我国肿瘤介入专业技术人员职业暴露调查与分析
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摘要
目的了解我国肿瘤介入专业技术人员职业暴露和防护现状,提高自身职业防护与安全意识,为国家相关部门制定相关政策提供依据。方法 2017年9月至10月,网络发放调查问卷至中国抗癌协会肿瘤介入学专业委员会各委员单位,邀请相关专业技术人员参与调查。结果共回收调查问卷1 314份,其中有效问卷1 225份,有效率93.2%。针刺伤发生率为77.3%(947/1 225),其中15例(1.6%)导致乙型肝炎病毒(HBV)感染,16例(1.7%)感染丙型肝炎病毒(HCV),12例(1.3%)感染梅毒,31例(2.5%)造成伤口感染。91.5%(1 121/1 225)在日常诊疗工作中接触化疗药物,其中929例(75.9%)由医师和护士合作配制化疗药物,呼吸道、皮肤接触是主要暴露途径,分别占71.4%(800例)、78.7%(882例);94.8%(1 161/1 225)在日常介入诊疗工作中接触X线电离辐射,分别有741例(60.5%)、405例(33.1%)接触放射性粒子、放射性药物;55.9%(685/1 225)因医疗实践与患者或家属产生纠纷,分别有32.9%、21.4%受到患者或其家属语言暴力、肢体暴力,628例(51.3%)表现出职业倦怠,分别有38.6%有焦虑倾向,21.7%有抑郁倾向;55.8%(683/1 225)出现腰背疼痛,38.9%(477/1 225)出现颈椎病,部分人员表现为下肢静脉曲张、腰椎间盘突出等机械性损伤,皮肤、血液、内分泌系统异常亦不少见,有的患有白内障、恶性肿瘤等疾病。结论我国肿瘤介入从业人员职业暴露与防护现状不容乐观,加强安全防护培训,提高自身防护意识,装备安全有效的防护设备、设施,制定和执行严格的防护及管理措施,对减少职业暴露危害和改善自身健康具有重要意义。
Objective To investigate the present situation of occupational exposure and protection of professionals involved in tumor intervention in China so as to improve their own awareness of occupational protection and safety, and to provide the basis for the relevant government departments to formulate scientific and reasonable policies. Methods From September to October 2017, self-designed questionnaires were distributed through the internet to the members of Professional Committee on Cancer Intervention, China Anti-Cancer Association to invite relevant professionals to participate in this investigation. Results A total of1314 questionnaires were collected, of which 1 225 were valid with an effective rate of 93.2%. The incidence of needling injury was 77.3%(947/1225), of which 15 professionals(1.6%) resulted in hepatitis B virus(HBV) infection, 16 professionals(1.7%) were infected with hepatitis C virus(HCV), 12 professionals(1.3%) were infected with syphilis, and 31 professionals(2.5%) developed wound infection. A total of91.5% of the professionals(1121/1225) were exposed to chemotherapeutic drugs in their daily diagnosis and treatment, in 929 cases(75.9%) the preparation of chemotherapeutic drugs was made by doctors and nurses working together. Respiratory tract contact and skin contact were the main exposure routes, the incidences were 71.4%(800 cases) and 78.7%(882 cases) respectively. A total of 94.8% of the professionals(1 161/1 225) were exposed to X-ray ionizing radiation in routine interventional diagnosis and treatment, including exposure to radioactive particles(741 cases, 60.5%) and exposure to radiopharmaceuticals(405 cases,33.1%). A total of 55.9% of professionals(685/1 225) had disputes with patients or their family members in medical practice, subjecting to language violence(32.9%) or physical violence(21.4%). A total of 628 professionals(51.3%) showed job burnout, including anxiety tendency(38.6%) and depression tendency(21.7%), 55.8% of professionals(683/1 225) had lumbar and back pain, and 38.9% of professionals(477/1 225) developed cervical spondylosis. Some of professionals showed mechanical injuries such as varicose veins of the lower extremities, protrusion of the lumbar intervertebral disc, etc. Abnormalities of skin, blood and endocrine systems were not uncommonly seen. Some professionals suffered from cataracts, malignant tumors and other diseases. Conclusion The present situation of occupational exposure and protection in cancer intervention practitioners in China is not optimistic. Therefore, it is extremely urgent to strengthen safety protection training, to raise awareness of self-protection, to equip safe and effective protective equipment and facilities, to formulate strict protection and management measures, and at the same time to strengthen the enforcement and supervision, which is of great significance to reduce the hazards of occupational exposure and to improve the health of practitioners.(J Intervent Radiol, 2019, 28: 586-590)
Objective To investigate the present situation of occupational exposure and protection of professionals involved in tumor intervention in China so as to improve their own awareness of occupational protection and safety, and to provide the basis for the relevant government departments to formulate scientific and reasonable policies. Methods From September to October 2017, self-designed questionnaires were distributed through the internet to the members of Professional Committee on Cancer Intervention, China Anti-Cancer Association to invite relevant professionals to participate in this investigation. Results A total of1314 questionnaires were collected, of which 1 225 were valid with an effective rate of 93.2%. The incidence of needling injury was 77.3%(947/1225), of which 15 professionals(1.6%) resulted in hepatitis B virus(HBV) infection, 16 professionals(1.7%) were infected with hepatitis C virus(HCV), 12 professionals(1.3%) were infected with syphilis, and 31 professionals(2.5%) developed wound infection. A total of91.5% of the professionals(1121/1225) were exposed to chemotherapeutic drugs in their daily diagnosis and treatment, in 929 cases(75.9%) the preparation of chemotherapeutic drugs was made by doctors and nurses working together. Respiratory tract contact and skin contact were the main exposure routes, the incidences were 71.4%(800 cases) and 78.7%(882 cases) respectively. A total of 94.8% of the professionals(1 161/1 225) were exposed to X-ray ionizing radiation in routine interventional diagnosis and treatment, including exposure to radioactive particles(741 cases, 60.5%) and exposure to radiopharmaceuticals(405 cases,33.1%). A total of 55.9% of professionals(685/1 225) had disputes with patients or their family members in medical practice, subjecting to language violence(32.9%) or physical violence(21.4%). A total of 628 professionals(51.3%) showed job burnout, including anxiety tendency(38.6%) and depression tendency(21.7%), 55.8% of professionals(683/1 225) had lumbar and back pain, and 38.9% of professionals(477/1 225) developed cervical spondylosis. Some of professionals showed mechanical injuries such as varicose veins of the lower extremities, protrusion of the lumbar intervertebral disc, etc. Abnormalities of skin, blood and endocrine systems were not uncommonly seen. Some professionals suffered from cataracts, malignant tumors and other diseases. Conclusion The present situation of occupational exposure and protection in cancer intervention practitioners in China is not optimistic. Therefore, it is extremely urgent to strengthen safety protection training, to raise awareness of self-protection, to equip safe and effective protective equipment and facilities, to formulate strict protection and management measures, and at the same time to strengthen the enforcement and supervision, which is of great significance to reduce the hazards of occupational exposure and to improve the health of practitioners.(J Intervent Radiol, 2019, 28: 586-590)
引文
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[13]王斯妮,贾中芝,胡红杰,等.钇-90微球的特性、放射栓塞的操作技术及安全防护---钇-90微球放射栓塞系列回顾(一)[J].介入放射学杂志,2017,26:952-958.
[14]Wild P,Gauron C,Champion K,et al.Effects of chronic lowdose exposure to ionizing radiation on physician microvascular structure revealed by nail fold capillaroscopy[J].Radiat Environ Biophys,2016,55:71-79.
[15]Principi S,Delgado Soler C,Ginjaume M,et al.Eye lens dose in interventional cardiology[J].Radiat Prot Dosimetry,2015,165:289-293.
[16]Basic B,Beganovic A,Skopljak-Beganovic A,et al.Occupational exposure doses in interventional procedures in Bosnia and Herzegovina[J].Radiat Prot Dosimetry,2011,144:501-504.
[17]张彦坤,张晓娜,李玉静,等.佩戴铅防护眼镜对介入工作人员的眼晶状体防护效果的探讨[J].中国医药导刊,2016,18:426-428.
[18]于伟跃,陈法国,韩毅,等.铅眼镜对介入手术中职业人员防护效果的研究现状[J].辐射防护,2017,37:507-514.
[19]Dixon RG,Khiatani V,Statler JD,et al.Society of interventional radiology:occupational back and neck pain and the interventional radiologist[J].J Vasc Interv Radiol,2017,28:195-199.
[2]Hussain SA,Latif AB,Choudhary AA.Risk to surgeons:a survey of accidental injuries during operations[J].Br J Surg,1988,75:314-316.
[3]Abatzoglou I,Koukourakis M,Konstantinides S.Reduction of the radiation dose received by interventional cardiologists following training in radiation protection[J].Radiat Prot Dosimetry,2013,155:119-121.
[4]Baffoy-Fayard N,Maugat S,Sapoval M,et al.Potential exposure to hepatitis C virus through accidental blood contact in interventional radiology[J].J Vasc Interv Radiol,2003,14:173-179.
[5]Deipolyi AR,Prabhaka r AM,Naidu S,et al.Needlestick injuries in interventional radiology are common and underreported[J].Radiology,2017,285:870-875.
[6]Gutta N,Meek J.Radiation safety update:what every interventional radiologist must know[J].J Vasc Interv Radiol,2016,27:S215.
[7]Mairs WD.Occupational dose constraints for the lens of the eye for interventional radiologists and interventional cardiologists in the UK[J].Br J Radiol,2016,89:20150551.
[8]NIOSH alert 2004:Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings[EB/OL].http://www.cdc.gov/niosh/docs/2004-165/pdfs/2004-165.pdf.Accessed August 30,2016.
[9]Sugiura S,Nakanishi H,Asano M,et al.Multicenter study for environmental and biological monitoring of occupational exposure to cyclophosphamide in Japan[J].J Oncol Pharm Pract,2011,17:20-28.
[10]Hon CY,Teschke K,Chua P,et al.Occupational exposure to antineoplastic drugs:identification of job categories potentially exposed throughout the hospital medication system[J].Saf Health Work,2011,2:273-281.
[11]Huang YW,Zhang NH,Tong DM,et al.Investigation on occupational exposure to 5-fluorouracil in pharmacy intravenous admixture service of a hospital[J].Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi,2010,28:414-417.
[12]Garin E,Laffont S,Rolland Y.Occupational radiation exposure for medical staff performing90Y loaded microsphere radioembolization[J].J Vasc Interv Radiol,2016,27:S70.
[13]王斯妮,贾中芝,胡红杰,等.钇-90微球的特性、放射栓塞的操作技术及安全防护---钇-90微球放射栓塞系列回顾(一)[J].介入放射学杂志,2017,26:952-958.
[14]Wild P,Gauron C,Champion K,et al.Effects of chronic lowdose exposure to ionizing radiation on physician microvascular structure revealed by nail fold capillaroscopy[J].Radiat Environ Biophys,2016,55:71-79.
[15]Principi S,Delgado Soler C,Ginjaume M,et al.Eye lens dose in interventional cardiology[J].Radiat Prot Dosimetry,2015,165:289-293.
[16]Basic B,Beganovic A,Skopljak-Beganovic A,et al.Occupational exposure doses in interventional procedures in Bosnia and Herzegovina[J].Radiat Prot Dosimetry,2011,144:501-504.
[17]张彦坤,张晓娜,李玉静,等.佩戴铅防护眼镜对介入工作人员的眼晶状体防护效果的探讨[J].中国医药导刊,2016,18:426-428.
[18]于伟跃,陈法国,韩毅,等.铅眼镜对介入手术中职业人员防护效果的研究现状[J].辐射防护,2017,37:507-514.
[19]Dixon RG,Khiatani V,Statler JD,et al.Society of interventional radiology:occupational back and neck pain and the interventional radiologist[J].J Vasc Interv Radiol,2017,28:195-199.