedical devices and personal protective equipment (PPE), can meet thechallenges we face with Ebola, malaria, Zika and other bloodborne diseases. TheEPINet data help us understand where the greatest risks are occurring and allowus to focus resources where they will be most effective.”
The Consensus Statement and Call to Action on Improving Work Wear for Workersat Risk of Exposure to Blood, Body Fluids, and Other Biologic Hazardshighlights the need to address the high rate of injuries and illnessexperienced by healthcare workers. It presents data documenting the roleconventional healthcare worker uniforms play in the spread of pathogens andincludes a call to action to increase the national sense of urgency abouthealthcare worker exposures to dangerous body fluids. It also seeks to determinethe best path forward for implementing consensus performance standards for PPEand new technologies such as active barrier apparel.
The Consensus Statement pointed to EPINet data from 2010-2014 indicating thatabout 70% of all reported occupational splash or splatter exposures involvingbody fluids were contaminated with blood. Yet more than 40% of the affectedworkers indicated that they were wearing everyday clothes or non-protectivescrubs or uniforms during the exposure, and only 17% were wearing a protectivegown. The Consensus Statement noted that these data leave a great deal of roomfor implementation of innovative approaches to reduce exposure and any harmthat might result.
Mitchell added, “Akey goal of the Center is to serve as a catalyst bringing together diversestakeholders to identify and document actionable healthcare worker safetyissues and to leverage their expertise, leadership and influence to bring aboutpositive change. This Consensus Statement working group did a tremendous job ofmaking the case for better worker protection from the unexpected blood and bodyfluid exposures that are ubiquitous in healthcare settings. Improved practicesand new technologies designed to protect workers from unanticipated exposuresare increasingly available, and we look forward to working with otherorganizations to support healthcare institutions’initiatives to address this important issue.”
The Consensus Statement and Call to Action was formulated by representativesfrom the American Federation of Teachers, AFL-CIO, Service EmployeesInternational Union, Association of Federal Government Employees, HealthcareSurfaces Summit and Association for the Healthcare Environment. The effort wassupported by an unrestricted educational grant from Vestagen ProtectiveTechnologies, Inc.
About EPINet®
The EPINet surveillance system gives healthcare facilities standardized toolsto:
Track occupational Sharp Object Injuries and Blood and Body Fluid incidents. Prevent occupational injuries andillnesses.
Reduce exposures to microorganisms that cause infectious disease, illness andinfection. Reduce costs and improve quality.
Since its introduction in 1992, EPINet has been distributed to over 1,500 U.S.hospitals and to hospitals in 95 countries. Sharps injury and blood and bodyfluid exposure data from participating healthcare facilities is collected on anannual basis, merged into an aggregate database and analyzed using EPINetsoftware. Participating hospitals vary in size, geographic location and teachingstatus. Access to the EPINet system is offered to healthcare facilities aroundthe world free of charge. For more information, visitinternationalsafetycenter.org/use-epinet/.
Source: International Safety Center 图文编辑：宋小船 审稿：陈文森 卢先雷
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