{"id":26390,"date":"2023-03-06T14:43:13","date_gmt":"2023-03-06T11:43:13","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=26390"},"modified":"2023-03-21T13:45:19","modified_gmt":"2023-03-21T10:45:19","slug":"delici-kesici-alet-yaralanmalari-sonucunda-kan-ve-vucut-sivilariyla-temas","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/03\/06\/delici-kesici-alet-yaralanmalari-sonucunda-kan-ve-vucut-sivilariyla-temas\/","title":{"rendered":"Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131n\u0131n Be\u015f Y\u0131ll\u0131k Bir S\u00fcre\u00e7te Ger\u00e7ekle\u015fen Delici-Kesici Alet Yaralanmalar\u0131 Sonucunda Kan ve V\u00fccut S\u0131v\u0131lar\u0131yla Temaslar\u0131n\u0131n De\u011ferlendirilmesi"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda ilk olarak 1984 y\u0131l\u0131nda i\u011fne batmas\u0131 yaralanmas\u0131 sonucu geli\u015fen kazan\u0131lm\u0131\u015f insan ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fi virusu (human immunodeficiency virus \u2013 HIV) infeksiyonu olgusunun bildirilmesinin ard\u0131ndan, delici-kesici alet yaralanmalar\u0131n\u0131n neden oldu\u011fu riskler konusundaki kayg\u0131lar ve fark\u0131ndal\u0131k artm\u0131\u015ft\u0131r. G\u00fcn\u00fcm\u00fczde, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda perk\u00fctan giri\u015fimler s\u0131ras\u0131nda ger\u00e7ekle\u015febilen delici-kesici alet yaralanmalar\u0131n\u0131n, hepatit B virusu (HBV), hepatit C virusu (HCV) ve HIV gibi kan yoluyla bula\u015fan infeksiyonlar a\u00e7\u0131s\u0131ndan \u00f6nemli riskler ta\u015f\u0131d\u0131\u011f\u0131 bilinmektedir. HBV infeksiyonu i\u00e7in enjekt\u00f6r ile yaralanmalarda risk %18-30 aras\u0131nda de\u011fi\u015firken, HCV\u2019de bu oran %1.8\u2019dir. HIV infeksiyonunda ise risk oranlar\u0131; perk\u00fctan giri\u015fim s\u0131ras\u0131nda kontamine kana maruziyette %0.3, kan ve v\u00fccut s\u0131v\u0131lar\u0131yla temas durumunda %0.09\u2019dur. S\u00f6z konusu risk oranlar\u0131, maruziyetin tipi, kayna\u011f\u0131n infektivitesi gibi fakt\u00f6rlerle de\u011fi\u015fkenlik g\u00f6stermektedir. Her y\u0131l d\u00fcnya genelinde sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda, delici-kesici alet yaralanmalar\u0131n\u0131n yakla\u015f\u0131k 66 000 HBV, 16 000 HCV ve 200-5000 HIV infeksiyonuna neden oldu\u011fu tahmin edilmektedir (1). ABD Hastal\u0131k Kontrol ve \u00d6nleme Merkezleri (CDC) taraf\u0131ndan yay\u0131nlanan bir k\u0131lavuzda, HIV ge\u00e7i\u015fini \u00f6nlemek amac\u0131yla evrensel \u00f6nlemler<\/i> (universal precautions) ba\u015fl\u0131\u011f\u0131 alt\u0131nda t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131 infekte kan ve v\u00fccut s\u0131v\u0131lar\u0131na maruziyetten korumak i\u00e7in yap\u0131lmas\u0131 gerekenler tan\u0131mlanm\u0131\u015ft\u0131r. Bu k\u0131lavuza g\u00f6re, hizmet verilen t\u00fcm bireylerin v\u00fccut s\u0131v\u0131lar\u0131 infekte kabul edilerek i\u015flemler \u00f6ncesi \u00f6nlemlerin al\u0131nmas\u0131 zorunludur. Eldiven kullan\u0131lmas\u0131n\u0131n yan\u0131 s\u0131ra deri ve muk\u00f6z membranlara bula\u015fmay\u0131 \u00f6nlemek i\u00e7in \u00f6nl\u00fck, maske, g\u00f6zl\u00fck kullan\u0131lmas\u0131 gereklidir. Ayr\u0131ca t\u00fcm bu uygulamalar yap\u0131lan e\u011fitimlerle g\u00fcncellenmelidir. Temas sonras\u0131nda infeksiyon bula\u015fma takibi i\u00e7in hastane \u0130nfeksiyon Kontrol Komitesi (EKK)\u2019ne ba\u015fvurulmal\u0131d\u0131r (2).<\/p>\n

Bu \u00e7al\u0131\u015fmada, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 taraf\u0131ndan yaralanma nedeni ile EKK\u2019ye yap\u0131lan ba\u015fvurular incelenerek; \u00e7al\u0131\u015fanlar\u0131n demografik \u00f6zellikleri, yaralanmalar\u0131n nedenleri ve 2015 y\u0131l\u0131ndaki art\u0131\u015f\u0131n sebebi ara\u015ft\u0131r\u0131ld\u0131.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda, 610 yatakl\u0131 \u00fc\u00e7\u00fcnc\u00fc basamak \u00f6zel bir hastanede Ocak 2013-Aral\u0131k 2017 tarihleri aras\u0131nda EKK\u2019ye yap\u0131lan ba\u015fvurular, \u201ckan-v\u00fccut s\u0131v\u0131lar\u0131 ile temas\/delici-kesici alet yaralanma kay\u0131t ve izlem formlar\u0131<\/i>\u201d arac\u0131l\u0131\u011f\u0131yla retrospektif olarak de\u011ferlendirildi. Veriler; sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ya\u015f\u0131, cinsiyeti, mesle\u011fi, yaralanmaya maruz kald\u0131klar\u0131 birim ve delici-kesici alet yaralanmalar\u0131 sonucu kan ve v\u00fccut s\u0131v\u0131lar\u0131yla temaslar\u0131 a\u00e7\u0131s\u0131ndan incelendi. Ayr\u0131ca, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na, infeksiyon kontrol hem\u015fireleri ve uzman hekimler taraf\u0131ndan verilen e\u011fitimlerin kat\u0131l\u0131m kay\u0131tlar\u0131na ve ki\u015fisel koruyucu ekipman (KKE) temin edilip edilmedi\u011fine bak\u0131ld\u0131. Maruziyet sonras\u0131 EKK\u2019ye ba\u015fvuru yapan \u00e7al\u0131\u015fanlar\u0131n; HBsAg, anti-HBs, anti-HIV ve anti-HCV test sonu\u00e7lar\u0131, yaralanmaya neden olan malzemenin ne oldu\u011fu, hasta biliniyorsa hastan\u0131n HBsAg, anti-HCV ve anti-HIV test sonu\u00e7lar\u0131 incelendi. Yaral\u0131 personelin meslek gruplar\u0131, birimleri ve yaralanma sonras\u0131 yap\u0131lan uygulamalar de\u011ferlendirildi. Verilerin analizi, SPSS 15.0 program\u0131 (IBM Corp., ABD) kullan\u0131larak yap\u0131ld\u0131.<\/p>\n

BULGULAR\u00a0<\/span><\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> Y\u0131llara G\u00f6re Yaralanan Sa\u011fl\u0131k Personelinin \u00c7al\u0131\u015ft\u0131\u011f\u0131 Birimler<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Y\u0131llara G\u00f6re Yaralanan Sa\u011fl\u0131k Personelinin G\u00f6revleri<\/p><\/div>\n

\"\"<\/a>

Tablo 3.<\/strong> Y\u0131llara G\u00f6re Toplam ve Temasl\u0131 Personel Say\u0131s\u0131<\/p><\/div>\n

EKK\u2019ye ba\u015fvuran personelin say\u0131s\u0131 175 olup ya\u015f ortalamas\u0131 31.5\u00b18 y\u0131ld\u0131. Olgular\u0131n %58.5\u2019i erkek, %41.5\u2019i kad\u0131nd\u0131. En y\u00fcksek say\u0131daki olgu grubu 66 (%37.7) ki\u015fi ile hem\u015firelerdi; bunu 38 (%21.7) ki\u015fi ile temizlik g\u00f6revlileri\/hasta bak\u0131c\u0131lar ve 30 ki\u015fi (%17.1) ile stajyerler izliyordu.\u00a0 <\/span>En fazla say\u0131da yaralanma ameliyathanelerde [39 (%22.3)], acil serviste [33 (%18.8)], yo\u011fun bak\u0131m \u00fcnitesinde [32 (%18.3)] ve cerrahi servislerde [22 (%12.6)] g\u00f6r\u00fcld\u00fc (Tablo 1-3).\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 4.<\/strong> Y\u0131llara G\u00f6re Sa\u011fl\u0131k Personelinin Kan ve V\u00fccut S\u0131v\u0131lar\u0131 ile Temas Durumu<\/p><\/div>\n

Olgular\u0131n; 117 (%62.5)\u2019si i\u011fne batmas\u0131, 45 (%24)\u2019i kesici alet ve 25 (%13.5)\u2019i kan ve v\u00fccut s\u0131v\u0131lar\u0131yla temas sonucu yaralanm\u0131\u015ft\u0131 (Tablo 4). Yaralanma sonucu, olgular\u0131n %48\u2019inin su, sabunlu su veya %10 povidon iyot \u00e7\u00f6zeltisiyle yaralanan b\u00f6lgeyi temizledi\u011fi tespit edildi; kalan %52 oran\u0131ndaki grup hi\u00e7bir i\u015flem uygulamam\u0131\u015ft\u0131. Olgular\u0131n 144 (%82.3)\u2019\u00fcnde yaralanman\u0131n hangi hastada kullan\u0131lan malzemeden kaynakland\u0131\u011f\u0131 bilinirken 31(%17.7)\u2019inde bilinmedi\u011fi g\u00f6r\u00fcld\u00fc.<\/p>\n

Yaralanmaya neden olan malzemenin kullan\u0131ld\u0131\u011f\u0131 hastalar\u0131n 16\u2019s\u0131nda HBsAg ve be\u015finde anti-HCV testleri pozitifti. T\u00fcm personelin anti-HCV ve anti-HIV test sonu\u00e7lar\u0131 negatifti. Anti- HBs test sonucu yaralanm\u0131\u015f personelin 122 (%69.7)\u2019sinde pozitif, 53 (%30.3)\u2019\u00fcnde negatifti. Anti-HBs test sonucu negatif olan t\u00fcm personelin hepatit B a\u015f\u0131 program\u0131na al\u0131nd\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. Bir \u00e7al\u0131\u015fan\u0131n HBsAg de\u011feri pozitif olup d\u00fczenli olarak takip edilmi\u015fti. HBsAg pozitif hastalarla temas\u0131 olan \u00e7al\u0131\u015fanlar\u0131n hepsinde anti-HBs test sonu\u00e7lar\u0131 pozitifti. Yaralanma sonras\u0131 hi\u00e7bir \u00e7al\u0131\u015fanda akut hepatit B veya akut hepatit C infeksiyonu geli\u015fmedi\u011fi g\u00f6r\u00fcld\u00fc. Bir hastan\u0131n anti-HIV sonucu pozitifti ve bu hasta ile temas etti\u011fini belirten 10 \u00e7al\u0131\u015fandan sekizi hastan\u0131n kan veya v\u00fccut s\u0131v\u0131lar\u0131 ile temasl\u0131 kabul edilip antiretroviral profilaksi ba\u015flanm\u0131\u015ft\u0131. Bir y\u0131l takip edilen sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda bula\u015fma tespit edilmemi\u015fti.<\/p>\n

Hastanemiz \u00e7al\u0131\u015fanlar\u0131na; EKK taraf\u0131ndan el hijyeni, delici-kesici alet yaralanmalar\u0131, KKE kullan\u0131m\u0131, t\u0131bbi at\u0131k y\u00f6netimi, dezenfektan kullan\u0131m\u0131 konulu e\u011fitimlerin her y\u0131l d\u00fczenli olarak verilmektedir. Be\u015f y\u0131l boyunca ger\u00e7ekle\u015ftirilen e\u011fitimlerin kat\u0131l\u0131m oranlar\u0131na bak\u0131ld\u0131\u011f\u0131nda \u00e7al\u0131\u015fanlar\u0131n 4235 (%98)\u2019i e\u011fitim alm\u0131\u015ft\u0131. Kan ve v\u00fccut s\u0131v\u0131lar\u0131 ile temas\u0131 olan \u00e7al\u0131\u015fanlar e\u011fitimlerin tamam\u0131na kat\u0131lm\u0131\u015ft\u0131. EKK taraf\u0131ndan, yaralanmalar\u0131n en fazla g\u00f6r\u00fcld\u00fc\u011f\u00fc ameliyathane, yo\u011fun bak\u0131m ve acil servise ayr\u0131ca delici-kesici alet yaralanmalar\u0131 ile ilgili b\u00f6l\u00fcm i\u00e7i e\u011fitimler d\u00fczenlenmi\u015fti. Buna ek olarak 2015 y\u0131l\u0131ndaki say\u0131 art\u0131\u015f\u0131n\u0131n HIV ta\u015f\u0131yan hasta ba\u015fvurusu ile ili\u015fkili olabilece\u011fi d\u00fc\u015f\u00fcn\u00fclerek t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na \u201cHIV ve Bula\u015f Yollar\u0131<\/i>\u201d ba\u015fl\u0131kl\u0131 e\u011fitim verilmi\u015fti.<\/p>\n

\u0130RDELEME<\/h2>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda, perk\u00fctan giri\u015fim s\u0131ras\u0131nda meydana gelen yaralanmalar sonucu kan yolu ile maruziyet ya\u015fayan en riskli gruplar; hem\u015fireler, hekimler, di\u015f hekimleri, yard\u0131mc\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ve temizlik personelidir (3). \u00c7al\u0131\u015fmam\u0131zda da hem\u015fireler %37.7 oran\u0131yla en fazla yaralanan grubu olu\u015ftururken bunu %21.7 oran\u0131yla temizlik g\u00f6revlileri\/hasta bak\u0131c\u0131lar ve %17.1 oran\u0131yla stajyerler izledi. Hekim yaralanmalar\u0131, %6.3 oran\u0131yla di\u011fer gruplara g\u00f6re olduk\u00e7a d\u00fc\u015f\u00fckt\u00fc. \u00c7al\u0131\u015fanlar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011fu i\u011fne batmas\u0131 (%62.5) ve kesici alet yaralanmas\u0131 (%24.0) bildirirken, %13.5\u2019i kan ve v\u00fccut s\u0131v\u0131lar\u0131na temas tarif ediyordu. Alt\u0131ok ve arkada\u015flar\u0131 (4), delici-kesici aletle yaralanmalar\u0131n %83 oran\u0131yla en \u00e7ok hem\u015fire ve ebelerde g\u00f6r\u00fcld\u00fc\u011f\u00fcn\u00fc bunu %74.3 oran\u0131yla laborantlar\u0131n, %66.2 oran\u0131yla da hekimlerin izledi\u011fini bildirmi\u015ftir; ayr\u0131ca yaralanmalar\u0131n \u00e7o\u011funlukla (%89.2) enjekt\u00f6r i\u011fnesi ile ger\u00e7ekle\u015fti\u011fi ifade edilmi\u015ftir. Bozkurt ve arkada\u015flar\u0131 (5) \u00e7al\u0131\u015fmalar\u0131nda, yaralanma olgular\u0131n\u0131n %90\u2019\u0131n\u0131n i\u011fne batmas\u0131 ile yaralanma, %5\u2019inin kesici alet yaralanmas\u0131 ve %5\u2019inin de kan ve v\u00fccut s\u0131v\u0131lar\u0131na maruziyet sonucu oldu\u011funu bildirmi\u015ftir. Oma\u00e7 ve arkada\u015flar\u0131n\u0131n (6) meslek grubu olarak sadece hem\u015fireleri ald\u0131klar\u0131 \u00e7al\u0131\u015fmada, 860 hem\u015fireden 578 (%67.2)\u2019inin son \u00fc\u00e7 ay i\u00e7erisinde delici-kesici alet yaralanmas\u0131na maruz kald\u0131\u011f\u0131 rapor edilmi\u015ftir. Yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada, hem\u015fire grubunun ilk s\u0131rada yer almas\u0131 ile ilgili olarak; hem\u015firelerin invazif i\u015flem s\u0131kl\u0131\u011f\u0131n\u0131n fazla olmas\u0131 (damar yolu a\u00e7\u0131lmas\u0131, enjeksiyon, kan alma, kan \u015fekeri \u00f6l\u00e7\u00fcm\u00fc, vb.), i\u015f yo\u011funlu\u011fu ve bu alandaki \u00e7al\u0131\u015fan say\u0131s\u0131n\u0131n yetersizli\u011fi nedeniyle dikkat eksikli\u011finin ve standart koruyucu g\u00fcvenlik \u00f6nlemlerine uyumda eksikliklerin ortaya \u00e7\u0131kt\u0131\u011f\u0131 belirtilmi\u015ftir (7). \u00c7al\u0131\u015fmam\u0131zda da invazif i\u015flem s\u0131kl\u0131\u011f\u0131n\u0131n fazla olmas\u0131 ve benzer \u00e7al\u0131\u015fma \u015fartlar\u0131 nedeniyle hem\u015firelerin yaralanma oranlar\u0131ndaki y\u00fcksekli\u011fin a\u00e7\u0131klanabilece\u011fi d\u00fc\u015f\u00fcn\u00fcld\u00fc.\u00a0<\/span><\/span><\/p>\n

Stajyer \u00f6\u011frenciler aras\u0131nda yaralanma oran\u0131 % 17.1 ile ikinci s\u0131rada yer al\u0131yordu. Yaralanan stajyerlerin hepsinin hem\u015fire oldu\u011fu g\u00f6r\u00fcld\u00fc ve bu sorunun tecr\u00fcbesizlikten kaynakland\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fcld\u00fc. Stajyer \u00f6\u011frencileri delici-kesici alet yaralanmalar\u0131ndan korumak i\u00e7in; e\u011fitim, denetim, rehberlik ve ba\u011f\u0131\u015f\u0131klama programlar\u0131n\u0131n g\u00f6zden ge\u00e7irilmesi, yaralanmaya neden olan fakt\u00f6rlerin belirlenmesi ve \u00f6nlemlerin al\u0131nmas\u0131 son derece \u00f6nemlidir<\/span>.<\/p>\n

CDC\u2019nin de\u011ferlendirmesine g\u00f6re sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda ortaya \u00e7\u0131kan delici-kesici alet yaralanmalar\u0131n\u0131n %62-80\u2019i \u00f6nlenebilir niteliktedir (8). HCV ve HIV infeksiyonlar\u0131n\u0131 \u00f6nlemeye y\u00f6nelik a\u015f\u0131 uygulamas\u0131 hen\u00fcz s\u00f6z konusu de\u011filken HBV infeksiyonunu \u00f6nlemek i\u00e7in ba\u011f\u0131\u015f\u0131klama uygulanabilmektedir. HIV i\u00e7in kullan\u0131lan profilaksi program\u0131 hem uzun s\u00fcreli hem de maliyetlidir (9). T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan 1998 y\u0131l\u0131ndan bu yana HBV a\u015f\u0131s\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na \u00fccretsiz olarak yap\u0131lmaktad\u0131r. Ancak Tosun ve arkada\u015flar\u0131 (10) 4127 kat\u0131l\u0131mc\u0131 ile yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, a\u015f\u0131lanmayan 798 (%19) sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 oldu\u011funu tespit etmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda, EKK\u2019ye ba\u015fvuran sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n 53 (%30.3)\u2019\u00fcn\u00fcn anti-HBs test sonucu negatifti. Hepatit B a\u015f\u0131s\u0131 olmayanlar\u0131n 52\u2019si a\u015f\u0131 program\u0131na al\u0131nm\u0131\u015f; HIV infeksiyonu a\u00e7\u0131s\u0131ndan riskli kabul edilen 8 \u00e7al\u0131\u015fana profilaksi verilmi\u015ftir. Bir y\u0131l takip edilen sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda hastal\u0131k g\u00f6r\u00fclmemi\u015ftir.\u00a0<\/span><\/p>\n

Ki\u015fisel koruyucu ekipmanlar, infekte v\u00fccut s\u0131v\u0131lar\u0131 ile temas potansiyeli olan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131 koruman\u0131n yan\u0131 s\u0131ra hastalar\u0131 da sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n mikrobiyal floras\u0131ndan korumak i\u00e7in tasarlanm\u0131\u015ft\u0131r (11). Sa\u011fl\u0131k alan\u0131nda en yayg\u0131n kullan\u0131lan KKE\u2019ler; eldivenler, \u00f6nl\u00fckler, maskeler, respirat\u00f6rler, g\u00f6zl\u00fckler ve sperliklerdir. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 hem kendilerini hem de bak\u0131m verdikleri hastalar\u0131 korumak i\u00e7in farkl\u0131 i\u015flemlerde farkl\u0131 KKE\u2019lerin bir veya birka\u00e7\u0131n\u0131 birlikte kullanmak durumundad\u0131r. Bu nedenle yap\u0131lacak her i\u015flem i\u00e7in do\u011fru KKE se\u00e7iminin yap\u0131lmas\u0131 ve se\u00e7ilen KKE\u2019nin do\u011fru \u015fekilde kullan\u0131lmas\u0131 gerekmektedir (12). Koruyucu g\u00f6zl\u00fckler, g\u00f6zler i\u00e7in koruyucu bir bariyer sa\u011flamaktad\u0131r. Ki\u015fisel numaral\u0131 lensler optimum g\u00f6z korumas\u0131 sa\u011flamaz ve koruyucu g\u00f6zl\u00fckler yerine kullan\u0131lmamal\u0131d\u0131r. Koruyucu g\u00f6zl\u00fckler g\u00f6zleri veya numaral\u0131 ki\u015fisel lensleri \u00e7evrelemeli ve rahat bir \u015fekilde g\u00f6ze oturmal\u0131d\u0131r. Bu\u011fulanmayan nitelikteki koruyucu g\u00f6zl\u00fckler g\u00f6rme berrakl\u0131\u011f\u0131n\u0131 korumaya da yard\u0131mc\u0131 olmaktad\u0131r. A\u011f\u0131z, burun ve g\u00f6z korunmas\u0131 istenen b\u00f6lgelerdir ve bu ama\u00e7la y\u00fcz siperlikleri kullan\u0131lmaktad\u0131r. \u00d6rne\u011fin sekresyonlar aspire edilirken veya yara irrigasyonunda maskeler veya koruyucu g\u00f6zl\u00fckler takmak yerine y\u00fcz siperli\u011fi tercih edilebilir. Y\u00fcz siperli\u011fi aln\u0131 tamamen kaplamal\u0131, \u00e7enenin alt\u0131na kadar uzanmal\u0131 ve y\u00fcz\u00fcn etraf\u0131n\u0131 sarmal\u0131d\u0131r (13-15). Lateks eldivenler iyi bir koruyucu bariyer olu\u015fturdu\u011fu i\u00e7in, eldivenin \u00fcst\u00fcnden ger\u00e7ekle\u015febilecek perk\u00fctan giri\u015fim yaralanmalar\u0131ndan ki\u015fiyi koruyarak infeksiyon olas\u0131l\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcrmektedir. L\u00fcmensiz i\u011fnenin lateks eldivenden ge\u00e7erken inokulum miktar\u0131n\u0131n 10-100 kata kadar azald\u0131\u011f\u0131 belirtilmi\u015ftir (16). Bunun d\u0131\u015f\u0131nda \u00e7ift kat eldiven giyilmesinin de koruyuculu\u011fu art\u0131rd\u0131\u011f\u0131 bildirilmi\u015f olmakla birlikte gerek di\u015f hekimlerinde gerekse cerrahi operasyon yapan hekimlerde konforu ve hissiyat\u0131 azaltabilece\u011finden kullan\u0131m\u0131 tercihe b\u0131rak\u0131lm\u0131\u015ft\u0131r (17). Bizim \u00e7al\u0131\u015fmam\u0131zda da t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na \u00e7al\u0131\u015ft\u0131\u011f\u0131 alana uygun KKE\u2019ler hastane y\u00f6netimi taraf\u0131ndan temin edilmi\u015f ve KKE kullan\u0131m\u0131 ile ilgili e\u011fitimler verilmi\u015fti. \u00c7al\u0131\u015fmam\u0131zda, en y\u00fcksek yaralanma oran\u0131n\u0131n %86.5 ile perk\u00fctan giri\u015fimler esnas\u0131nda oldu\u011fu tespit edildi; bunlar\u0131n %62.5\u2019i i\u011fne batmas\u0131 ile yaralanma olup yaralanmalarda i\u011fne \u00e7e\u015fidi ile ilgili bir ayr\u0131m yap\u0131lmam\u0131\u015ft\u0131. \u00d6zellikle yatakl\u0131 servislerde \u00e7al\u0131\u015fan hem\u015fireler aras\u0131nda bu oran\u0131n daha fazla oldu\u011fu tespit edildi. Perk\u00fctan i\u015flem yaralanmalar\u0131nda sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %65\u2019inin eldiven kulland\u0131\u011f\u0131 tespit edildi. Eldiven kullanmayan %35 oran\u0131ndaki grup yo\u011fun \u00e7al\u0131\u015ft\u0131klar\u0131n\u0131 bu nedenle eldiven kullanmay\u0131 unuttuklar\u0131n\u0131 belirtmi\u015fti. Kan\/v\u00fccut s\u0131v\u0131lar\u0131na maruziyeti olan \u00e7al\u0131\u015fanlar tek bir grupta incelendi. Bu gruptaki \u00e7al\u0131\u015fanlarda (n=25) temaslar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funun (%76.0; n=19) hasta kan\u0131n\u0131n ellerine bula\u015fmas\u0131 di\u011ferlerinin ise g\u00f6ze kan s\u0131\u00e7ramas\u0131 (n=6) \u015feklinde oldu\u011fu g\u00f6r\u00fcld\u00fc. Hasta kan\u0131n\u0131n sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n cildine bula\u015ft\u0131\u011f\u0131 grupta hi\u00e7bir \u00e7al\u0131\u015fan\u0131n eldiven giymedi\u011fi tespit edildi. Bu grupta bulunan ki\u015filerin 15 (%79)\u2019i laboratuvar \u00e7al\u0131\u015fan\u0131yd\u0131 ve neden eldiven kullanmad\u0131klar\u0131 soruldu\u011funda \u00e7al\u0131\u015fma esnas\u0131nda barkodlar\u0131n eldivene yap\u0131\u015fmas\u0131ndan dolay\u0131 eldivenle \u00e7al\u0131\u015f\u0131rken zorland\u0131klar\u0131n\u0131 bu nedenle \u00e7o\u011funlukla eldivensiz \u00e7al\u0131\u015ft\u0131klar\u0131n\u0131 bildirmi\u015flerdi. G\u00f6ze kan s\u0131\u00e7ramas\u0131 olan ve koruyucu g\u00f6zl\u00fck kullanmayan d\u00f6rt sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n kullanmama gerek\u00e7esi bu\u011fulanmayd\u0131; kullanan iki \u00e7al\u0131\u015fan ise koruyucu g\u00f6zl\u00fc\u011fe ra\u011fmen kan temas\u0131n\u0131n oldu\u011funu bildirmi\u015fti. Y\u00fcz koruyucu siperli\u011fin ise hi\u00e7bir sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 taraf\u0131ndan kullan\u0131lmad\u0131\u011f\u0131 tespit edildi. Koruyucu g\u00f6zl\u00fck kullanmas\u0131na ra\u011fmen g\u00f6ze temas oldu\u011fu d\u00fc\u015f\u00fcn\u00fcl\u00fcnce; KKE se\u00e7iminde dikkatli olman\u0131n, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n istek ve \u015fik\u00e2yetlerini g\u00f6z \u00f6n\u00fcnde bulundurarak se\u00e7im yapman\u0131n veya alternatif se\u00e7enekler sunman\u0131n \u00e7al\u0131\u015fan sa\u011fl\u0131\u011f\u0131 i\u00e7in \u00f6nemli oldu\u011fu g\u00f6r\u00fclmektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda dikkat \u00e7eken bir di\u011fer nokta, 2015 y\u0131l\u0131ndaki yaralanma nedeniyle ba\u015fvurular\u0131n di\u011fer y\u0131llara g\u00f6re olduk\u00e7a y\u00fcksek olmas\u0131yd\u0131. Y\u0131llara g\u00f6re sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n say\u0131lar\u0131 ve \u00e7al\u0131\u015fma saatleri incelendi\u011finde anlaml\u0131 d\u00fczeyde bir farkl\u0131l\u0131k olmad\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc (Tablo 3). 2015 y\u0131l\u0131n\u0131n ilk \u00fc\u00e7 ayl\u0131k d\u00f6neminde ba\u015fvuru say\u0131s\u0131 45\u2019ti; EKK\u2019ye yap\u0131lan toplam m\u00fcracaat say\u0131s\u0131 o y\u0131l i\u00e7inde yap\u0131lan t\u00fcm m\u00fcracaatlar\u0131n %65.2\u2019sini olu\u015fturuyordu. Sebebi incelendi\u011finde; ilgili d\u00f6nemde hastanemizin acil servisine ba\u015fvuran bir hastan\u0131n HIV pozitif oldu\u011fu ve \u00f6z ge\u00e7mi\u015f\/kronik hastal\u0131klar formu doldurulurken bu durumu sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na s\u00f6ylemedi\u011fi, anti-HIV testinin sonucunun pozitif oldu\u011funun anla\u015f\u0131lmas\u0131 \u00fczerine s\u00f6z konusu hastan\u0131n v\u00fccut s\u0131v\u0131lar\u0131 ile temas\u0131n\u0131n oldu\u011funu s\u00f6yleyen 10 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n EKK\u2019ye m\u00fcracaat etti\u011fi anla\u015f\u0131ld\u0131. Ayr\u0131ca bu olay nedeniyle ayn\u0131 \u00fc\u00e7 ayl\u0131k periyotta durumun ciddiyetinin fark\u0131na var\u0131lmas\u0131 ve t\u00fcm riskli temaslarda sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n komiteye m\u00fcracaat etmeleri sonucu kay\u0131tlar\u0131n artt\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fcld\u00fc. Bu da bize di\u011fer y\u0131llarda temasl\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 say\u0131s\u0131n\u0131n ger\u00e7ekte daha fazla olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrd\u00fc. Anti-HIV testi pozitif hasta ile temas\u0131n\u0131n oldu\u011funu belirten sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ile yap\u0131lan g\u00f6r\u00fc\u015fmelerde baz\u0131 \u00e7al\u0131\u015fanlar\u0131n hastan\u0131n acil \u015fartlarda beyin cerrahlar\u0131 taraf\u0131ndan ameliyata al\u0131nd\u0131\u011f\u0131n\u0131 ve anti-HIV sonucunun pozitif oldu\u011funu sonradan \u00f6\u011frendiklerini bu nedenle KKE kullan\u0131m\u0131nda\u00a0 <\/span>daha dikkatsiz davrand\u0131klar\u0131n\u0131 s\u00f6ylediler. Hastan\u0131n v\u00fccut s\u0131v\u0131lar\u0131 ile temas\u0131 oldu\u011funu d\u00fc\u015f\u00fcnen 10 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 ba\u015fvurusundan sekizi riskli kabul edildi. Tek bir hastadan kaynakl\u0131 temasl\u0131 say\u0131s\u0131n\u0131n y\u00fcksek olmas\u0131 d\u00fc\u015f\u00fcnd\u00fcr\u00fcc\u00fcyd\u00fc ancak \u00e7al\u0131\u015fan\u0131n beyan\u0131 temel al\u0131nd\u0131\u011f\u0131ndan g\u00f6r\u00fc\u015fmelerdeki riskli olarak beyan edilen durumlar kay\u0131t alt\u0131na al\u0131nd\u0131. Riskli kabul edilmeyen iki ki\u015fi hastay\u0131 ameliyat eden beyin cerrahisi doktorlar\u0131yd\u0131; KKE\u2019leri eksiksiz kulland\u0131klar\u0131, bula\u015fma olmad\u0131\u011f\u0131 ve bu nedenle temaslar\u0131n\u0131n riskli kabul edilmedi\u011fi g\u00f6r\u00fcld\u00fc. Riskli kabul edilenlerden ikisi laborantt\u0131; hastadan al\u0131nan kanlar\u0131 \u00e7al\u0131\u015f\u0131rken eldiven giymediklerini ve kan ile temaslar\u0131 oldu\u011funu bildirmi\u015flerdi. Laborantlar, ellerindeki cilt b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn bozuk oldu\u011fu gerek\u00e7esiyle riskli temasl\u0131 kabul edilmi\u015fti. Riskli kabul edilen iki ameliyathane hem\u015firesi operasyon esnas\u0131nda g\u00f6zl\u00fck kullanmad\u0131klar\u0131n\u0131 ve g\u00f6zlerine kan s\u0131\u00e7rad\u0131\u011f\u0131n\u0131 beyan etmi\u015fti; kalan 4 ki\u015fi yine hem\u015fire olup ameliyat esnas\u0131nda KKE\u2019leri uygun olarak kulland\u0131klar\u0131 halde g\u00f6zlerine kan s\u0131\u00e7rad\u0131\u011f\u0131n\u0131 bildirmi\u015fti. G\u00f6zl\u00fck kullanmayan iki ameliyathane hem\u015firesi ameliyat esnas\u0131nda g\u00f6zl\u00fc\u011f\u00fcn bu\u011fuland\u0131\u011f\u0131n\u0131 bu nedenle g\u00f6zl\u00fck kullanmamay\u0131 tercih ettiklerini ifade etmi\u015fti. G\u00f6zl\u00fck kullanan hem\u015fireler ise ameliyat esnas\u0131nda g\u00f6zl\u00fcklerinin alt k\u0131sm\u0131ndan g\u00f6zlerine kan s\u0131\u00e7rad\u0131\u011f\u0131n\u0131 bildirmi\u015fti.<\/p>\n

Edinsel imm\u00fcn yetmezlik sendromu (acquired immune deficiency syndrome – AIDS) hastal\u0131\u011f\u0131n\u0131n primer olarak cinsel yolla bula\u015fmas\u0131 infekte ki\u015filere kar\u015f\u0131 toplumsal \u00f6nyarg\u0131 olu\u015fmas\u0131na, ki\u015filerin etiketlenmeye ve temel sa\u011fl\u0131k hakk\u0131n\u0131 elde etmede ayr\u0131mc\u0131l\u0131\u011fa maruz kalmas\u0131na yol a\u00e7maktad\u0131r. Bu durum hastal\u0131\u011f\u0131n \u00f6nlenmesini ve tedavisini olduk\u00e7a zorla\u015ft\u0131rmakta, yay\u0131l\u0131m\u0131n\u0131 kolayla\u015ft\u0131rmaktad\u0131r (18). \u00d6zellikle HIV\/AIDS\u2019in \u00f6nlenmesinde ve tedavisinde g\u00f6rev alan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda hastal\u0131\u011fa kar\u015f\u0131 \u00f6nyarg\u0131 bulunmas\u0131, ciddi bir sorundur. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ayr\u0131mc\u0131 davran\u0131\u015flar\u0131 HIV pozitif bireylerin destek alma konusundaki karar verme s\u00fcre\u00e7lerini etkiler; ayr\u0131mc\u0131l\u0131\u011fa maruz kalacaklar\u0131n\u0131 d\u00fc\u015f\u00fcnen bireyler g\u00f6n\u00fcll\u00fc dan\u0131\u015fma, destek ve tedavi kurulu\u015flar\u0131na ba\u015fvurma se\u00e7eneklerinden uzakla\u015f\u0131r. Bu da HIV pozitif bireylerin bula\u015ft\u0131r\u0131c\u0131l\u0131\u011f\u0131n\u0131 art\u0131r\u0131r ve tedaviye uyumlar\u0131n\u0131 azalt\u0131r (19). Bu nedenle sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n HIV pozitif bireylere kar\u015f\u0131 var olan \u00f6nyarg\u0131lar\u0131n\u0131n ve ayr\u0131mc\u0131 davran\u0131\u015flar\u0131n\u0131n ortadan kald\u0131r\u0131lmas\u0131 HIV\/AIDS tedavisinde primer hedef olmal\u0131d\u0131r. D\u00fcnyada sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131ndaki \u00f6nyarg\u0131n\u0131n nedenleri; etiketlemenin ne oldu\u011funun ve ne sonu\u00e7lar do\u011furdu\u011funun bilinmemesi, bilgi eksikli\u011fine ba\u011fl\u0131 olarak HIV pozitif bireylerle s\u0131radan temastan bile korkulmas\u0131, HIV pozitif bireylerin ahlaki olmad\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclen davran\u0131\u015flarla ili\u015fkilendirilmesidir (20). T\u00fcrkiye\u2019de de benzer nedenler ge\u00e7erlidir (19,21). Bayrak ve arkada\u015flar\u0131n\u0131n (22) 2014 y\u0131l\u0131nda yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, HIV\/AIDS hakk\u0131ndaki bilgi eksikli\u011fi ve \u00f6nyarg\u0131n\u0131n t\u00fcm kat\u0131l\u0131mc\u0131lar aras\u0131nda y\u00fcksek oranda bulundu\u011fu tespit edilmi\u015ftir; lise mezunu olanlarda ve hem\u015firelerde bu oran daha y\u00fcksek, \u00fcniversite mezunu olanlarda ve doktorlarda daha d\u00fc\u015f\u00fck bulunmu\u015ftur. Kat\u0131l\u0131mc\u0131lar\u0131n bilgi d\u00fczeyi artt\u0131k\u00e7a \u00f6nyarg\u0131lar\u0131n azald\u0131\u011f\u0131 da saptanm\u0131\u015ft\u0131r. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda HIV\/AIDS\u2019e kar\u015f\u0131 var olan \u00f6nyarg\u0131lar\u0131n nedenlerinden birinin hastal\u0131kla ilgili bilgi yetersizli\u011fi oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f ve \u00f6nyarg\u0131lar\u0131n \u00f6nlenmesi i\u00e7in sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n bilgi d\u00fczeylerinin y\u00fckseltilmesi gerekti\u011fi sonucuna var\u0131lm\u0131\u015ft\u0131r. \u00c7al\u0131\u015fmam\u0131zda da HIV pozitif hastam\u0131z\u0131n hastaneye ba\u015fvurdu\u011funda hastal\u0131\u011f\u0131 ile ilgili bilgiyi vermedi\u011fi anla\u015f\u0131lm\u0131\u015ft\u0131r. Yap\u0131lan g\u00f6r\u00fc\u015fmede, hasta HIV pozitif olarak uzun s\u00fcredir ba\u015fka bir merkezde takip edildi\u011fini ifade etmi\u015ftir. Ayr\u0131ca sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n tepkisinden \u00e7ekindi\u011fini, hastal\u0131\u011f\u0131ndan \u00f6t\u00fcr\u00fc sa\u011fl\u0131k hizmetinden faydalanamayaca\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fc i\u00e7in bu bilgiyi gizledi\u011fini de bildirmi\u015ftir.\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n retrospektif \u00f6zelli\u011fi nedeniyle; yaralanmaya neden olan delici-kesici aletler, yaralanma b\u00f6lgeleri, yaralanmaya neden olan davran\u0131\u015flar, yaralanma zaman\u0131 ve \u00e7al\u0131\u015fanlar\u0131n mesleki deneyim s\u00fcreleri ile ilgili olarak veri toplanamam\u0131\u015f ve yorumda bulunulamam\u0131\u015ft\u0131r.<\/p>\n

Sonu\u00e7 olarak; sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n kan ve v\u00fccut s\u0131v\u0131lar\u0131 ile temaslar\u0131n\u0131n azalt\u0131labilmesi i\u00e7in uygun KKE\u2019lerin temini ve do\u011fru bir \u015fekilde kullan\u0131m\u0131 kadar sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n uyumsuzluklar\u0131n\u0131n nedenlerinin sorgulanmas\u0131 da son derece \u00f6nemlidir. Ekipmanlar\u0131n yetersiz kald\u0131\u011f\u0131 durumlarda gerekli d\u00fczenlemelerin yap\u0131l\u0131p sorunun acilen giderilmesi \u00e7al\u0131\u015fan sa\u011fl\u0131\u011f\u0131 i\u00e7in olduk\u00e7a \u00f6nemlidir. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n, her t\u00fcrl\u00fc kan ve v\u00fccut s\u0131v\u0131lar\u0131 ile temas durumunda hi\u00e7 vakit kaybetmeden EKK\u2019ye ba\u015fvurmalar\u0131n\u0131n gerekti\u011fi e\u011fitimlerde mutlaka vurgulanmal\u0131d\u0131r. D\u00fczenlenen e\u011fitimlerde t\u0131bbi bilgilerin yan\u0131nda \u00f6zellikle HIV\/AIDS ile ilgili pozitif tutum ve davran\u0131\u015flar\u0131n kazan\u0131laca\u011f\u0131 ba\u015fl\u0131klar da olmal\u0131d\u0131r. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda var olan \u00f6nyarg\u0131lar\u0131n nedenleri ara\u015ft\u0131r\u0131larak bunlar\u0131n ortadan kald\u0131r\u0131lmas\u0131na y\u00f6nelik \u00f6nlemler mutlaka al\u0131nmal\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda ilk olarak 1984 y\u0131l\u0131nda i\u011fne batmas\u0131 yaralanmas\u0131 sonucu geli\u015fen kazan\u0131lm\u0131\u015f insan ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fi virusu (human immunodeficiency virus \u2013 HIV) infeksiyonu olgusunun bildirilmesinin ard\u0131ndan, delici-kesici alet yaralanmalar\u0131n\u0131n neden oldu\u011fu riskler konusundaki kayg\u0131lar ve fark\u0131ndal\u0131k artm\u0131\u015ft\u0131r. G\u00fcn\u00fcm\u00fczde, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda perk\u00fctan giri\u015fimler s\u0131ras\u0131nda ger\u00e7ekle\u015febilen delici-kesici alet yaralanmalar\u0131n\u0131n, hepatit B virusu (HBV), hepatit C virusu […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5629,5628,5630],"class_list":["post-26390","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-igne-batmasi","tag-kan-ve-vucut-sivilari-ile-temas","tag-kke-kullanimi"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26390","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=26390"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26390\/revisions"}],"predecessor-version":[{"id":26845,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26390\/revisions\/26845"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=26390"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=26390"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=26390"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}