針扎之處置與預(yù)防醫(yī)療品質(zhì)與病人安全

1、針扎之處置,追蹤,與預(yù)防----醫(yī)療品質(zhì)與病人安全,歐聰億感染科萬(wàn)芳醫(yī)院臺(tái)北醫(yī)學(xué)大學(xué),SARS 之經(jīng)驗(yàn),醫(yī)護(hù)人員需先保護(hù)自己,才有能力救治別人.,Needlestick injury,醫(yī)療品質(zhì)與病人安全,Health Care Organization Management Standards1.Quality Improvement and Patient safety2.Prevention and Control of

2、 infections3.Governance, Leadership, and Direction4.Facility Management and Safety 5.Staff Qualification and Education6.Management of Communication and Information.,何為感染控制?What is infection control?,資料來(lái)源：Seto Wh博士，亞

3、太感染控制學(xué)會(huì)主席,Infection Control Concept,資料來(lái)源：Seto Wh博士，亞太感染控制學(xué)會(huì)主席,感控理念架構(gòu)Infection Control Concept Cascade,Patient Oriented Infection Control Commitment,預(yù)防醫(yī)療照護(hù)相關(guān)感染HAI Prevention,病患及醫(yī)護(hù)人員的安全 與醫(yī)療品質(zhì)息息相關(guān)而醫(yī)護(hù)人員的安全, 其中以針扎為最常見(jiàn)

4、. ( 其他包括: TB, SARS, H1N1,輻射安全…. ),針扎的處置,Hepatitis B virus Hepatitis C virusSyphilisHIV ( Human immunodeficiency virus ),,一般民眾,醫(yī)療機(jī)構(gòu)請(qǐng)就近前往（藥癮）愛(ài)滋病指定醫(yī)院或具備愛(ài)滋病毒快速篩檢能力之醫(yī)療機(jī)構(gòu)，並通知當(dāng)?shù)匦l(wèi)生局協(xié)助處理利用HIV快速檢驗(yàn)試劑可以在1小時(shí)內(nèi)得知是否為感染者，但仍需要注意空窗

5、期問(wèn)題。另B肝、C肝、梅毒亦可能透過(guò)血液傳染，應(yīng)詢問(wèn)醫(yī)師是否需作任何預(yù)防感染處置措施。如已知來(lái)源者，請(qǐng)先取得其同意後方得檢驗(yàn)；若無(wú)法取得其同意，則評(píng)估其是否為HIV感染高危險(xiǎn)群，以做為是否預(yù)防性用藥之參考。,若檢驗(yàn)陰性但病人有危險(xiǎn)行為（如毒癮者且共用針頭等），則仍應(yīng)收集病人資料，到愛(ài)滋病指定醫(yī)院由醫(yī)師判斷是否需用藥。預(yù)防性藥物要越早使用越好，最好是≦6小時(shí)內(nèi)，超過(guò)48小時(shí)以上效果差。皮膚傷口接觸到愛(ài)滋病毒陽(yáng)性血液(例如被針頭刺穿)

6、後受到傳染的危險(xiǎn)性約為0.3% ，黏膜接觸後受傳染的危險(xiǎn)性約為0.09%。接觸到HbsAg(+),HbeAg(-)危險(xiǎn)性約為1-6%，兩者均陽(yáng)性危險(xiǎn)性約為22-31%。接觸到HCV(+)危險(xiǎn)性約為1.8%。,HIV PEP,Basic:AZT 200mg tid+3TC 150mg bidfor 4 weeksExpanded:basic regimens( 2 NRTI ) + PI ( p

7、rotease inhibitor ) or + NNRTI,Timing of PEP initiation,Initiate as soon as possible,Postexposure testing,1.In patients with basic regimens:FU HIV serology at 1.5,3, & 6 mons2.In patients with expanded

8、regimens:FU HIV serology to 12 mons3.HIV testing in any suspected acuteretroviral syndrome4.Direct viral assays is not recommended for routine use,Hepatitis B Exposure,Exposure person Source:HBs

9、 Ag(-)Unvaccinated Initiate HB vaccineVaccinated No rx necessary,,,Hepatitis B Exposure,Exposure person Source: HBs Ag(+)Unvaccinated HBIG + vaccine

10、Vaccinated If anti-HBS(+),follow up If anti-HBS(-),HBIG + vaccine,,Hepatitis C Exposure,No specific treatmen

11、t at present.Follow up 1,3 ,6, 12 months,Syphilis exposure,If the patient’s serology : TPHA> 160, Benzathine penicillin 1 vial IM st .Follow up 1, 3, 6 months.,Prevention,,防止針扎的五大作為,Develop an institution-wide cul

12、ture of safety in the work environmentPromote reporting of sharps injuries and injury hazardsAnalyze sharps injury data for prevention planningSelect/evaluate sharps injury prevention devicesEducate and train healthc

13、are personnel,感控理念架構(gòu)Infection Control Concept Cascade,ER與CCU全面使用安全針具後之針扎狀況,來(lái)源: 中部某醫(yī)學(xué)中心資料,ER危險(xiǎn)針具扎傷分析,來(lái)源: 中部某醫(yī)學(xué)中心資料,Sharps container,Single dose, protective system,安全針具/器,動(dòng)脈採(cǎi)血針,安全性靜脈留置針,無(wú)針式輸液套接頭,一般注射針頭,Summary,Sharps inju

14、ries are an important concernIncreased risk of disease transmissionHigh costs to personnel and healthcare systemMost sharps injuries are preventableNeedlestick Safety and Prevention Act requires prevention efforts be