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도규 하
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1 의료관련감염관리 : 제21권제2호 2016 Korean J Healthcare Assoc Infect Control Prev 2016;21(2): 원저 응급실간호사의혈액매개감염지식, 감염관리인지도, 수행도및수행관련요인 공혜경 1 ㆍ박태정 2 ㆍ박경연 3 좋은삼선병원 1, ( 전 ) 좋은삼선병원 2, 신라대학교간호학과 3 Knowledge on Blood-Borne Infection, Awareness and Compliance on Blood-Borne Infection Control, and Factors Influencing Compliance among Emergency Nurses Hye Kyung Kong 1, Tae Jeong Park 2, Kyung-Yeon Park 3 Good Samsun Hospital 1, (Former) Good Samsun Hospital 2, Department of Nursing, Silla University 3, Busan, Korea Background: Emergency nurses are at risk of blood-borne infection as they are often exposed to blood and potential infections. The purpose of this study was to identify knowledge of blood-borne infections, awareness and compliance on, and predictors of compliance with among nurses in emergency rooms. Methods: Participants (N=169) in emergency rooms were recruited in B city from September 26 to October 26, The emergency nurses knowledge levels on blood-borne infections and awareness and compliance on were retrospectively investigated. Results: The significant predictors of compliance on blood-borne among emergency nurses were use of personal protective equipment (β=0.28, P<0.001), awareness on blood-borne (β = 0.28, P<0.001), confirmation of whether patients suffered from blood-borne infections prior to nursing care (β=0.26, P<0.001), experience in education (β=0.16, P=0.022), and history of blood exposure (β= 0.14, P=0.040). Conclusion: The results showed that in addition to improving nurses personal efforts to prevent blood-borne infections, systematic support in medical administration is needed; this may include preparing standardized assessment forms to distinguish patients with blood-borne infections at the first hospital visit and increasing use of personal protective equipment for blood-borne. Keywords: Blood borne, Emergency, Infection control, Nurse Introduction Received: May 13, 2016 Revised: June 8, 2016 Accepted: August 10, 2016 Correspondence to: Kyung-Yeon Park, Department of Nursing, Silla University, 140 Baegyang-daero, 700beon-gil, Sasang-gu, Busan 46958, Korea Tel: , Fax: kypark@silla.ac.kr *This is a modified and supplemented paper presented at the Good samsun hospital nursing conference, 응급실은응급환자에대한사정, 검사및응급처치전반에대한신속성을요하는부서이다. 따라서대상자들이가진감염성질환에대한정보를알지못한상태에서침습적검사및처치를수행할수있다. 뿐만아니라만취상태, 의식저하자및소아등치료협조가안되는환자들로인해다양한처치와검사시에혈액매개감염원에

2 66 공혜경 / 박태정 / 박경연 노출될위험이있다 [1]. 의료인에게있어서혈액매개감염은근무중에주삿바늘과같은날카로운기구에찔리거나상처가있는피부나점막이혈액에노출되어발생하며, 이는 B형간염, C형간염, 사람면역결핍바이러스 (human immunodeficiency virus, HIV) 등심각한혈액매개감염을초래할수있다 [2,3]. 병원직원대상연구에의하면 6개월간주삿바늘찔림경험자는응답자의 48.7%, 손상이없는피부나점막에혈액이나체액이노출된자는 49.7% 이었다 [4]. 감염관리전담간호사가근무하고혈액매개질환에노출되었을때의행동지침이있는의료기관가운데서도많게는직원들의 51.7% 가혈액매개감염원에노출된것으로보고되어 [5] 일반적인감염감시에국한하지않는, 감염전파방법별혹은위험부서별관련연구가더심층적으로활발히이루어져야할필요가있다. 임상현장실무에서의뾰족한기구에의한의료인손상의대부분은의료인자신에의한것이었고 [6] 혈액매개감염은공기매개감염이나접촉매개감염, 비말매개감염에비해상대적으로의료인의각별한주의와노력으로예방이가능하므로 [2] 연구의결과는실무적용을통해의료인의혈액매개감염원노출발생률감소라는가시적인성과로이어질수있을것이다. 병원내부서중에서는중환자실, 투석실, 응급실, 수술실, 특수검사실에근무하는의료종사자들의 98.9% 가혈액이나체액에노출된경험이있었으며 [7] 간호사는국내외모두에서혈액과체액에높은빈도로노출되었다 [5,8]. 다수환자와접촉하는간호사들은감염전파자로서의위험도도높아의료기관감염관리에대한책임감을통감하여야하며, 응급실간호사는혈액매개감염원에대한정보가없는상태에서간호업무를하게되므로혈액매개감염관리지침에따른더욱엄격한실천이요구된다. 지금까지이루어진간호사를대상으로한국내감염관리연구들은일반적인의료관련감염관리에대한지식, 인지도및수행도에대한연구이거나 [9,10] 임상현장에서문제가되고있는반코마이신내성장알균 (vancomycin-resistant Enterococcus, VRE), 메티실린내성황색포도알균 (Methicillin-resistant Staphylococcus aureus, MRSA) 등다제내성균을다룬연구가주를이루었다 [10,11]. 혈액매개감염관련선행연구들은혈액매개감염의원인이되는자상관련연구 [12], 혈액매개감염의실태나혈액매개감염원의노출수준을확인한연구 [13] 가있었으나, 혈액매개감염원에대한노출위험이높은응급실간호사들의혈액매개감염에대한지식수준이나감염관리에대한연구는찾기어렵다. 이에. 본연구는응급실간호사들을대상으로혈액매개감염에대한지식정도와혈액매개감염관리에대한인식도및수행도를알아보고, 혈액매개감염관리수행도에영향을주는요인을확인하여혈액매개감염예방을위한의료기관의감염관리방안마련의기초자료로활용하고자한다. Materials and Methods 1. 연구대상및자료수집방법본연구의근접모집단은일개광역시에소재하는 11개의응급실에서근무하는간호사들이다. 연구대상병원은상급종합병원 1곳과종합병원 10곳으로모두감염관리실과감염관리위원회가있으며감염관리지침을구비하고있는곳이었다. 응급실근무인력수를고려하여간호부에서요청한만큼연구표본수는확정되었고, 배부된설문지 190부중 175부가회수되어 92.1% 의회수율을보였으며, 불성실한응답을한 6부의설문지를제외한 169부를최종분석하였다. 표본수는 G-power 3.1 프로그램을이용하여산출하였다. Linear multiple regression을분석하기위해 α=0.05, medium sized effect size f=0.15, power=0.95, numbers of predictors=15를투입했을때본연구에서필요한최소표본수는 89명이적절하나, 일개광역시내협조가능한종합병원과상급종합병원전수조사를시도하고해당병원의응급실간호사수가반영되어표본수는 190 명이었다. 자료수집기간은 2012년 9월 26일부터 2012년 10월 26일까지이었으며각병원의관련부서장에게연구의목적과방법을설명하고연구참여

3 응급실간호사의혈액매개감염감염관리수행관련요인 67 에대한동의를받았다. 이후연구의목적, 방법, 연구참여의자발성및철회에대한정보를연구대상자에게제공하고연구참여동의서에서면동의한간호사에한하여자가보고형설문지를작성하도록하였다. 2. 연구도구자가보고형설문지를이용하였으며성별, 교육수준, 임상총경력, 응급실경력, 직위, 업무량, 의료기관의인증여부, 감염관리교육경험, 감염관리지침여부가포함된일반적특성과환자혈액노출경험, 개인보호장구비치, 간호행위전환자의혈액매개감염여부확인문항이포함된혈액매개감염관련특성 [7,9-11], 혈액매개감염에대한지식, 혈액매개감염관리인지도와수행도로구성하였다. 1) 혈액매개감염에대한지식혈액매개감염에대한지식은 Park과 Kim [14] 이작성한총 19문항으로구성된도구를사용하였다. 도구는혈액매개감염경로 11문항, 혈액매개감염환자에노출후관리및예방접종 5문항, 주삿바늘관리 3문항의총 19문항으로구성되었으며정답일경우 1점, 오답일경우 0점을부여하여 0-19점의점수분포를가진다. 도구개발당시의전문가타당도지수는 0.84이었고본연구에서전문가에의한내용타당도검증을받았다. 2) 혈액매개감염관리인지도와수행도혈액매개감염관리인지도는미국질병관리본부의표준주의지침 9개항목과미국산업안전보건청의혈액매개병원체예방규칙을근거로 Choi와 Lee [15] 가개발한혈액매개감염예방지침수행측정도구를사용하였다. 도구는손씻기, 장갑착용, 이중장갑착용, 개인보호장구착용, 주삿바늘사용, 날카로운기구사용, 피부상처관리, 환경관리각각모두 3문항씩총 8영역 24문항으로구성되었다. 5점 Likert 척도로 전혀중요하지않다 1점에서 매우중요하다 5점으로산정하며점수가높을수록인지도가높음을의미하며본연구에서의신뢰도계수 Cronbach s alpha는 0.93 이었다. 혈액매개감염관리수행도는혈액매개감염관리인지도와동일한 24개문항을사용하여얼마나잘실천하고있는가를 거의하지않는 다 1점에서 항상한다 5점의 Likert 척도로측정하였고점수가높을수록수행도가높음을의미하며본연구에서의신뢰도계수 Cronbach s alpha는 0.88이었다. 3. 자료분석방법측정된자료값들은빈도, 백분율, 평균과표준편차로표시하였으며, 통계자료는 SPSS version 20.0 (PASW; Chicago, IL, USA) 을이용하여유의수준 0.05에서양측검증으로유의성을판정하였다. 제특성별혈액매개감염에대한지식, 혈액매개감염관리인지도및수행도의차이는독립 t 검정및일원분산분석을이용하고사후검정은 Scheffe test를하였다. 혈액매개감염에대한지식, 혈액매개감염관리인지도및수행도간의상관관계는 Pearson correlation coefficient로확인하였으며, 단변량분석에서유의했던변수들에대해단계적다중회귀분석을수행하여혈액매개감염관리수행도에영향을주는요인을확인하였다. Results 1. 혈액매개감염에대한지식, 혈액매개감염관리인지도및수행도연구대상간호사들의혈액매개감염에대한지식은 1점만점에 0.7±0.14점, 혈액매개감염관리인지도와수행도는 5점만점에각각 4.4±0.45점, 3.5±0.57점이었다 (Table 1). 2. 제특성별혈액매개감염에대한지식, 혈액매개감염관리인지도및수행도의차이혈액매개감염에대한지식에유의한차이를보인변수는교육수준이었으며 (F=4.96, P=0.008) 응급실간호사들의혈액매개감염관리의인지도는업무량 (F=3.99, P=0.020) 과병원인증평가여부 (t=1.97, P=0.050) 에따라차이가있었다. 혈액매개감염관리수행도는감염관리교육을받은경험이있는간호사들이그렇지않은간호사들보다혈액매개감염관리수행도가더높았다 (t=2.64, P=0.009) (Table 1).

4 68 공혜경 / 박태정 / 박경연 Table 1. Knowledge of blood borne infection, awareness and compliance with blood borne by participants characteristics (N=169) Variables N (%)* Knowledge of blood borne infection M±SD t/f P (Scheffe) Awareness with blood borne M±SD t/f P (Scheffe) Compliance with blood borne M±SD t/f P Gender Male 21 (12.4) 0.7± ± ± Female 148 (87.6) 0.7± ± ±0.62 Education (degree) 3 year nursing 4.5± ± college a (a>c) Bachelor b 57 (33.9) 0.7± ± ±0.57 Master/Doctotal c 19 (11.4) 0.6± ± ±0.59 Duration of working as a nurse (months) (19.8) 0.7± ± ± (30.3) 0.7± ± ± (12.5) 0.8± ± ± (37.4) 0.7± ± ±0.52 Duration of working as an ER (months) (24.3) 0.7± ± ± (37.3) 0.7± ± ± (15.4) 0.8± ± ± (21.9) 0.7± ± ±0.55 Position General nurse 142 (84.0) 0.7± ± ± Charfe nurse 19 (11.3) 0.7± ± ±0.48 Head nurse 8 (4.7) 0.8± ± ±0.67 Work load Adequate a 54 (32.0) 0.7± ± ± Moderate b 86 (50.9) 0.4± ±0.43 (a,b>c) 3.5±0.55 Overload c 29 (17.1) 0.7± ± ±0.69 Hospital accreditation Yes 103 (60.9) 0.7± ± ± No 66 (39.1) 0.7± ± ±0.52 Infection control education Yes 141 (83.4) 0.7± ± ± No 28 (16.6) 0.7± ± ±0.60 Guideline of Yes 146 (86.4) 0.7± ± ± No 2 (1.2) 0.6± ± ±0.53 Don t know 21 (12.4) 0.7± ± ±0.54 Total score 13.7± ± ±13.62 Mean score 0.7± ± ±0.57 *N (%) mean the number and percent of nurses who answered each question and missing data are eliminated. 3. 혈액매개감염관련특성별혈액매개감염에대한지식, 혈액매개감염관리인지도및수행도의차이주사침자상사고나혈액이눈에튀거나피부점막등에묻는등의혈액노출경험이있다고응 답한간호사가그렇지않은간호사보다수행도가낮았고 (t= 3.27, P=0.001), 응급실내필요한개인보호장구를비치하고있는곳에근무하는간호사들이그렇지않는곳에근무하는간호사들보다혈액매개감염관리수행도가더높았다 (t=3.69, P<0.001). 간호행위전환자의혈액매개

5 응급실간호사의혈액매개감염감염관리수행관련요인 69 감염여부검사를확인하는간호사가확인하지않는간호사보다혈액매개감염관리를더잘수행하였다 (t=3.92, P<0.001). 혈액노출사고를담당하는전담부서유무는응급실간호사들의혈액매개감염관리수행도에의미있는차이를보이지않았다 (t=1.05, P=0.352) (Table 2). 4. 혈액매개감염에대한지식, 혈액매개감염관리에대한인지도와수행도간의상관관계응급실간호사들의혈액매개감염관리인지도가높을수록혈액매개감염관리수행도도높았다 (r=0.25, P=0.001). 혈액매개감염에대한지식은혈액매개감염관리인지도 (r=0.13, P=0.102) 와수행도 (r=0.14, P=0.081) 모두에서의미있는관련성이없었다 (Table 3). 5. 응급실간호사들의혈액매개감염관리수행도에대한영향요인회귀식의가정을검정한결과, 다중공선성확인을위한공차한계는 이었으며, 분산팽창요인 (VIF) 은 이었다. Cook s D의최대값이 0.05로 1.0 이상인개체는없었다. Durbin-Watson 을이용하여오차의자기상관을검정한결과검 정통계량이 2.00으로오차항의자기상관이없었으며잔차의분석결과선형성, 정규성및등분산성가정을만족하였다. 응급실내에개인보호장구가구비되어있을수록 (β=0.28, P<0.001), 혈액매개감염관리인지도가높을수록 (β=0.28, P< 0.001), 응급실에내원한환자들에게간호를제공하기전혈액매개감염여부를확인할수록 (β=0.26, P<0.001), 감염관리교육을받은경험이있을수록 (β=0.16, P=0.022), 혈액매개감염원에노출된경험이없을수록 (β= 0.14, P=0.040) 혈액매개감 Table 3. Correlation among knowledge of blood borne infection, awareness and compliance with blood borne (N=169) Awareness with blood borne Compliance with blood borne Knowledge of blood borne infection r (P) 0.13 (0.102) Awareness with blood borne r (P) 0.14 (0.081) 0.25 (0.001) Table 2. Knowledge of blood borne infection, awareness and compliance with blood borne by blood borne infection related characteristics (N=169) Variables Categories N (%)* Knowledge of blood borne infection Awareness with blood borne Compliance with blood borne M±SD t/f P M±SD t/f P M±SD t/f P History of Yes 75 (44.4) 0.7± ± ± blood exposure No 94 (55.6) 0.7± ± ±0.54 for the last 6 months Department of blood exposure accidents Personal protective equipments Check for blood borne infection with patient at time of prior nursing care Yes 147 (87.0) 0.7± ± ± No 5 (3.0) 0.8± ± ±0.48 Don t know 12 (7.0) 0.7± ± ±0.50 No response 5 (3.0) Yes 100 (59.2) 0.7± ± ± <0.001 No 69 (40.8) 0.7± ± ±0.48 Yes 60 (35.5) 0.85± ± ± <0.001 No 109 (64.5) 0.7± ± ±0.55 *N (%) mean the number and percent of nurses who answered each question and missing data are eliminated.

6 70 공혜경 / 박태정 / 박경연 Table 4. Predictors of compliance with blood borne among nurses in emergency room (N=169) Variables B SE β t P Personal protective equipments <0.001 Awareness with blood borne infection <0.001 Check for blood borne infection with patient at time of prior nursing care <0.001 Infection control education History of blood exposure for the last 6 months Model summary: F=13.05, P<0.001, Adjusted R 2 =26.4, Dummy coded 1=have history of blood exposure for the last 6 months, take the education, equipped personal protective equipments in emergency room, check for blood borne infection with patient at time of prior nursing care. 염관리수행도가높았다. 이들변수들은혈액매개감염관리수행도에 26.4% 의설명력을나타내었다 (Table 4). Discussion 연구결과응급실간호사들의혈액매개감염관리수행도는 5점만점에 3.5점으로인지도 4.4점보다더낮았다. 즉, 혈액매개감염원이노출을예방하기위한감염예방지침이중요하다고생각하는인지도에비해실제지침을실천하는정도는그에미치지못하였다. 이는응급실간호사대상감염관리연구 [13] 나종합병원간호사전체를대상으로한병원감염예방에대한연구 [16] 의결과와같은것이다. 혈액매개감염관리에대한교육및조사분석의궁극적목적은감염관리실천을통해서의료인의혈액매개감염원노출발생률을감소시키는것임을고려할때감염관리실천을방해하는요인에대한다각도의연구가필요하다고본다. 혈액매개감염에대한지식은 1점만점에 0.7점으로서다소부족한것으로나타났으며동일한도구로측정한수술실간호사들의지식 0.76점 [14] 과유사하였다. 응급실간호사들의혈액매개감염관리수행도에영향을주는요인은개인보호장구구비, 혈액매개감염관리에대한인지도, 환자간호전혈액매개감염여부의확인, 감염관리교육및혈액매개감염원에노출된경험유무이었다. 응급실내개인보호장구비치여부는간호사들의혈액매개감염관리수행도에가장큰영향력을보였다. 이는 Janjua 등 [17] 의연구결과와같은것이다. 그러나본연구결과개인보호장구착용 이포함되는혈액매개감염관리수행도는 5점만점에 3.5점으로나타나, 개인보호장구를구비하고있는곳에근무하는간호사들이모두개인보호장구를잘착용하고있다고보기는어려운것으로나타났다. 응급실에서근무하는간호사대상연구 [18] 에서개인보호장구의착용이응급처치나시술에방해가되기때문에감염예방행위를잘수행하지않는다고하여개인보호장구를비치하는것못지않게개인보호장구착용에대한지지체계나중요성에대한인식을강화하는교육및동기부여가필요함을알수있었다. 응급실인력은개인보호장구를착용하여야함을표준지침으로제시하고있음 [19] 에도불구하고연구대상자들의 40.8% 가혈액매개감염예방에필요한개인보호장구를보유하지않아서, 응급실간호사들의안전확보를위한검토가필요함을알수있었다. 혈액매개감염관리에대한인지도가높을수록수행도도높았는데이러한관련성은선행연구 [14] 와일관된것이다. 하지만혈액매개감염에대한지식은감염관리에대한인지도및수행도와는관련이없었는데, 이는 VRE 감염에대한지식이 VRE 감염관리인지도및수행도와상관이없었던연구 [11] 와동일한결과이다. 이는혈액매개감염에대한지식만으로는부족하고감염관리의필요성에대해얼마나인지하고있는지가감염관리실천에더핵심적인요소임을의미하는것이다. 간호행위전환자의혈액매개질환감염여부를확인하는간호사들이확인하지않는간호사들보다혈액매개감염관리를더잘실천하였다. 간호행위전환자의혈액매개질환감염여부를

7 응급실간호사의혈액매개감염감염관리수행관련요인 71 확인한다는것은감염관리에대한인지가있음을의미하는것으로, 인지도과수행도간관련성을보였던연구결과를지지하는것이다. 일반적인감염관리교육을받은간호사들이교육을받지않은간호사들보다혈액매개감염관리수행도가더높아서일반적인표준주의감염관리교육의중요성 [20,21] 을다시한번확인할수있었다. 반면교육수준은혈액매개감염에대한지식과비례하지는않았다. 교육수준과구체적인감염관련지식이나수행도간의관련성은선행연구에서도관련이없거나일관된결과를보이지않고있다 [9,22]. 이상의두변수의결과를통해교육수준그자체보다는구체적인감염관리에대한교육여부가감염관리에의미있는것임을알수있었고, 학교교과과정에서혹은졸업후의료기관에서의감염관리교육이필요함을알수있었다. 환자혈액에노출된경험이있었던간호사가그렇지않은간호사보다혈액매개감염관리수행도가낮았는데이는 An 등 [13] 의결과와같은것으로혈액매개감염관리주의지침에대한수행도가높아서혈액노출경험이더작았던것에서기인된결과로해석된다. 응급실에근무하는본연구대상자들중주사침자상사고나혈액이눈에튀거나혹은피부점막등에묻는등의혈액노출경험이있다고응답한자들은전체대상자의 44% 로, 400병상이상의종합병원간호사를대상으로한연구 [13] 에서의혈액노출경험 56.5%, 2009 년연구에서의 48% 보다낮았다. 최근의료기관의자체질평가및의료기관인증평가등을거치면서감염관리에대한인식향상으로혈액노출빈도도감소하게된것으로해석된다. 다만본연구에서혈액노출이란주사침자상사고와혈액이눈에튀거나피부점막등에묻은경우등이모두포함되는데, 조사에서는이모든것을포함하여한번이라도경험하였는지를조사하여각혈액노출사례별로구분하여보고하지못한한계가있다. 추후연구를통해세부적인사례별구분과분석이필요하다고본다. 결론적으로, 혈액이나잠재적감염성을지닌물질에대한노출이예상되는응급실간호사들의혈액매개감염원에의노출을예방하기위해서 는, 간호사개인차원과행정적지원차원두가지의노력이필요함을알수있었다. 개인보호장구구비를위한행정적지원이혈액매개감염관리이행독려에우선되어야할것이며, 간호사개인은구비된보호장구착용을위한인식의변화가필요하고, 혈액매개감염여부를환자내원시체크하는체계마련이필요함을알수있었다. Summary 배경 : 응급실간호사들은혈액이나잠재적감염원에대한노출이잦아서혈액매개감염에이환될위험을안고있다. 본연구를통해응급실간호사들의혈액매개감염에대한지식, 감염관리에대한인지도및수행도를파악하고수행도에영향을주는요인을확인하고자하였다. 방법 : 2012년 9월 26일부터 10월 26일까지 B 시의응급실간호사를대상으로후향적조사방법으로대상자의특성, 혈액매개감염에대한지식, 혈액매개감염관리에대한인지도및수행도를조사하였다. 결과 : 응급실간호사들의혈액매개감염에대한지식점수는 0.7점, 혈액매개감염관리에대한인지도는 4.4점, 수행도는 3.5점이었다. 응급실간호사들의혈액매개감염관리수행도에개인보호장구구비여부 (β=0.28. P<0.001) 가가장큰영향을주었고, 그외혈액매개감염관리에대한인지도 (β=0.28. P<0.001), 간호수행전환자의혈액매개감염이환여부확인 (β=0.26. P<0.001), 감염관리피교육경험 (β=0.16. P=0.022), 환자의혈액에대한노출경험 (β= P=0.040) 이유의한영향요인이었다. 결론 : 응급실간호사의혈액매개감염원에대한노출발생률감소를위해서는간호사개인의노력뿐아니라개인보호장구나내원초기단계에서의혈액매개감염질환에이환된환자의확인을위한표준화된사정양식의구비등의료기관차원에서의체계적인지원이함께필요함을알수있었다.

8 72 공혜경 / 박태정 / 박경연 Acknowledgements 본연구는 2012년좋은삼선병원간호부학술대회발표논문을토대로수정작성한것으로자료수집및연구에협조해주신모든병원관계자분들에게감사드립니다. References 1. Jo GR. Influencing factors on the compliance about standard precautions among ICU and ER nurses [Unpublished master s thesis]. Seoul; Seoul National University, Ayranci U, Kosgeroglu N. Needlestick and sharps injuries among nurses in the healthcare sector in a city of western Turkey. J Hosp Infect 2004;58: Kosgeroglu N, Ayranci U, Vardareli E, Dincer S. Occupational exposure to hepatitis infection among Turkish nurses: frequency of needle exposure, sharps injuries and vaccination. Epidemiol Infect 2004;132: Lue MK. A survey of occupational exposure to blood and body fluids in health care workers [Master's thesis] Ulsan: Ulsan University; Park MR, Kim JE, Park ES, Choi JS, Jung SY, Song YG, et al. A multicenter descriptive study of bloodborne exposures among health care workers in Seoul and Gyeonggi-Do. Korean J Nosocomial Infect Control 2003;8: Lopez RA, Rayan GM, Monlux R. Hand injuries during hand surgery: a survey of intraoperative sharp injuries of the hand among hand surgeons. J Hand Surg Eur Vol 2008;33: Choi JS. Development and evaluation of web-based, blood-borne program [PhD dissertation]. Seoul; Seoul National University, Yassi A, McGill M. Determinants of blood and body fluid exposure in a large teaching hospital: hazards of the intermittent intravenous procedure. Am J Infect Control 1991;19: Park SY, Shin DS, Lee HG, Kim HS. Compliance with nosocomial infection vontrol and telated factors among emergency room nurses. J Korean Acad Fundam Nurs 2008;15: Yoo MS, Son YJ, Ham HM, Park MM, Um AH. A comparative study of nurses' recognition and practice level of general nosocomial infection, MRSA and VRE. J Korean Acad Fundam Nurs 2004;11: Park YM, Park KY. Influence of VRE knowledge and awareness with VRE in compliance with VRE among nurses in intensive care units. J Korean Biol Nurs Sci 2009;11: Park S, Jeong IS, Jun SS. Effect of sharps injury prevention program on the incidence and reporting of sharp injury among nurses. Korean J Hosp Manag 2013;18; An JY, Lee YM, Song JH. A study on performance level for universal precautions on bloodborne infections among nurses in hospitals. J Korean Acad Soc Nurs Edu 2010;16: Park SJ, Kim KS. The knowledge, perception and compliance to prevent from blood borne infection for operating room nurses. J Korean Acad Adult Nurs 2009;2: Choi OH, Lee GE. Factors influencing for the compliance of preventing bloodborne infection for operating nurses. Korean J Occup health Nurs 2006:15: Ahn JS, Kim YH, Kim M. Performance of preventive actions to be exposed to infection in emergency nurses and its influencing factors. J Muscle Jt Health 2015;22: Janjua NZ, Razaq M, Chandir S, Rozi S, Mahmood B. Poor knowledge--predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan. BMC Infect Dis 2007;7:81.

9 응급실간호사의혈액매개감염감염관리수행관련요인 Jo HS, Yu KH. A study on the level of recognition and performance of the clinical nurses about the prevention of nosocomial infection. Korean J Occup Health Nurs 2001:10: Seo YH, Oh HY. Knowledge, perception, safety climate, and compliance with hospital infection standard precaution among hospital nurses. J Korean Clin Nurs Res 2010:16: Cheong HJ, Cho CM. The study of knowledge and performance about preventive action of the nosocomial infection in nurses. J Korean Clin Nurs Res 2004;9: Gerberding JL. Clinical practice. Occupational exposure to HIV in health care settings. N Engl J Med 2003;348: Sax H, Perneger T, Hugonnet S, Herrault P, Chraïti MN, Pittet D. Knowledge of standard and isolation precautions in a large teaching hospital. Infect Control Hosp Epidemiol 2005; 26:

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1.. Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University :