Bloodborne Pathogen Risk in Home Healthcare Workers

建议进行一项为期四年的多学科合作流行病学研究，旨在确定家庭医护人员血液/体液暴露事件的发生率和风险因素。使用定性和定量方法，我们建议通过解决以下四个具体目标来解决关于这一庞大且不断增长的工作人口的重要知识差距：(1)确定HHCW随机样本中职业性血液/体液暴露事件的患病率和发生率(使用患者护理时间等分母)；(2)确定与暴露事件、乙肝疫苗遵从性和暴露后不合格的后续行动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(人口统计数据、工会成员身份、心理社会因素等)；B)工作/任务、工作/控制变量(工作流程、工作进度、工作量、病例/组合等)；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、医疗监测计划等)；d)患者特征；以及e)工作环境因素(家庭环境条件、家庭和邻里的安全和安保、家庭成员的影响等)；(3)估计丙型肝炎病毒和乙肝病毒的血清阳性率，并确定乙肝疫苗接种者中乙肝表面抗体的量度；以及(4)确定成功降低风险的机会和 使用参与性行动研究团队为家庭保健工作者量身定做的干预措施。 为了实现这些具体目标，我们将通过我们的合作伙伴从2500名家庭保健工作者中随机抽取一批，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)犹太家庭和医院生活护理服务，(5)美国护士协会，(6)宾夕法尼亚大学家庭护理协会，以及(7)德克萨斯家庭保健协会。 这项建议扩大了我们在过去十年中进行的涉及医院和非医院医护人员的风险评估研究。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，而且估计70万家庭保健工作者可获得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。 这项研究将提高我们对家庭保健工作者面临的风险的理解，并使我们能够适当地集中我们的风险管理精力和资源。

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.