手術室發生之針扎與尖銳物傷害：原因分析與改善方案

Abstract

背景與目的：近年來發生於醫院的針扎與尖銳物傷害逐漸被重視，同時安全針具的普及使用，這類的穿刺傷害雖然已有減少，但仍未能有效地被控制，尤其是發生在手術室裡的傷害。因此，本研究的宗旨是探討與分析某醫學中心五年內所發生的針扎與尖銳物傷害的事件，尋找危險因子與解決方案，以達到持續提升醫護人員的職場安全。研究方法：本研究收納在2016年1月至2020年12月發生於台灣北部某家醫學中心的針扎與尖銳物傷害的事件並依據發生於手術室內與醫院其他地點的這類傷害分為兩組。我們比較兩組病人的背景資料，受傷機轉，刺傷物品及臨床結果。統計學上有意義的標準則訂在p<0.05。研究結果：在五年的研究期間，共有157位醫療工作人員有針扎與尖銳物傷害，其中護理師佔了56.0％而醫師為37.6％。大部分的傷害發生在醫院年資少於三年的工作者身上（73.2％，115/157）。手術室以外的地點所發生的傷害均為個人的針扎行為。相比較之下，手術室內有21件（41.2％）是手術醫師對助手或護理師所造成的傷害，其中15件（71.4％）是由於不正確的傳遞尖銳物造成。結論：絕大部份發生在手術室的針扎與尖銳物傷害都是由於人為因素造成。要有效的減少這些傷害則必須透過人員的持續教育，確實執行使用尖銳物之作業流程，同時仔細檢討與根本分析每一件發生的事故傷害。  Introduction: Despite the increased awareness of needle sticks and sharps inju-ries and the development of safety needles, these injuries continue to occur not infre-quently in a hospital setting. The purpose of the study was to critically examine these incidences and to identify risk factors associated with them. Methods: We analyzed sharps injuries occurred between 2016 and 2020 in a tertiary medical center in Taiwan. We compared those that occurred in the operating rooms (OR) with those that oc-curred outside the OR. The demographics of the health care workers injured, the of-fending objects, and the mechanisms of injury were compared between two groups of patients. Significant level was determined when p<0.05. Results: Among 157 hospital workers injured during the study period, the group of workers most commonly injured was nurses (56.0%), followed by physicians and surgeons (37.6%). The majority of those injured had a working experience of fewer than three years (73.2%, 115/157). Injuries that occurred outside the OR were self-inflicted due to the inappropriate han-dling of needled syringes. In comparison, 21 (41.2%, 21/51) of injuries in the OR were inflicted by operating surgeons. Among them, 15 (71.4%) were due to inappropriate transfer of surgical sharps. Conclusions: Most sharps injuries that occurred in the OR were due to human factors and were preventable. Greater effort is needed to create a safer working environment in the OR through education of hospital personnel, development of stringent OR policies for handing of surgical instruments, and critical review of every incidence of injury.