台灣醫療人員的針扎問題
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台灣醫療人員的針扎問題 - 流行病學、國際經驗與防治現況 PowerPoint PPT Presentation


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台灣醫療人員的針扎問題 - 流行病學、國際經驗與防治現況. 台大醫學院護理學系所 醫療人員安全衛生中心 蕭淑銖 (RN; PhD). 台灣醫學教育學會 2010.04.24. Healthcare workers. Working in healthcare environment But not necessarily in healthy environment. 臺灣針頭與銳物扎傷,體液、血液暴觸長期研究架構. 醫護人員針扎傷害 – 與國際同步之通報系統. Chinese EPINet.

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台灣醫療人員的針扎問題 - 流行病學、國際經驗與防治現況

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台灣醫療人員的針扎問題-流行病學、國際經驗與防治現況

台大醫學院護理學系所

醫療人員安全衛生中心

蕭淑銖 (RN; PhD)

台灣醫學教育學會

2010.04.24


Healthcare workers

Healthcare workers

  • Working in healthcare environment

  • But not necessarily in healthy environment


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臺灣針頭與銳物扎傷,體液、血液暴觸長期研究架構


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醫護人員針扎傷害 –

與國際同步之通報系統

Chinese EPINet

Center for Medical Employee Safety & Health (C-MESH)


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Standardized surveillance system by Reporting to

C-MESH

網址:

http:// epinet.cmesh.org.tw

C-MESH:

Center for Medical Employees’ Safety and Health

Many times of modifications

and LOTS of COMMUNICATION!!


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  • 截至2009年12月09日為止,通報了2,924件針頭或尖銳物扎傷意外事件,154件血液體液暴觸事件,共3,078件醫療工作意外事件。

  • 合作醫院之職業類別人數分佈


Annual number of percutaneous injuries by number of healthcare workers

Annual number of percutaneous injuries by number of healthcare workers

#NSI = 6.9 + 0.034 * #HCWs. R2 = 0.67. P=0.0003


Annual number of percutaneous injuries by patient days cared

Annual number of percutaneous injuries by patient-days cared

#NSI = 8.5 + 2.2 * #[10,000 patient-days cared]. R2 = 0.79. P<0.0001


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3.19

8,286

CMESH-醫療人員安全衛生中心


Percutaneous injuries pcis among the participating hospitals and the estimated pcis for taiwan

Percutaneous Injuries (PCIs) Among the Participating Hospitals and the Estimated PCIs for Taiwan

(Shiao et al., RINAH 2008)


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Incidence of individual kinds of needles in Taiwan


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回函

一、醫療人員安全衛生中心之中文版EPINet針扎監控系統所得資料,可統計醫療院所各項針型之扎傷率,亦可推算全國各項醫療人員針扎及血液體液暴觸之危險性。以一年期間參與通報之15家醫院,總員工數8714位,被靜脈留置針扎傷而通報者共計13件。若以全國醫療人員總數192,611員推算,則全國一年間有287次醫療人員被靜脈留置針扎傷。

二、由於通報率難以逹到百分之一百,以上估計的扎傷率為低估,亦即全國真正扎傷率,應遠高於每年287次。

三、靜脈留置針是直接與血液接觸的醫療器材,均為患者血液污染性針頭,因此其傳染病毒性肝炎、AIDS等經血液傳染疾病之風險高。以國內可經血液傳染疾病盛行率而言,住院患者16.7%有B型肝炎之帶原(其中感染性特強的HBeAg陽性血液1.7%);且有12.7%之C肝帶原率。因此推算全國每年有超過84位之醫療人員被具傳染性之靜脈留置針扎傷


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全民健康保險特殊材料給付規定


Mechanisms of percutaneous injuries

Mechanisms of Percutaneous Injuries

(Shiao et al., RINAH 2008)


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Incidence of contact with contaminated sharps, by infectious patients and estimated total injuries per year

(Shiao et al., RINH 2008)


Previous studies on seroprevalence

Previous studies on seroprevalence

  • In-patients in a tertiary referral center (1998)

    • HBsAg (+) 16.7%

    • Anti-HCV (+) 12.7%

    • Anti-HIV (+) 0.8%

(Shiao et al., Am J Infect Control 2002)

13.9%

16.6% (this study, 2006)

0.8%


Seroprevalence of hep b among source patients

Seroprevalence of hep B among source patients


Seroprevalence of hep c among source patients

Seroprevalence of hep C among source patients


Seroprevalence of hiv among source patients

Seroprevalence of HIV among source patients


Not every percutaneous injury was reported to the hospital

Not every percutaneous injury was reported to the hospital

  • Under-reporting was 1/2 ~ 4/5 in previous studies

  • We compare reporting and a retrospective survey (12 month recall of injuries) to determine the under-reporting rates


Incidence of pi 10 2004 to 09 2005 compaing epinet with recall survey

Incidence of PI 10/2004 to 09/2005: Compaing EPINet with recall survey

(Shiao et al., 2009)

CMESH-醫療人員安全衛生中心


Reason for not reporting

Reason for not-reporting

CMESH-醫療人員安全衛生中心


True rate of pcis

True rate of PCIs…

  •  33,600 per year in Taiwan,

Or 4 PCIs every hour!

CMESH-醫療人員安全衛生中心


What happens to healthcare workers sustaining percutaneous injury

What happens to healthcare workers sustaining percutaneous injury

  • Long process of follow-up

  • Risk of seroconversion

  • Mentally stressed


Impact

Impact

  • Understanding of the true severity of percutaneous injuries

  • Safer healthcare environment

    • Regulations

    • Reporting

  • International exchanges

    • International comparisons of surveillance

    • Assisting development of the reporting system


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勞工安全衛生設施規則修正條款

規範雇主為防止工作環境或作業活動引起之物理性、化學性、生物性及人因性危害,應採取危害辨識、評估及控制之措施。(修正條文第19條之二)

增訂雇主對於供勞工使用之呼吸防護具之選擇、使用及維護方法,應依國家標準規定辦理。(修正條文第277條)

增訂雇主對於使勞工從事遭生物病原體污染之廢棄物處理時,應優先採用機械器具處理,以避免勞工感染疾病。(修正條文第296條)

增訂雇主對於生物病原體或受其污染物品之儲存,為避免污染物質洩漏或尖銳物品穿刺之情形,應使用防止洩漏或不易穿透材質之容器盛裝。(修正條文第297條)

規範雇主對於工作場所有生物病原體危害之虞者,應訂定生物病原體危害暴露控制計畫,據以落實執行。(修正條文第297條之一)

規範雇主對於作業中遭受生物病原體污染之針具或尖銳物品扎傷之勞工,應建立扎傷感染災害調查制度並採取必要之防治措施。(修正條文第297條之二)


And some things untold but hold great impacts

And, some things “Untold” but hold great Impacts…


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受針扎護理師

  • 那時候是我幫同事扶病人的腳,可是她可能硬針抽出來的時候不知道我手在那,就直接往我手扎下去。

  • 扎第一刻就是眼淚快掉出來,問學姊,學姊也是很冷的跟你說就針去急診,其實那時候心情真的是很低落,覺得就是因為沒有人要理你。

  • 過了兩三天,我放完假回來,那個病人他檢查出來VDRL(+)又有C肝這樣子,那剛好我又上到那一team,那一交班,學姊她們不敢跟我講,就畫一朵梅花這樣子,那一看就知道,心情就更低落。

  • 學姊又在旁邊開玩笑,以後妳先生阿,如果你被感染梅毒阿,不能怪妳先生怎樣怎樣。就會更害怕。那種,那時候的想法是覺得說那我真的被感染到了怎麼辦?

  • 因為有allergy的經驗,所以那時候掛急診,醫生建議要打,說那就再做penicillin test,結果是negative,那他說要打。


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  • 打到第四次之後就開始allergy,那時候我只是覺得頭整個是昏的,眼睛一直冒星星這樣子,沒過多久就倒了,對,就是整個就是allergy shock這樣子。之後她們就把我放在那個ICU裡面,其實那時候又加了ambu,如果我那時候我沒有醒來的話阿,可能endo就插上去了。

  • 她們是說反正我就一路被抬到ICU的床上,ㄏㄟˋ,她們說我好像有一點黑,就cyanosis這樣子,那就開始擠ambu,可是之後我可能就醒了,那醒來可能因為shock的關係,可能血管在收縮吧,就一直chillness這樣子,反正那時候就覺得,糟了如果當下沒醒的話怎麼辦?整個就是快要憂鬱症發生了。

  • 就還蠻擔心自己之後有什麼事情的話,對,因為其實爸爸年紀也大了,那時候是覺得說 (流淚),如果我今天有什麼事的話,那他們要怎麼辦?那時候是這樣覺得,妳又會看到我爸這樣子,又看到我媽在旁邊就是狂掉眼淚,就是那時候其實還在用氧氣,對,那時候還在用氧氣,那沒什麼力氣,然後看到她們這樣,我會覺得說我怎麼會這麼不孝,我怎麼讓這種事情發生。」


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Nov 6, 2000

“This morning at 11:00am President Clinton signed the Needlestick Safety and Prevention Act into law in an Oval Office ceremony in the White House. The U.S. is the first country to pass a law guaranteeing the safest protective technology to prevent occupational infection from bloodborne pathogens. The next frontier is the rest of the world. “


The needlestick safety and prevention act november 6 2000

The Needlestick Safety and Prevention ActNovember 6, 2000

2007/5/24


Needlestick safety and prevention act

Needlestick Safety and Prevention Act

 Health care employers must evaluate andimplement safer medical devices designed to minimize occupational exposure. The safety feature must be integrated into the device and not a separate accessory

2001

  • Health care workers must be involved in the product

    evaluation process

Health care facilities must maintain a sharps injury log


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CMESH-醫療人員安全衛生中心


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CMESH-醫療人員安全衛生中心


The first civil suit case about occupational hepatitis in japan courtesy of dr toru yoshikawa

The first civil suit case about occupational hepatitis in Japan(Courtesy of Dr. Toru Yoshikawa)

Mar.1999, OSAKA

A nurse who was infected to HCV from a needlestick Injury filed a suit for 30 million yen against the hospital.

  • 原告主張:安全配慮義務違反

  • 針刺し事故防止の遵守事項の説明なし

  • 患者がC型肝炎であると説明なし

  • 針刺し後の処置方法について説明なし

civil suite

通常のやり方をしておらず,

病院主張:針刺しは本人の過失

  • Osaka District Court sentenced the hospital to pay 27 million yen ($10,000,000).

(木戸内清:医学・医療における安全衛生, 医事新報,3954:47-61.2000.)

CMESH-醫療人員安全衛生中心

March 9, 1999. Asahi news paper


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安全針具品項與醫療院所層級分佈狀況

CMESH-醫療人員安全衛生中心


Appreciations the 100 participating hospitals who report pcis to c mesh

AppreciationsThe 100 Participating hospitals who report PCIs to C-MESH

C-MESH: Center for Medical Employees’ Safety and Health


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