Schoenhoff D D, Lane T W, Hansen C J
Internal Medicine Training Program, Moses Cone Health System, Greensboro, NC 27401-1020, USA.
Infect Control Hosp Epidemiol. 1997 Sep;18(9):633-6. doi: 10.1086/647688.
To determine the knowledge of rubella immune status among practicing obstetrician-gynecologists in the United States and of rubella immunity policies covering healthcare workers in the obstetric-care office setting.
Mailed survey questionnaire, August through December 1994.
Physicians from multiple-practice sites including private office, public institution, university or teaching hospital, and closed panel health maintenance organization settings.
3,302 practicing obstetrician-gynecologists, chosen by a systematic random sample from the AMA national physician database.
Participants were defined as rubella immune if they reported knowledge of prior rubella vaccination or positive antibody titer. Knowledge of a policy for documenting rubella immunity among employees in the office-based practice setting also was assessed.
Questionnaires were returned from 50% (1,666) of the 3,302 surveyed, and 96% (1,599) were evaluable. Approximately 20% (304/1,599) of the responding obstetrician-gynecologists did not have knowledge of documented rubella immunity, and the majority of office-based practices did not require documentation of rubella immunity in the following groups: physicians, 66% (723/1,094); office nurses, 62% (666/1,070); and other office staff, 69% (728/1,063). Sixty-two percent (993/1,599) of responding physicians had individual rubella serologies performed, with 916 known to be positive, 53 reported negative, and 24 reported unknown. Fifty-seven percent (918/1,599) reported receiving monovalent rubella vaccine or trivalent measles-mumps-rubella vaccine. Multiple logistic regression analysis revealed the following to be independent predictors of positive immune status among respondents: female gender (odds ratio [OR], 2.4; 95% confidence interval [CI95], 1.8-3.1), medical school graduation since 1980 (OR, 2.6; CI95, 2.0-3.3), providing obstetric or fertility services (OR, 1.5; CI95, 1.2-1.9), and group practice setting (> or = 5 physicians; OR, 1.2; CI95, 1.1-1.4).
Nationally, nearly one of every five practicing obstetricians may not have documented rubella immunity, and the majority of office-based practices have no system for assuring such immunity. Rubella immunity should extend beyond the hospital setting, with consideration for requiring rubella immunity as a condition for employment. Methods for effective implementation and documentation of current guidelines need to be addressed, particularly in the office setting.
确定美国执业妇产科医生对风疹免疫状态的了解情况，以及产科护理办公室环境中涵盖医护人员的风疹免疫政策。
1994年8月至12月邮寄调查问卷。
来自多个执业地点的医生，包括私人诊所、公共机构、大学或教学医院以及封闭式健康维护组织。
从美国医学协会国家医生数据库中通过系统随机抽样选择的3302名执业妇产科医生。
如果参与者报告有风疹疫苗接种史或抗体滴度呈阳性，则被定义为风疹免疫。还评估了对办公室执业环境中员工风疹免疫记录政策的了解情况。
在3302名被调查者中，50%（1666名）返回了问卷，96%（1599名）可用于评估。约20%（304/1599）的回复妇产科医生不知道有记录的风疹免疫情况，并且大多数办公室执业环境在以下人群中不要求记录风疹免疫情况：医生，66%（723/1094）；办公室护士，62%（666/1070）；以及其他办公室工作人员，69%（728/1063）。62%（993/1599）的回复医生进行了个体风疹血清学检测，其中916名已知为阳性，53名报告为阴性，24名报告结果未知。57%（918/1599）报告接种过单价风疹疫苗或三联麻疹 - 腮腺炎 - 风疹疫苗。多因素逻辑回归分析显示，以下因素是受访者中免疫状态为阳性的独立预测因素：女性（优势比[OR]，2.4；95%置信区间[CI95]，1.8 - 3.1），1980年以后医学院毕业（OR，2.6；CI95，2.0 - 3.3），提供产科或生育服务（OR，1.5；CI95，1.2 - 1.9），以及团体执业环境（≥5名医生；OR，1.2；CI95，1.1 - 1.4）。
在全国范围内，近五分之一的执业妇产科医生可能没有记录的风疹免疫情况，并且大多数办公室执业环境没有确保这种免疫的系统。风疹免疫应扩展到医院环境之外，考虑将风疹免疫作为就业条件。需要解决有效实施和记录当前指南的方法，特别是在办公室环境中。
