臺灣博碩士論文加值系統

針扎傷害為醫療工作者最常見亦為最重要之職業傷害之一，據調查，在台灣醫療工作者曾經於工作場所中發生針扎事件的比例約為87.3%。因針扎事件而可能感染包括B型肝炎、C型肝炎、愛滋病、梅毒等20多種疾病。除了會導致工作人員的身心傷害，同時也會付出相當多的醫療成本，故適時地分析針扎資料及調查醫療成本，有助於管理及預防針扎事故。有鑑於此，本研究針對醫療機構進行針扎流行病學調查、醫療成本的統計及特殊族群-清潔人員的相關調查，以作為主管單位管理改善針扎傷害的依據。
本研究採橫斷式的研究方式，分析中部地區某醫學中心90-92年間共452位通報針扎的醫療工作者針扎的發生的相關因素及統計因針扎傷害進行追蹤時所耗費的時間和醫療成本。此外，並於93年12月對該醫學中心清潔人員進行問卷調查，以評估清潔人員實際針扎狀況及其知識態度行為的差異。
研究結果顯示，針扎者平均年齡為29.2歲，平均工作年資為4.0年，以護理人員針扎人次最多(54.0%)，醫師次之(12.8%)，實習生及清潔人員再次之(佔7.5%及6.4%)，發生地點以一般病房(38%)及手術室(23%)為最多。醫師針扎率為0.3%，護理人員針扎率為0.4%，屬院內員工之清潔人員針扎率為0.3%，實習醫師針扎率為3.6%；所有人員中未感染B型肝炎而有B肝抗體者達90%，三年中僅一人感染C型肝炎( 0.2%)。而統計結果發現，各職稱別在針扎原因、地點、時間、工作年資等相關因素上皆具有統計學上的意義(P<0.05)。
醫療成本方面，通報針扎者平均每人看診次數為2.3次，檢驗次數為2.0次，每人進行針扎追蹤需花費時間約43.5分鐘及醫療費用2,869元。若以追蹤疾病來看，當針扎來源患者無任何疾病時，平均每次每人花費1,840元，當針扎來源為B型肝炎患者，平均每次每人花費約2,017元，當若來源為C型肝炎患者，則花費約3,921元，若為梅毒陽性患者，則花費約2,553元，若為HIV/AIDS陽性患者，則每人花費約8,096元。
在清潔人員的問卷調查方面，有效問卷共190份(回收率92%)。女性佔多數，共172人(佔90.5%)，平均年齡為46.5歲，平均工作年資為5.2年；院內員工佔34.7%；外包員工佔65.3%。教育程度以國小以下程度最多，佔56.2%；無感染B型肝炎且有B肝抗體者僅佔30.3%。此外，所有人員中有68.8%上過針扎在職教育。一年內曾發生過針扎事件者共有17位(針扎率為8.9%)，主要發生針地點為一般病房(52.9%)。若依身份別進一步分析，發現在性別、年齡、工作單位、工作年資、教育程度、宗教信仰及知識態度行為上皆具有統計學上的意義(P值<0.05)。
結論：本研究顯示推行工作人員施打B型肝炎疫苗，可有效保護員工健康，避免感染B型肝炎且可降低針扎傷害的醫療成本。因此政府單位應考慮推行醫療工作者施打B型肝炎疫苗以降低因針扎事件感染疾病的風險。此外，結果顯示醫院之清潔人員發生針扎機率高，而個人教育水準及針扎知識明顯偏低，因此主管者應加強管理及教育，以避免職業傷害的發生。

Needlestick injuries are one of the most important occupational injuries for healthcare workers. According to the investigation, the percentage of healthcare workers who ever sustain a needlestick injury at workplace is about 87.3% in Taiwan. Needlestick injuries have a substantially greater risk of almost 20 types of disease transmission, such as HBV、HCV、HIV/AIDS、syphilis. In addition, it can cause negative effect psychologically and physically, not mentioning the vast amount of medical cost. Therefore, it is suggested that timely analyzing the data of needlestick injuries and assessing the cost can effectively prevent and control the incidence of needlestick injuries. In view of this, this study investigated a medical center, using epidemiology of needlestick injuries, statistics of medical cost, and investigation of special group-cleaner as indication for the related unit to improve needlestick injuries.
A cross-sectional study was conducted among 452 reported healthcare workers who sustained needlestick injures at a medical center in the midland during 2001 to 2003. Not only the cause of needlestick injury was investigated, but also the occurred medical cost as well as injury tracking time was calculated. In December 2004, a questionnaire was used as a tool to assess the actual situation of needlestick injuries on cleaners and the difference among knowledge、attitude and behavior of them.
The result showed that among all needlestick injury workers, the mean age was 29.2, and the mean service seniority was 4.0 years. The majority occupation were nurses(54.0%)、followed by medical doctors (12.8%)、medical students(7.5%), and cleaners(6.4%). Most injuries was happened in general wards (38%) and operation rooms (23%). The incidence of needlestick injury among medical doctors was 3%, nurses 0.4%, medical students 3.6%, and in-house cleaners 0.3%. 90% of overall injured healthcare workers were not effected Hepatitis B and had antibody for hepatitis B virus. The study shows occupation has significant difference among cause、time、place、service seniority, and etc (P<0.05).
In view of medical cost, the average outpatient visits caused by needlestick injuries are 2.3 per person and mean examination was 2.0 per person. Average time spent on tracking down the cause was 43.5 minutes and medical cost was NT$2,869/per person. Considering different transmitted diseases on tracking cost, NT$1,840/per person was cost when no diseases occurred on needlestick injuries, NT$2,017 was cost when the source was Hepatitis B patients, NT$2,553 for syphilis positive, and NT$8,096 for HIV/AIDS positive.
As for the questionnaire by cleaners, 190 out of 206 questionnaires were effective (or response rate 92%). Among 190 effective questionnaires, the mean age was 46.5 and 90.5% were women. Mean service seniority was 5.2 years. In-house cleaners were 34.7%, while outsourced cleaners were 65.3%. Most of their education was primary school level, accounting for 56.2% of 190 cleaners. Only 30.3% of the cleaners had hepatitis B virus antibodies. Besides, 68.8% had been accepted on-the-job training to avoid needlestick injuries. 17 persons had reported needlestick injury, accounting for 8.9% of the group. Most injuries were occurred in general wards, which is 52.9%. There were significant difference among sex、age、unit、service seniority、education、religion、knowledge and attitude of needlestick injuries as risk factors in work status (P<0.05)。
Conclusion：This study showed that encouraging the injection of hepatitis B vaccines on healthcare workers not only can effectively prevent incidence of hepatitis B transmission through needlestick injuries but also decrease related medical cost. Therefore, the administration unit should consider the possibility to accomplish hepatitis B vaccine on healthcare workers to reduce risk of infected diseases. Furthermore, the result showed high risk of needlestick injuries on cleaners, which may be due to the low level of education and knowledge of needlestick injuries. It is suggested that enhancing management and further education are important keys to avoid this type of injuries.

目 錄
中文摘要 ---------------------------------------------------------------- I
英文摘要 ---------------------------------------------------------------- III
目錄 -------------------------------------------------------------------- V
附圖 -------------------------------------------------------------------- VII
附表 -------------------------------------------------------------------- VIII

第一章 緒論
第一節 研究背景與動機 --------------------------------------------------- 1
第二節 研究目的 --------------------------------------------------------- 4
第三節 研究架構 --------------------------------------------------------- 5
第四節 名詞定義 --------------------------------------------------------- 7
第二章 文獻探討
第一節 針扎分佈情形 ----------------------------------------------------- 8
第二節 常見的針扎追蹤疾病 ----------------------------------------------- 11
第三節 針扎傷害的醫療成本 ----------------------------------------------- 21
第三章 針扎傷害通報資料分析
第一節 研究背景 --------------------------------------------------------- 31
第二節 研究方法與材料 --------------------------------------------------- 32
第一項 研究架構 --------------------------------------------------------- 32
第二項 研究對象 --------------------------------------------------------- 33
第三項 研究方法 --------------------------------------------------------- 34
第四項 資料處理與分析 --------------------------------------------------- 37
第三節 研究結果 --------------------------------------------------------- 38
第一項 針扎員工基本資料分析 --------------------------------------------- 38
第二項 各職稱別間之差異分析 --------------------------------------------- 41
第三項 員工追蹤狀態之差異分析 ------------------------------------------- 43
第四節 討論與建議 ------------------------------------------------------- 46
第一項 討論 ------------------------------------------------------------- 46
第二項 研究限制 --------------------------------------------------------- 50
第三項 研究建議 --------------------------------------------------------- 50
第四章 針扎傷害醫療成本評估
第一節 研究背景 --------------------------------------------------------- 69
第二節 研究方法與材料 --------------------------------------------------- 70
第一項 研究架構 --------------------------------------------------------- 70
第二項 研究對象 --------------------------------------------------------- 71
第三項 研究方法 --------------------------------------------------------- 71
第四項 資料處理與分析 --------------------------------------------------- 72
第三節 研究結果 --------------------------------------------------------- 73
第一項 時間測量結果 ----------------------------------------------------- 73
第二項 針扎員工醫療成本基本資料分析 ------------------------------------- 73
第三項 各因素之醫療成本耗費分析 ---------------------------------------- 74
第四節 討論與建議 ------------------------------------------------------- 78
第一項 討論 ------------------------------------------------------------- 78
第二項 研究限制 --------------------------------------------------------- 82
第三項 研究建議 --------------------------------------------------------- 83
第五章 清潔人員針扎傷害調查
第一節 研究背景 --------------------------------------------------------- 88
第二節 研究方法與材料 --------------------------------------------------- 89
第一項 研究架構 --------------------------------------------------------- 89
第二項 研究對象 --------------------------------------------------------- 90
第三項 研究方法 --------------------------------------------------------- 90
第四項 資料處理與分析 --------------------------------------------------- 91
第三節 研究結果 --------------------------------------------------------- 92
第一項 清潔人員基本資料分析 --------------------------------------------- 92
第二項 清潔人員身份屬性之差異分析 --------------------------------------- 96
第四節 討論與建議 ------------------------------------------------------- 100
第一項 討論 ------------------------------------------------------------- 100
第二項 研究限制 --------------------------------------------------------- 105
第三項 研究建議 ---------------------------------------------------- 106
第六章 結論 ------------------------------------------------------------- 123
第七章 參考文獻---------------------------------------------------------- 125
附錄 -------------------------------------------------------------------- 129

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