Bloodborne Pathogen Risk in Home Healthcare Workers

建议进行一项为期四年的多学科流行病学合作研究，旨在确定家庭保健工作者血液/体液接触事件的发生率和危险因素。使用定性和定量方法，我们建议通过解决以下四个具体目标来解决这一庞大且不断增长的工作人口的重要知识缺口：(1)在随机抽样的卫生保健工作者中确定职业血液/体液暴露事件的患病率和发生率（使用患者护理小时等分母）；(2)确定与暴露事件、HBV疫苗依从性和暴露后随访不合格相关的危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、工会会员、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/组合等）；C)组织变量（资源的可得性和充分性，包括安全装置和其他控制措施的可得性；安全气候、安全培训、医疗监测方案等）；D)患者特征；e)工作环境因素（家庭环境条件、家庭和邻里的安全保障、家庭成员的影响等）；(3)估计HCV和HBV的血清患病率，并确定HBV疫苗中HBsAb的含量；(4)识别成功的风险降低机会和

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.