{"id":28669,"date":"2024-06-29T14:52:44","date_gmt":"2024-06-29T11:52:44","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=28669"},"modified":"2024-06-29T15:33:44","modified_gmt":"2024-06-29T12:33:44","slug":"kan-ve-vucut-sivilariyla-riskli-temas","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2024\/06\/29\/kan-ve-vucut-sivilariyla-riskli-temas\/","title":{"rendered":"Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131n\u0131n Kan ve V\u00fccut S\u0131v\u0131lar\u0131yla Riskli Temaslar\u0131n\u0131n Son 10 Y\u0131l \u0130\u00e7indeki Seyri: Bir \u00dcniversite Hastanesi Deneyimi"},"content":{"rendered":"

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

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n, hastane ortamlar\u0131nda kan ve v\u00fccut s\u0131v\u0131lar\u0131na maruziyeti d\u00fcnya \u00e7ap\u0131nda yayg\u0131n ve ciddi mesleki risklerdendir (1<\/span>,2<\/span>). S\u00f6z konusu maruziyetlerin nedeni b\u00fcy\u00fck \u00f6l\u00e7\u00fcde kesici ve delici alet yaralanmas\u0131 (KDAY) (%71) ve cilt ve mukoza temas\u0131 (%29) kaynakl\u0131d\u0131r (3). Amerika Birle\u015fik Devletleri (ABD)\u2019nde her y\u0131l 300 000\u2019den fazla sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n KDAY\u2019lara maruz kald\u0131\u011f\u0131 tahmin edilmektedir (3). Bu durum kan ve v\u00fccut s\u0131v\u0131lar\u0131na maruziyet kaynakl\u0131 infeksiyon riski nedeniyle \u00f6nemli bir endi\u015fe kayna\u011f\u0131d\u0131r (4,5). Her ne kadar b\u00fcy\u00fck \u00e7o\u011funlu\u011fu infeksiyon ile sonu\u00e7lanmamakla birlikte, kan ve v\u00fccut s\u0131v\u0131lar\u0131yla riskli temas sonucu geli\u015fen infeksiyonlar mesleki bir tehdit olmaya devam etmektedir (5). Kan ve v\u00fccut s\u0131v\u0131lar\u0131na maruz kal\u0131nmas\u0131 durumunda hepatit B virusu (HBV), hepatit C virusu (HCV) ve insan ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fi virusu (human immunodeficiency virus – HIV) gibi etkenlerin bula\u015fma riski tart\u0131\u015f\u0131lmaz bir ger\u00e7ektir. Ayr\u0131ca, bu riskli temaslar kan ve v\u00fccut s\u0131v\u0131lar\u0131yla bula\u015ft\u0131\u011f\u0131 bildirilen 60 patojen i\u00e7in de kaynak olu\u015fturur (5,6).\u00a0Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda KDAY\u2019lara atfedilen y\u0131ll\u0131k infeksiyon say\u0131lar\u0131; HBV i\u00e7in 66 000 (da\u011f\u0131l\u0131m: 2400-240 000), HCV i\u00e7in 16 000 (da\u011f\u0131l\u0131m: 6000-
\n86 000) ve HIV i\u00e7in 1000 (da\u011f\u0131l\u0131m: 200-5000) olarak tahmin edilmektedir (7). Riskli temaslar\u0131n sonucunda geli\u015febilecek infeksiyonlar sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda kayg\u0131, korku ve depresyon gibi ruh sa\u011fl\u0131\u011f\u0131n\u0131 etkileyen stresli bir s\u00fcre\u00e7 ya\u015fanmas\u0131na da neden olmaktad\u0131r. Ayr\u0131ca, s\u00f6z konusu riskli temaslar\u0131n sonras\u0131ndaki takip s\u00fcreci ve sonu\u00e7lar\u0131 hastanelere \u00f6nemli ekonomik y\u00fck olu\u015fturmaktad\u0131r; yap\u0131lan kan testleri, temas sonras\u0131 profilaksi, infeksiy\u00f6z patojenlerle olu\u015fan infeksiyonlar\u0131n k\u0131sa ve uzun s\u00fcreli tedavileri, i\u015f g\u00fcc\u00fc kayb\u0131 ve psikiyatrik destek en \u00f6nemli maliyet unsurlar\u0131d\u0131r (4). \u0130nfeksiyonlar\u0131n tedavisi ve \u00e7al\u0131\u015fma saatlerinin kayb\u0131 sonucu ortaya \u00e7\u0131kan potansiyel masraflar hari\u00e7, tek bir KDAY\u2019\u0131n neden oldu\u011fu maliyet 110 Avro ile 272 Avro aras\u0131nda de\u011fi\u015fmektedir (8,9). Kaynak hastada HBV, HCV veya HIV infeksiyonu varl\u0131\u011f\u0131nda maliyetin ortalama 1966 Avro oldu\u011fu bildirilmi\u015ftir (10<\/span>). HBV\u2019ye kar\u015f\u0131 a\u015f\u0131 ile korunmak m\u00fcmk\u00fcn olup hepatit B a\u015f\u0131s\u0131n\u0131n mesleki maruziyet riski ta\u015f\u0131yan t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na uygulanmas\u0131 gerekirken a\u015f\u0131lanma oranlar\u0131n\u0131n yetersiz oldu\u011fu g\u00f6r\u00fclmektedir (5, 11-13).\u00a0Yap\u0131lan \u00e7al\u0131\u015fmalar, kan ve v\u00fccut s\u0131v\u0131lar\u0131yla riskli temaslar\u0131n bildirimlerinin yetersiz oldu\u011funu da g\u00f6stermektedir (14-16).<\/p>\n

Ancak, bu sorunun ortaya konmas\u0131 ve kontrol \u00f6nlemlerinin geli\u015ftirilebilmesi i\u00e7in riskli temaslar\u0131n aktif olarak izlenmesi ve bildirilmesi hayati \u00f6nem ta\u015f\u0131maktad\u0131r. Bu \u00e7al\u0131\u015fmada amac\u0131m\u0131z; bir \u00fcniversite hastanesinde sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n kan ve v\u00fccut s\u0131v\u0131lar\u0131na maruziyet durumlar\u0131n\u0131n y\u0131llar i\u00e7indeki de\u011fi\u015fimini belirlenmek, \u0130nfeksiyon Kontrol Komitesi (\u0130KK) taraf\u0131ndan izlem s\u00fcrecinde saptanan sorunlara y\u00f6nelik d\u00fczenleyici faaliyetlerin bu riskli temaslar \u00fczerindeki etkisini de\u011ferlendirmek ve i\u015f sa\u011fl\u0131\u011f\u0131 g\u00fcvenli\u011fini iyile\u015ftirecek uygulamalara yol g\u00f6sterici olmakt\u0131r. Ayr\u0131ca \u00e7al\u0131\u015fmam\u0131zda, COVID-19 pandemi s\u00fcrecinin s\u00f6z konusu riskli temaslar \u00fczerindeki olumlu ve olumsuz etkilerini de de\u011ferlendirdik.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Bu \u00e7al\u0131\u015fma, t\u0131p fak\u00fcltesi, sa\u011fl\u0131k meslek y\u00fcksek okulu ve sa\u011fl\u0131k bilimleri fak\u00fcltesi ebelik\/hem\u015firelik \u00f6\u011frencilerinin pratik uygulamalar\u0131n\u0131n da y\u00fcr\u00fct\u00fcld\u00fc\u011f\u00fc, ortalama 743 yatakl\u0131, \u00fc\u00e7\u00fcnc\u00fc basamak bir \u00fcniversite hastanesinde ger\u00e7ekle\u015ftirildi. Hastanemizin yatak kapasitesi, 2013 y\u0131l\u0131nda 709 iken 2022 y\u0131l\u0131nda 826\u2019ya y\u00fckselmi\u015ftir. Hastanedeki ortalama sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 say\u0131s\u0131 2243 olup, 2013 y\u0131l\u0131nda 1817 olan sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 say\u0131s\u0131 2022 y\u0131l\u0131nda 2904\u2019e ula\u015fm\u0131\u015ft\u0131r. Hastanede staj yapan t\u0131p fak\u00fcltesi \u00f6\u011frenci say\u0131s\u0131, 2013 y\u0131l\u0131nda 583 iken 2022 y\u0131l\u0131nda 869\u2019a y\u00fckselmi\u015ftir. Ayr\u0131ca, sa\u011fl\u0131k hizmetleri meslek y\u00fcksek okulu ve sa\u011fl\u0131k bilimleri fak\u00fcltesi ebelik\/hem\u015firelik b\u00f6l\u00fcm\u00fc \u00f6\u011frencilerinden, aral\u0131kl\u0131 olarak, y\u0131lda yakla\u015f\u0131k 464 \u00f6\u011frenci hastanemizde staj g\u00f6rmektedir. Hastanemizin sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n cinsiyet da\u011f\u0131l\u0131m\u0131 benzer olmakla birlikte, hem\u015firelerin \u00e7o\u011funlu\u011funu kad\u0131nlar olu\u015fturmaktad\u0131r. Hastanemizde staj yapan t\u0131p fak\u00fcltesi \u00f6\u011frencilerinin de cinsiyet da\u011f\u0131l\u0131m\u0131 benzer olup ebelik\/hem\u015firelik b\u00f6l\u00fcm\u00fc \u00f6\u011frencilerinin %75\u2019ini kad\u0131nlar olu\u015fturmaktad\u0131r.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, hastanemizdeki sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n 1 Ocak 2013 ve 31 Aral\u0131k 2022 tarihleri aras\u0131ndaki riskli temaslar\u0131 de\u011ferlendirildi; s\u00f6z konusu riskli temaslar, KDAY\u2019lar\u0131n yan\u0131 s\u0131ra deri ve mukoza ile kan ve v\u00fccut s\u0131v\u0131lar\u0131yla temas\u0131 da i\u00e7ermektedir. Veriler, riskli temas sonras\u0131 \u0130KK\u2019ya ba\u015fvuran ve infeksiyon kontrol hem\u015firesi taraf\u0131ndan doldurulan KDAY ve kan\/v\u00fccut s\u0131v\u0131lar\u0131yla temas izlem formlar\u0131n\u0131n retrospektif olarak de\u011ferlendirilmesiyle elde edildi.\u00a0 <\/span>\u0130zlem formunda; ya\u015f, cinsiyet, meslek grubu, \u00e7al\u0131\u015f\u0131lan birim, \u00e7al\u0131\u015fma y\u0131l\u0131, riskli temas tarihi, saati ve yeri, riskli temas\u0131n hangi aktivite s\u0131ras\u0131nda ve nas\u0131l geli\u015fti\u011fi ve ki\u015fisel koruyucu donan\u0131m (KKD) kullan\u0131m durumu, kaynak hasta belli ise hastan\u0131n HBsAg, anti-HCV ve anti-HIV serolojisi, sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n temas b\u00f6lgesi i\u00e7in yapt\u0131\u011f\u0131 ilk m\u00fcdahale uygulamalar\u0131 ve hepatit B, hepatit C ve HIV y\u00f6n\u00fcnden bir y\u0131ll\u0131k izlem sonu\u00e7lar\u0131na ait bilgiler sorgulanmaktayd\u0131. Formda, hastanemizde pratik uygulama yapan t\u0131p fak\u00fcltesi, sa\u011fl\u0131k hizmetleri meslek y\u00fcksek okulu ve ebelik\/hem\u015firelik \u00f6\u011frencileri stajyer olarak grupland\u0131r\u0131ld\u0131.<\/p>\n

Ayr\u0131ca, \u00e7al\u0131\u015fma periyodu s\u00fcresince \u0130KK taraf\u0131ndan uygulanan d\u00fczenleyici faaliyetlerin riskli temaslar \u00fczerindeki etkisi de\u011ferlendirildi. Bu faaliyetler; yeni ba\u015flayan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na oryantasyon program\u0131 i\u00e7inde ve t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na her y\u0131l en az bir kez verilen e\u011fitimleri, \u0130KK taraf\u0131ndan y\u00fcr\u00fct\u00fclen riskli temas s\u00fcrveyans\u0131 s\u00fcresince riskli temas oranlar\u0131ndaki art\u0131\u015fa paralel olarak i\u00e7eri\u011fi d\u00fczenlenerek s\u0131kl\u0131\u011f\u0131 art\u0131r\u0131lan e\u011fitimleri, riskli temas ile \u0130KK\u2019ya ba\u015fvuran sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n birebir e\u011fitimleri, izlem s\u00fcrecinde saptanan sorunlara y\u00f6nelik at\u0131k y\u00f6netimini, kesici-delici alet kutular\u0131n\u0131n say\u0131s\u0131n\u0131n ve kullan\u0131m\u0131n\u0131n art\u0131r\u0131lmas\u0131n\u0131, hasta ba\u015f\u0131nda kullan\u0131labilecek daha k\u00fc\u00e7\u00fck hacimli kesici-delici alet kutular\u0131n\u0131n temin edilmesini, hasta ba\u015f\u0131 tedavi tepsilerinin olu\u015fturulmas\u0131n\u0131 ve bunlar\u0131n i\u00e7inde k\u00fc\u00e7\u00fck hacimli kesici-delici alet kutular\u0131n\u0131n kullan\u0131m\u0131n\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131n\u0131, COVID-19 pandemisi s\u00fcrecinde t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na y\u00f6nelik s\u0131kla\u015ft\u0131r\u0131lan, \u00f6zellikle standart infeksiyon kontrol \u00f6nlemlerini i\u00e7eren, periyodik e\u011fitimlerin uygulanmas\u0131n\u0131 i\u00e7ermekteydi. Yap\u0131lan uygulamalar\u0131n ba\u015far\u0131s\u0131 riskli temas oran\u0131n\u0131n azalmas\u0131yla de\u011ferlendirildi.<\/p>\n

Verilerin analizi, SPSS (Statistical Package for the Social Sciences) versiyon 21.0 program\u0131 (IBM Corp., Armonk, NY, ABD) ile yap\u0131ld\u0131. Tan\u0131mlay\u0131c\u0131 istatistikler i\u00e7in say\u0131lar ve y\u00fczdeler, normal da\u011f\u0131l\u0131ma uygunlukta ortalama \u00b1 standart sapma (SS) ve normal da\u011f\u0131l\u0131ma uygunluk yoksa medyan (\u00e7eyrekler aras\u0131 aral\u0131k) kullan\u0131ld\u0131.<\/p>\n

\u00c7al\u0131\u015fma i\u00e7in Kocaeli \u00dcniversitesi T\u0131p Fak\u00fcltesi Giri\u015fimsel Olmayan Klinik Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 15 Haziran 2023 tarih ve 2023\/10.19 karar numaras\u0131yla onay al\u0131nd\u0131.<\/p>\n

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

\u015eekil 1.<\/strong> Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131nda Geli\u015fen Riskli Yaralanmalar (2013-2022)<\/p><\/div>\n

On y\u0131ll\u0131k takip s\u00fcrecinde, kan ve v\u00fccut s\u0131v\u0131lar\u0131 ile riskli temas nedeniyle \u0130KK\u2019ya 625 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n ba\u015fvuruda bulundu\u011fu tespit edildi. \u00c7al\u0131\u015fanlar\u0131n 561\u2019i sadece bir kez, 56\u2019s\u0131 iki kez, alt\u0131s\u0131 \u00fc\u00e7 kez, biri d\u00f6rt kez ve biri be\u015f kez olmak \u00fczere toplam 700 kez \u0130KK\u2019ya ba\u015fvuru yap\u0131lm\u0131\u015ft\u0131. Riskli temas nedeniyle \u0130KK\u2019ya ba\u015fvuru say\u0131s\u0131 2013 y\u0131l\u0131nda 40 iken 2022 y\u0131l\u0131nda 91\u2019e y\u00fckselmi\u015fti. Ba\u015fvurular\u0131n 643 (%91.9)\u2019\u00fcn\u00fc KDAY ve 57 (%8.1)\u2019sini cilt ve mukozal temas olu\u015fturmaktayd\u0131; \u0130KK\u2019ya ba\u015fvuru say\u0131lar\u0131n\u0131n y\u0131llar i\u00e7indeki da\u011f\u0131l\u0131m\u0131 \u015eekil 1\u2019de verildi.<\/p>\n

\u0130nfeksiyon Kontrol Komitesi\u2019ne ba\u015fvuran 625 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n, 422 (%60)\u2019si kad\u0131n ve 203 (%40)\u2019\u00fc erkekti. Toplam say\u0131s\u0131 700 olan riskli temas\u0131n %66.7\u2019si kad\u0131nlarda geli\u015fmi\u015f olup kad\u0131nlardaki KDAY ile cilt ve mukozal temas oranlar\u0131 s\u0131ras\u0131yla %66.4 ve %70.2 idi. Medyan ya\u015f 25 (\u00e7eyrekler aras\u0131 aral\u0131k=23-32; ya\u015f da\u011f\u0131l\u0131m\u0131=18-53) y\u0131l olup \u00e7al\u0131\u015fanlar\u0131n %69.3\u2019\u00fc 18-29, %21.1\u2019i 30-39, %8.3\u2019\u00fc 40-49 ve %1.3\u2019\u00fc 50 ya\u015f ve \u00fczerindeydi.<\/p>\n

\"\"<\/a>

\u015eekil 2.<\/strong> Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131nda Geli\u015fen Riskli Yaralanmalar (2013-2022)<\/p><\/div>\n

Birimlere g\u00f6re da\u011f\u0131l\u0131ma bak\u0131ld\u0131\u011f\u0131nda riskli temaslar\u0131n 262 (%37.4)\u2019si dahili birimlerde, 171 (%24.4)\u2019i cerrahi birimlerde, 112 (%16)\u2019si acil serviste ve 52 (%7.4)\u2019si ameliyathanede ger\u00e7ekle\u015fmi\u015fti. Dahili ve cerrahi birimlerde temas oranlar\u0131 %53 ila %66 aras\u0131nda de\u011fi\u015fmekteydi; ancak 2021 y\u0131l\u0131nda %80.6\u2019lara varan bir art\u0131\u015f ya\u015fand\u0131\u011f\u0131 tespit edildi. Acil serviste geli\u015fen riskli temaslar\u0131n en s\u0131k olarak 2020 y\u0131l\u0131nda geli\u015fti\u011fi, 2021\u2019de azald\u0131\u011f\u0131 ve takiben 2022\u2019de tekrar art\u0131\u015f e\u011filimine ge\u00e7ti\u011fi belirlendi (\u015eekil 2). G\u00fcnd\u00fcz vardiyas\u0131ndaki temas oran\u0131 %71.3 idi.<\/p>\n

\"\"<\/a>

\u015eekil 3.<\/strong> Riskli Temas ile Ba\u015fvuran Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131n\u0131n Meslek Gruplar\u0131na G\u00f6re Y\u0131llar \u0130\u00e7indeki Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

Bildirimde bulunan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n 267 (%38)\u2019si stajyer, 185 (%26)\u2019i hem\u015fire, 173 (%25)\u2019\u00fc temizlik personeli, 38 (%5)\u2019i doktor ve 37 (%5)\u2019si ise di\u011fer sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 idi. \u0130lk d\u00f6rt y\u0131lda, riskli temas\u0131 olan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n \u00e7o\u011funlu\u011funu temizlik personelinin olu\u015fturdu\u011fu saptand\u0131. \u0130nfeksiyon Kontrol Komitesi taraf\u0131ndan yap\u0131lan aktif s\u00fcrveyans ile bu y\u00fcksekli\u011fin belirlenmesi sonucu temizlik personeline y\u00f6nelik periyodik e\u011fitimler art\u0131r\u0131lm\u0131\u015f ve y\u0131llar i\u00e7inde bildirimlerin oran\u0131 %48\u2019den %6\u2019ya kadar azalm\u0131\u015ft\u0131. Buna kar\u015f\u0131l\u0131k, stajyerlerin bildirim oranlar\u0131na bak\u0131ld\u0131\u011f\u0131nda; 2013 y\u0131l\u0131nda %23 olan oran 2022 y\u0131l\u0131nda %61\u2019e y\u00fckselmi\u015fti (\u015eekil 3). Doktorlarda riskli temas bildirim oran\u0131 ortalama %5 olup en fazla bildirim %9 ile 2022 y\u0131l\u0131nda yap\u0131lm\u0131\u015ft\u0131. Stajyerlerle birlikte be\u015f y\u0131l ve alt\u0131nda \u00e7al\u0131\u015fma y\u0131l\u0131na sahip, riskli temasa maruz kalan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n oran\u0131 %75.9 iken 10 y\u0131ldan fazla \u00e7al\u0131\u015fma y\u0131l\u0131na sahip sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda bu oran %11.9 idi.<\/p>\n

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Tablo 1.<\/strong> Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131nda Riskli Temas Nedenlerinin Y\u0131llar \u0130\u00e7indeki Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

\u0130nfeksiyon Kontrol Komitesi\u2019nin m\u00fcdahaleleri ile d\u00f6nemsel olarak riskli temas nedenlerinde farkl\u0131l\u0131klar oldu\u011fu g\u00f6r\u00fcld\u00fc. \u00d6rne\u011fin 2013 y\u0131l\u0131nda en s\u0131k riskli temas\u0131n at\u0131k toplama s\u0131ras\u0131nda geli\u015fti\u011fi tespit edildikten sonra ba\u015flanan at\u0131k y\u00f6netimi e\u011fitimleri ve at\u0131k y\u00f6netimine y\u00f6nelik d\u00fczenlemelerle, y\u0131llar i\u00e7inde at\u0131k toplama s\u0131ras\u0131ndaki yaralanmalar %38 oran\u0131nda azalm\u0131\u015ft\u0131. Di\u011fer yanda 2022 y\u0131l\u0131nda en s\u0131k kar\u015f\u0131la\u015f\u0131lan riskli temas nedenleri; invazif giri\u015fim uygulamalar\u0131 (%45) ve i\u011fne ucu kapa\u011f\u0131n\u0131 kapatma (%15) s\u0131ras\u0131nda geli\u015fen yaralanmalard\u0131; en s\u0131k kar\u015f\u0131la\u015f\u0131lan riskli temas i\u011fne batmas\u0131 (%75.4) idi. \u0130\u011fne batmas\u0131 yaralanmalar\u0131nda y\u0131llar i\u00e7inde k\u0131smi bir azalma g\u00f6r\u00fclmekle birlikte 2022 y\u0131l\u0131nda bu oran %65 idi (Tablo 1). <\/span><\/p>\n

Riskli temas sonras\u0131nda sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %58\u2019inin ayn\u0131 g\u00fcn, %29\u2019unun 24-72 saat i\u00e7inde, %13\u2019\u00fcn\u00fcn ise 72 saatten sonra \u0130KK\u2019ya ba\u015fvurdu\u011fu saptand\u0131; 72 saati ge\u00e7en ba\u015fvuru oran\u0131 2013\u2019te %17.5 iken 2022\u2019de bu oran %13\u2019e gerilemi\u015fti. Riskli temas s\u0131ras\u0131nda sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %79\u2019unun uygun KKD kulland\u0131\u011f\u0131 ve KKD kullan\u0131m oran\u0131n\u0131n 2020 y\u0131l\u0131nda en y\u00fcksek seviyeye (%93) ula\u015ft\u0131\u011f\u0131 tespit edildi. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %75\u2019inin temas sonras\u0131 do\u011fru yara bak\u0131m\u0131 yakla\u015f\u0131m\u0131 sergiledi\u011fi g\u00f6r\u00fcl\u00fcrken do\u011fru yakla\u015f\u0131m\u0131n 2022 y\u0131l\u0131nda %88\u2019e ula\u015ft\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc; temas yerinin s\u0131k\u0131larak kanat\u0131lmas\u0131 (%80) KDAY sonras\u0131 en s\u0131k yap\u0131lan yanl\u0131\u015f uygulamayd\u0131.<\/p>\n

\"\"<\/a>

\u015eekil 4.<\/strong> Kayna\u011f\u0131 Bilinmeyen Riskli Temaslar\u0131n Y\u0131llar \u0130\u00e7indeki Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Kayna\u011f\u0131 Bilinen Riskli Temasl\u0131larda HBV, HCV ve HIV Seropozitifli\u011fi<\/p><\/div>\n

Riskli temaslar\u0131n %32\u2019sinde kayna\u011f\u0131n bilinmedi\u011fi, 2013\u2019ten 2022 y\u0131l\u0131na kadar ise kayna\u011f\u0131 bilinmeyen riskli temas oran\u0131n\u0131n %40 azald\u0131\u011f\u0131 saptand\u0131 (\u015eekil 4). Temas kayna\u011f\u0131 bilinen 478 (%68) sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n 71 (%15)\u2019inde HBsAg, 35 (%7)\u2019inde anti-HCV ve 7 (%2)\u2019sinde anti-HIV pozitifli\u011fi saptanm\u0131\u015f olup toplam 113 (%24) \u00e7al\u0131\u015fanda HBV, HCV veya HIV bula\u015fma riski oldu\u011fu g\u00f6r\u00fcld\u00fc (Tablo 2). Riskli temasa maruz kalan hem\u015firelerin %96 (177\/185)\u2019s\u0131, stajyerlerin %93 (247\/267)\u2019\u00fc, doktorlar\u0131n %87 (33\/38)\u2019si, temizlik personelinin %56.1 (97\/173)\u2019i ve di\u011fer sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %84 (31\/37)\u2019\u00fc hepatit B\u2019ye kar\u015f\u0131 ba\u011f\u0131\u015f\u0131kt\u0131. HBsAg pozitif kaynak ile temas eden 71 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n 5 (%7)\u2019inin hepatit B virusuna ba\u011f\u0131\u015f\u0131k olmad\u0131\u011f\u0131n\u0131n saptanmas\u0131 \u00fczerine imm\u00fcnglobulin ve hepatit B a\u015f\u0131s\u0131 uygulanm\u0131\u015ft\u0131; anti-HIV pozitif kaynak ile temas eden yedi sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131na ise bir ay s\u00fcreyle antiretroviral profilaksi uyguland\u0131\u011f\u0131 belirlendi. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n bir y\u0131ll\u0131k takipleri sonucunda, hi\u00e7bir riskli temasl\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131nda hepatit B ve HIV infeksiyonu geli\u015fmezken, 35 anti-HCV pozitif hasta ile temas eden sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131ndan birinde anti-HCV pozitifli\u011fi tespit edildi\u011fi g\u00f6r\u00fcld\u00fc.\u00a0<\/span><\/p>\n

\u0130RDELEME<\/h2>\n

\u00c7al\u0131\u015fmam\u0131z tek merkezli, uzun s\u00fcreli ve kan ve v\u00fccut s\u0131v\u0131lar\u0131yla riskli temasa maruz kalan \u00e7ok say\u0131da sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131 i\u00e7eren bir s\u00fcrveyans \u00e7al\u0131\u015fmas\u0131d\u0131r. Elde edilen veriler riskli temas ile ili\u015fkili sorunlar\u0131n yan\u0131 s\u0131ra bu sorunlara y\u00f6nelik olarak al\u0131nan \u00f6nlemlerin ve tekrarlayan e\u011fitimlerin etkinli\u011fini de ortaya koydu.\u00a0 <\/span>Ayr\u0131ca, COVID-19 pandemisinin ve bu pandemi s\u00fcrecindeki infeksiyon kontrol \u00f6nlemlerinin riskli temaslar \u00fczerindeki olumlu ve olumsuz etkilerini de\u011ferlendirme \u015fans\u0131 da elde edildi.<\/p>\n

Yap\u0131lan \u00e7al\u0131\u015fmalar, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ya\u015fad\u0131klar\u0131 riskli maruziyetleri bildirme oranlar\u0131n\u0131n olduk\u00e7a d\u00fc\u015f\u00fck oldu\u011funu g\u00f6stermektedir. Farkl\u0131 \u00e7al\u0131\u015fmalarda, hem\u015firelik \u00f6\u011frencilerinin %44 ila %86.9\u2019unun riskli yaralanmalar\u0131 rapor etmedikleri bildirilmi\u015ftir (13,17-19). Korkmaz ve arkada\u015flar\u0131 (20) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada, doktorlar\u0131n riskli temas\u0131 rapor etmeme oran\u0131 %81\u2019dir. Karabay ve arkada\u015flar\u0131 (21) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada, e\u011fitim sonras\u0131 riskli temas bildirimlerinin artt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (21). \u00c7al\u0131\u015fmam\u0131zda da y\u0131llar i\u00e7inde riskli temas bildiriminde bulunan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n say\u0131s\u0131n\u0131n artt\u0131\u011f\u0131, COVID-19 pandemisi sonras\u0131 2022 y\u0131l\u0131nda en y\u00fcksek seviyeye ula\u015ft\u0131\u011f\u0131 belirlendi. Bu durum, COVID-19 pandemisi nedeniyle kesintiye u\u011frayan sa\u011fl\u0131k hizmetlerinin normalle\u015fmesiyle ili\u015fkili olabilece\u011fi gibi COVID-19 pandemisinde artan e\u011fitimler ve \u0130KK ile t\u00fcm disiplinlerin daha yak\u0131n ileti\u015fiminin yaratt\u0131\u011f\u0131 olumlu bir sonu\u00e7 da olabilir. Di\u011fer yanda, T\u00fcrkiye\u2019de COVID-19 pandemisi d\u00f6neminde sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n mesleki risklerinin de\u011ferlendirildi\u011fi bir \u00e7al\u0131\u015fmada, pandemi d\u00f6neminde kan ve v\u00fccut s\u0131v\u0131lar\u0131 ile riskli temasa maruz kalman\u0131n azald\u0131\u011f\u0131 bildirilmi\u015ftir (12). \u0130nfeksiyon Kontrol Komitesi, COVID-19 pandemi s\u00fcrecinin ba\u015f\u0131ndan itibaren d\u00fczenlenen iyi tasarlanm\u0131\u015f e\u011fitim ve bilin\u00e7lendirme programlar\u0131n\u0131n riskli temaslar\u0131n azalmas\u0131nda son derece etkili oldu\u011funu belirtmi\u015ftir. Riskli temaslar\u0131 \u00f6nlemeye y\u00f6nelik periyodik e\u011fitim programlar\u0131 olduk\u00e7a \u00f6nemli olmakla birlikte, \u00e7al\u0131\u015fmam\u0131z \u0130KK ile s\u00fcrekli aktif ileti\u015fimin ve sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n riskli temaslar\u0131n\u0131 bildirmeleri y\u00f6n\u00fcnde te\u015fvik edilmesinin, bildirimleri art\u0131rabilece\u011fini g\u00f6sterdi.<\/p>\n

Kan ve v\u00fccut s\u0131v\u0131lar\u0131yla riskli temaslar\u0131n \u00e7o\u011funlu\u011funu KDAY\u2019lar olu\u015fturmaktad\u0131r. Literat\u00fcre g\u00f6re, KDAY\u2019lar\u0131n k\u00fcresel bir sorun oldu\u011fu g\u00f6r\u00fclmektedir (1,2,3). \u00dclkemizde yap\u0131lan \u00e7al\u0131\u015fmalarda, kan ve v\u00fccut s\u0131v\u0131lar\u0131yla riskli temaslar\u0131n %74-%96\u2019s\u0131n\u0131 KDAY\u2019lar\u0131n olu\u015fturdu\u011fu bildirilmi\u015ftir (21-29). \u00c7al\u0131\u015fmam\u0131zda da benzer \u015fekilde riskli temas nedeniyle yap\u0131lan bildirimlerin \u00e7o\u011funlu\u011fu KDAY kaynakl\u0131 olup bu konuda e\u011fitim programlar\u0131n\u0131n iyile\u015ftirilmesi ve hastane d\u00fczeyinde kapsaml\u0131 KDAY \u00f6nleme programlar\u0131n\u0131n olu\u015fturulmas\u0131 gereklili\u011fini ortaya \u00e7\u0131kt\u0131.<\/p>\n

Yap\u0131lan \u00e7al\u0131\u015fmalarda, riskli temasa maruz kalan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n \u00e7o\u011funlu\u011funu gen\u00e7 ya\u015f grubu (ortalama=20.8-29.2 y\u0131l) ve kad\u0131nlar olu\u015fturmaktad\u0131r (13,22,24,26,30,31). Harman-Gu\u0308nerken ve arkada\u015flar\u0131n\u0131n (11) yapt\u0131\u011f\u0131 g\u00fcncel bir \u00e7al\u0131\u015fmada ise KDAY geli\u015fen sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %58.5\u2019inin erkek oldu\u011fu bildirilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda ise kad\u0131n cinsiyet ve gen\u00e7 ya\u015f grubunda riskli temas oran\u0131n\u0131n daha fazla oldu\u011fu tespit edildi. Hastanemizdeki t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n cinsiyet da\u011f\u0131l\u0131m\u0131 benzer olmakla birlikte hem\u015firelerin \u00e7o\u011funlu\u011funu kad\u0131nlar olu\u015fturmaktad\u0131r. Hastanemizde staj yapan t\u0131p fak\u00fcltesi \u00f6\u011frencilerinin de cinsiyet da\u011f\u0131l\u0131m\u0131 benzer iken hem\u015firelik \u00f6\u011frencilerinin %75\u2019i kad\u0131nd\u0131r. Bu nedenle, \u00e7al\u0131\u015fmam\u0131zda riskli temas ba\u015fvurular\u0131nda kad\u0131n cinsiyet oran\u0131 daha fazla saptanm\u0131\u015f olabilir. Ayr\u0131ca, \u00e7o\u011funlukla kad\u0131nlardan olu\u015fan hem\u015firelerin ve hem\u015firelik \u00f6\u011frencilerinin riskli temas\u0131 \u00f6nemseyerek daha fazla bildirimde bulunmas\u0131, kad\u0131nlardaki riskli temas fazlal\u0131\u011f\u0131n\u0131n bir di\u011fer nedeni olabilir. Gen\u00e7 ya\u015f grubunda ve be\u015f y\u0131l ve alt\u0131nda mesleki \u00e7al\u0131\u015fma y\u0131l\u0131 olan grupta riskli temaslar\u0131n daha fazla bildirilmesinin nedeni\u00a0 <\/span>t\u0131bbi pratik uygulamalar\u0131ndaki yetersizlikleri olabilir. Tecr\u00fcbe yetersizli\u011fi olan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na y\u00f6nelik pratik e\u011fitimler veya sim\u00fclasyon merkezlerinde deneyim kazand\u0131rma gibi d\u00fczenlemeler gen\u00e7 ve\/veya tecr\u00fcbesiz gruplar\u0131 riskli maruziyetlere kar\u015f\u0131 koruyacakt\u0131r.<\/p>\n

Karako\u00e7 ve arkada\u015flar\u0131n\u0131n yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, KDAY\u2019lar\u0131n en s\u0131k ameliyathane \u00e7al\u0131\u015fanlar\u0131nda (%43) geli\u015fti\u011fi bildirilmi\u015ftir (32). Harman-Gu\u0308nerken ve arkada\u015flar\u0131n\u0131n (11) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada ise en fazla yaralanman\u0131n ameliyathanelerde (%22.3) ger\u00e7ekle\u015fti\u011fi bildirilmi\u015f olup bunu acil servis (%18.8) ve yo\u011fun bak\u0131m \u00fcniteleri (%18.3) izlemektedir. \u00c7al\u0131\u015fmam\u0131zda, riskli temaslar\u0131n en s\u0131k dahili ve cerrahi servislerde geli\u015fti\u011fi ve 2021 y\u0131l\u0131nda %80.6\u2019ya varan belirgin bir art\u0131\u015f oldu\u011fu g\u00f6r\u00fcld\u00fc. Bu art\u0131\u015f\u0131n nedeni; hastanemizde COVID-19 pandemisi s\u00fcrecinde, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n d\u00f6n\u00fc\u015f\u00fcml\u00fc olarak COVID-19 servislerinde \u00e7al\u0131\u015ft\u0131r\u0131lmas\u0131, klinik servislerin yerlerinin de\u011fi\u015ftirilmesi ve artan i\u015f y\u00fck\u00fc olabilir. Acil serviste en s\u0131k riskli temas\u0131n 2020\u2019de geli\u015fmesi, takiben 2021 y\u0131l\u0131nda azalmas\u0131 ve 2022 y\u0131l\u0131nda tekrar art\u0131\u015f\u0131 ise acil serviste \u00e7al\u0131\u015fan \u00f6\u011frenci say\u0131s\u0131n\u0131n COVID-19 pandemisi s\u00fcrecinde azalmas\u0131 ve normalle\u015fme sonucu stajyer \u00f6\u011frenci say\u0131s\u0131n\u0131n art\u0131\u015f\u0131 ile a\u00e7\u0131klanabilir. Ayr\u0131ca, \u00fclkemizde yap\u0131lan \u00e7al\u0131\u015fmalarda, riskli temaslar\u0131n \u00e7o\u011funlukla g\u00fcnd\u00fcz vardiyas\u0131nda (%69-90) geli\u015fti\u011fi bildirilmi\u015ftir (22,25,32-34). \u00c7al\u0131\u015fmam\u0131zda da literat\u00fcrle uyumlu olarak riskli temaslar ile en s\u0131k g\u00fcnd\u00fcz vardiyas\u0131nda (%71.3) kar\u015f\u0131la\u015f\u0131ld\u0131; bu durum g\u00fcnd\u00fcz vardiyas\u0131nda stajyer say\u0131s\u0131n\u0131n daha fazla olmas\u0131 ve i\u015f yo\u011funlu\u011funun fazlal\u0131\u011f\u0131 ile ili\u015fkilendirildi. Hastane idareleri taraf\u0131ndan \u00e7al\u0131\u015fma ko\u015fullar\u0131na ve i\u015f y\u00fck\u00fcne g\u00f6re \u00e7al\u0131\u015fan say\u0131s\u0131n\u0131n art\u0131r\u0131lmas\u0131 g\u00fcnd\u00fcz vardiyas\u0131ndaki riskli temas say\u0131s\u0131n\u0131 azaltabilir.<\/p>\n

Sag\u0306l\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda en fazla hangi personel grubunun riskli temasa maruz kald\u0131\u011f\u0131 pek \u00e7ok \u00e7al\u0131\u015fmada ara\u015ft\u0131r\u0131lm\u0131\u015f ve farkl\u0131 sonuc\u0327lara ula\u015f\u0131lm\u0131\u015ft\u0131r. Harman-Gu\u0308nerken ve arkada\u015flar\u0131n\u0131n (11) \u00e7al\u0131\u015fmas\u0131ndaki bulgular; hem\u015fireler (%37.7), temizlik g\u00f6revlileri\/hasta bak\u0131c\u0131lar (%21.7) ve stajyerler (%17.1) \u015feklindedir. \u00dclkemizdeki bir devlet hastanesinde yap\u0131lan \u00e7al\u0131\u015fman\u0131n bulgular\u0131 da bir \u00f6nceki \u00e7al\u0131\u015fma ile benzer olup\u00a0 <\/span>riskli temas oranlar\u0131; hem\u015fireler (%69.7), temizlik personeli (%17.5) ve stajyerlerde (%2.3) olarak bildirilmi\u015ftir (30). Bir \u00fcniversite hastanesinde yap\u0131lan \u00e7al\u0131\u015fmada da hem\u015fireler %60.8 ile en riskli grubu olu\u015ftururken bunu %32.4 ile temizlik personeli izlemi\u015ftir (28). Martin ve arkada\u015flar\u0131 da (35) \u00e7al\u0131\u015fmalar\u0131nda,\u00a0 <\/span>hem\u015fireleri yaralanmalar i\u00e7in en riskli meslek grubu olarak bildirilmi\u015flerdir. Altunal ve arkada\u015flar\u0131 (26) ile Dizli-Yelgin ve arkada\u015flar\u0131n\u0131n (33) yapt\u0131klar\u0131 \u00e7al\u0131\u015fmalarda ise stajyerler\u00a0 <\/span>%45.6 ve %42.7 oranlar\u0131 ile \u00f6ne \u00e7\u0131km\u0131\u015ft\u0131r. \u00c7al\u0131\u015fmam\u0131zda, riskli temasa maruz kalan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n mesleki da\u011f\u0131l\u0131m\u0131n\u0131n y\u0131llar i\u00e7inde de\u011fi\u015fkenlik g\u00f6sterdi\u011fi belirlendi. \u0130lk d\u00f6rt y\u0131lda, riskli temas\u0131 olan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n \u00e7o\u011funlu\u011funu temizlik personeli olu\u015ftururken, zamanla temizlik personelindeki yaralanmalar\u0131n azald\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc; buna kar\u015f\u0131n son y\u0131llarda, stajyerler bu konuda \u00f6ne \u00e7\u0131km\u0131\u015ft\u0131.<\/p>\n

Yap\u0131lan bir meta-analizde, doktorlarda i\u011fne batmas\u0131 yaralanmalar\u0131n\u0131n oran\u0131 %10.5 ile %86.2 aras\u0131nda bildirilmi\u015ftir (1)<\/span>. \u00dclkemizde yap\u0131lan \u00e7al\u0131\u015fmalarda ise riskli temasa maruz kalan doktor oranlar\u0131 %4.7 ila %16.9 aras\u0131nda de\u011fi\u015fmektedir (23,26). Azap ve arkada\u015flar\u0131n\u0131n (36) yapt\u0131klar\u0131 bir \u00e7al\u0131\u015fmada, riskli temas sonras\u0131 hem\u015firelerin %41\u2019inin t\u0131bbi yard\u0131m isterken doktorlar\u0131n %10\u2019unun t\u0131bbi yard\u0131m istedi\u011fi bildirilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda, doktorlardaki ortalama riskli temas bildirim oran\u0131 (%5) d\u00fc\u015f\u00fck saptanm\u0131\u015f olup en fazla ba\u015fvuru %9 oran\u0131 ile 2022 y\u0131l\u0131nda g\u00f6r\u00fcld\u00fc. Doktorlardaki riskli temas oran\u0131n az olmas\u0131n\u0131n nedeninin bildirim eksikli\u011fiyle ili\u015fkili oldu\u011fu d\u00fc\u015f\u00fcn\u00fcld\u00fc. Bunun nedeni, infeksiyon etkenlerine kars\u0327\u0131 korunma yollar\u0131n\u0131 bildiklerini du\u0308s\u0327u\u0308nmeleri veya olay\u0131 o\u0308nemsememeleri olabilir. \u00c7al\u0131\u015fmam\u0131zda doktorlarda en fazla riskli temas nedeniyle ba\u015fvurunun 2022 y\u0131l\u0131nda saptanmas\u0131, COVID-19 d\u00f6neminde doktorlarla \u0130KK\u2019nin artan ileti\u015fiminin bir sonucu olup disiplinler aras\u0131 ileti\u015fimin gereklili\u011fini g\u00f6stermesi a\u00e7\u0131s\u0131ndan \u00f6nemlidir.<\/p>\n

Yap\u0131lan \u00e7al\u0131\u015fmalarda, riskli temas\u0131n genellikle klinik deneyim yetersizli\u011fi olan ve daha az \u00e7al\u0131\u015fma y\u0131l\u0131na sahip sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda geli\u015fti\u011fi bildirilmi\u015ftir (25,26). \u00c7al\u0131\u015fmam\u0131zda da stajyerlerle birlikte be\u015f y\u0131l ve alt\u0131nda \u00e7al\u0131\u015fma y\u0131l\u0131na sahip riskli temasa maruz kalan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n oran\u0131 %75.9 iken 10 y\u0131ldan fazla \u00e7al\u0131\u015fma y\u0131l\u0131na sahip sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda %11.9 idi.<\/p>\n

Riskli temaslar\u0131n aktif s\u00fcrveyans\u0131, hedefe y\u00f6nelik planlama ve d\u00fczenleyici faaliyetlerin y\u00f6nlendirilmesi i\u00e7in \u00e7ok \u00f6nemlidir. Karako\u00e7 ve arkada\u015flar\u0131n\u0131n (32) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, mesleki yaralanma oranlar\u0131n\u0131n y\u00fcksek (%9.6) saptanmas\u0131 sonras\u0131 ba\u015flat\u0131lan \u2018planla-uygula-kontrol et-\u00f6nlem al (PUK\u00d6) d\u00f6ng\u00fcs\u00fc\u2019 c\u0327al\u0131s\u0327mas\u0131 ve verilen eg\u0306itimlerle KDAY oran\u0131n\u0131n %4.4\u2019 du\u0308s\u0327u\u0308ru\u0308ldu\u0308\u011f\u00fc bildirilmi\u015ftir; ancak, bir y\u0131l sonra tekrar art\u0131\u015f (%8.6) saptanmas\u0131 nedeniyle yeniden PUKO\u0308 d\u00f6ng\u00fcs\u00fc c\u0327al\u0131s\u0327mas\u0131 ba\u015flat\u0131lm\u0131\u015f kontrol edici \u00e7al\u0131\u015fmalar\u0131n s\u00fcreklili\u011finin sa\u011flanmas\u0131n\u0131n \u00f6nemi de vurgulanm\u0131\u015ft\u0131r. Hastanemizde de e\u011fitim ve at\u0131k y\u00f6netimi ile ilgili d\u00fczenlemeler sonras\u0131, temizlik personelinin at\u0131k toplama esnas\u0131ndaki yaralanmalar\u0131n\u0131n \u00f6n\u00fcne ge\u00e7ilmi\u015ftir.\u00a0 <\/span>Temizlik personelinde ula\u015ft\u0131\u011f\u0131m\u0131z bu ba\u015far\u0131 sonras\u0131, stajyerlerdeki riskli temas y\u00fcksekli\u011fi \u00f6n plana \u00e7\u0131km\u0131\u015f ve \u00f6ncelikle bu gruba y\u00f6nelik infeksiyon kontrol programlar\u0131n\u0131n planlanmas\u0131 gereklili\u011fi ortaya \u00e7\u0131km\u0131\u015ft\u0131r.<\/p>\n

KDAY\u2019lar \u00e7o\u011funlukla i\u011fne batma yaralanmas\u0131yla olu\u015fmaktad\u0131r. \u0130\u011fne batmas\u0131 yaralanma prevalans\u0131, geli\u015fmi\u015f \u00fclkelerde geli\u015fmemi\u015f \u00fclkelere g\u00f6re daha d\u00fc\u015f\u00fckt\u00fcr. Do\u011fu Akdeniz B\u00f6lgesi\u2019nde sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ABD\u2019den 1.9 kat daha fazla i\u011fne ucu batma yaralanmalar\u0131na maruz kald\u0131\u011f\u0131 bildirilmi\u015ftir. Ayn\u0131 \u00e7al\u0131\u015fmada, en \u00f6nemli risk fakt\u00f6r\u00fcn\u00fcn, g\u00fcvenli olmayan enjeksiyon uygulamalar\u0131 oldu\u011fu ve g\u00fcvenli bir ortam, \u00f6nleme programlar\u0131 ve uygun \u00f6nleme ekipman\u0131 olu\u015fturmak i\u00e7in yeterli b\u00fct\u00e7enin tahsis edilmesi ile g\u00fcvenli olmayan enjeksiyonlar\u0131n \u00f6nlenebilece\u011fi belirtilmi\u015ftir (1). \u00dclkemizde i\u011fne batma yaralanmalar\u0131 farkl\u0131 oranlarda (%61.7-%96.2) bildirilmi\u015ftir (21-23,25,26). \u00c7al\u0131\u015fmam\u0131zda da literat\u00fcrle benzer olarak, en s\u0131k invazif giri\u015fim uygulamalar\u0131nda (%32) ve i\u011fne batmas\u0131 sonucu (%76) riskli temas geli\u015fti\u011fi belirlendi. <\/b>Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda mesleki olarak i\u011fne batmas\u0131 yaralanmas\u0131na maruz kalma prevalans\u0131n\u0131n literat\u00fcr ile paralel olarak y\u00fcksek saptanmas\u0131, i\u015f sa\u011fl\u0131\u011f\u0131 ve g\u00fcvenli\u011fi hizmetlerinin iyile\u015ftirilmesi ihtiyac\u0131n\u0131 ortaya koymaktad\u0131r.\u00a0Standart \u00f6nlemlerin uygulanmas\u0131, korumal\u0131 enjekt\u00f6rlerin kullan\u0131ma sokulmas\u0131 ile g\u00fcvenli enjeksiyon uygulamalar\u0131, bu riskli temaslar\u0131n azalt\u0131lmas\u0131nda ve bula\u015fmalar\u0131n \u00f6nlenmesinde \u00f6nemli rol oynayabilir. Hastanemizde artan e\u011fitim s\u0131kl\u0131\u011f\u0131na ra\u011fmen, i\u011fne ucunun kapa\u011f\u0131n\u0131n kapat\u0131lmas\u0131 s\u0131ras\u0131nda geli\u015fen yaralanmalar irdelenmelidir.<\/span><\/p>\n

Ert\u00fcrk Sengel ve arkada\u015flar\u0131n\u0131n (23) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %67.6\u2019s\u0131n\u0131n ilk 24 saat, %80.1\u2019inin ilk 48 saat ve %90.1\u2019inin ise ilk 72 saat i\u00e7inde bildirimde bulundu\u011fu bildirilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda da sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n b\u00fcy\u00fck bir b\u00f6l\u00fcm\u00fcn\u00fcn ilk 72 saat i\u00e7inde \u0130KK\u2019ya ba\u015fvurdu\u011fu, 72 saati ge\u00e7en ba\u015fvuru oran\u0131n\u0131n y\u0131llar i\u00e7inde azalarak 2022\u2019de %13\u2019e geriledi\u011fi belirlendi. Hastanemizde 72 saati ge\u00e7en ba\u015fvuru oran\u0131nda azalma olmas\u0131na ra\u011fmen, istenen ba\u015far\u0131n\u0131n sa\u011flanamad\u0131\u011f\u0131 ve bunun nedenlerinin irdelenmesi gerekti\u011fi d\u00fc\u015f\u00fcn\u00fcld\u00fc.<\/p>\n

Bahcecik ve arkada\u015flar\u0131n\u0131n (37) \u00e7al\u0131\u015fmas\u0131nda, bir \u00fcniversite hastanesinde \u00e7al\u0131\u015fan hem\u015firelerin %71\u2019inin yetersiz g\u00fcvenlik \u00f6nlemi ald\u0131\u011f\u0131, \u00f6zel bir hastanede \u00e7al\u0131\u015fan hem\u015firelerin ise %86\u2019s\u0131n\u0131n yeterli bir \u015fekilde g\u00fcvenlik \u00f6nlemlerini ald\u0131klar\u0131 bildirilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda ortalama KKD kullan\u0131m oran\u0131 %79 olup COVID-19 pandemisinin etkisinin yo\u011fun ya\u015fand\u0131\u011f\u0131 2020 y\u0131l\u0131nda en y\u00fcksek KKD kullan\u0131m oran\u0131na (%93) ula\u015f\u0131ld\u0131\u011f\u0131 belirlendi. COVID-19 pandemisi s\u00fcrecinde \u00e7ok s\u0131k uygulanan e\u011fitimlere ve servislerde yayg\u0131n olarak as\u0131lan KKD kullan\u0131m afi\u015flerine ra\u011fmen %100 KKD kullan\u0131m oran\u0131na ula\u015f\u0131lamam\u0131\u015f olmas\u0131 d\u00fc\u015f\u00fcnd\u00fcr\u00fcc\u00fcd\u00fcr. Periyodik olarak yap\u0131lacak e\u011fitim programlar\u0131 ile fark\u0131ndal\u0131k art\u0131r\u0131larak KKD kullan\u0131m oranlar\u0131n\u0131n iyile\u015ftirilmesini sa\u011flayabilir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda literat\u00fcrle benzer bir \u015fekilde, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n \u00e7o\u011funda maruziyet sonras\u0131 temas b\u00f6lgesinin su ve sabunla veya mukozal temasta su ile y\u0131kamas\u0131 \u015feklinde do\u011fru yakla\u015f\u0131m sergiledi\u011fi g\u00f6r\u00fcl\u00fcrken, en s\u0131k yap\u0131lan yanl\u0131\u015f uygulama riskli temas yerinin s\u0131k\u0131larak kanat\u0131lmas\u0131yd\u0131 (38); bunun nedenleri mutlaka irdelenmeli ve d\u00fczenleyici faaliyetler planlanmal\u0131d\u0131r.<\/p>\n

Yap\u0131lan g\u00fcncel bir \u00e7al\u0131\u015fmada, riskli temaslar\u0131n %17.7\u2019sinde kayna\u011f\u0131n bilinmedi\u011fi belirtilmi\u015ftir (11). \u00c7al\u0131\u015fmam\u0131zda, kayna\u011f\u0131 bilinmeyen riskli yaralanmalar 2013 y\u0131l\u0131nda %58 ile \u00e7ok y\u00fcksek bir de\u011fere sahipken; at\u0131k y\u00f6netimi, kesici-delici alet kutular\u0131n\u0131n temini ve kullan\u0131m\u0131n\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 ile y\u0131llar i\u00e7inde bu oran\u0131n azald\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc.<\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda HBV infeksiyon riski, genel pop\u00fclasyona g\u00f6re neredeyse 10 kat daha fazla bildirilmi\u015ftir (18). Riskli temas ya\u015fayan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n hepatit B a\u015f\u0131lanma durumlar\u0131na ili\u015fkin \u00e7al\u0131\u015fmalar mevcuttur. Karata\u015f ve arkada\u015flar\u0131n\u0131n (13) \u00e7al\u0131\u015fmas\u0131nda, hem\u015firelik \u00f6\u011frencilerinin %78.4\u2019\u00fcn\u00fcn hepatit B a\u015f\u0131s\u0131 oldu\u011fu tespit edilmi\u015ftir. Y\u0131ld\u0131r\u0131m ve arkada\u015flar\u0131n\u0131n (39) \u00e7al\u0131\u015fmas\u0131nda, sa\u011fl\u0131k meslek lisesi \u00f6\u011frencilerinde HBV a\u015f\u0131lanma oran\u0131 %40 iken \u00f6\u011frencilerin mesleki riskleri hakk\u0131ndaki bilgi d\u00fczeyleri olduk\u00e7a d\u00fc\u015f\u00fck bulunmu\u015ftur. Kutlu ve arkada\u015flar\u0131 (40) \u00e7al\u0131\u015fmalar\u0131nda, 200 t\u0131p fak\u00fcltesi \u00f6\u011frencisinin %59.6\u2019s\u0131n\u0131n hepatit B a\u015f\u0131s\u0131 oldu\u011funu bildirmi\u015ftir . \u00c7al\u0131\u015fmam\u0131zda, riskli temas bildirimi yapan hem\u015firelerin %96 (177\/185)\u2019s\u0131, stajyerlerin %93 (247\/267)\u2019\u00fc, doktorlar\u0131n %87 (33\/38)\u2019si, temizlik personelinin %56 (97\/173)\u2019s\u0131 ve di\u011fer sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %84 (31\/37)\u2019\u00fc hepatit B\u2019ye kar\u015f\u0131 ba\u011f\u0131\u015f\u0131kl\u0131k kazanm\u0131\u015ft\u0131. Bu veriler, hastanemizde \u00f6zellikle temizlik personeline y\u00f6nelik hepatit B ba\u011f\u0131\u015f\u0131klama programlar\u0131n\u0131n gereklili\u011fini g\u00f6stermekle birlikte, t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda %100 a\u015f\u0131lama oranlar\u0131na ula\u015fmas\u0131 hedeflenmelidir.<\/p>\n

Perk\u00fctan maruziyet, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 aras\u0131nda HBV\u2019nin yakla\u015f\u0131k %37\u2019sinden, HCV\u2019nin %39\u2019undan ve HIV olgular\u0131n\u0131n %4.4\u2019\u00fcnden sorumludur (7).\u00a0Y\u0131lda her 100 KDAY ba\u015f\u0131na 0.42 HBV infeksiyonu, 0.05-1.30 HCV infeksiyonu ve 0.04-0.32 HIV infeksiyonu geli\u015fti\u011fi bildirilmi\u015ftir (10<\/span>). \u00c7al\u0131\u015fmam\u0131zda, hepatit B riskli temas\u0131 olan ve ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bulunmayan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n, a\u015f\u0131 ve imm\u00fcnglobulin uygulamas\u0131 ile korunabildi\u011fi tespit edildi. Ancak, bu sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 riskli temas \u00f6ncesi a\u015f\u0131lanm\u0131\u015f olsayd\u0131 imm\u00fcnglobulin gereksinimi olmayacak ve gereksiz bir i\u015f y\u00fck\u00fc ve ek maliyet olu\u015fturulmayacakt\u0131. \u00c7al\u0131\u015fmam\u0131zda, antiretroviral profilaksi uygulanan yedi hastan\u0131n hi\u00e7birinde HIV infeksiyonu geli\u015fmedi\u011fi, anti-HCV pozitif 35 hasta ile temas eden sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131ndan birinde anti-HCV pozitifli\u011fi geli\u015fti\u011fi tespit edildi. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n a\u015f\u0131lar\u0131n\u0131n tam olmas\u0131, m\u00fcmk\u00fcn oldu\u011funca riskli temaslar\u0131 \u00f6nleyecek \u00e7al\u0131\u015fma ko\u015fullar\u0131n\u0131n sa\u011flanmas\u0131, riskli temas sonras\u0131 do\u011fru yakla\u015f\u0131m ve erken ba\u015fvuru ile uygun profilaksi uygulamalar\u0131n\u0131 i\u00e7eren b\u00fct\u00fcnc\u00fcl bir yakla\u015f\u0131m olumsuz sonu\u00e7lar\u0131n ya\u015fanmas\u0131n\u0131 \u00f6nleyecektir.<\/p>\n

Bu \u00e7al\u0131\u015fma, tek bir merkezde meydana gelen kan ve v\u00fccut s\u0131v\u0131lar\u0131yla geli\u015fen riskli temaslar\u0131 i\u00e7ermekte olup ki\u015filerin \u0130KK\u2019ye bildirimlerine dayanmaktad\u0131r. Bu nedenle, \u00e7al\u0131\u015fma s\u00fcresi boyunca meydana gelen t\u00fcm riskli temaslar\u0131 kapsamamaktad\u0131r.\u00a0 <\/span>Riskli temas izlem formlar\u0131nda zamanla de\u011fi\u015fiklikler yap\u0131lmas\u0131 nedeniyle, \u00e7al\u0131\u015fma retrospektif olarak yap\u0131ld\u0131\u011f\u0131ndan, veri toplamada sadece mevcut formlardaki ve hastane sisteminde yer alan bilgiler kullan\u0131labilmi\u015ftir ve stajyer \u00f6\u011frenci say\u0131lar\u0131 formlar\u0131m\u0131zda yer almad\u0131\u011f\u0131ndan t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 say\u0131s\u0131 belirlenememi\u015f ve t\u00fcm riskli grupta bildirilen riskli temas oran\u0131 hesaplanamam\u0131\u015ft\u0131r.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131ndaki en \u00f6nemli riskli temas\u0131n i\u011fne batmas\u0131 olmas\u0131 ve bu riskli temas\u0131n en s\u0131k stajyerlerde g\u00f6r\u00fclmesi dikkat \u00e7ekicidir. Ayr\u0131ca, \u00e7al\u0131\u015fman\u0131n kapsam\u0131 i\u00e7indeki d\u00f6nemde yap\u0131lan e\u011fitimler ve at\u0131k y\u00f6netimi uygulamalar\u0131yla temizlik personelinin at\u0131k toplama esnas\u0131ndaki yaralanmalar\u0131n\u0131n \u00f6n\u00fcne ge\u00e7ilmesindeki ba\u015far\u0131 umut vericidir. \u00a0Di\u011fer yanda stajyerlerdeki riskli temas oranlar\u0131n\u0131ncy\u00fcksekli\u011fi, bu gruba y\u00f6nelik infeksiyon kontrol programlar\u0131n\u0131n planlanmas\u0131 gereklili\u011fini ortaya koymu\u015ftur.<\/p>\n

Sonu\u00e7 olarak; sa\u011fl\u0131k kurulu\u015flar\u0131nda d\u00fczenli olarak kan ve v\u00fccut s\u0131v\u0131lar\u0131yla riskli temaslar\u0131n izlenmesi, kay\u0131t alt\u0131na al\u0131nmas\u0131, sorunlar\u0131n ortaya konularak hedefe y\u00f6nelik infeksiyon kontrol \u00f6nlemlerinin olu\u015fturulmas\u0131, periyodik e\u011fitimlerin planlanmas\u0131, olu\u015fturulan d\u00fczenleyici faaliyetlerin uygulanmas\u0131n\u0131n sa\u011flanmas\u0131 ve denetlenmesiyle sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 i\u00e7in maruziyet risklerinin azalt\u0131lmas\u0131n\u0131 sa\u011flanacakt\u0131r. Bu yakla\u015f\u0131m hem i\u015f g\u00fcc\u00fcn\u00fcn hem de sa\u011fl\u0131k harcamalar\u0131n\u0131n daha etkin bir \u015fekilde kullan\u0131lmas\u0131 i\u00e7in de gereklidir.\u00a0 <\/span>Ayr\u0131ca bu kapsamda \u00e7ok merkezli \u00e7al\u0131\u015fmalar yap\u0131larak olas\u0131 b\u00fct\u00fcn riskleri, bu riskleri \u00f6nleyecek veya azaltacak yasal d\u00fczenlemeleri ve \u00f6nleyici faaliyetleri i\u00e7eren ulusal bir yakla\u015f\u0131m ortaya konulabilir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n, hastane ortamlar\u0131nda kan ve v\u00fccut s\u0131v\u0131lar\u0131na maruziyeti d\u00fcnya \u00e7ap\u0131nda yayg\u0131n ve ciddi mesleki risklerdendir (1,2). S\u00f6z konusu maruziyetlerin nedeni b\u00fcy\u00fck \u00f6l\u00e7\u00fcde kesici ve delici alet yaralanmas\u0131 (KDAY) (%71) ve cilt ve mukoza temas\u0131 (%29) kaynakl\u0131d\u0131r (3). Amerika Birle\u015fik Devletleri (ABD)\u2019nde her y\u0131l 300 000\u2019den fazla sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n KDAY\u2019lara maruz kald\u0131\u011f\u0131 tahmin edilmektedir […]<\/p>\n","protected":false},"author":6,"featured_media":28830,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5912,4372,5911,3675],"class_list":["post-28669","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-igne-batmasi-yaralanmasi","tag-infeksiyon-kontrolu","tag-kan-ve-vucut-sivilariyla-riskli-temas","tag-saglik-calisanlari"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28669","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\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=28669"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28669\/revisions"}],"predecessor-version":[{"id":29005,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28669\/revisions\/29005"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/28830"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=28669"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=28669"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=28669"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}