Gershon R R, Karkashian C D, Vlahov D, Kummer L, Kasting C, Green-McKenzie J, Escamilla-Cejudo J A, Kendig N, Swetz A, Martin L
Department of Environmental Health Sciences, Johns Hopkins University School of Public Health, Baltimore, Md. 21205, USA.
J Occup Environ Med. 1999 Mar;41(3):181-9. doi: 10.1097/00043764-199903000-00007.
There were three main objectives of this cross-sectional study of Maryland State correctional health care workers. The first was to evaluate compliance with work practices designed to minimize exposure to blood and body fluids; the second, to identify correlates of compliance with universal precautions (UPs); and the third was to determine the relationship, if any, between compliance and exposures. Of 216 responding health care workers, 34% reported overall compliance across all 15 items on a compliance scale. Rates for specific items were particularly low for use of certain types of personal protective equipment, such as protective eyewear (53.5%), face mask (47.2%) and protective clothing (33.9%). Compliance rates were highest for glove use (93.2%) waste disposal (89.8%), and sharps disposal (80.8%). Compliance rates were generally not associated with demographic factors, except for age; younger workers were more likely to be compliant with safe work practices than were older workers (P < 0.05). Compliance was positively associated with several work-related variables, including perceived safety climate (i.e., management's commitment to infection control and the overall safety program) and job satisfaction, and was found to be inversely associated with security-related work constraints, job/task factors, adverse working conditions, workplace discrimination, and perceived work stress. Bloodborne exposures were not uncommon; 13.8% of all respondents had at least one bloodborne exposure within the previous 6 months, and compliance was inversely related to blood and body fluid exposures. This study identified several potentially modifiable correlates of compliance, including factors unique to the correctional setting. Infection-control interventional strategies specifically tailored to these health care workers may therefore be most effective in reducing the risk of bloodborne exposures.
这项针对马里兰州惩教医疗保健工作者的横断面研究有三个主要目标。第一个目标是评估对旨在尽量减少接触血液和体液的工作规范的遵守情况；第二个目标是确定与遵守普遍预防措施（UPs）相关的因素；第三个目标是确定遵守情况与暴露之间的关系（如果存在的话）。在216名回复的医疗保健工作者中，34%的人在一项遵守情况量表上报告称在所有15项内容上总体遵守。某些类型个人防护设备的使用的特定项目比率特别低，如防护眼镜（53.5%）、口罩（47.2%）和防护服（33.9%）。手套使用（93.2%）、废物处理（89.8%）和锐器处理（80.8%）的遵守率最高。除年龄外，遵守率一般与人口统计学因素无关；年轻工作者比年长工作者更有可能遵守安全工作规范（P<0.05）。遵守情况与几个与工作相关的变量呈正相关，包括感知到的安全氛围（即管理层对感染控制和整体安全计划的承诺）和工作满意度，并且发现与安全相关的工作限制、工作/任务因素、不利的工作条件、工作场所歧视和感知到工作压力呈负相关。血源性病原体暴露并不罕见；所有受访者中有13.8%在过去6个月内至少有一次血源性病原体暴露，并且遵守情况与血液和体液暴露呈负相关。这项研究确定了几个可能可改变的遵守情况相关因素，包括惩教环境特有的因素。因此，专门针对这些医疗保健工作者的感染控制干预策略可能在降低血源性病原体暴露风险方面最有效。
