Gershon Robyn R M, Pearson Julie M, Sherman Martin F, Samar Stephanie M, Canton Allison N, Stone Patricia W
Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Am J Infect Control. 2009 Sep;37(7):525-33. doi: 10.1016/j.ajic.2008.10.022. Epub 2009 Feb 12.
Patients continue to enter home health care (HHC) "sicker and quicker," often with complex health problems that require extensive intervention. This higher level of acuity may increase the risk of percutaneous injury (PI), yet information on the risk and risk factors for PI and other types of exposures in this setting is exceptionally sparse. To address this gap, a large cross-sectional study of self-reported exposures in HHC registered nurses (RNs) was conducted.
A convenience sample of HHC RNs (N=738) completed a survey addressing 5 major constructs: (1) worker-centered characteristics, (2) patient-related characteristics, (3) household characteristics, (4) organizational factors, and (5) prevalence of PIs and other blood and body fluid exposures. Analyses were directed at determining significant risk factors for exposure.
Fourteen percent of RNs reported one or more PIs in the past 3 years (7.6 per 100 person-years). Nearly half (45.8%) of all PIs were not formally reported. PIs were significantly correlated with a number of factors, including lack of compliance with Standard Precautions (odds ratio [OR], 1.72; P=.019; 95% confidence interval [CI]: 1.09-2.71); recapping of needles (OR, 1.78; P=.016; 95% CI: 1.11-2.86); exposure to household stressors (OR, 1.99; P=.005; 95% CI: 1.22-3.25); exposure to violence (OR, 3.47; P=.001; 95% CI: 1.67-7.20); mandatory overtime (OR, 2.44; P=.006; 95% CI: 1.27-4.67); and safety climate (OR, 1.88; P=.004; 95% CI: 1.21-2.91) among others.
The prevalence of PI was substantial. Underreporting rates and risk factors for exposure were similar to those identified in other RN work populations, although factors uniquely associated with home care were also identified. Risk mitigation strategies tailored to home care are needed to reduce risk of exposure in this setting.
患者进入家庭医疗保健（HHC）时病情往往更重且来得更快，通常伴有需要广泛干预的复杂健康问题。这种更高的 acuity 水平可能会增加经皮损伤（PI）的风险，然而，关于这种情况下 PI 及其他类型暴露的风险和风险因素的信息极为稀少。为填补这一空白，对家庭医疗保健注册护士（RN）中自我报告的暴露情况进行了一项大型横断面研究。
对家庭医疗保健 RN（N = 738）的便利样本进行了一项调查，涉及 5 个主要方面：（1）以工作者为中心的特征，（2）与患者相关的特征，（3）家庭特征，（4）组织因素，以及（5）PI 及其他血液和体液暴露的发生率。分析旨在确定暴露的显著风险因素。
14%的 RN 报告在过去 3 年中有一次或多次 PI（每 100 人年 7.6 次）。几乎一半（45.8%）的所有 PI 未正式报告。PI 与许多因素显著相关，包括不遵守标准预防措施（比值比[OR]，1.72；P = 0.019；95%置信区间[CI]：1.09 - 2.71）；重新盖帽（OR，1.78；P = 0.016；95%CI：1.11 - 2.86）；暴露于家庭压力源（OR，1.99；P = 0.005；95%CI：1.22 - 3.25）；暴露于暴力（OR，3.47；P = 0.001；95%CI：1.67 - 7.20）；强制加班（OR，2.44；P = 0.006；95%CI：1.27 - 4.67）；以及安全氛围（OR，1.88；P = 0.004；95%CI：1.21 - 2.91）等。
PI 的发生率相当高。尽管也确定了与家庭护理独特相关的因素，但漏报率和暴露风险因素与其他 RN 工作人群中发现的相似。需要针对家庭护理量身定制风险缓解策略，以降低这种情况下的暴露风险。
