Bloodborne Pathogen Risk in Home Healthcare Workers

家庭医护人员的血源性病原体风险

• 批准号: 7073296
• 负责人: ROBYN R.M. GERSHON
• 金额: $ 49.96万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7073296
• 关键词: active immunization; antibody; blood; body fluids; clinical research; communicable disease transmission; disease /disorder proneness /risk; environmental exposure; focus groups; health behavior; health care personnel; hepatitis B virus group; hepatitis C virus; hepatitis vaccine; home health care; human subject; interview; mental health; occupational hazard; psychological tests; questionnaires; safety equipment

Proposed is a four-year collaborative and multidisciplinary epidemiological study designed to determine rates and risk factors for blood/body fluid exposure incidents in home healthcare workers. Using both qualitative and quantitative methodologies, we propose to address important knowledge gaps regarding this large and growing work population by addressing the following four specific aims: (1) to determine prevalence and incidence (using a denominator such as patient-care hours) of occupational blood/body fluid exposure incidents in a random sample of HHCWs; (2) to identify the independent and joint effects of risk factors associated with exposure incidents, HBV vaccine compliance and substandard post-exposure follow-up, including: a) worker-centered factors (demographics, union membership, psychosocial factors, etc.); b) job/task, job/control variables (work flow, work pace, workload, case/mix etc.); c) organizational variables (availability and adequacy of resources, including the availability of safety devices and other control measures; safety climate, safety training, medical surveillance programs, etc.); d) patient characteristics; and e) work environment factors (environmental conditions in the home, safety and security of the home and neighborhood, impact of family members, etc.); (3) to estimate seroprevalence of HCV, and HBV and to determine the measure of HBsAb in HBV vaccinees; and (4) to identify successful risk reduction opportunities and interventions tailored to home healthcare workers using participatory action research teams. In order to meet these specific aims we will recruit a random sample of 2500 home healthcare workers through our collaborating partners, including: (1) the New York State Public Employees Federation, (2) New York State Nurses Association, (3) Visiting Nurse Service of New York, (4) the Jewish Home & Hospital LifeCare Services, (5) American Nurses Association, (6) PennCare at Home at the University of Pennsylvania, and (7) Texas Association for Home Healthcare. This proposal extends previous risk assessment studies we have conducted over the past decade involving both hospital-based and non-hospital based health care workers. Given that there are both effective primary (e.g., engineering devices) and secondary (e.g., post-exposure prophylaxis) preventive strategies for managing risk and given that the extent of risk and the prevalence of risk management controls available to the estimated 700,000 home health care workers is largely unknown, the public health siqnificance of this problem cannot be overstated. This study will improve our understanding of the risks facing home health care workers and allow us to focus our risk management energies and resources appropriately.

提议的是一项为期四年的合作和多学科的流行病学研究，旨在确定家庭医疗保健工人血液/体液暴露事件的率和风险因素。使用定性和定量方法，我们建议通过解决以下四个特定目的来解决有关这个较大且不断增长的工作人群的重要知识差距：（1）确定在HHCWS随机样本中，在职业血液/体液暴露的事件中确定职业血液/体液暴露事件的患病率和发病率（例如患者护理小时）； （2）确定与暴露事件，HBV疫苗合规性和暴露后随访相关的风险因素的独立和联合影响，包括：a）以工人为中心的因素（人口统计学，工会成员资格，社会心理因素等）； b）工作/任务，工作/控制变量（工作流程，工作节奏，工作量，案例/混音等）； c）组织变量（资源的可用性和充分性，包括安全设备和其他控制措施的可用性；安全气候，安全培训，医疗监视计划等）； d）患者特征； e）工作环境因素（家庭和邻里的房屋，安全和安全的环境条件，家庭成员的影响等）； （3）估计HCV和HBV的血清阳性，并确定HBV疫苗中HBSAB的度量； （4）确定成功降低风险的机会和 使用参与式行动研究团队为家庭医疗保健工人量身定制的干预措施。 为了实现这些具体目标，我们将通过我们的合作伙伴随机招募2500名家庭医疗保健工人，包括：（1）纽约州公共雇员联合会，（2）纽约州护士协会，（3）纽约访问护士服务，（4）（4）犹太家庭和医院生活局，（4）犹太人生活和医院的生活，（5）美国护士协会，（5）美国宾夕法尼亚州的宾夕法尼亚州，宾夕法尼亚州，（宾夕法尼亚州）用于家庭医疗保健。 该建议扩展了我们在过去十年中进行的先前风险评估研究，涉及基于医院和非医院的医疗保健工作者。鉴于既有有效的主要（例如工程设备）和次要（例如暴露后预防）的预防策略来管理风险，并且鉴于估计的700,000名家庭医疗保健工作者的风险程度和风险管理控制率在很大程度上是不明智的，因此，公共保健服务是不明显的，这是对这个问题的公共保健服务。 这项研究将提高我们对家庭医疗保健工作者面临的风险的理解，并使我们能够适当地关注风险管理能量和资源。