臺灣博碩士論文加值系統

尖銳物扎傷是醫療工作人員最主要的職業傷害，可能因此導致病原菌由病人傳染給工作人員。本研究旨在探討醫護人員工作中尖銳物扎傷的發生率與相關因素。採橫斷式調查法（Cross-Sectional Survey），研究對象為某醫學中心第一線醫護人員，採立意取樣，選取一般病房、手術室、加護病房、產房、洗腎室等單位之醫護人員共906人（回收率73.5%）。以研究者所擬定之結構式問卷收集資料，內容含蓋個人基本特質、尖銳物扎傷情況、通報情況、對尖銳物扎傷的知識及態度。資料收集期間為96年5月10日至96年5月30日止。本研究之主要結果如下：
(1)醫護人員有45.5%最近一年曾有工作中被尖銳物扎傷的經驗，平
均0.76次/人/年，其中43%屬污染性尖銳物扎傷。醫師發生尖銳
物扎傷的次數平均0.74次/人/年，汙染性扎傷平均0.48次/人/
年；護理人員發生尖銳物扎傷的次數平均0.77次/人/年，汙染性
扎傷平均0.27次/人/年。
(2)污染性尖銳物扎傷向院方通報率為62.3%。未進行通報的原因包
括覺得程序麻煩、病人沒有血液傳染性疾病、沒有時間等。
(3)造成醫護人員銳物扎傷的種類，以一般注射器最多，其次為小玻
璃藥瓶。發生尖銳物扎傷的醫療步驟，以雙手回套針頭蓋最多。
(4)最近10次會接觸到針頭的程序中，採針頭不回套、直接丟入回收
容器平均5.95次，執行單手回套平均2.46次，執行雙手回套平
均 1.56次。
(5)尖銳物扎傷率，男性較女性高；醫師較護理人員高；教育程度為
大學者最高；外科系病房最高，手術室次之，加護單位最低；年
紀愈輕、年資愈少，扎傷之總次數愈多。
(6)尖銳物扎傷知識愈好，污染尖銳物扎傷次數愈少；尖銳物扎傷態
度愈正向，尖銳物扎傷及污染尖銳物扎傷次數愈少。
(7)尖銳物扎傷知識得分，女性高於男性，知識以「內科系」最高，
「手術室」最低，曾接受尖銳物扎傷相關教育者，較未接受者
高。
(8)尖銳物扎傷態度得分，女性高於男性；護理人員高於醫師；「手
術室」最高，「外科系」最低；年資愈多，態度得分愈高。
(9)「扎傷知識」與「整體態度」及「不回套針頭次數」呈顯著正相
關；「整體態度」與「不回套針頭次數」呈顯著正相關。
(10)尖銳物扎傷重要的預測因子為「教育程度」及「整體態度」，
教育程度為大學者發生尖銳物扎傷的勝算比是教育程度為研究所
以上的2.646倍；汙染性扎傷重要的預測因子為「職稱」、「科
別」及「整體態度」，醫師發生污染性尖銳物扎傷的勝算比是護
理人員的2.302倍，手術室人員發生污染尖銳物扎傷的勝算比是
加護病房的3.895倍。
本研究發現醫師、外科系、手術室及年輕資淺同仁是尖銳物扎傷的高危險群，對尖銳物扎傷的態度是最重要的預測因素，結果可做為日後擬定提升工作安全政策之參考。

Needlestick and sharps injuries (NSIs) are the main issue of occupational safety among healthcare workers injuries because of the potential risk of transmission of infectious diseases. The purposes of this study include:(1)understanding the occurrence and reporting rate of NSIs among doctors and nurses in a medical center; (2)identifying associated factors with NSIs. From May 10th to May 30th in 2007, purposive sampling of subjects was conducted for this cross-sectional survey in a medical center, by means of structured questionnaires. From 418 doctors and 814 nurses , 251 and 814 completed questionnaires were respectively obtained with response rates of the doctors and nurses being 60.0% and 80.5% respectively (totally 73.5%).
The results of this study are as follow:
(1) Totally, 45.5% of the subjects experienced NSI in the previous year with an average of occurrence 0.76 events/
person/year. 43% of NSI events involved contamininated devices. Doctors and nurses had NSIs with averages of occurrence to be 0.74 events/doctor/yearand 0.77 events/nurse/year respectively.
(2) 62.3% of NSI events were reported. The reasons of no motivation in reporting NSI events included the complicated procedure of reporting NSI events, no known infection diseases in the involved patients and lack of enough time for reporting.
(3) The commonest devices of NSIs were syringe-needles and opening an ampoule or vial in descending order. The most common medical procedure causing NSIs was recapping of syringe needles.
(4) On recalling the recent ten times of handling syringe needles, the subjects got the
averages of disposal of uncapped syringe needles directly to the collecting boxes,
recapping synringe needles by single hand and recapping by double hands to be 5.95 times, 2.46 times and 1.56 times respectively.
(5) Of the mean occurrences of NSIs, male was higher than female and doctors were higher than nurses. Besides, the Bachelors were the highest considering educational
level. The mean occurrences were highest at surgery wards, followed by operation rooms, but lowest at intensive care units. The younger and lesser job experience of the subjects, the higher were the occurrences of NSIs.
(6) The better knowledge about NSIs of the subjects, the lesser was the occurrence. The better attitude of subjects to NSIs, the lesser was the occurrence.
(7) The knowledges of female subjects about NSIs were better than these of males. The subjects from department of internal medicine got the highest knowledge score while those from the operation rooms got the lowest score. Those who had ever received educational courses about NSIs got higher score than those uneducated.
(8) Considering scoring of attitudes to NSIs, females were higher than males and nurses higher than doctors. In addition, the subjects in operation rooms got the highest score while those in Department of Surgery got the lowest.
(9) The scores of knowledge about and attitudes to NSIs got significantly positive Pearson correlation with the frequencies of disposing uncapped syringe needles while the scores of attitudes got significantly positive Pearson correlation with frequencies of uncapped syringe needles.
(10) The important predictive factors in occurrence of NSIs are education level and attitude scores. Logistic regression indicated that the odds ratio in NSIs of those getting Bachelor degree to those getting Master degree or higher degree is 2.646(95% C.I.=1.106–6.330).
The important predictive factors in contaminated NSIs included titles, departments and net attitudes. Besides, the odds ratio in NSIs of doctors to nurses was 2.302 (95% C.I.=1.127-4.704) and the odds ratio of subject in operation room to subjects in intensive care units was 3.895 (95% C.I.=1.682-9.017).
In conclusion, the highest risk group of NSI included doctors, those working in operation room and the less experienced. The most important predictive factor in NSI was attitude of each staff. The outcome of this study may provide information for improving safety policy in hospital.

口試委員會審定書………………………………………………………i
誌謝…………………………………………………………………… ii
中文摘要………………………………………………………………iii
英文摘要………………………………………………………………v
目錄 ………………………………………………………………viii
表目錄 …………………………………………………………… x
第一章 緒論 …………………………………………………………1
第一節 研究背景與動機 ……………………………………….1
第二節 研究目的 ……… ………………………………………2
第三節 名詞界定 …………………………………………… 2
第二章 文獻探討 ……………………………………………… 3
第一節 醫護人員尖銳物扎傷的情況 ………………………… 3
第二節 醫護人員尖銳物扎傷的相關因素 …………………… 5
第三節 尖銳物扎傷的預防 …………………………………… 7
第三章 研究設計與方法 ……………………………………… 9
第一節 研究架構與研究設計 ………………………………… 9
第二節 研究假說 ……………………………………………… 10
第三節 研究工具與材料 ……………………………………… 10
第四節 資料處理與統計分析 ………………………………… 13
第四章 研究結果 ……………………………………………… 14
第一節 描述性分析 …………………………………………… 14
第二節 雙變項統計分析 ……………………………………… 18
第三節 多變項統計分析 ……………………………………… 22
第五章 討論 …………………………………………………… 40
第一節 描述性結果討論 ……………………………………… 40
第二節 推論性統計結果討論 ………………………………… 43
第三節 研究限制 ……………………………………………… 46
第六章 結論與建議 …………………………………………… 47
第一節 結論 …………………………………………………… 47
第二節 建議 …………………………………………………… 49

參考文獻……………………………………………………… 51
附錄 …………………………………………………………… 54
表4-1 醫護人員基本特………………………………………… 23
表4-2 醫護人員最近一年尖銳物扎傷情形…………………… 25
表4-3 造成醫護人員扎傷的尖銳物種類……………………… 26
表4-4 醫護人員發生尖銳物扎傷的醫療步驟………………… 26
表4-5 醫護人員尖銳物扎傷預防及處理知識………………… 27
表4-6 醫護人員對尖銳物扎傷的態度--尖銳物扎傷發生率
及嚴重度感受 ..................................28
表4-7 醫護人員對尖銳物扎傷的態度--尖銳物扎傷相關因素
之看法……............................. 28
表4-8 醫護人員對尖銳物扎傷的態度—採取預防扎傷措施
之意願………........................... 29
表4-9 醫護人員對尖銳物扎傷的態度--扎傷預防措施有效
性之看法……........................... 29
表4-10 醫護人員對尖銳物扎傷的態度--扎傷事件通報及
處理…............................……… 30
表4-11 醫護人員尖銳物處理方式…………………………… 30
表4-12 醫護人員基本特質與尖銳物扎傷之雙變項分析…… 31
表4-13 醫護人員年齡、年資與是否發生尖銳物扎傷之相關
分析…..........................…… 32
表4-14 醫護人員年齡、年資與與尖銳物扎傷次數之相關
性............................................32
表4-15 醫護人員尖銳物扎傷態度、知識、處理尖銳物方式
與發生尖銳物扎傷之雙變項分析……………..... 33
表4-16 醫護人員基本特質與尖銳物扎傷態度、知識、處理
尖銳物方式之雙變項分析…………………………… 34
表4-17 醫護人員基本特質與處理尖銳物方式之雙變項分析 36
表4-18 醫護人員年資、尖銳物扎傷態度、知識、處理尖銳物方式
及扎傷次數之相關性分析…………………………… 37
表4-19 醫護人員尖銳物扎傷之多變項對數迴歸分
析………....................…………… 38
表4-20 醫護人員污染性尖銳物扎傷之多變項對數迴歸分析 39

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