Faraldsfræði stunguóhappa á Landspítalanum á árunum 1986-2011. Lýsandi rannsókn

Abstract

Verði heilbrigðisstarfsmenn fyrir stunguóhappi, líkamsvessamengun eða biti (óhappi) tengt smitandi sjúklingi (áhættuóhappi) geta þeir smitast af lifrarbólguveiru B (HBV), lifrarbólguveiru C (HCV) eða HIV. Smithættan er mest í tengslum við stunguóhöpp af völdum holra nála. Markmið rannsóknarinnar var að lýsa faraldsfræði tilkynntra óhappa starfsmanna Landspítala og greina vanskráningu þeirra. Afturskyggn lýsandi rannsókn.Unnið var úr tilkynningum óhappa frá starfsmönnum Landspítala tímabilið 1986-2011. Hlutfall óhappa var reiknað eftir aldri og starfsstéttum og dreifing óhappa eftir tildrögum og deildum fundin. Hlutfall áhættuóhappa var fundið og hlutfall starfsmanna sem voru bólusettir gegn HBV þegar óhapp varð. Hlutfall vanskráðra óhappa var áætlað fyrir tímabilið 01.01.2005-31.12.2011. Á tímabilinu urðu að minnsta kosti 4089 óhöpp en 3587 þeirra voru tilkynnt og blóðrannsókn framkvæmd hjá 2578 starfsmönnum. Nálægt þriðjungur óhappa tengdist því að ekki var unnið samkvæmt grundvallarsmitgát og holar nálar tengdust stunguóhöppum í 54,7% tilvika. Hlutfall tilkynninga frá læknum og læknanemum var lágt, eða 17,9%. Á tímabilinu reyndust 50,3% starfsmanna bólusettir gegn HBV þegar óhapp varð. Áhættuóhöpp voru 2,6% tilkynntra óhappa, oftast tengd sjúklingi með HCV. Tveir starfsmenn smituðust af HCV á tímabilinu. Áætluð vanskráning óhappa reyndist 28,0% á árunum 2005-2011. Þar sem mörg óhöpp tengjast röngum vinnubrögðum má vænta þess að fræðsla um grundvallarsmitgát og rétta umgengni við beitta og oddhvassa hluti fækki óhöppum. Þar sem holar nálar tengdust rúmlega helmingi stunguóhappa má vænta þess að innleiðing öryggisnála og öryggishluta fækki stunguóhöppum tengdum holum nálum. Hvetja þarf enn frekar til HBV-bólusetningar og tilkynninga á óhöppum. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Needlesticks, bodyfluid exposure and bites (incident) put healthcare workers (HCWs) at risk of hepatitis B, C and HIV particularly if patients are infected (high risk incident). The risk of infection is greatest from bore-hollow needles. The aim of the study was to describe the epidemiology of reported incidents and evaluate underreporting by HCWs at Landspítali University Hospital (LUH). A retrospective descriptive study of reported incidents during 1986-2011. The ratio of incidents was calculated according to the HCWs age and profession and distribution by source and wards. The ratio of high risk incidents and vaccination status against HBV at time of incident was determined as well as underreporting during 01.01.2005-31.12.2011. Results: At least 4089 incidents occured during the study period but 3587 were reported and blood samples taken from 2578 patients. Approximately a third of the incidents were associated with non-compliance with standard precaution and 54,7% of needlesticks were associated with bore-hollow needles. Few reports came from physicians and medical students (17,9%). During the study period 50,3% HCWs were vaccinated against HBV at time of incident. High risk incidents were 94 (2.6%), mostly related to hepatitis C (64,9%). Two HCWs became infected with HCV. During 2005-2011 underreporting was estimated to be 28,0%. Conclusion: Improved education of standard precaution when handling needles and sharps at LUH may reduce the number of incidents. Introduction of safety-needles and safety-devices may greatly reduce needlesticks as a large number of incidents were associated with hollow needles. Improved HBV vaccination among HCWs and reporting incidents should be encouraged.