BBP EXPOSURE AND RISK FACTORS IN NON-HOSPITAL BASED HCWS

建议进行一项为期三年的多学科合作研究，旨在确定非医院医护人员血液/体液暴露事件的发生率和风险因素。这项建议是我们在过去10年进行的研究的延伸，研究范围包括以医院为基地的和非以医院为基地的母婴健康院。这项工作通过关注大范围和多样化的非医院环境，包括数据特别稀少的几个环境，对早期的研究进行了补充。鉴于有有效的一级(如工程设备)和二级(如暴露后预防)预防战略来管理风险，并鉴于许多非医院环境中的风险程度和风险管理控制的普遍性在很大程度上是未知的，这个问题的公共卫生意义怎么强调都不为过。这项研究旨在通过从广泛的非医院环境中收集数据来解决重要的知识差距，这些非医院环境包括：1)精神残疾设施，2)疗养院，3)药物治疗设施，4)艾滋病诊所，5)紧急医疗服务(EMS)，6)医生办公室和诊所，7)血液透析诊所，8)警察部门，9)惩教设施，10)家庭保健和临终关怀设施。这些群体之所以被选中，要么是因为已发表的报告称他们可能处于高风险状态(例如EMS)，要么是因为关于潜在风险的坊间报道(例如惩教人员)，要么是因为最近的数据表明他们可能处于危险之中(警察)，要么仅仅是因为缺乏关于这一群体的信息(临终关怀员工)。为了达到研究的具体目的和目的，我们将随机抽取6000名员工(每组600人)接受一项保密的自填式邮寄调查。此外，还将随机选择1000名医院护士作为样本，以便对医院和非医院工作环境进行职业比较。参加者将从下列机构招募：(A)纽约州公共雇员联合会；(B)纽约州巡警慈善协会；(C)纽约州护士协会；(D)纽约州惩教署。我们这项研究的首要目标是确定数据驱动的降低风险的机会。这将由创新的参与性行动研究小组完成，该小组由研究人员和研究参与者组成。这项研究的一个重要而新颖的成果将是开发风险网格，这是一种简单的工具，员工和雇主可以使用它来确定暴露风险，以及重要的是，为降低风险而采取的步骤。这项研究将提高我们对非医院卫生工作者面临的风险的认识，并使我们能够适当地集中精力和资源。

Proposed is a three-year collaborative, multidisciplinary, study designed to determine rates and risk factors for blood/body fluid exposure incidents in non-hospital based health care workers (HCWs). This proposal is an extension of studies we have conducted over the past decade involving hospital-based and non-hospital based HCWs. This work augments earlier research by focusing on a large and diverse range of non-hospital settings, including several for which data are particularly sparse. 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 in many non-hospital settings is largely unknown, the public health significance of this problem cannot be overstated. This study is designed to address important knowledge gaps by collecting data from a wide variety of non- hospital settings, including: 1) mental disabilities facilities, 2) nursing homes, 3) drug treatment facilities, 4) AIDS clinics, 5) emergency medical services (EMS) , 6) doctors' offices and clinics, 7) hemodialysis clinics, 8) police departments, 9) correctional facilities, and 10) home health care and hospice facilities. These groups were chosen either because of published reports that they may be at high risk (e.g., EMS) or anecdotal reports of potential risk (e.g., correctional officers) or because recent data suggest that they may be at risk (police officers) or simply because there is a lack of information on this population (hospice employees). In order to meet the specific aims and goals of the study we will randomly select a sample of 6000 employees (600 per group) to receive a confidential self-administered mailed survey. Additionally, a sample of 1000 hospital based nurses will also be randomly selected to allow for occupational comparisons between hospital and non-hospital work settings. Participants will be recruited from the following agencies: (a) the New York Public Employees Federation, (b) the New York Patrolmen's Benevolent Association, (c) the New York State Nurses Association, and (d) the New York State Department of Correctional Services. Our overarching goal of the study is to identify data-driven opportunities for risk reduction. This will be accomplished by innovative Participatory Action Research teams, comprised of both researchers and study participants. An important and novel product of this study will be the development of a Risk grid a simple tool that employees and employers can use to determine exposure risk and, importantly, the steps to take to reduce that risk. This study will improve our understanding of the risks facing non-hospital HCWs and allow us to focus our energies and resources appropriately.