Analysering af stikuheld ved Aalborg Universitetshospital

Needle stick injuries at Aalborg University Hospital

Mols, Emma Sofie Jurvanen

5. semester (speciale)

Medicin, Kandidat

2021

2021-01-05

26

Sundhedspersonale kan blive udsat for blodbårne infektioner som hepatitis B (HBV), hepatitis C og hiv, især ved stikskader eller kontakt med blodtilblandede væsker. Selvom disse infektioner er relativt sjældne i Danmark, er ekspositioner hyppige; op mod 80 % af danske læger har haft mindst ét stikuheld i deres karriere. Den 1. januar 2020 overtog Infektionsmedicinsk Afdeling håndteringen af stikuheld på Aalborg Universitetshospital og indførte ændrede arbejdsgange. Der fandtes ikke tidligere en samlet opgørelse over uheldene. Dette studie kortlægger stikuheld håndteret ved Aalborg Universitetshospital og beskriver hvor, hvordan og hos hvem de opstår, samt i hvilken grad de tilskadekomne følger den anbefalede behandling og opfølgning. Formålet er at pege på mulige forbedringer, fx i strategien for HBV-primærvaccination. Vi gennemgik alle stikuheld fra 1. januar 2020 til 1. juni 2021. For hvert uheld registrerede vi skademekanisme og -sted, immunstatus hos den tilskadekomne, blodprøver taget på tilskadekomne og smittekilde, samt om den planlagte behandling og opfølgning blev gennemført. Oplysningerne blev indsamlet i en REDCap-database og analyseret i STATA. I alt blev 503 stikuheld rapporteret, heraf 297 på hospitalet. Stik med kanyle var den hyppigste eksposition. På 13,4 % af de kendte smittekilder blev der taget en stikuheldsprofil (blodprøvepanel for smitterisiko). Blandt de tilskadekomne på hospitalet var 42,8 % forudvaccineret mod HBV. I 199 (39,6 %) sager blev den anbefalede behandlings- og opfølgningsplan ikke fulgt. På hospitalet gennemførte 53,4 % HBV-vaccineserien efter uheldet, og 72,5 % fik taget de opfølgende blodprøver; tallene var lavere uden for hospitalet. Resultaterne peger på behov for forbedringer i håndteringen af stikuheld. Relevante tiltag kan omfatte undervisning i forebyggelse af blodbåren smitte, konsekvent udfyldelse af stikuheldsjournaler, korrekt akutbehandling, samt tydeliggørelse af vigtigheden af at gennemføre HBV-vaccination og opfølgende blodprøver.

Healthcare workers risk exposure to blood-borne infections such as hepatitis B (HBV), hepatitis C, and HIV, especially through needlestick injuries or contact with blood-contaminated fluids. Although these infections are relatively uncommon in Denmark, exposures are frequent; up to 80% of Danish doctors have had at least one needlestick during their career. On 1 January 2020, the Department of Infectious Diseases took over the management of needlestick incidents at Aalborg University Hospital and introduced new procedures. No previous hospital-wide overview existed. This study maps needlestick incidents handled at Aalborg University Hospital and describes where, how, and among whom they occur, as well as how well injured staff adhere to recommended treatment and follow-up. The aim is to identify areas for improvement, for example in the strategy for primary HBV vaccination. We reviewed all incidents from 1 January 2020 to 1 June 2021. For each case, we recorded the mechanism and location, the injured person’s immune status, blood tests taken from the injured person and the source patient, and whether the planned treatment and follow-up were completed. Data were collected in a REDCap database and analyzed in STATA. A total of 503 incidents were reported, 297 of them on the hospital premises. Needlestick exposure with a needle was the most common. A needlestick exposure test panel (blood tests for infection risk) was performed for 13.4% of known source patients. Among hospital staff who were injured, 42.8% had been vaccinated against HBV beforehand. In 199 cases (39.6%), the recommended treatment and follow-up plan was not followed. In-hospital, 53.4% completed the HBV vaccine series after the incident and 72.5% completed follow-up blood tests; rates were lower outside the hospital. These findings indicate room for improvement in needlestick management. Suggested steps include education on preventing blood-borne transmission, consistent completion of incident records, correct acute management, and emphasizing the importance of completing HBV vaccination and follow-up blood tests.

[Dette resumé er omskrevet med hjælp fra AI baseret på projektets originale resumé]

Stikuheld

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