血源性病原体的职业暴露与预防.pptVIP

血源性病原体的职业暴露与预防 血源性病原体的职业暴露与预防 Hepatitis B Vaccination Any one with occupational exposure to blood or OPIM should be vaccinated recommended unless: employee has documentation of receipt of series antibody testing shows immunity employee has medical contraindications 血源性病原体的职业暴露与预防 Hepatitis B Vaccination available within 10 working days of work start date if employee declines, must sign statement of declination employee may request the series later 血源性病原体的职业暴露与预防 Hepatitis B Vaccination Safety very safe vaccine US: as of 2000 more than 100 million adults have received vaccine with few side effects serious reactions are rare mild symptoms may occur: soreness at injection site, low-grade fever may be given during pregnancy 血源性病原体的职业暴露与预防 Hepatitis B Vaccination Effectiveness at least 90% of adults are immune after completing the three doses of vaccine since 1985, 90% reduction of number of HCW infected with HBV, largely due to vaccine 血源性病原体的职业暴露与预防 Decline in HBV Cases Among Healthcare Workers Following Vaccination OSHA mandates HBV vaccination 17,000 800 This regulation had the greatest impact in eliminating HBV transmission among healthcare workers. Mahoney F et al. Archives of Int Med 157 (1997): 2601-2603 血源性病原体的职业暴露与预防 暴露发生后处理程序是什么？ 局部紧急处理 局部皮肤洗、冲、挤，70％酒精消毒 大量水冲洗眼睛 安全事故报告和随访 向医院感染管理科及时报告 及时确定暴露后药物预防（PEP） 如要服药则需在24小时内完成 暴露者血液检测：0周、4周、8周、12周、 6月 感染评估 建立安全事故登记和报告制度 血源性病原体的职业暴露与预防 如何进行局部处理？ 如是血液、体液等溅洒于皮肤粘膜表面应立即先用肥皂，再用清水、自来水或生理盐水冲洗 如溅入口腔、眼睛等黏膜部位，立即用清水、自来水或生理盐水长时间彻底冲洗 如发生皮肤粘膜针刺伤、切割伤、咬伤等出血性损伤，应立即挤出损伤局部的血，然后用清水、自来水或生理盐水等彻底冲洗，再用碘伏、75%酒精、0.2%次氯酸钠、0.2%～0.5%过氧乙酸、酸性氧化电位水等消毒创面 血源性病原体的职业暴露与预防 受伤医务人员监测及处理流程 病人为HBsAg (+) 受伤医务人员 HBsAg(+)或 Anti-HBs(+)或 Anti-HBc (+) 不需注射疫苗或HBIG 受伤者医务人员 HBsAg（–） Anti-HBs（–） 未注射疫苗（–） 24小时内注射HBIG并注射疫苗 受伤医务人员 HBsAg（–） Anti-HBs（–） 注射疫苗但未 产生抗体 24小时内注射HBIG再补一针疫苗 刺伤后6个月，一年监测GOT,GPT,HBsAG,anti-HBs,anti-HBc 受伤医务人员 HBsAg（–） Anti-HBs（–） 正在注射疫苗 未产生抗体 24小时内注射HBIG继续完成疫苗注射 血源性病原体的职业暴露与预防 病人为 anti-HCV (+) 受伤者取血查anti-HCV 受伤者 anti-HCV (+) 受伤者 anti-HCV（