The Management of Needlestick Injuries
The Management of Needlestick Injuries
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DOI：
10.3238/arztebl.2013.0061
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发表时间：
2013-02-01
影响因子：
7.7
通讯作者：
Wicker, Sabine
中科院分区：
文献类型：
--
作者：
Himmelreich, Heiko;Rabenau, Holger F.;Wicker, Sabine
背景：据估计，欧洲每年发生100万例针刺伤（nsi）。关于预防nsi的理事会指令2010/32/EU描述了预防的最低要求，并呼吁实施地方，国家和欧洲范围的报告系统。该指令将于2013年5月11日在所有欧盟成员国实施。本研究的目的是评估（并改进）德国一家三级医院针刺伤的报告和治疗程序。方法：对该院NSI报告制度进行为期18个月的前瞻性观察研究，确定NSI发生率、指标患者血源性病原体患病率、暴露后预防启动率、受影响医护人员血清学检测率。结果：在研究期间，519例自伤报告给意外保险医生，共547个工作日。86.5%的指数患者进行了乙型和丙型肝炎（HBV和HCV）和人类免疫缺陷病毒（HIV）的血清学研究；这导致了两个初步诊断（活动性乙型肝炎和丙型肝炎各一个）。449例患者中有92例（五分之一）至少感染了一种血源性病原体。41名卫生保健工作者开始了艾滋病毒接触后预防。出现1例丙型肝炎病毒传播并得到成功治疗。除此之外，没有传染。结论：完整报告nsi是识别危险操作和确保对受影响的医护人员进行最佳治疗的先决条件。为了有效地治疗自伤，意外险医生必须具备高度的跨学科能力。
Background: An estimated 1 million needlestick injuries (NSIs) occur in Europe each year. The Council Directive 2010/32/EU on the prevention of NSIs describes minimum requirements for prevention and calls for the implementation of local, national and Europe-wide reporting systems. The Directive is to be implemented by all EU member states by 11 May 2013. The purpose of this study was to assess (and improve) the procedures for the reporting and treatment of needlestick injuries in a German tertiary-care hospital.Methods: We carried out a prospective observational study of the NSI reporting system in the hospital over a period of 18 months and determined the incidence of NSIs, the prevalence of blood-borne pathogens among index patients, the rate of initiation of post-exposure prophylaxis, and the rate of serological testing of the affected health care personnel.Results: 519 instances of NSI were reported to the accident insurance doctor over the period of the study, which consisted of 547 working days. 86.5% of the index patients underwent serological study for hepatitis B and C (HBV and HCV) and for the human immune deficiency virus (HIV); this resulted in two initial diagnoses (one each of active hepatitis B and hepatitis C) in the index patient. 92 of 449 index patients, or one in five, was infected with at least one blood-borne pathogen. HIV post-exposure prophylaxis was initiated in 41 health care workers. One case of hepatitis C virus transmission arose and was successfully treated. Other than that, no infection was transmitted.Conclusion: Complete reporting of NSIs is a prerequisite for the identification of risky procedures and to ensure optimal treatment of the affected health care personnel. The accident insurance doctor must possess a high degree of interdisciplinary competence in order to treat NSI effectively.