According to a survey by the World Health Organization, 40% of medical staff have been accidentally injured by needles. Medical staff have high occupational exposure and infection opportunities and frequencies, and they suffer huge occupational exposure risks and pressures in their daily work.
Depending on the patient’s blood, body fluids, secretions, etc., there are potential infectious diseases, remember this.
Occupational exposure is not limited to sharps injuries, but also includes contamination such as blood and body fluids.
What is occupational exposure? The meaning of occupational exposure satisfies the following two points.
1. Exposure to risk factors may damage human health and endanger life.
2. Workers are exposed to these risk factors because of their occupational relationships.
(It is simply understood that medical personnel are exposed to these risk factors at work, then it is called occupational exposure)
The occupational exposure of medical staff is mainly divided into the following major blocks:
1. Infectious occupational exposure.
2. Occupational exposure to radiation.
3. Chemical (such as disinfectants, certain chemicals)
4. Other occupational exposures.
Let’s talk about radioactive exposure first:
Generally speaking, it is often referred to as X-ray, CT, intervention, etc. Now the walls of the imaging room and the CT room are specially isolated with lead plates, relatively speaking, the radiation is still much less. However, those involved in interventional nuclear medicine are relatively hard-pressed. Although they will wear a lead coat of more than ten kilograms when helping patients, they will still eat a lot of rays (so it is not recommended for young doctors who have not given birth to children) . In addition, some of our patients who need cholangiography before removing the T-tube will also take them to take the film in person, and create a contrast agent while taking the film for the patient. Will it cause any cancer or mutation, it depends on the will of God.
Then talk about chemical drugs:
This is also divided into liquid and gaseous. For the gaseous one, wear special protective masks and work clothes. For the liquid one, you can only use gloves and work clothes. If you can get it, you can get it. Relatively speaking, it is not too troublesome.
Focus let’s talk about infectious occupational exposure:
This is the most common, the most important, and the most troublesome for us, involving headaches such as hepatitis B and HIV. To be specific:
Let’s talk protection first. This is more important than treatment.
The patient’s blood, body fluids, secretions, and excreta are regarded as the source of infection. Corresponding measures should be taken when contacting the patient’s damaged mucous membranes and incomplete skin.
1. Preventive measures for contact transmission.
Direct contact with the patient’s non-intact skin or mucous membranes is mainly done with hands, as these lesions may contain communicable diseases such as intestinal infections, skin infections, multi-drug resistant bacteria, hepatitis, HIV, etc.
2. Protective measures for droplet transmission.
Such as colds, whooping core, meningitis, mumps and so on.
Masks are routine, not only worn by doctors, but also required by patients. There seem to be two types of surgical masks and N95.
N95 masks are generally worn when exposed to relatively powerful viruses or bacteria, such as SARS, bird flu, etc. (I won’t talk much about the correct way to wear the two masks here).
Work clothes are also a must, so you can bring these germs home, thinking about so many germs, it’s pretty dirty.
Patients with the same disease should be placed in a room to prevent cross-infection, and the room and equipment should be sterilized after discharge.
Try to reduce the number of people in the border to visit to avoid transmission.
3. Airborne precautions
Similar to droplet transmission, it is still masks, hats and overalls. If there are highly pathogenic bacteria, they must be sent to the isolation ward for isolation. The doctor must put on the isolation suit before entering.
After talking about the protection, let’s talk about the processing method:
No matter how good the protection is, there are always some things that you can’t protect. You often walk by the river, and you don’t have wet shoes.
In surgery, it is commonplace to be injured by needles. It doesn’t matter if the patient has no infectious disease, but many patients have hepatitis B, and very few have AIDS. If you hurt your hand at this time, it would be quite a pain in the ass.
(The following are not only for medical personnel, but also for non-medical personnel. Things are a little boring. Interested friends can take a closer look, just in case.)
Let’s talk about the general processing method first:
1. Rinse with normal saline, squeeze gently around the wound (do not directly squeeze the wound locally), drain the blood from the injured wound, rinse the wound with normal saline, and then disinfect with 75% ethanol or 0.5% iodophor .
2. Report to the head of the department, report to the hospital sense management department, and evaluate the occupational exposure (these things are fully reimbursed by the hospital).
3. After the assessment, they may be prescribed preventive medication according to the situation. At the same time, blood will be drawn to detect the corresponding infection indicators.
After talking about the general treatment principles, let’s talk about the special treatment of two more important exposed diseases: hepatitis B and AIDS.
Let’s talk about hepatitis B first, there are two cases:
1. Situation 1, medical staff have never been vaccinated against hepatitis B
If you are infected by an HBsAg-positive patient at this time, then you have to get hepatitis B immune globulin, and you have to get vaccinated at the same time.
If the patient’s HBsAg is negative, then you don’t need to play immunoglobulin, just go for the vaccination. (But I will definitely fight, multiple protection is always good)
2. In the second case, the doctor has been vaccinated.
If infected by a HBsAg-positive patient and the HBsAg antibody concentration in the medical staff is greater than 10MIU/ml, treatment is not required, and immunoglobulin is required when it is less than 10MIU/ml.
If the patient’s HBsAg is negative, don’t worry about it, just go and spit it happily after the surgery.
(The summary of personal irresponsibility is, no matter what negative or positive, you have not been vaccinated, if you are infected, go for immunoglobulin plus vaccination, if you have been vaccinated, go for one directly Immune globulin, simple and rude, no worries)
Besides, AIDS is a terrible disease.
There are three levels of HIV exposure.
Primary exposure: The body fluids or blood of AIDS patients contaminate the skin or mucous membranes damaged by medical staff. Low exposure, short time
Secondary exposure: Contaminate the exposure source for a long time and in a large amount. Or direct stab wounds and cuts to the skin from the exposure source, with minor injuries such as needle sticks and abrasions. Needle stick injuries during our surgery are generally classified as secondary exposures.
Level 3 exposure: The exposure source stabs and cuts the skin, the damage is large, there is a deep wound or the wound has visible blood. Intraoperative knife cuts generally fall into the third grade.
In addition, according to the viral load, it is divided into three types: mild, severe and unknown source of exposure.
Mild: HIV-positive, but low titers, infected individuals are asymptomatic, and CD4 counts are generally normal.
Severe: HIV-positive, but high titers, infected individuals are clinically symptomatic, and CD4 counts generally decline.
Unexplained: Unsure whether the patient is HIV-positive.
After talking so much, the key that everyone cares about is treatment.
The implementation of preventive medicine is justified.
1. Prophylactic medication as early as possible, preferably within 4 hours, no more than 24 hours at the latest.
2. The preventive medication program is divided into basic medication program and intensive medication program
Basic medication schedule: 2 reverse transcriptase inhibitors, regular dose, 28 days
Intensive medication program: 2 reverse transcriptase inhibitors + 1 protease inhibitor, regular dose, 28 days.
3. When the first level exposure occurs and the virus carrier is mild, no preventive medication is required, and the rest are generally required (don’t take risks, life is important)
4. Follow-up. At 4, 8, 12 weeks and 6 months after exposure, HIV antibodies were tested, and drug toxicity was monitored and managed. Observe and record early symptoms, etc., and deal with them urgently.
(Medication does not mean that AIDS is cured, it just kills the virus as much as possible, reduces the probability of your attack, or delays the attack as much as possible, so you should always monitor and prevent it in the later stage. Even if the attack occurs, early detection and early treatment. )
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