臺灣博碩士論文加值系統

摘要

針頭與尖銳物扎傷為醫療工作人員最常見的職場危害，也是醫療工作者感染血體液傳染疾病的主要途徑。而在醫療行為執行過程中，醫院醫師常是醫療團隊的核心主導人物，然而其針扎危害暴露現況卻一直被忽略，因此本論文研究目的在於探討醫師發生針頭與尖銳物扎傷的盛行率與危險因子。本研究以衛生福利部國民健康署於2011年5月至8月間在100家醫院70,622位醫療從業人員進行之「醫療職場員工身心壓力與安全需求問卷」為資料來源，針對當中4,310份由「醫師」職類所填答的樣本，回溯分析醫師在職場發生針頭與尖銳物扎傷之可能原因。在這4,310份醫師樣本中，有912與698份樣本回答曾在工作中發生針扎或刀片銳器割傷（發生率分別為21.2%與16.2%）。深入分析與醫師有無發生針扎或割傷事件相關之變項，發現年齡（小於35歲）、學歷（專科與大學）、年資（在2~5年）、最近一週總工時（大於84小時）、業務場域（在開刀房、產房、病房或急診室）、服務醫院層級（屬醫學中心）、每天睡眠時間（在5小時（含）以下），有吸菸與喝酒習慣、處於很大工作壓力或強烈憂鬱情緒狀態等因子，可能與醫師針頭與尖銳物扎傷事件有關。本研究結果顯示醫師針扎或割傷的實際發生率，高於近年以中文版針扎防護通報系統（Exposure Prevention Network，EPINet）通報與回溯性資料計算所得的醫師針扎事件通報率。而且醫師發生針頭與尖銳物扎傷危害可能與醫師的臨床經驗、風險暴露程度及其對風險預防措施的遵從度、工作過荷程度等因素有關。根據本研究，建議未來醫院除了應強化針扎通報與預防措施稽核外，更應致力排除醫師在實際作業面採用針扎防護措施所面臨的困難，並客製化專屬此族群的針扎防護措施，且應在醫師早期職涯階段加強針扎防護的實際操作訓練，同時也應重視醫師過勞所引發的針札危害，以保障醫師工作與病人就醫的安全。另外，未來質性研究應與量性研究並重，特別是應在醫師人員發生針扎事件時即進行深度訪談，以實際了解個案發生經過與背後原因，進而找出針扎行為的預測因子，以協助設計有效的行為改變措施。

關鍵詞：針扎、尖銳物品扎傷、醫師

Abstract

Needlestick and sharp injuries (NSIs) are a common occupational hazard and the main cause of infectious blood and body-fluid transmitted disease for hospital medical staff. Risks of NSIs in physicians, however, have long been neglected while physicians often act as a team leader during clinical practice. The purpose of this study is to update the prevalence of NSIs in physicians and identify their underlying risk factors. A nationwide survey of “Workplace health and safety needs in hospitals” conducted in 70,622 medical staffs (including physicians, nurses and other medical professionals) at 100 hospitals by the National Health Department in Ministry of Health and Welfare of Taiwan between May to August of 2011 was adapted. Among which the survey questionnaires returned by 4,310 physicians were the foci of the current study. As a result, 912 (21.2%) needlestick injuries and 698 (16.2%) sharp injuries were reported respectively in the total 4,310 questionnaires. Further analysis revealed that the risk factors of occupational NSIs were heightened by age (<35 y), education level (college or underneath), years in practice (between 2 to 5 years), total working hours in the most recent week (>84 hrs), places of practice (operational room, delivery room, general ward or emergency room), hospital levels of service (medical center), daily sleep time (≦5 hrs), having habits of smoking and/or drinking and being in a high work pressures or strong depressed moods. In conclusion, the present study shows that the actual rate of NSI incidence in physicians might be higher than that notified in the Exposure Prevention Information Network (EPINet) or inferred from data in previous retrospective studies. The affecting factors of NSI events involve physician’s clinical experiences, extent of risk exposure, compliance of preventive measures and work overload. In addition to encouraging hospitals to impose NSI incidence report and audit of preventive measures, it is suggested that hospitals should dedicate in removing the obstacles that reduce physician’s compliance of NSI preventive measures during their everyday practices and in developing needle protective measures that are customized to the needs of high-risk groups. Hospitals should also strengthen the hands-on skills for needlestick or sharp protection in physician’s early stages of career, and pay attention to physician’s over workload underlying NSI events for sake of both physicians’ and patients’ safety. Future researchers should conduct both qualitative and quantitative study, in which in-depth interviews need to be done immediately after NSI events in order to understand the reasons behind so as to identify behavioral predictors and countermeasures of NSI.

Key words: Needlestick injury, sharp injury, physicians

目錄

誌謝………………………………………………………………… i
中文摘要…………………………………………………………… iii
英文摘要…………………………………………………………… v
目錄………………………………………………………………… vii
圖目錄……………………………………………………………… ix
表目錄……………………………………………………………… x
第一章 導論……………………………………………………….. 1
第一節 研究背景…………………………………………….. 1
第二節 文獻回顧…………………………………………….. 3
第三節 研究目的…………………………………………….. 10
第二章 研究方法…………………………………………………. 11
第一節 研究材料及研究對象……………………………….. 11
第二節 研究架構…………………………………………….. 12
第三節 變項操作型定義…………………………………….. 13
第四節 資料分析方法……………………………………….. 15
第三章 研究結果…………………………………………………. 16
第一節 基本資料分析………………………………………. 16
第二節 個人基本特質與針扎、割傷發生與否的相關分析. 20
第三節 個人基本特質與發生針扎、刀片或銳物割傷之相關性分析……………………………………………………… 24
第四節 研究結果小結………………………………………... 31
第四章 綜合討論………………………………………………….. 32
第一節 主要研究結果與討論………………………………... 32
第二節 本研究之優點與限制………………………………... 38
第三節 本研究之建議與未來方向…………………………… 39
參考文獻……………………………………………………………. 40
附錄…………………………………………………………………. 46

圖目錄
圖一 2004-2014 年各年度不同職種醫事人員的針扎發生率趨勢圖... 5

表目錄
表一 2004-2014 年各年度不同職種醫事人員針扎發生率…..………. 6
表二 自變項與依變項的操作型定義………………………………….. 13
表三 個人基本特質分布……………………………………………….. 18
表四 個人基本特質與是否發生針扎、銳品割傷之卡方分析……….. 21
表五 影響針扎之危險因子分析（使用多變項邏輯式迴歸分析）…….. 25
表六 發生刀片或銳品割傷之危險因子分析（使用多變項邏輯式迴歸分
析）………………………………… 28

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