初级保健中血源性病原体暴露的管理:一个质量改进项目

IF 0.6 Q4 HEALTH CARE SCIENCES & SERVICES
Sarah E. Hewitt, Erik Southard
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引用次数: 0

摘要

接触血源性病原体对卫生保健工作者构成严重风险。随着越来越多的初级保健提供者被要求提供职业卫生服务,血源性病原体(BBP)暴露的评估和治疗可能是压倒性的。缺乏关于如何处理这些接触的知识可能导致不良后果,包括如果处理不当,转化为人类免疫缺陷病毒(HIV)和乙型肝炎病毒。为了帮助提供者了解暴露管理的最佳实践,制定了详细的协议和有针对性的教育。该方案强调了评估HIV、乙型肝炎病毒和丙型肝炎病毒源患者的重要性;对受伤工人进行相同项目、破伤风状况和暴露后预防(PEP)需求的评估。方法回顾性回顾方案实施前12个月和实施后8个月的病历,评估5项循证标准的依从性,并在需要时适当使用PEP。感兴趣的变量包括(a)源患者的正确识别,(b)源患者实验室的准确性,(c)当日员工实验室的完成情况,(d)员工实验室的准确性,以及(e)员工破伤风状态的评估。这些类别的完成率在方案前病例(n = 7)中为14%至43%,在方案后病例(n = 7)中为100%。有针对性的教育和详细的BBP暴露评估和治疗方案相结合,提高了最佳实践护理的依从性;该项目还提高了员工的满意度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of bloodborne pathogen exposures in primary care: A quality improvement project
Background Exposure to bloodborne pathogens poses a serious risk to healthcare workers. As more primary care providers are being asked to perform occupational health services, the evaluation and treatment of bloodborne pathogen (BBP) exposures can be overwhelming. Lack of knowledge about how to handle these encounters can lead to poor outcomes, including conversion to human immunodeficiency virus (HIV) and hepatitis B virus if not handled properly. To assist providers with understanding best practices for the management of exposures, a detailed protocol and targeted education were developed. The protocol addressed the importance of evaluating the source patient for HIV, hepatitis B virus, and hepatitis C virus; injured workers were assessed for the same items, tetanus status, and the need for post-exposure prophylaxis (PEP). Methods A retrospective chart review for 12 months before the implementation of the protocol and eight months after implementation was completed to assess compliance with five evidence-based criteria and the appropriate use of PEP when indicated. Findings Variables of interest included (a) correct identification of the source patient, (b) accuracy of source patient labs, (c) completion of same-day employee labs, (d) accuracy of employee labs, and (e) evaluation of the employee's tetanus status. The rate of completion of these categories ranged from 14% to 43% in pre-protocol cases (n = 7), and 100% in post-protocol cases (n = 7). Conclusions The combination of targeted education and a detailed protocol for evaluating and treating BBP exposures resulted in increased compliance with best-practice care; the project also improved employee satisfaction.
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