Occupational exposures to blood in a dental teaching environment: results of a ten-year surveillance study.
Occupational exposures to blood in a dental teaching environment: results of a ten-year surveillance study.
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牙科教学环境中血液的职业暴露：十年监测研究的结果。
DOI：
10.1002/j.0022-0337.2001.65.5.tb03413.x
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发表时间：
2001
影响因子：
2.3
通讯作者：
D. Kotelchuck
中科院分区：
文献类型：
--
作者：
F. Younai;D. Murphy;D. Kotelchuck
职业暴露评估可以帮助修改实践、重新设计设备和有针对性的教育工作。本报告中提供的数据是作为大型牙科教学机构十年职业接触血液或其他潜在传染性材料的监测计划的一部分收集的。从 1987 年到 1997 年，总共记录了 504 起经皮/非完整皮肤和粘膜暴露事件。其中，494 起（98%）是经皮的，10 起（2%）是粘膜的，每起都涉及到牙科护理人员 (DCW) 的眼睛。在 504 起暴露事件中，414 起（82.1%）发生在牙科学生中，60 起（11.9%）发生在工作人员中，30 起（6%）发生在教师中。 191 例 (37.9%) 暴露为浅表（无出血），260 例（51.6%）为中度暴露（有些出血），53 例（10.5%）为深层暴露（大量出血）。从暴露情况来看，279例（54.5%）的伤害发生在手术后（使用设备后），大部分与器械清理有关； 210 例（41.0%）发生在术中（使用设备期间）； 23 起（4.5%）是 DCW 在牙科手术室与尖锐物体碰撞而发生的（8 起涉及多种情况）。该学院的总体暴露率为每 10,000 名就诊患者 2.46+/-0.11 SD。学生群体的平均率为每 100 人年 4.02+/-0.20 SD，其中高年级学生的比率最高。本报告中观察到的血液和体液职业接触率与其他几个教育机构发布的报告一致。牙科教学机构面临着保护学生和患者群体免受血源性感染的独特挑战。教育工作必须不仅仅是传授普遍预防措施，还应包括引入更安全的产品和临床程序，以最大限度地减少与学生学习过程中动手操作相关的风险。
Evaluation of occupational exposures can assist with practice modifications, redesign of equipment, and targeted educational efforts. The data presented in this report has been collected as part of a ten-year surveillance program of occupational exposures to blood or other potentially infectious materials in a large dental teaching institution. From 1987 to 1997, a total of 504 percutaneous/non-intact skin and mucous membrane exposures were documented. Of these, 494 (98 percent) were percutaneous, and 10 (2 percent) were mucosal, each involving a splash to the eye of the dental care worker (DCW). Among the 504 exposures, 414 (82.1 percent) occurred among dental students, 60 (11.9 percent) among staff, and 30 (6 percent) among faculty. One hundred ninety-one (37.9 percent) exposures were superficial (no bleeding), 260 (51.6 percent) were moderate (some bleeding), and 53 (10.5 percent) were deep (heavy bleeding). Regarding the circumstances of exposure, 279 (54.5 percent) of the injuries occurred post-operatively (after the use of the device), and most were related to instrument clean-up; 210 (41.0 percent) occurred intra-operatively (during the use of the device); and 23 (4.5 percent) occurred when a DCW collided with a sharp object in the dental operatory (eight cases involved more than one circumstance). The overall exposure rate for the college was 2.46+/-0.11 SD per 10,000 patient visits. The average rate for the student population was 4.02+/-0.20 SD per 100 person-years, with the highest rates being observed among junior year students. The observed rates of occupational exposures to blood and body fluids in this report are consistent with published reports from several other educational settings. Dental teaching institutions are faced with the unique challenge of protecting the student and patient populations against bloodborne infections. Educational efforts must go beyond mere teaching of universal precautions and should include the introduction of safer products and clinical procedures that can minimize the risks associated with the hands-on aspects of the students' learning process.