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1 병원감염관리 : 제20권제2호 2015 Korean J Nosocomial Infect Control 2015;20(2): 원저 노인요양기관종사자의호흡기감염예방지식과이행도 김옥선 상지대학교간호학과 Knowledge and Compliance with Prevention of Respiratory Tract Infection Among Workers in Geriatric Facilities Og Son Kim Department of Nursing Science, Sangji University, Wonju, Korea Background: Prevention of respiratory infection among workers in geriatric facilities is important because the workers can transmit these infections to the elderly. Therefore, this study intended to assess the knowledge and compliance of preventive behavior against respiratory tract infection among these workers. Methods: Data were collected from 202 workers in geriatric facilities via a questionnaire-based survey from July 19 to August 8, Data were analyzed using the SPSS 21.0 program. Results: Among the workers, 44.6% experienced respiratory tract infection in the last 1 year. The score for knowledge of respiratory tract infection prevention among the workers was 10.6 points out of 12. The average score for compliance of the preventive behavior against respiratory tract infection was 34.6 points out of 48. The correlation between preventive knowledge and compliance of the preventive behavior against respiratory tract infection was not verified (r=0.00, P=0.967). Conclusion: In this study, the level of knowledge of respiratory infection prevention among the workers in the elderly care facility was high. However, the level of compliance was not sufficiently high. In addition, no correlation was found between their preventive knowledge and compliance. Therefore, a preventive program that focuses on the compliance of respiratory infection prevention rather than on its knowledge needs to be developed. Keywords: Compliance, Knowledge, Respiratory tract infections 1. 연구의필요성 Introduction 노인은노화에따른면역력의변화로인해병 Received: March 13, 2015 Revised: November 12, 2015 Accepted: November 26, 2015 Correspondence to: Og Son Kim, Department of Nursing Science, Sangji University, 83 Sangjidae-gil, Wonju 26339, Korea Tel: , Fax: oskim-icp@hanmail.net *This research was supported by Sangji University Research Fund in 원균에노출될경우쉽게감염될수있으며, 이경우젊은성인보다예후가좋지못하다 [1-3]. 노인에게서발생할수있는다양한감염중호흡기계감염은비교적가벼운감기에서부터사망의주요원인인패혈증을유발할수있는폐렴등다양하며, 기침이나대화중에발생하는비말이나호흡기분비물의접촉을통해감염균이쉽게전파된다. 특히최근노인요양기관이증가하였으며 [4,5], 호흡기계감염환자가많은겨울철에는이들기관의직원, 방문객등이적절한호흡기감염예방법을지키지않을경우노인요양기관에상주하는다른노인들에게쉽게감염을전파시킬수있다 [2,6,7]. 그러므로노인요양기관에서의

2 62 김옥선 호흡기감염관리는중요한부분이라할수있다. 그러나일부연구에따르면호흡기감염관리수행수준은다른감염관리영역보다비교적낮았다 [8,9]. 노인요양기관에근무하는간호사의감염관리수행수준을조사한한연구에서는 8가지세부영역중호흡기감염관리부분은평균이하였고 [8], 노인요양기관간호사의병원감염관리이행도를조사한한연구에서는 6개의영역중호흡기감염관리가평균이하였다 [9]. 노인요양기관종사자는면역이취약한노인의간호나활동보조등을통해이들과접촉이많으며, 부적절한호흡기감염예방행위는질병을전파시킬수있으므로노인요양기관에근무하는종사자들의호흡기감염예방을위한노력은매우중요하다. 호흡기감염을예방하기위해서는예방법에대한올바른지식과이에따른예방법의이행이중요하다. 호흡기감염을포함한전반적인감염예방에대한지식과그이행정도에대한연구 [10-13] 는다수있으나상급종합병원이나종합병원에근무하는간호사를포함한일부의료종사자를대상으로한연구가대부분이며 [10-12], 노인요양기관종사자들을대상으로한연구로는감염관리에대한연구가주로수행되었고 [6,8,9,13,14], 국내노인요양기관종사자들의호흡기감염예방지식과이행수준에대한구체적인연구는수행된바없다. 이에노인요양기관에서의호흡기감염예방프로그램개발에근거가되는기초자료로서국내노인요양기관종사자들의호흡기감염예방지식과이행도실태조사가필요하다고판단되어본연구를수행하였다. Materials and Methods 1. 연구설계본연구는노인요양기관종사자들의호흡기감염예방지식과이행수준을파악하고, 관계를규명하기위한서술적조사연구이다. 2. 연구대상경기도와전라도에소재한노인요양기관 4곳에근무하는종사자들과노인간호사회보수교육에참여한노인요양기관종사자를대상으로하 였다. 연구대상자수는 G*power program version (Franz Faul, University Kiel, Germany) 을사용하여상관관계분석에필요한최소표본수를구하였다. 중간수준의효과크기인 0.3, 유의수준 0.05, 검정력 0.95로양측검정할때최소 134명의표본이필요하였다. 이에기초하여무응답자를고려하여 250명에게설문지를배부하였고, 연구참여에동의하고모든항목에응답한 202명의자료를분석에이용하였다. 3. 연구도구본연구의도구는구조화된자가보고식설문지를이용하였다. 설문지는대상자의일반적특성과호흡기감염예방관련특성, 호흡기감염예방지식, 호흡기감염예방이행에대한내용으로구성하였다. 1) 일반적특성및호흡기감염예방관련특성문헌고찰을기초로일반적특성과호흡기감염예방관련특성에대한 12문항을연구자가개발하였다. 일반적특성은대상자의인구학적특성과노인요양기관의특성에대한문항으로성별, 연령, 학력, 직종, 노인요양기관근무경력, 근무하는기관의병상수와소재지를포함한 8문항으로구성하였다. 호흡기감염예방관련특성은호흡기감염예방교육경험, 기침예절에대해알고있는지, 최근 1년이내에호흡기감염경험, 전년도인플루엔자유행기간동안인플루엔자예방접종을했는지를포함한 4문항으로구성하였다. 2) 호흡기감염예방지식호흡기감염예방지식은 Yoon & Kim이개발한임신부의호흡기감염예방지식측정도구를연구자에게수정사용동의를받은후노인요양기관종사자에게적절하게수정하여사용하였다 [15]. Yoon & Kim의도구 15문항중 3문항을삭제하고 12문항으로수정하였다. 수정한도구는감염관리전문간호사자격증을소지하고 10년이상의감염관리경험이있는간호학과교수 4인과감염관리전문간호사 1인에게내용타당도검증을받아표현이모호한문장을수정하였으며, 12 문항모두내용타당도지수 (content validity index) 가 80% 이상이었다. 호흡기감염예방지식측정

3 호흡기감염예방지식과이행도 63 도구 12문항은외출후손씻기, 물과비누로씻기, 15초이상문지르기를포함한손위생 3문항, 인플루엔자예방접종 2문항, 기침하는사람이주위에있으면코와입가리기와 90 cm 이상거리두기, 감염유행시기에외출할때는코와입만지지않기를포함한격리주의 3문항, 영양섭취, 과로하지않기, 운동, 감염의심시병원진료를포함한건강관리 4문항으로구성하였다. 각항목별로정답은 1점, 오답과모름은 0점으로처리하여최저 0점에서최고 12점이며, 점수가높을수록지식수준이높은것으로해석하였다. 3) 호흡기감염예방이행도감염예방이행도평가에도 Yoon & Kim이개발한도구를사용하였으며 [15], 도구의신뢰도는 Cronbach's α=0.80이었다. 수정한도구는외출후손씻기, 물과비누로씻기, 15초이상문지르기를포함한손위생 3문항, 인플루엔자예방접종 1문항, 기침하는사람이주위에있으면코와입가리기와 90 cm 이상거리두기, 유행시사람많은곳가지않기와외출시코와입만지지않기를포함한격리주의 4문항, 영양섭취, 과로하지않기, 운동, 감염의심시병원진료를포함한건강관리 4문항으로, 각문항은 전혀그렇게안한다 1점, 거의그렇게안한다 2점, 대체로그렇게한다 3점, 항상그렇게한다 4점으로, 최저 12점에서최고 48점으로점수가높을수록이행수준이높은것을의미한다. 4. 자료수집편의추출한경기도와전라도소재 4개노인요양기관과노인간호사회담당자에게연구목적을직접설명하고설문조사허락을받은후 2014년 7월 19일부터 8월 8일까지 3주간자료수집을하였다. 연구자가노인요양기관과노인간호사회담당자를직접만나서연구윤리, 자료조사방법등에대해설명한후기관별로담당자가설문지를배부및회수하도록하였다. 각담당자들은대상자들에게연구목적과연구윤리부분에대해안내한후설문지첫장에안내된연구목적과연구윤리부분을읽고, 의문사항이있으면기관의담당자나연구자에게문의하도록했으며, 연구참여동의하는경우에한해서설문지에응답 하도록하였다. 총 250부의설문지를배부하였으며이중설문조사에동의하지않거나부적절하게응답한 48부는제외하고최종 202부의설문지를분석에이용하였다. 5. 윤리적고려본연구는상지대학교연구윤리위원회승인 (IRB 과제번호 : HR-01-02) 을받은후진행하였다. 연구대상자들에게연구의목적, 익명성, 비밀보장, 언제든지연구참여에동의하지않은경우철회가능함등을포함한안내문을제시한후연구참여동의시에만설문에참여하도록하였다. 6. 자료분석자료는 IBM SPSS Statistics for Windows ver (IBM Corp. Armonk, NY, USA) 를이용하여분석하였다. 대상자의일반적특성, 호흡기감염예방지식과이행정도는빈도, 백분율, 평균과표준편차를산출하였다. 대상자의특성에따른호흡기감염예방지식과이행정도는 t-test, oneway ANOVA 로분석하였으며, one-way ANOVA 로분석후유의한변수는 Scheffe test로사후검증을하였다. 지식과이행도간의상관관계분석은 Pearson's correlation coefficient를이용하였다. Results 1. 대상자들의특성대상자들의연령은평균 43.56세였고, 86.0% 가전문대학이상의학력이었다. 직종별로는간호사가 64.2% 로가장많았고, 기타직종으로간호조무사, 요양보호사, 간병인, 사회복지사등이있었으며, 노인요양기관근무경력은평균 5.85년이었다. 대상자들이근무하는노인요양기관의소재지는경기도가 61.2% 로가장많았고, 침상수는평균 개였다. 53.0% 가호흡기감염예방교육을받은경험이있었으며, 78.2% 는전년도인플루엔자유행기간동안인플루엔자예방접종을했고, 44.6% 는최근 1년이내호흡기감염경험이있었다 (Table 1).

4 64 김옥선 Table 1. General and respiratory tract infection prevention related characteristics of the subjects (N=202) Characteristics Categories n (%) or M±SD General Characteristics Gender Female 194 (96.4) Male 8 (4.0) Age (year) (9.4) (21.8) (41.6) (27.2) M±SD 43.6±9.47 Education level* High school 28 (14.0) College 98 (49.0) University 74 (37.0) Job* Nurse 129 (64.2) Others 47 (23.4) Career in long-term care facility (year) <1 20 (9.9) 1-<5 87 (43.1) 5-<10 62 (30.7) (16.3) M±SD 5.9±6.06 Beds of facility* < (11.7) (38.8) (29.6) (19.9) M±SD 264.4± Location of facility* Seoul 21 (10.4) Gyeonggi-do/Incheon 123 (61.2) Others 57 (28.4) Respiratory Infection Prevention related Characteristics Education for prevention of respiratory tract infection* Yes 105 (53.0) No 93 (47.0) Know about cough etiquette Yes 183 (90.6) No 19 (9.4) Influenza vaccination during last influenza season Yes 158 (78.2) No 44 (21.8) Experience of respiratory tract infection for last 1 year Yes 90 (44.6) No 112 (55.4) *Excluded non-respondent; Nurse's aid, long-term care worker, patient helper, social worker etc. 2. 호흡기감염예방지식노인요양기관종사자들의호흡기감염예방지식점수는 12점만점에 10.62점으로 100점으로환산시 88.50점이었다. 세부범주별로보면, 손위생에대한지식은 3점만점에 2.63점, 예방접종에대한지식은 2점만점에 1.64점, 격리주의는 3점만점에 2.82점, 건강관리는 4점만점에 3.53점이었으며, 100점으로환산시격리주의가 94.00점으로가장높았고, 예방접종이 82.00점으로가장낮았다 (Table 2). 3. 호흡기감염예방이행호흡기감염예방이행점수는 48점만점에 34.56점으로 100점으로환산시 72.00점이었다. 세부범주별로보면, 손위생이행점수는 12점만점에 10.23점, 예방접종이행점수는 4점만점에 3.04점, 격리주의이행점수는 16점만점에 점, 건강관리이행점수는 16점만점에 10.67점이었고, 100점으로환산시손위생이 85.25점으로가장높았고, 격리주의가 66.31점으로가장낮았다 (Table 2).

5 호흡기감염예방지식과이행도 65 Table 2. Knowledge and compliance of respiratory tract infection prevention (N=202) Knowledge Compliance Categories M±SD Converted mean out of 100 Possible range M±SD Converted mean out of 100 Possible range Hand hygiene 2.6± ± Vaccination 1.7± ± Isolation precaution 2.8± ± Health management 3.5± ± Total 10.6± ± 대상자의특성에따른호흡기감염예방지식과이행수준비교대상자의특성에따른지식점수는교육수준, 직종, 전년도인플루엔자예방접종만이유의한차이를보였다. 교육수준은고등학교졸업이하보다전문대졸과대학교졸업이상의지식점수가높았으며, 직종별로는간호사가기타직종보다높았고, 전년도에인플루엔자예방접종을시행한경우가그렇지않은경우보다지식점수가높았다. 대상자의특성에따른이행수준점수차이는호흡기감염예방교육, 전년도인플루엔자예방접종, 최근 1년이내에호흡기감염경험여부만이통계적으로유의했다. 호흡기감염이행수준은예방교육을받은경우가그렇지않은경우보다높았으며, 전년도인플루엔자예방접종을시행한경우가접종하지않은경우보다높았고, 최근 1년이내에호흡기감염경험이있는경우에이행수준점수가높았다 (Table 3). 5. 호흡기감염예방지식과이행간의상관관계호흡기감염예방지식과이행간에는상관관계가확인되지않았다 (r= 0.00, P=0.967). 그러나세부영역별로분석한결과인플루엔자예방접종지식과인플루엔자예방접종이행 (r=0.32, P<0.001), 손위생지식과건강관리이행 (r= 0.25, P<0.001), 손위생지식과이행총합 (r= 0.15, P=0.034) 간에는낮은수준의양의상관관계가있었다 (Table 4). Discussion 호흡기감염은크고작은유행이가끔씩발생하기때문에조사시기에따라감염발생빈도에상당한차이를보일수있다 [16,17]. 본연구에서노인요양기관종사자의최근 1년간호흡기감염률이 44.6% 인결과에기초해볼때상당수의종사자들이호흡기감염을경험하고있음을알수있으며, 이들이면역이저하된노인에게감염을전파시킬수있음을감안할때감염전파예방을위한노력이더욱필요하다. 호흡기감염의전파를예방하기위해서는올바른감염예방법에대해알고있어야한다. 본연구에참여한노인요양기관종사자들의호흡기감염예방지식점수는과거연구에서의지식점수보다높았다 [15,18-20]. 본연구대상자들의지식점수가높은것은 2009년신종인플루엔자유행이후다양한대중매체를이용하여호흡기감염예방에대한정보를국가가제공하였기때문에조사대상자들이호흡기감염예방에대해일정수준알고있었으리라판단된다. 신종인플루엔자유행이후에시행된임신부들의호흡기감염예방지식 [15] 보다도본연구대상자들의지식점수가높은것은조사대상이일반인이아니라간호사를포함한노인요양기관종사자들이었으므로면허증이나자격증취득을위한교육과정이나보수교육등을통해일정수준지식을갖추었기때문으로판단된다. 이전연구에서감염예방이행도는 % 수준으로연구마다차이가있으며 [10-13,15], 본연구에서의호흡기감염예방이행도는선행연구에서보고된감염예방이행수준범위안에속하였다. 그러나본연구대상자들이감염에취약

6 66 김옥선 Table 3. Knowledge and compliance of respiratory tract infection prevention by the characteristics (N=202) Characteristics Categories Knowledge Compliance M±SD t or F (P) M±SD t or F (P) General Characteristics Gender Female 10.7± (0.090) 34.7± (0.191) Male 9.8± ±6.16 Age (year) ± (0.600) 32.6± (0.165) ± ± ± ± ± ±4.74 Education level* High school a 9.7± (0.002) 35.8± (0.157) College b 10.9±1.43 a<b,c 33.9±4.68 University c 10.7± ±5.07 Job* Nurse 10.9± (<0.001) 34.7± (0.590) Others 10.1± ±5.63 Career in long-term care <1 10.5± (0.726) 35.0± (0.548) facility (year) 1-<5 10.6± ± < ± ± ± ±5.27 Beds of facility* < ± (0.687) 33.7± (0.448) ± ± ± ± ± ±5.50 Location of facility* Seoul 10.9± (0.457) 36.3± (0.188) Gyeonggi-do/Incheon 10.7± ±4.97 Others 10.5± ±5.24 Respiratory Infection Prevention related Characteristics Education of respiratory Yes 10.8± (0.087) 35.4± (0.020) infection prevention* No 10.4± ±4.61 Know about cough etiquette Yes 10.7± (0.151) 34.8± (0.083) No 10.2± ±3.64 Influenza vaccination during Yes 10.8± (0.031) 35.0± (0.036) last influenza season No 10.1± ±5.04 Respiratory infection for Yes 10.5± (0.211) 35.4± (0.031) last 1 year No 10.7± ±4.96 *Excluded non-respondent. Table 4. Relationships between knowledge and compliance of respiratory tract infection prevention (N=202) Variables Hand hygiene Vaccination Knowledge Droplet precaution Health management Total r (P) r (P) r (P) r (P) r (P) Compliance Hand hygiene 0.05 (0.447) Vaccination 0.08 (0.283) 0.32 (<0.001) Isolation precaution 0.08 (0.250) 0.04 (0.599) 0.05 (0.502) Health management 0.25 (<0.001) 0.01 (0.856) 0.11 (0.126) 0.03 (0.676) Total 0.15 (0.034) (0.341) 0.05 (0.467) 0.00 (0.950) (0.967)

7 호흡기감염예방지식과이행도 67 한노인이고이들과접촉이많은업무특성을감안할때감염예방이행수준을좀더높이기위한노력이필요하다. 특히세부항목중손위생과예방접종은이행수준이높은데비해격리주의와건강관리부분은낮았으므로격리주의와건강관리부분의이행수준을높이기위한노력이필요하다. 본연구에서전년도인플루엔자예방접종여부에따른호흡기감염예방지식수준에는차이가없었으나감염예방행위이행수준은차이가있었다. 이는호흡기감염예방행위인인플루엔자예방접종에영향을미치는요인으로지식은유의하지않았으나전년도예방접종이유의한요인이었던연구결과와도유사하다 [21,22]. 그러므로호흡기감염예방이행증진프로그램을개발할때는행위의습관화를유도할수있는전략이효과적일것으로보인다. 교육은지식과이행을증진시키기위해가장흔히사용되는전략으로교육을통해지식을함양하며, 긍정적인행동의변화를유도할수있다 [23]. 그러나본연구에서는호흡기감염예방교육을받은경우가그렇지않은경우보다감염예방이행수준은높았으나지식수준은차이가없었다. 교육여부에따른지식수준에차이가없었던것은 2009년신종인플루엔자가유행할때정부차원에서라디오등다양한대중매체를이용하여호흡기감염예방법에대한교육을시행하였으며 [24], 신종인플루엔자유행이지나간이후에도호흡기감염예방에대한정보를제공하고있다. 비록본연구대상자들이교육에참여하지는않았으나 90.6% 가기침예절에대해알고있는것으로추측해보면, 대상자들이호흡기감염예방교육을받지않았다고했으나기침예절에대해알고있는것은대중매체를통한호흡기감염예방홍보의주요내용중에하나로기침예절에대한교육과홍보가이루어졌으므로이를통해정보를습득하는것으로판단된다. 호흡기감염예방지식과이행간에상관관계를분석한결과지식과이행간에는상관관계가없었다. 이는연구에참여한대상자들의지식수준이상당히높았으며, 높은지식수준은변별력있는변수로서의역할을하지못함으로인해지식과이행간에상 관관계가없었을것으로판단된다. 그러므로노인요양기관종사자들의건강증진과이들로인한감염의전파를예방하기위해호흡기감염예방프로그램을계획할때는호흡기감염예방이행수준을증진시키기위해지식수준을높이려는방법은효과가낮을것으로생각되며, 본연구에서이행수준이모두낮았던직종을중심으로이행수준을높이는데목적을둔프로그램이필요하다. Summary 배경 : 노인요양기관종사자들은면역이저하된노인들에게호흡기감염을전파할수있으므로이들의호흡기감염예방은중요하다. 이에노인요양기관에서의호흡기감염예방프로그램개발에근거가되는기초자료로서노인요양기관종사자들의호흡기감염예방에대한지식과이행도를파악하기위하여시행되었다. 방법 : 2014년 7월 19일부터 8월 8일까지설문지를이용하여노인요양기관에근무하는 202명의종사자들에게서자료를수집하였다. 수집한자료는 SPSS 21.0 Program을이용하여분석하였다. 결과 : 노인요양기관에근무하는조사대상자의 44.6% 가최근 1년이내에호흡기감염을경험하였다. 조사대상자들의호흡기감염예방지식은 12점만점중 10.6점이었으며, 감염예방이행점수는 48점만점중 34.6점이었다. 호흡기감염예방지식과이행간에는상관관계가확인되지않았다 (r=0.00, P=0.967). 결론 : 본연구에서노인요양기관에근무하는종사자들의호흡기감염예방지식수준은높았으나이행은높은수준이아니었고, 지식과이행간에상관관계가없었다. 그러므로지식수준을높이기보다다양한호흡기감염예방이행수준을높이는데초점을둔프로그램개발을고려해야할것이다. References 1. Chung DR. Infectious diseases emergencies in

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<BFCFBCBA30362DC0B1BFECC3B62E687770> 韓國保健看護學會誌 Journal of Korean Public Health Nursing Volume 26. No. 2, 248-257, August 2012 http://dx.doi.org/10.5932/jkphn.2012.26.2.248 중심단어 : 남자대학생, 성의식, 성태도 남자대학생의 성의식과 성태도 * 김 상 희 ** 윤 우 철 ***