{"id":32437,"date":"2026-09-29T11:20:54","date_gmt":"2026-09-29T08:20:54","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=32437"},"modified":"2026-09-29T12:07:32","modified_gmt":"2026-09-29T09:07:32","slug":"saglik-calisanlarinda-kacirilmis-asi-firsatlari","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2026\/09\/29\/saglik-calisanlarinda-kacirilmis-asi-firsatlari\/","title":{"rendered":"Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131nda A\u015f\u0131yla \u00d6nlenebilir Hastal\u0131klara Kar\u015f\u0131 Potansiyel Ka\u00e7\u0131r\u0131lm\u0131\u015f A\u015f\u0131 F\u0131rsatlar\u0131"},"content":{"rendered":"

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

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, mesleki uygulamalar s\u0131ras\u0131nda infeksiy\u00f6z ajanlara maruziyet riskinin y\u00fcksek olmas\u0131 ve ayn\u0131 zamanda imm\u00fcns\u00fcprese, ya\u015fl\u0131 veya kronik hastal\u0131\u011f\u0131 bulunan duyarl\u0131 hasta gruplar\u0131na infeksiyon bula\u015ft\u0131rma potansiyelleri nedeniyle a\u015f\u0131lama a\u00e7\u0131s\u0131ndan \u00f6ncelikli risk gruplar\u0131 aras\u0131nda yer almaktad\u0131r (1,2). Bu nedenle sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ba\u011f\u0131\u015f\u0131klanmas\u0131, yaln\u0131zca bireysel korunma a\u00e7\u0131s\u0131ndan de\u011fil, hasta g\u00fcvenli\u011fi ve sa\u011fl\u0131k hizmetlerinin s\u00fcreklili\u011fi a\u00e7\u0131s\u0131ndan da kritik \u00f6neme sahiptir. Bunun yan\u0131 s\u0131ra, ba\u011f\u0131\u015f\u0131klanma konusunda y\u00fcksek fark\u0131ndal\u0131\u011fa sahip olan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, toplumda a\u015f\u0131 k\u00fclt\u00fcr\u00fcn\u00fcn yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131nda ve a\u015f\u0131 teredd\u00fcd\u00fcn\u00fcn giderilmesinde g\u00fc\u00e7l\u00fc birer rol model olarak toplum sa\u011fl\u0131\u011f\u0131na katk\u0131 sa\u011flayabilir.<\/p>\n

\u0130\u015f sa\u011fl\u0131\u011f\u0131 ve g\u00fcvenli\u011fi kapsam\u0131nda y\u00fcr\u00fct\u00fclen periyodik taramalarda genellikle kan yoluyla bula\u015fan patojenlere, \u00f6zellikle hepatit B profilaksisine odaklan\u0131lmaktad\u0131r; buna kar\u015f\u0131n solunum yoluyla bula\u015fan veya belirli risk gruplar\u0131 i\u00e7in hayati \u00f6nem ta\u015f\u0131yan a\u015f\u0131lar (influenza, pn\u00f6mokok, hepatit A, vb.) \u00e7o\u011fu zaman ikinci planda kalabilmektedir. Oysa etkin bir \u00e7al\u0131\u015fan sa\u011fl\u0131\u011f\u0131 program\u0131, yaln\u0131zca yasal y\u00fck\u00fcml\u00fcl\u00fcklerin yerine getirilmesini de\u011fil, bireysel risk fakt\u00f6rlerini dikkate alan kapsaml\u0131 ve dinamik bir ba\u011f\u0131\u015f\u0131klama y\u00f6netimini de i\u00e7ermelidir.<\/p>\n

Solunum yolu infeksiyonlar\u0131 aras\u0131nda \u00f6nemli bir morbidite ve i\u015f g\u00fcc\u00fc kayb\u0131 nedeni olan influenza, sa\u011fl\u0131k hizmeti sunumunda aksamalara ve ciddi nozokomiyal salg\u0131nlara yol a\u00e7abilmektedir. Bu nedenle Amerika Birle\u015fik Devletleri (ABD) Hastal\u0131k Kontrol ve Korunma Merkezi (Centers for Disease Control and Prevention, CDC) ve Ba\u011f\u0131\u015f\u0131klama Uygulamalar\u0131 Dan\u0131\u015fma Komitesi (Advisory Committee on Immunization Practices, ACIP) hasta g\u00fcvenli\u011finin sa\u011flanmas\u0131 ve sa\u011fl\u0131k personelinin korunmas\u0131 amac\u0131yla t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na y\u0131ll\u0131k influenza a\u015f\u0131lamas\u0131n\u0131 g\u00fc\u00e7l\u00fc bi\u00e7imde \u00f6nermektedir (3). Buna kar\u015f\u0131n literat\u00fcr, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda influenza a\u015f\u0131lanma oranlar\u0131n\u0131n hedeflenen d\u00fczeylerin olduk\u00e7a alt\u0131nda kald\u0131\u011f\u0131n\u0131; a\u015f\u0131 teredd\u00fcd\u00fc, risk alg\u0131s\u0131n\u0131n d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc ve yanl\u0131\u015f inan\u0131\u015flar\u0131n bu durum \u00fczerinde belirleyici oldu\u011funu ortaya koymaktad\u0131r (4\u20137).<\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ba\u011f\u0131\u015f\u0131klanmas\u0131nda s\u0131kl\u0131kla g\u00f6z ard\u0131 edilen bir di\u011fer alan pn\u00f6mokok a\u015f\u0131lamas\u0131d\u0131r. Streptococcus pneumoniae<\/i> infeksiyonlar\u0131na kar\u015f\u0131 a\u015f\u0131lama, genel pop\u00fclasyonda \u00e7o\u011funlukla 65 ya\u015f \u00fczeri bireyler veya belirli komorbiditelere sahip ki\u015filer i\u00e7in \u00f6nerilmekte olup sa\u011fl\u0131kl\u0131 kabul edilen sa\u011fl\u0131k personeli i\u00e7in rutin bir endikasyon olarak de\u011ferlendirilmemektedir (8,9). Ancak sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 homojen ve tamamen sa\u011fl\u0131kl\u0131 bir grup de\u011fildir; bu grupta diyabet, kronik kalp ya da akci\u011fer hastal\u0131\u011f\u0131 gibi pn\u00f6mokok infeksiyonlar\u0131 a\u00e7\u0131s\u0131ndan risk olu\u015fturan durumlara sahip bireyler yer almaktad\u0131r. Bu risk grubundaki personelin a\u015f\u0131lanmas\u0131 hayati \u00f6nem ta\u015f\u0131makla birlikte, T\u00fcrkiye\u2019de sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n pn\u00f6mokok ba\u011f\u0131\u015f\u0131klanma durumunu ve risk grubu y\u00f6netimini ele alan \u00f6zg\u00fcn \u00e7al\u0131\u015fma say\u0131s\u0131 s\u0131n\u0131rl\u0131d\u0131r (10).\u00a0<\/span><\/p>\n

Benzer \u015fekilde, hepatit A a\u015f\u0131lamas\u0131 da eri\u015fkin ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131nda s\u0131kl\u0131kla ihmal edilmektedir (11). T\u00fcrkiye\u2019nin epidemiyolojik ge\u00e7i\u015f s\u00fcreci dikkate al\u0131nd\u0131\u011f\u0131nda, gen\u00e7 eri\u015fkin n\u00fcfusun \u00f6nemli bir k\u0131sm\u0131n\u0131n \u00e7ocukluk \u00e7a\u011f\u0131nda infeksiyonla kar\u015f\u0131la\u015fmadan eri\u015fkinli\u011fe ula\u015ft\u0131\u011f\u0131 ve dolay\u0131s\u0131yla seronegatif oldu\u011fu bilinmektedir. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n hastane ortam\u0131nda fekal-oral bula\u015fma riski bulunan alanlarda (pediatri klinikleri, laboratuvarlar, at\u0131k y\u00f6netimi birimleri, vb.) g\u00f6rev alabilece\u011fi g\u00f6z \u00f6n\u00fcnde bulunduruldu\u011funda, ba\u011f\u0131\u015f\u0131k olmayan personelin a\u015f\u0131lanmam\u0131\u015f olmas\u0131 hem i\u015f sa\u011fl\u0131\u011f\u0131 hem de toplum sa\u011fl\u0131\u011f\u0131 a\u00e7\u0131s\u0131ndan \u00f6nemli bir risk olu\u015fturmaktad\u0131r (11).<\/p>\n

D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), a\u015f\u0131lanma i\u00e7in bir kontrendikasyonu olmayan bireylerin, sa\u011fl\u0131k hizmeti ald\u0131\u011f\u0131 bir temas s\u0131ras\u0131nda ba\u011f\u0131\u015f\u0131klanma durumunun sorgulanmamas\u0131 ve endikasyonu olan a\u015f\u0131n\u0131n yap\u0131lmamas\u0131n\u0131 \u201cka\u00e7\u0131r\u0131lm\u0131\u015f a\u015f\u0131 f\u0131rsat\u0131\u201d (missed opportunities for vaccination) olarak tan\u0131mlamaktad\u0131r (12). \u0130\u015f sa\u011fl\u0131\u011f\u0131 birimlerinde ger\u00e7ekle\u015ftirilen periyodik taramalar, yaln\u0131zca mevcut hastal\u0131klar\u0131n saptanmas\u0131 i\u00e7in de\u011fil, ayn\u0131 zamanda bu ka\u00e7\u0131r\u0131lm\u0131\u015f f\u0131rsatlar\u0131n belirlenmesi ve telafi edilmesi a\u00e7\u0131s\u0131ndan da stratejik bir \u00f6neme sahiptir. Tarama yap\u0131lmas\u0131na ra\u011fmen risk grubundaki bir sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131na a\u015f\u0131 yap\u0131lmam\u0131\u015f olmas\u0131, bireysel bir tercihten \u00e7ok sistemsel eksikli\u011fe i\u015faret etmektedir.<\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n, a\u015f\u0131laman\u0131n bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n \u00f6nlenmesinde temel ve etkili bir ara\u00e7 oldu\u011funu; salg\u0131nlar\u0131n kontrol alt\u0131na al\u0131nmas\u0131n\u0131 h\u0131zland\u0131rd\u0131\u011f\u0131n\u0131 ve nozokomiyal bula\u015fma riskini belirgin bi\u00e7imde azaltt\u0131\u011f\u0131n\u0131 bilmeleri beklenmektedir. A\u015f\u0131ya eri\u015fimlerinin g\u00f6rece kolay olmas\u0131 ve i\u015fe giri\u015f ile periyodik izlem s\u00fcre\u00e7lerinde i\u015f sa\u011fl\u0131\u011f\u0131 ve g\u00fcvenli\u011fi birimleriyle d\u00fczenli temas halinde olmalar\u0131 da sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ba\u011f\u0131\u015f\u0131klama uygulamalar\u0131n\u0131n eksiksiz ve g\u00fcncel olmas\u0131n\u0131 gerektirmektedir. Ancak pratikte, bu olanaklar\u0131n her zaman etkin kullan\u0131lmad\u0131\u011f\u0131 ve a\u015f\u0131yla \u00f6nlenebilir hastal\u0131klara kar\u015f\u0131 ba\u011f\u0131\u015f\u0131klaman\u0131n \u00e7o\u011fu zaman yetersiz kald\u0131\u011f\u0131 g\u00f6r\u00fclmektedir.<\/p>\n

Bu \u00e7al\u0131\u015fmada, \u00fc\u00e7\u00fcnc\u00fc basamak bir sa\u011fl\u0131k kurulu\u015funda periyodik i\u015f sa\u011fl\u0131\u011f\u0131 taramalar\u0131 sonras\u0131nda sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na uygulanan a\u015f\u0131lar\u0131n de\u011ferlendirilmesi; rutin taramalar\u0131n \u00f6tesine ge\u00e7ilerek risk gruplar\u0131n\u0131n pn\u00f6mokok, influenza ve hepatit A a\u015f\u0131lanma durumlar\u0131n\u0131n incelenmesi ve ka\u00e7\u0131r\u0131lm\u0131\u015f a\u015f\u0131 f\u0131rsatlar\u0131n\u0131n boyutunun ortaya konulmas\u0131 ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/b><\/h2>\n

Bu \u00e7al\u0131\u015fma, Ordu \u00dcniversitesi T\u0131p Fak\u00fcltesi E\u011fitim ve Ara\u015ft\u0131rma Hastanesi\u2019nde g\u00f6rev yapan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na (doktor, hem\u015fire, ebe, sa\u011fl\u0131k teknisyeni, temizlik personeli, vb.) y\u00f6nelik ger\u00e7ekle\u015ftirilen periyodik i\u015f sa\u011fl\u0131\u011f\u0131 taramalar\u0131n\u0131n ve ba\u011f\u0131\u015f\u0131klama kay\u0131tlar\u0131n\u0131n incelendi\u011fi retrospektif kesitsel bir ara\u015ft\u0131rma olarak y\u00fcr\u00fct\u00fcld\u00fc.<\/p>\n

\u00c7al\u0131\u015fma verileri 1 Ocak 2016 ile 1 Ocak 2026 tarihleri aras\u0131ndaki periyodik muayene d\u00f6nemini kapsamaktad\u0131r. Ancak \u00e7al\u0131\u015fman\u0131n kesitsel tasar\u0131m\u0131na uygun olarak personelin zaman i\u00e7indeki de\u011fi\u015fimi izlenmedi; m\u00fckerrer verileri \u00f6nlemek ve kohortun \u00e7al\u0131\u015fma d\u00f6nemindeki son ba\u011f\u0131\u015f\u0131kl\u0131k profilini yans\u0131tmak amac\u0131yla, birden fazla taramas\u0131 bulunan her bir \u00e7al\u0131\u015fan\u0131n yaln\u0131zca en g\u00fcncel tarihli tarama kayd\u0131 analize d\u00e2hil edildi. Verilerinde eksiklik bulunan veya \u00e7al\u0131\u015fma s\u00fcresi i\u00e7inde g\u00f6revden ayr\u0131lan sa\u011fl\u0131k personeli \u00e7al\u0131\u015fma d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131. Sonu\u00e7 olarak, incelenen toplam 2650 periyodik tarama kayd\u0131ndan m\u00fckerrer olanlar, veri eksikli\u011fi bar\u0131nd\u0131ranlar ve g\u00f6revden ayr\u0131lanlar \u00e7\u0131kar\u0131ld\u0131ktan sonra toplam 775 tekil sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 analize d\u00e2hil edildi.<\/p>\n

Ara\u015ft\u0131rma verileri; hastane bilgi y\u00f6netim sistemi, \u0130\u015f Sa\u011fl\u0131\u011f\u0131 ve G\u00fcvenli\u011fi Birimi ar\u015fivinde yer alan \u201cSa\u011fl\u0131k Personeli Periyodik Tarama Formlar\u0131\u2019\u2019ndaki personel \u00f6z bildirimleri, laboratuvar sonu\u00e7lar\u0131, a\u015f\u0131 poliklini\u011fine ait elektronik sistem kay\u0131tlar\u0131 ve a\u015f\u0131lama dosyalar\u0131ndan elde edildi. Kat\u0131l\u0131mc\u0131lar\u0131n demografik \u00f6zellikleri, t\u0131bbi \u00f6yk\u00fc ve komorbiditeleri (diyabet, kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131, ast\u0131m, kronik kalp yetmezli\u011fi, kronik b\u00f6brek yetmezli\u011fi, imm\u00fcns\u00fcprese durumlar, vb.) kay\u0131t alt\u0131na al\u0131nd\u0131. T\u0131bbi kay\u0131tlar\u0131ndan serolojik durum [hepatit A (anti-HAV IgG), hepatit B (HBsAg\/anti-HBs), k\u0131zam\u0131k, k\u0131zam\u0131k\u00e7\u0131k, kabakulak ve su\u00e7i\u00e7e\u011fi (VZV)] ve a\u015f\u0131lama durumu [hepatit B, hepatit A, k\u0131zam\u0131k-k\u0131zam\u0131k\u00e7\u0131k-kabakulak a\u015f\u0131s\u0131 (MMR), su\u00e7i\u00e7e\u011fi, pn\u00f6mokok, meningokok ve mevsimsel influenza] elde edildi.<\/p>\n

Risk Gruplar\u0131n\u0131n ve Potansiyel Ka\u00e7\u0131r\u0131lm\u0131\u015f A\u015f\u0131 F\u0131rsat\u0131\u2019n\u0131n Tan\u0131mlanmas\u0131<\/b><\/h3>\n

\u00c7al\u0131\u015fmada a\u015f\u0131 endikasyonlar\u0131, T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Geni\u015fletilmi\u015f Ba\u011f\u0131\u015f\u0131klama Program\u0131 ve ACIP eri\u015fkin ba\u011f\u0131\u015f\u0131klama rehberleri referans al\u0131narak belirlendi (9,13,14). \u0130lgili rehberlere uygun olarak risk gruplar\u0131 a\u015fa\u011f\u0131da verildi:<\/p>\n

Pn\u00f6mokok Riski<\/strong><\/em><\/p>\n

ACIP 2024 \u00f6nerileri do\u011frultusunda 50 ya\u015f ve \u00fczerindeki t\u00fcm eri\u015fkinler ile 19\u201349 ya\u015f aral\u0131\u011f\u0131nda olup kronik hastal\u0131\u011f\u0131 (alkolizm; konjestif kalp yetmezli\u011fi ve kardiyomiyopatiler de dahil olmak \u00fczere kronik kalp hastal\u0131\u011f\u0131; kronik karaci\u011fer hastal\u0131\u011f\u0131; kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131, amfizem ve ast\u0131m da dahil olmak \u00fczere kronik akci\u011fer hastal\u0131\u011f\u0131; sigara kullan\u0131m\u0131; veya diabetes mellitus) veya imm\u00fcnos\u00fcpresyon, (kronik b\u00f6brek yetmezli\u011fi, nefrotik sendrom, imm\u00fcn yetmezlik, iyatrojenik imm\u00fcnos\u00fcpresyon, malignite, HIV infeksiyonu, Hodgkin hastal\u0131\u011f\u0131, l\u00f6semi, lenfoma, multipl miyelom, organ nakli, aspleni, orak h\u00fccreli anemi veya di\u011fer hemoglobinopatiler), beyin omurilik s\u0131v\u0131s\u0131 ka\u00e7a\u011f\u0131 veya koklear implant\u0131 olanlar \u201cpn\u00f6mokok a\u015f\u0131s\u0131 endikasyonu olan risk grubu\u201d olarak tan\u0131mland\u0131. \u0130zole hipertansiyonu olanlar, pn\u00f6mokok a\u015f\u0131s\u0131 endikasyonu bulunan risk grubuna dahil edilmedi (9).<\/p>\n

Pn\u00f6mokok De\u011ferlendirmesi\u00a0<\/span><\/strong><\/em><\/p>\n

Elli ya\u015f ve \u00fczerindeki \u00e7al\u0131\u015fanlar ile daha gen\u00e7 ya\u015fta olup pn\u00f6mokok a\u00e7\u0131s\u0131ndan risk durumu bulunan \u00e7al\u0131\u015fanlar\u0131n a\u015f\u0131lanma durumu, 2025 y\u0131l\u0131 sonunda a\u015f\u0131 poliklini\u011fi dosyalar\u0131 ve elektronik sistem kay\u0131tlar\u0131 \u00fczerinden kontrol edildi. De\u011ferlendirme tarihindeki g\u00fcncel endikasyona g\u00f6re a\u015f\u0131s\u0131z olanlar, pn\u00f6mokok a\u015f\u0131s\u0131 a\u00e7\u0131s\u0131ndan \u201ckar\u015f\u0131lanmam\u0131\u015f a\u015f\u0131lama gereksinimi\u201d olarak tan\u0131mland\u0131. Dolay\u0131s\u0131yla pn\u00f6mokok analizi, ge\u00e7mi\u015f y\u0131llardaki her bir tarama tarihinde ge\u00e7erli rehberin geriye d\u00f6n\u00fck olarak bireysel d\u00fczeyde uygulanmas\u0131 \u015feklinde de\u011fil, 2025 y\u0131l\u0131 sonu itibar\u0131yla mevcut endikasyon ve kay\u0131tl\u0131 a\u015f\u0131lanma durumunun kesitsel olarak de\u011ferlendirilmesi olarak yap\u0131ld\u0131.\u00a0<\/span><\/p>\n

\u0130nfluenza Riski<\/strong><\/em><\/p>\n

T\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 risk grubu kabul edilmekle birlikte, \u00f6zellikle kronik hastal\u0131\u011f\u0131 olanlar \u201cy\u00fcksek riskli grup\u201d olarak kategorize edildi. \u0130nfluenza i\u00e7in \u201ckar\u015f\u0131lanmam\u0131\u015f a\u015f\u0131lama gereksinimi\u201d hesaplan\u0131rken, a\u015f\u0131n\u0131n sezonluk koruyuculu\u011fu dikkate al\u0131narak, 2025 y\u0131l\u0131 sezonundaki a\u015f\u0131lanma durumu esas al\u0131nd\u0131. Kurum d\u0131\u015f\u0131nda uygulanm\u0131\u015f influenza a\u015f\u0131lar\u0131na ili\u015fkin kay\u0131tlara ula\u015f\u0131lamad\u0131\u011f\u0131ndan, bu veriler analize dahil edilmedi.<\/p>\n

Hepatit A Riski<\/strong><\/em><\/p>\n

Anti-HAV IgG testi negatif saptanan sa\u011fl\u0131k personeli \u201cduyarl\u0131 (riskli) grup\u201d olarak kabul edildi.<\/p>\n

Hepatit B De\u011ferlendirmesi<\/strong><\/em><\/p>\n

Hepatit B de\u011ferlendirmesinde tarama an\u0131ndaki laboratuvar sonu\u00e7lar\u0131 dikkate al\u0131nd\u0131; anti-HBs >10 \u0130\u00dc\/ml seropozitif, <10 \u0130\u00dc\/ml ise seronegatif olarak kabul edildi.<\/p>\n

Potansiyel Ka\u00e7\u0131r\u0131lm\u0131\u015f A\u015f\u0131 F\u0131rsat\u0131<\/strong><\/em><\/p>\n

A\u015f\u0131 endikasyonu bulunmas\u0131na (\u00f6rne\u011fin kronik hastal\u0131\u011f\u0131 olmas\u0131 veya seronegatif olmas\u0131) ve sa\u011fl\u0131k birimine ba\u015fvurmu\u015f olmas\u0131na ra\u011fmen, tarama kartlar\u0131nda ilgili a\u015f\u0131n\u0131n \u00f6nerildi\u011fine, uyguland\u0131\u011f\u0131na veya reddedildi\u011fine ili\u015fkin kay\u0131t bulunmayan durumlar \u201cpotansiyel ka\u00e7\u0131r\u0131lm\u0131\u015f a\u015f\u0131 f\u0131rsat\u0131\u201d olarak de\u011ferlendirildi.<\/p>\n

\u0130statistiksel Analiz<\/b><\/h3>\n

Verilerin istatistiksel analizi IBM SPSS Statistics 23.0 program\u0131 (IBM Corp., Armonk, NY, ABD) kullan\u0131larak ger\u00e7ekle\u015ftirildi. De\u011fi\u015fkenlerin normal da\u011f\u0131l\u0131ma uygunlu\u011fu Kolmogorov-Smirnov ve Shapiro-Wilk testleri ile de\u011ferlendirildi. S\u00fcrekli de\u011fi\u015fkenler ortalama ve standart sapma olarak, kategorik de\u011fi\u015fkenler ise say\u0131 (n) ve y\u00fczde (%) olarak ifade edildi. Kategorik verilerin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda Pearson \u03c7\u00b2 testi veya Fisher kesin testi kullan\u0131ld\u0131. T\u00fcm analizlerde istatistiksel anlaml\u0131l\u0131k d\u00fczeyi p<\/i><0.05 olarak kabul edildi.<\/p>\n

\u00c7al\u0131\u015fma protokol\u00fc, Helsinki Bildirgesi ilkelerine uygun olarak y\u00fcr\u00fct\u00fcld\u00fc ve Ordu \u00dcniversitesi T\u0131p Fak\u00fcltesi taraf\u0131ndan 7 Ocak 2026 tarihinde 01\/10-2026 karar numaras\u0131yla onayland\u0131. \u00c7al\u0131\u015fman\u0131n retrospektif do\u011fas\u0131 nedeniyle bireysel bilgilendirilmi\u015f onam al\u0131nmad\u0131.<\/p>\n

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

Tablo 1.<\/strong> Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131n\u0131n Demografik ve Mesleki \u00d6zellikleri<\/p><\/div>\n

\u00c7al\u0131\u015fmaya sa\u011fl\u0131k taramas\u0131 yap\u0131lan toplam 775 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 dahil edildi; ya\u015f ortalamas\u0131 37.1\u00b19.9 y\u0131l olup 549\u2019u (%70.8) kad\u0131nd\u0131. Mesleki da\u011f\u0131l\u0131ma bak\u0131ld\u0131\u011f\u0131nda, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %44.8\u2019ini hem\u015fireler, %14.5\u2019ini doktorlar olu\u015fturdu (Tablo 1).<\/p>\n

Toplam 46 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 (%6) en az bir kronik hastal\u0131\u011fa sahipti ve baz\u0131lar\u0131nda birden fazla hastal\u0131k bulundu\u011fundan toplam 56 kronik hastal\u0131k tan\u0131s\u0131 kaydedildi. En s\u0131k g\u00f6r\u00fclen komorbiditeler s\u0131ras\u0131yla diabetes mellitus (n=20, %2.6), kalp yetmezli\u011fi ve hipertansiyondu (her ikisi i\u00e7in n=11, %1.4). Saptanan di\u011fer kronik hastal\u0131klar kronik hepatit B (n=7, %0.9), hipotiroidi (n=4, %0.5), kronik b\u00f6brek yetmezli\u011fi (n=2, %0.3) ve splenektomi (n=1, %0.1) idi.<\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n viral hepatit ve a\u015f\u0131yla \u00f6nlenebilir hastal\u0131klar seropozitiflik sonu\u00e7lar\u0131 a\u015fa\u011f\u0131da sunuldu:<\/p>\n

Hepatit B (HBV)<\/strong><\/em><\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n 693\u2019\u00fcnde (%89.4) anti-HBs pozitifli\u011fi (>10 \u0130\u00dc\/ml) g\u00f6r\u00fcld\u00fc. Yedi (%1) sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131nda kronik HBV infeksiyonu mevcutken, tarama an\u0131nda anti-HBs d\u00fczeyi <10 \u0130\u00dc\/ml olan 75 (%9.6) birey bulunuyordu. Meslek gruplar\u0131na g\u00f6re anti-HBs da\u011f\u0131l\u0131m\u0131 incelendi\u011finde, pozitiflik oranlar\u0131n\u0131n gruplar aras\u0131nda istatistiksel olarak anlaml\u0131 farkl\u0131l\u0131k g\u00f6sterdi\u011fi saptand\u0131 (p<\/i><0.001). En y\u00fcksek seropozitiflik %95.6 ile hem\u015firelerde g\u00f6r\u00fcl\u00fcrken; sekreter (%77) ve temizlik personeli (%79.2) gruplar\u0131nda bu oran\u0131n hastane genelindeki orandan daha d\u00fc\u015f\u00fck oldu\u011fu belirlendi.<\/p>\n

Hepatit A (HAV)<\/strong><\/em><\/p>\n

Toplam 617 (%79.6) sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131nda anti-HAV IgG pozitifli\u011fi g\u00f6r\u00fcld\u00fc. Anti-HAV negatif saptanan 158 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n 60\u2019\u0131na (%38) hepatit A a\u015f\u0131s\u0131 uygulanm\u0131\u015fken, 98\u2019inin (%62) a\u015f\u0131s\u0131z oldu\u011fu belirlendi.<\/p>\n

Meslek gruplar\u0131na g\u00f6re hepatit A ba\u011f\u0131\u015f\u0131kl\u0131k durumu incelendi\u011finde, gruplar aras\u0131nda istatistiksel olarak anlaml\u0131 bir farkl\u0131l\u0131k saptand\u0131 (p<\/i><0.031). Do\u011fal yolla veya a\u015f\u0131lama ile kazan\u0131lan toplam ba\u011f\u0131\u015f\u0131kl\u0131k oran\u0131n\u0131n en y\u00fcksek oldu\u011fu grup temizlik personeli (%94.8) idi. Buna kar\u015f\u0131n, anti-HAV negatif ve a\u015f\u0131s\u0131z (korunmas\u0131z) personelin da\u011f\u0131l\u0131m\u0131na bak\u0131ld\u0131\u011f\u0131nda, bu oran\u0131n doktorlarda (%17) ve hem\u015firelerde (%15.6) en y\u00fcksek oldu\u011fu g\u00f6r\u00fcld\u00fc.<\/p>\n

K\u0131zam\u0131k (Rubeola)<\/strong><\/em><\/p>\n

\u00c7al\u0131\u015fanlar\u0131n 689\u2019unda (%88.9) seropozitiflik saptan\u0131rken, 86\u2019s\u0131nda (%11.1) ba\u011f\u0131\u015f\u0131kl\u0131k bulunmad\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. Meslek gruplar\u0131 incelendi\u011finde, en y\u00fcksek k\u0131zam\u0131k IgG pozitifli\u011fi oran\u0131 %92.5 ile hem\u015firelerde g\u00f6r\u00fcld\u00fc.<\/p>\n

K\u0131zam\u0131k\u00e7\u0131k (Rubella)<\/strong><\/em><\/p>\n

Toplam 744 (%96) \u00e7al\u0131\u015fanda seropozitiflik saptand\u0131. Rubella ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 olmayan toplam 31 (%4) \u00e7al\u0131\u015fan bulunurken bunlar\u0131n 26\u2019s\u0131 do\u011furganl\u0131k \u00e7a\u011f\u0131nda olan konjenital rubella sendromu riski ta\u015f\u0131yan kad\u0131n \u00e7al\u0131\u015fanlard\u0131.<\/p>\n

Kabakulak (Mumps)<\/strong><\/em><\/p>\n

Kabakulak seropozitifli\u011fi 733 (%94.5) ki\u015fide saptand\u0131. Kabakulak ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bulunmayan toplam 42 (%5.5) \u00e7al\u0131\u015fan vard\u0131 ve bunlar\u0131n 14\u2019\u00fc eri\u015fkin ya\u015fta infeksiyon ge\u00e7irmesi halinde or\u015fit riski ta\u015f\u0131yan erkeklerdi.<\/p>\n

Su\u00e7i\u00e7e\u011fi<\/strong><\/em><\/p>\n

Su\u00e7i\u00e7e\u011fi seropozitifli\u011fi 753 (%97.2) ki\u015fide saptand\u0131. Ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 olmayan 22 (%2,8) \u00e7al\u0131\u015fan vard\u0131.\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 2.<\/strong> Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131nda A\u015f\u0131yla \u00d6nlenebilir Hastal\u0131klar\u0131n Meslek Gruplar\u0131na G\u00f6re Seropozitiflik ve Ba\u011f\u0131\u015f\u0131klama Durumu Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

Meslek gruplar\u0131 kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, k\u0131zam\u0131k, k\u0131zam\u0131k\u00e7\u0131k, kabakulak ve su\u00e7i\u00e7e\u011fi seropozitiflik oranlar\u0131 a\u00e7\u0131s\u0131ndan istatistiksel olarak anlaml\u0131 bir farkl\u0131l\u0131k izlenmedi (p<\/i>>0.05). A\u015f\u0131yla \u00f6nlenebilir hastal\u0131klar\u0131n meslek gruplar\u0131na g\u00f6re seropozitiflik ve ba\u011f\u0131\u015f\u0131kl\u0131k durumu da\u011f\u0131l\u0131m\u0131 ayr\u0131nt\u0131l\u0131 olarak Tablo 2\u2019de sunuldu.<\/p>\n

Pn\u00f6mokok ve \u0130nfluenza<\/strong><\/em><\/p>\n

Genel grupta pn\u00f6mokok a\u015f\u0131lanma oran\u0131 %4.5 (n=35) olup 13 valanl\u0131 pn\u00f6mokokal konjuge a\u015f\u0131s\u0131 (PCV13) uygulanm\u0131\u015f olan 32 (%4.1), 23 valanl\u0131 pn\u00f6mokokal polisakkarit a\u015f\u0131s\u0131 (PPSV23) uygulanm\u0131\u015f olan ise sadece 3 (%0.4) \u00e7al\u0131\u015fan vard\u0131.\u00a0<\/span><\/p>\n

Kronik hastal\u0131k varl\u0131\u011f\u0131 veya ya\u015f kriteri nedeniyle pn\u00f6mokok a\u015f\u0131s\u0131 endikasyonu bulunan toplam 126 ki\u015fi saptand\u0131. Bu grup incelendi\u011finde; sadece %7.9\u2019unun (n=10) pn\u00f6mokok a\u015f\u0131s\u0131 oldu\u011fu ve bu a\u015f\u0131lar\u0131n tamam\u0131n\u0131n PCV13 oldu\u011fu belirlendi. Mevcut kay\u0131tlara g\u00f6re risk grubunda \u00f6nerilen pn\u00f6mokok a\u015f\u0131lama \u015femas\u0131n\u0131 tamamlam\u0131\u015f olan hi\u00e7bir sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 saptanmad\u0131. Ayn\u0131 grubun yaln\u0131zca %18.2\u2019sinin (n=23) influenza a\u015f\u0131s\u0131 oldu\u011fu g\u00f6r\u00fcld\u00fc.<\/p>\n

\u00c7al\u0131\u015fmada 50 ya\u015f ve \u00fczerindeki 108 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n %18.5\u2019i influenza, %7\u2019si ise PCV13 ile a\u015f\u0131lanm\u0131\u015ft\u0131. ACIP 2024 kriterlerine g\u00f6re bu ya\u015f grubundaki personelin %93\u2019\u00fcnde pn\u00f6mokok a\u015f\u0131s\u0131 a\u00e7\u0131s\u0131ndan g\u00fcncel bir \u201ckar\u015f\u0131lanmam\u0131\u015f a\u015f\u0131lama gereksinimi\u201d bulundu\u011fu saptand\u0131.<\/p>\n

G\u00fcncel rehberlere g\u00f6re izole hipertansiyon ve hipotiroidi gibi pn\u00f6mokok i\u00e7in risk olu\u015fturmayan tan\u0131lar d\u0131\u015fland\u0131\u011f\u0131nda, kronik hastal\u0131\u011f\u0131 bulunan 46 ki\u015finin 39\u2019unda pn\u00f6mokok a\u015f\u0131s\u0131 endikasyonu vard\u0131; bu grubun yaln\u0131zca 5\u2019inin a\u015f\u0131l\u0131 oldu\u011fu belirlendi. Kronik hastal\u0131\u011f\u0131 olup 50 ya\u015f alt\u0131nda olan 18 kat\u0131l\u0131mc\u0131n\u0131n yaln\u0131zca 2\u2019sine PCV13 a\u015f\u0131s\u0131 uygulanm\u0131\u015ft\u0131. \u00d6te yandan pn\u00f6mokok a\u015f\u0131s\u0131 endikasyonu bulunmayan 25 kat\u0131l\u0131mc\u0131n\u0131n pn\u00f6mokok a\u015f\u0131s\u0131 yapt\u0131rd\u0131\u011f\u0131 belirlendi.<\/p>\n

\"\"<\/a>

Tablo 3.<\/strong> Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131nda A\u015f\u0131lanma Durumu ve Potansiyel Ka\u00e7\u0131r\u0131lm\u0131\u015f A\u015f\u0131lama F\u0131rsatlar\u0131<\/p><\/div>\n

T\u00fcm \u00e7al\u0131\u015fma periyodu boyunca influenza i\u00e7in genel a\u015f\u0131 kabul\u00fc de\u011ferlendirildi\u011finde, 2015 y\u0131l\u0131 sonras\u0131nda herhangi bir zamanda en az bir kez influenza a\u015f\u0131s\u0131 yapt\u0131rd\u0131\u011f\u0131n\u0131 bildiren \u00e7al\u0131\u015fan say\u0131s\u0131 129 (%16.6) olarak saptand\u0131. Ancak a\u015f\u0131n\u0131n y\u0131ll\u0131k\/sezonluk koruyuculu\u011fu dikkate al\u0131narak g\u00fcncel a\u015f\u0131lanma durumu de\u011ferlendirildi\u011finde, 2025 y\u0131l\u0131 sezonunda influenza a\u015f\u0131s\u0131 olan sadece 13 (%1.7) ki\u015fi vard\u0131. Buna g\u00f6re 2025 y\u0131l\u0131na ait g\u00fcncel \u201ckar\u015f\u0131lanmam\u0131\u015f a\u015f\u0131lama gereksinimi\u201d (eksik a\u015f\u0131lama) oran\u0131 %98.3 olarak belirlendi. A\u015f\u0131lanma durumu ve \u201ckar\u015f\u0131lanmam\u0131\u015f a\u015f\u0131lama gereksinimi\u201d sonu\u00e7lar\u0131 Tablo 3\u2019te sunuldu.\u00a0<\/span><\/p>\n

\u0130RDELEME<\/b><\/h2>\n

Bu \u00e7al\u0131\u015fmada, periyodik i\u015f sa\u011fl\u0131\u011f\u0131 taramalar\u0131ndan ge\u00e7en sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda eri\u015fkin ba\u011f\u0131\u015f\u0131klamas\u0131n\u0131n farkl\u0131 bile\u015fenleri aras\u0131nda \u201cka\u00e7\u0131r\u0131lm\u0131\u015f a\u015f\u0131 f\u0131rsatlar\u0131\u201d bulundu\u011fu saptand\u0131. En belirgin bo\u015fluklar hepatit A, pn\u00f6mokok ve influenza a\u015f\u0131lamas\u0131nda g\u00f6r\u00fcld\u00fc; hepatit A a\u00e7\u0131s\u0131ndan duyarl\u0131 158 \u00e7al\u0131\u015fan\u0131n yaln\u0131zca %38\u2019inin a\u015f\u0131l\u0131 oldu\u011fu, pn\u00f6mokok endikasyonu bulunan 126 \u00e7al\u0131\u015fan\u0131n yaln\u0131zca %7.9\u2019unun a\u015f\u0131land\u0131\u011f\u0131 ve 2025 influenza sezonunda a\u015f\u0131l\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 oran\u0131n\u0131n %1.6\u2019da kald\u0131\u011f\u0131 belirlendi. \u00d6te yandan, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n yakla\u015f\u0131k %90\u2019\u0131nda koruyucu d\u00fczeyde anti-HBs (>10 \u0130\u00dc\/ml) oldu\u011fu g\u00f6r\u00fcld\u00fc. Ancak, kan ve v\u00fccut s\u0131v\u0131s\u0131 temas\u0131 a\u00e7\u0131s\u0131ndan y\u00fcksek risk ta\u015f\u0131yan bu meslek grubunda %9.6\u2019l\u0131k bir kesimin tarama an\u0131nda seronegatif (<10 \u0130\u00dc\/ml) olmas\u0131, i\u015f sa\u011fl\u0131\u011f\u0131 ba\u011flam\u0131nda dikkate de\u011fer bir a\u00e7\u0131\u011fa i\u015faret etmektedir. Uluslararas\u0131 kurulu\u015flar taraf\u0131ndan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ba\u011f\u0131\u015f\u0131klanmas\u0131 \u00f6ncelikli bir koruyucu strateji olarak tan\u0131mlanmas\u0131na ve g\u00fcncel yasal d\u00fczenlemelere ra\u011fmen, \u00e7al\u0131\u015fmam\u0131z\u0131n bulgular\u0131 sahadaki eri\u015fkin ba\u011f\u0131\u015f\u0131klama uygulamalar\u0131nda h\u00e2len \u00f6nemli bo\u015fluklar bulundu\u011funu g\u00f6stermektedir (1,8).<\/p>\n

Hepatit B i\u00e7in saptanan y\u00fcksek seropozitiflik, bu alanda daha yerle\u015fik bir kurumsal izlem bulundu\u011funu d\u00fc\u015f\u00fcnd\u00fcrmektedir. \u00c7al\u0131\u015fmam\u0131zda genel anti-HBs seropozitifli\u011fi %89.4 gibi y\u00fcksek bir oranda saptanm\u0131\u015f olmakla birlikte meslek gruplar\u0131na g\u00f6re yap\u0131lan analizde temizlik personeli (%79.2) ve sekreter (%77) gruplar\u0131nda bu oran\u0131n hastane ortalamas\u0131n\u0131n anlaml\u0131 d\u00fczeyde alt\u0131nda kald\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. Bu durum, hepatit B\u2019ye kar\u015f\u0131 korunman\u0131n t\u00fcm \u00e7al\u0131\u015fan gruplar\u0131nda e\u015fit d\u00fczeyde sa\u011flanamad\u0131\u011f\u0131n\u0131 ve baz\u0131 meslek gruplar\u0131nda ba\u011f\u0131\u015f\u0131klama hizmetlerine eri\u015fim ya da izlemin yetersiz kalabildi\u011fini g\u00f6stermektedir. Azap ve arkada\u015flar\u0131n\u0131n \u00e7al\u0131\u015fmas\u0131nda (15), sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda ya\u015fam boyu kan ve v\u00fccut s\u0131v\u0131s\u0131na maruziyet oran\u0131 %64 gibi y\u00fcksek bir d\u00fczeyde bildirilmi\u015ftir; ayn\u0131 \u00e7al\u0131\u015fmada yaralanmaya maruz kalan personelin %32\u2019sinin hepatit B a\u015f\u0131s\u0131n\u0131n olmad\u0131\u011f\u0131 da saptanm\u0131\u015ft\u0131r. \u00c7al\u0131\u015fmam\u0131zda da kesici-delici alet yaralanmalar\u0131 a\u00e7\u0131s\u0131ndan y\u00fcksek risk alt\u0131nda olan temizlik personelinin yakla\u015f\u0131k %20\u2019sinin korumas\u0131z (seronegatif) bulunmas\u0131, bu grupta ba\u011f\u0131\u015f\u0131klama a\u00e7\u0131s\u0131ndan \u00f6nemli bir bo\u015fluk oldu\u011funu d\u00fc\u015f\u00fcnd\u00fcrmektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda hepatit A ba\u011f\u0131\u015f\u0131kl\u0131k durumu da meslek gruplar\u0131na g\u00f6re anlaml\u0131 farkl\u0131l\u0131klar g\u00f6sterdi. Dikkat \u00e7ekici bir \u015fekilde, hepatit B\u2019deki tablonun aksine, anti-HAV negatif ve a\u015f\u0131s\u0131z \u00e7al\u0131\u015fan oran\u0131 doktorlarda (%17) ve hem\u015firelerde (%15.6) en y\u00fcksekti. Temizlik personelinin ise hepatit A a\u00e7\u0131s\u0131ndan %80.2 oran\u0131nda (do\u011fal veya a\u015f\u0131 yoluyla) ba\u011f\u0131\u015f\u0131k oldu\u011fu g\u00f6r\u00fcld\u00fc. Bu durum, i\u015f sa\u011fl\u0131\u011f\u0131 uygulamalar\u0131nda meslek gruplar\u0131na g\u00f6re ba\u011f\u0131\u015f\u0131klanma farkl\u0131l\u0131klar\u0131n\u0131n g\u00f6z \u00f6n\u00fcnde bulundurulmas\u0131 gerekti\u011fini g\u00f6stermektedir.<\/p>\n

Uluslararas\u0131 rehberler rutin hepatit A a\u015f\u0131s\u0131n\u0131 yaln\u0131zca belirli riskli birimlerdeki sa\u011fl\u0131k personeli ile s\u0131n\u0131rland\u0131rmakla birlikte bu yakla\u015f\u0131m \u00fclkemizin b\u00f6lgesel ger\u00e7ekleriyle \u00f6rt\u00fc\u015fmemektedir (1). G\u00fcncel meta-analiz verileri, T\u00fcrkiye\u2019nin hepatit A a\u00e7\u0131s\u0131ndan orta endemisite\/ge\u00e7i\u015f \u00fclkesi oldu\u011funu ve b\u00f6lgeler aras\u0131nda belirgin heterojenite bulundu\u011funu g\u00f6stermektedir (16). T\u00fcrkiye\u2019den 12 476 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131 kapsayan yak\u0131n tarihli bir \u00e7al\u0131\u015fmada, kat\u0131l\u0131mc\u0131lar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funun (%66.3) hepatit A a\u00e7\u0131s\u0131ndan a\u015f\u0131s\u0131z oldu\u011fu bildirilmi\u015f ve hastal\u0131\u011f\u0131n eri\u015fkin ya\u015fta fulminan seyredebilmesi nedeniyle seronegatif bireylerin a\u015f\u0131lanmas\u0131n\u0131n en g\u00fcvenli yakla\u015f\u0131m oldu\u011fu raporlanm\u0131\u015ft\u0131r (17). Ayr\u0131ca hastane prati\u011finde personelin g\u00f6rev yerinin zaman i\u00e7inde de\u011fi\u015febilmesi ve fekal-oral bula\u015fma a\u00e7\u0131s\u0131ndan riskli birimlere ge\u00e7i\u015f yapabilmesi, maruziyet riskinin yaln\u0131zca anl\u0131k g\u00f6rev yerine g\u00f6re de\u011ferlendirilmesini yetersiz k\u0131lmaktad\u0131r.\u00a0<\/span><\/p>\n

Nitekim T\u00fcrkiye Viral Hepatit Kontrol Program\u0131 da sa\u011fl\u0131k personelini risk grubu olarak tan\u0131mlayarak a\u015f\u0131 kapsay\u0131c\u0131l\u0131\u011f\u0131n\u0131n art\u0131r\u0131lmas\u0131n\u0131 hedeflemi\u015ftir (18). Uluslararas\u0131 rehberlerde sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 i\u00e7in evrensel rutin a\u015f\u0131 olarak \u00f6nerilmese de \u00fclkemizin ge\u00e7i\u015f endemisitesi, sa\u011fl\u0131k personelindeki y\u00fcksek seronegatiflik oran\u0131, hastal\u0131\u011f\u0131n eri\u015fkinlerde daha a\u011f\u0131r seyretmesi ve dinamik personel rotasyonlar\u0131 birlikte de\u011ferlendirildi\u011finde, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda hepatit A duyarl\u0131l\u0131\u011f\u0131n\u0131n taranmas\u0131 ve seronegatif olanlar\u0131n a\u015f\u0131lanmas\u0131 gerekli g\u00f6r\u00fcnmektedir. Bu \u00e7er\u00e7evede, periyodik i\u015f sa\u011fl\u0131\u011f\u0131 taramalar\u0131nda seronegatif oldu\u011fu saptanan sa\u011fl\u0131k personelinin a\u015f\u0131lanmamas\u0131, \u00e7al\u0131\u015fmam\u0131z a\u00e7\u0131s\u0131ndan \u201ckar\u015f\u0131lanmam\u0131\u015f a\u015f\u0131lama gereksinimi\u201d olarak de\u011ferlendirildi.<\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda k\u0131zam\u0131k\u00e7\u0131k ve kabakulak a\u00e7\u0131s\u0131ndan saptanan duyarl\u0131l\u0131k, yaln\u0131zca bireysel korunma a\u00e7\u0131s\u0131ndan de\u011fil, nozokomiyal bula\u015fman\u0131n \u00f6nlenmesi a\u00e7\u0131s\u0131ndan da \u00f6nemlidir. \u00c7al\u0131\u015fmam\u0131zda k\u0131zam\u0131k\u00e7\u0131k seronegatifli\u011finin %4, kabakulak seronegatifli\u011finin %5 d\u00fczeyinde bulunmas\u0131, i\u015f sa\u011fl\u0131\u011f\u0131 taramalar\u0131nda MMR ba\u011f\u0131\u015f\u0131klamas\u0131n\u0131n sistematik olarak de\u011ferlendirilmesi gerekti\u011fini g\u00f6stermektedir. \u00d6zellikle k\u0131zam\u0131k\u00e7\u0131k a\u00e7\u0131s\u0131ndan duyarl\u0131 kad\u0131n \u00e7al\u0131\u015fanlar ve kabakulak a\u00e7\u0131s\u0131ndan duyarl\u0131 erkek \u00e7al\u0131\u015fanlar, olas\u0131 ciddi komplikasyonlar nedeniyle dikkatle de\u011ferlendirilmesi gereken alt gruplard\u0131r.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n dikkat \u00e7ekici bulgular\u0131ndan biri, kronik hastal\u0131\u011f\u0131 olan veya ya\u015f kriteri nedeniyle risk grubunda bulunan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda pn\u00f6mokok ve influenza a\u015f\u0131lar\u0131n\u0131n son derece d\u00fc\u015f\u00fck oranlarda uygulanm\u0131\u015f olmas\u0131d\u0131r. Risk grubundaki pn\u00f6mokok a\u015f\u0131lanma oran\u0131 %8\u2019e kalm\u0131\u015f ve hi\u00e7bir \u00e7al\u0131\u015fan \u00f6nerilen a\u015f\u0131lama \u015femas\u0131n\u0131 tamamlamam\u0131\u015ft\u0131r. \u00d6zellikle ACIP\u2019\u0131n 2024 y\u0131l\u0131nda pn\u00f6mokok a\u015f\u0131s\u0131 endikasyon ya\u015f\u0131n\u0131 65\u2019ten 50\u2019ye d\u00fc\u015f\u00fcrmesiyle birlikte, \u00e7al\u0131\u015fmam\u0131zda bu ya\u015f grubunda %93 oran\u0131nda \u201ckar\u015f\u0131lanmam\u0131\u015f a\u015f\u0131lama gereksinimi\u201d oldu\u011fu ortaya \u00e7\u0131km\u0131\u015ft\u0131r (9). \u00d6te yandan, pn\u00f6mokok endikasyonu bulunmayan 25 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n a\u015f\u0131lanm\u0131\u015f olmas\u0131 da dikkat \u00e7ekicidir.\u00a0<\/span><\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda y\u0131ll\u0131k influenza a\u015f\u0131lamas\u0131 hem mesleki i\u015f g\u00fcc\u00fc kayb\u0131n\u0131 hem de duyarl\u0131 hastalara nozokomiyal bula\u015fmay\u0131 \u00f6nlemek amac\u0131yla g\u00fcncel uluslararas\u0131 rehberler (ACIP, DS\u00d6) taraf\u0131ndan kuvvetle \u00f6nerilmektedir (1,3,19). Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda influenza a\u015f\u0131lanma oranlar\u0131n\u0131n d\u00fcnya genelinde ortalama %41.7 civar\u0131nda oldu\u011fu bildirilmekle birlikte b\u00f6lgesel farkl\u0131l\u0131klar olduk\u00e7a belirgindir (19,20). T\u00fcrkiye\u2019de y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fmalarda ise y\u0131ll\u0131k a\u015f\u0131lanma oranlar\u0131 %4\u20138 civar\u0131nda rapor edilmi\u015f (5,21) olup \u00e7al\u0131\u015fmam\u0131zda 2025 sezonunda g\u00fcncel influenza a\u015f\u0131s\u0131 yapt\u0131ran sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n oran\u0131n\u0131n yaln\u0131zca %1.6 olmas\u0131 ciddi bir \u201ckar\u015f\u0131lanmam\u0131\u015f a\u015f\u0131lama gereksinimi\u201d tablosunu ortaya koydu.\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda 2015 y\u0131l\u0131 sonras\u0131nda en az bir kez influenza a\u015f\u0131s\u0131 yapt\u0131ranlar\u0131n oran\u0131 %17 idi. A\u015f\u0131n\u0131n koruyuculu\u011fu sezonluk oldu\u011fundan, bu veri g\u00fcncel ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 de\u011fil, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n \u201cgenel a\u015f\u0131 kabul\u00fcn\u00fc\u201d yans\u0131tmaktad\u0131r. Ge\u00e7mi\u015fte en az bir kez a\u015f\u0131 yapt\u0131rm\u0131\u015f olmalar\u0131na ra\u011fmen, g\u00fcncel 2025 sezonunda a\u015f\u0131lanma oran\u0131n\u0131n %1.6\u2019ya d\u00fc\u015fmesi, influenza a\u015f\u0131lamas\u0131nda s\u00fcreklili\u011fin sa\u011flanamad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fcrmektedir. Dolay\u0131s\u0131yla, influenza ba\u011f\u0131\u015f\u0131klamas\u0131nda rehberlerin hedefledi\u011fi oranlara ula\u015fabilmek i\u00e7in s\u00fcrecin \u00e7al\u0131\u015fanlar\u0131n bireysel karar\u0131na b\u0131rak\u0131lmamas\u0131; her sezon \u00f6ncesinde kurumsal d\u00fczeyde aktif y\u00f6nlendirme yap\u0131lmas\u0131 gerekmektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda hepatit B ba\u011f\u0131\u015f\u0131klamas\u0131nda sa\u011flanan y\u00fcksek ba\u015far\u0131 oran\u0131 ile pn\u00f6mokok ve influenza a\u015f\u0131lamalar\u0131ndaki d\u00fc\u015f\u00fck oranlar aras\u0131ndaki belirgin farkl\u0131l\u0131k; g\u00fcncel a\u015f\u0131 rehberlerinin i\u015f sa\u011fl\u0131\u011f\u0131 tarama programlar\u0131na sistematik bi\u00e7imde entegre edilemedi\u011fini ve uygulamalar\u0131n h\u00e2len geleneksel alanlara odakland\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fcrmektedir. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, kurumsal olarak \u00f6nceliklendirilen ve aktif takibi yap\u0131lan hepatit B a\u015f\u0131lamas\u0131na daha y\u00fcksek uyum g\u00f6sterirken, di\u011fer eri\u015fkin a\u015f\u0131lar\u0131nda eksikliklerin g\u00f6r\u00fclmesi kurumsal tarama ve y\u00f6nlendirme stratejilerinin yetersizli\u011finden kaynaklan\u0131yor olabilir. Kronik hastal\u0131\u011f\u0131 bulunan veya ileri ya\u015f nedeniyle risk ta\u015f\u0131yan \u00e7al\u0131\u015fanlar\u0131n periyodik taramalardan ge\u00e7melerine ra\u011fmen endikasyonu olan a\u015f\u0131lar\u0131n\u0131n yap\u0131lmam\u0131\u015f olmas\u0131 eri\u015fkin ba\u011f\u0131\u015f\u0131klamas\u0131nda \u201cpotansiyel ka\u00e7\u0131r\u0131lm\u0131\u015f a\u015f\u0131 f\u0131rsat\u0131\u201d olu\u015fturmaktad\u0131r. Sonu\u00e7 olarak, periyodik i\u015f sa\u011fl\u0131\u011f\u0131 taramalar\u0131n\u0131n yaln\u0131zca hepatit B odakl\u0131 dar bir \u00e7er\u00e7eveden \u00e7\u0131kar\u0131larak risk temelli ve b\u00fct\u00fcnc\u00fcl bir eri\u015fkin ba\u011f\u0131\u015f\u0131klama yakla\u015f\u0131m\u0131yla yeniden yap\u0131land\u0131r\u0131lmas\u0131 hem a\u015f\u0131lanma oranlar\u0131n\u0131n art\u0131r\u0131lmas\u0131nda hem de solunum yolu infeksiyonlar\u0131n\u0131n k\u00fcresel y\u00fck\u00fcn\u00fcn azalt\u0131lmas\u0131na katk\u0131 sa\u011flayabilir (22).\u00a0<\/span><\/p>\n

Periyodik muayeneler s\u0131ras\u0131nda ilgili a\u015f\u0131lar\u0131n hekim taraf\u0131ndan \u00f6nerilip \u00f6nerilmedi\u011fine veya personelin reddetme gerek\u00e7elerine dair verilerin kay\u0131tlarda yer almamas\u0131 \u00e7al\u0131\u015fmam\u0131z\u0131n k\u0131s\u0131tl\u0131l\u0131klar\u0131ndan biridir. Bir di\u011fer k\u0131s\u0131tl\u0131l\u0131k ise kurum d\u0131\u015f\u0131nda (aile hekimlikleri vb.) yapt\u0131r\u0131lan influenza a\u015f\u0131lar\u0131n\u0131n kurumsal sisteme yans\u0131mamas\u0131 ve %98.3 olarak hesaplanan eksik a\u015f\u0131lama oran\u0131n\u0131n oldu\u011fundan y\u00fcksek hesaplanm\u0131\u015f olma olas\u0131l\u0131\u011f\u0131d\u0131r. Ancak bu durum dahi, personelin kurum d\u0131\u015f\u0131 ba\u011f\u0131\u015f\u0131klama verilerinin i\u015f sa\u011fl\u0131\u011f\u0131 birimlerince rutin olarak izlenemedi\u011fine ve kurumsal kay\u0131t sistemlerindeki entegrasyon eksikli\u011fine i\u015faret etmektedir.\u00a0<\/span><\/p>\n

Sonu\u00e7 olarak, \u00e7al\u0131\u015fmam\u0131z sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda \u00f6zellikle pn\u00f6mokok ve influenza a\u015f\u0131lar\u0131 a\u00e7\u0131s\u0131ndan \u00f6nemli bir ba\u011f\u0131\u015f\u0131klama sorunu oldu\u011funu d\u00fc\u015f\u00fcnd\u00fcrmektedir. Hepatit B ile di\u011fer eri\u015fkin a\u015f\u0131lar\u0131 aras\u0131ndaki bu farkl\u0131l\u0131k, kurumsal izlem ve y\u00f6nlendirme s\u00fcre\u00e7lerinin \u00f6nemini ortaya koymaktad\u0131r. \u0130\u015f sa\u011fl\u0131\u011f\u0131 taramalar\u0131n\u0131n ayn\u0131 zamanda sistematik bir ba\u011f\u0131\u015f\u0131klama de\u011ferlendirmesi f\u0131rsat\u0131 olarak kullan\u0131lmas\u0131 ve eri\u015fkin a\u015f\u0131lama stratejilerinin kurumsal d\u00fczeyde g\u00fc\u00e7lendirilmesi hem sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n korunmas\u0131na hem de hastane i\u00e7i bula\u015fmalar\u0131n \u00f6nlenmesine \u00f6nemli katk\u0131 sa\u011flayabilir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, mesleki uygulamalar s\u0131ras\u0131nda infeksiy\u00f6z ajanlara maruziyet riskinin y\u00fcksek olmas\u0131 ve ayn\u0131 zamanda imm\u00fcns\u00fcprese, ya\u015fl\u0131 veya kronik hastal\u0131\u011f\u0131 bulunan duyarl\u0131 hasta gruplar\u0131na infeksiyon bula\u015ft\u0131rma potansiyelleri nedeniyle a\u015f\u0131lama a\u00e7\u0131s\u0131ndan \u00f6ncelikli risk gruplar\u0131 aras\u0131nda yer almaktad\u0131r (1,2). Bu nedenle sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ba\u011f\u0131\u015f\u0131klanmas\u0131, yaln\u0131zca bireysel korunma a\u00e7\u0131s\u0131ndan de\u011fil, hasta g\u00fcvenli\u011fi ve sa\u011fl\u0131k hizmetlerinin s\u00fcreklili\u011fi a\u00e7\u0131s\u0131ndan da […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5758,6369,4799,6370,4800,3675],"class_list":["post-32437","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-asilama","tag-hepatit-a-asilari","tag-influenza-asilari","tag-kacirilmis-asilama-firsatlari","tag-pnomokok-asilari","tag-saglik-calisanlari"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32437","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\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=32437"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32437\/revisions"}],"predecessor-version":[{"id":32639,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32437\/revisions\/32639"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=32437"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=32437"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=32437"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}