BBP EXPOSURE AND RISK FACTORS IN NON-HOSPITAL BASED HCWS

拟议的是一项为期三年的多学科协作研究，旨在确定非医院卫生保健工作者（HCW）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十年就驻院及非驻院医务工作者进行的研究的延伸。这项工作通过关注大量不同的非医院环境，包括数据特别稀少的几个环境，增强了早期的研究。假设存在有效的主要（例如，工程设备）和次级（例如，暴露后预防）的预防策略，并鉴于风险的程度和风险管理控制措施在许多非医院环境中的普遍性在很大程度上是未知的，这个问题对公共卫生的重要性怎么强调都不过分。本研究旨在通过从各种非医院环境中收集数据来解决重要的知识差距，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。选择这些组是因为已发表的报告表明他们可能处于高风险中（例如，EMS）或潜在风险的轶事报告（例如，这可能是因为最近的数据表明他们可能处于危险之中（警察），或者仅仅是因为缺乏关于这一群体的信息（临终关怀雇员）。为了达到研究的特定目的和目标，我们将随机选择6000名员工（每组600人）进行保密的自我管理邮寄调查。此外，还将随机选择1000名医院护士，以便在医院和非医院工作环境之间进行职业比较。参加者将从下列机构征聘：（a）纽约公务员联合会，（B）纽约巡警慈善协会，（c）纽约州护士协会，和（d）纽约州惩教署。我们研究的首要目标是确定数据驱动的减少风险的机会。这将由创新的行动研究小组完成，由研究人员和研究参与者组成。这项研究的一个重要和新颖的产品将是开发一个风险网格，一个简单的工具，雇员和雇主可以用来确定暴露风险，重要的是，采取措施，以减少这种风险。这项研究将提高我们对非医院医务工作者面临的风险的理解，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.