병원감염관리 : 제20권제2호 2015 Korean J Nosocomial Infect Control 2015;20(2):70-81 http://dx.doi.org/10.14192/kjnic.2015.20.2.70 원저 중앙공급실간호사의멸균과정에대한지식과교육요구도 윤지현 1 ㆍ정인숙 2 부산대학교병원간호부 1, 부산대학교간호대학 2 Knowledge and Educational Need of Central Supply Room Nurses for the Sterilization Process Ji Hyun Yun 1, Ihn Sook Jeong 2 Department of Nursing, Pusan National University Hospital 1, College of Nursing, Pusan National University 2, Yangsan, Korea Background: This study aimed to assess central supply room nurses knowledge on and educational needs for the sterilization process. Methods: The participants were 88 nurses working at central supply rooms of hospitals in Busan, Ulsan, and Gyeong-nam. From August to September 2014, knowledge and educational needs of the sterilization process were measured by using self-reported questionnaires. Data were analyzed by descriptive statistics, t test or analysis of variance (ANOVA), Scheffe test, and repeated-measures ANOVA with the SPSS 21.0 program. Results: The mean score for knowledge on the sterilization process was 39.58 out of 50 points and was highest in keeping sterilization (8.94 out of 10 points) and lowest in packing sterilization (6.82 out of 10 points). The mean score for knowledge was significantly higher in the nurses with postgraduate studies (F=3.35, P=0.040), in those with internal training (t=2.03, P=0.045), with three or more internal trainings (F=9.72, P<0.001), with external training (t=3.48, P=.001), with two or more external trainings (F=8.40, P=0.001), and in those working in hospitals with 700 beds or more (F=15.88, P<0.001). The mean score for educational need was 4.06 out of 5 points, ranging from 3.99 to 4.12 points. It was significantly higher in nurses aged 40 years and older (F=4.28, P=0.017) and in those working in hospitals with 700 beds or more (F=4.82, P=0.010). Conclusion: Nurses working in central supply rooms need education on the sterilization process. We recommend the development of a standardized textbook and an educational program based on the results of this study. Keywords: Central supply, Education, Knowledge, Sterilization Introduction 멸균 (sterilization) 은의료기구나물품에존재하 Received: April 28, 2015 Revised: June 4, 2015 Accepted: June 16, 2015 Correspondence to: Ihn Sook Jeong, College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeumeup, Yangsan 50612, Korea Tel: 051-510-8342, Fax: 051-510-8308 E-mail: jeongis@pusan.ac.kr *This manuscript is a condensed form of the first author s master s thesis from Pusan National University. 는미생물이없도록만드는과정 [1] 으로감염의위험성을줄이거나예방할수있는가장기본적인감염관리방법이다 [2]. 각종의료기구를이용한침습적처치로인한환자감염을예방하기위해서는사용되는물품에대한멸균과정의표준, 보관및멸균상태유지를위한수칙을준수하여야한다 [3]. 이에의료기관에서는중앙공급실을두어사용한기구를회수하여세척멸균을시행한후사용부서에공급하는업무를담당하도록하고있다 [4,5]. 멸균과정에는간호사는물론간호조무사, 기능직등다양한직종의인력이참여
중앙공급실간호사의멸균과정에대한지식과교육요구도 71 하고있는데그관리책임은중앙공급실간호사에게있다 [6]. 중앙공급실간호사는멸균과정에대한정확한지식을바탕으로멸균과정의정책과규정을수립하고전과정을관리해야한다 [6] 멸균과정은반납-세척-포장-멸균-멸균유지-불출로이루어지며 [7] 엄격하고과학적인원칙이적용되어야한다 [2]. 멸균에대한중요성이부각됨에따라국내의료기관평가인증제와병원신임평가에서도멸균이얼마나정확하게시행되고있는지를평가항목으로반영하고있다 [8]. 그러나실제조사결과에따르면멸균과정의많은부분이권고되는사항과는다르게실시되고있었다. 2010년실시된한조사결과에따르면조사대상중저온멸균되어야할수술기구의 36.3% 가멸균이아닌소독이되었고, 멸균기의상태를평가하는보위-딕검사 (Bowie-dick test) 를시행하지않는병원이 36.8%, 생물학적표지자 (biological indicator) 를사용하지않는병원이 16.4% 로나타났다 [9]. 의료기관에서사용하는의료기구나물품의멸균이중앙공급실에서이루어지고, 이에대한관리는중앙공급실간호사의책임임을감안할때중앙공급실간호사가멸균과정에대해올바른지식을지니고있는지에대한조사가필요한부분이다. 특히, 국내한보고에따르면중앙공급실에근무하는간호사의공급실경력은 2년미만이전체의약 1/3을차지하였다 [10]. 이전근무경험도멸균과정에관한업무를경험할수있는수술실등의경력자는 39.5% 에불과하고, 나머지는멸균과정에관한업무를경험할수없는부서의근무자들로나타났다 [10]. 간호사가중앙공급실에배치되기전이나직후에체계적으로멸균과정에대해교육받을수있는상설프로그램은국내에서는아직개발되어있지못하다. 단지병원중앙공급간호사회에서개최하는보수교육이나학술대회를통해비정기적으로교육을받고있는실정이다. 최근 3년간실시된보수교육내용을보면 2012년은전체 5개강좌중 4개가멸균확인과세척에관한내용이었고, 2013년은전체 8개강좌중 3개가멸균과정감시와멸균관리표준에관한내용이었으며 2014년은전체 7개강좌중 3 개강좌가세척과멸균방법에관한내용이었다 [11-13]. 그러나지난 3년간보수교육중어느것도반납-세척-포장-멸균-멸균유지-불출등멸균과정전체를다루지는못하였다. 학술대회역시현장에서근무하는실무자들이심층적으로연구한것을발표한것으로멸균과정전체를체계적으로교육하기에는부족한내용이었다. 따라서, 본연구는이러한제한된교육프로그램하에서중앙공급실간호사의멸균과정에대한지식과교육요구도를조사하고, 추후중앙공급실간호사를위한체계적인멸균과정교육프로그램의개발에활용하는데그목적이있었다. 구체적인연구목적은다음과같았다. 1) 중앙공급실간호사의멸균과정에대한지식과교육요구도를파악한다. 2) 중앙공급실간호사의제특성에따른멸균과정에대한지식과교육요구도를분석한다. Materials and Methods 1. 연구설계본연구의설계는부산광역시, 울산광역시, 경상남도소재병원의중앙공급실간호사의멸균과정에대한지식정도와교육요구도를파악하기위한서술적조사연구이다. 2. 연구대상연구대상은자료수집의접근성을고려하여본연구자가근무하고있는부산광역시에소재하는병원중중앙공급간호사회부산지회에소속된 34개병원에근무하는중앙공급실간호사 60명과울산광역시와경상남도소재 23개종합병원에근무하는중앙공급실간호사 44명전수를모집단으로하였다. 3. 연구도구연구도구는구조화된자가보고형설문지이며본연구와동일한목적을위해개발된설문지가없어연구자가개발하였다. 먼저멸균과정에대한설문항초안은연구자중 1인이관련문헌을참고하여멸균과정을크게 1 반납과세척 2 포장 3 멸균기관리및멸균방법 4 멸균표지자 5 멸균유지및불출등
72 윤지현 / 정인숙 5개범주로나눈 50문항이며, 각범주별문항수는 10개로구성하였다. 구체적인참고문헌은미국질병관리본부의지침과점검표 [14], 미국국제표준위원회의표준 [1], 한국멸균관리표준 [15], 중앙공급실업무표준안내서 [7] 와국내평가기준인병원신임평가기준 [16] 과의료기관평가인증기준 [17] 이었다. 다음은개발된설문항초안에대해전문가타당도검토를받았다. 중앙공급실간호사회학술이사 2인, 본연구의대상자가아닌대구와광주지역의중앙공급실간호사 2인, 부산지역의중앙공급실근무경력 8년이상의경력간호사 1인, 감염관리전문간호사 1인, 감염관리를전공한간호학교수 1인등으로구성된총 7인의전문가집단으로부터문항구성내용과어휘의적합성여부를검토받았다. 그결과 50문항중 13 문항에서수정을필요함을회신받았는데, 중앙공급실에서이루어지는행위가아니고실제사용부서에서이루어지는행위 2문항, 측정하고자하는내용이불명확한 4문항, 질문의내용이적절하지않은 7문항이었다. 날카로운일회용품은분리하여손상성폐기물박스에폐기한다. 등중앙공급실에서이루어지는행위가아닌 2문항은중앙공급실에서이루어지는행위로변경되었고, 자동세척기를사용할때에는제조사의지침에따라사용한다. 등내용이불명확한 4문항은문장이수정되었으며, 멸균기가정상작동될때는중앙공급실간호사의책임하에예방점검을실시한다. 등질문의내용이적절하지않은 7문항은삭제되고다른문항으로대체되었다. 이러한수정은일차적으로초안개발자가담당하였으며, 수정안은감염관리전공교수 1인에의해확인되었다. 이후수정된 13문항을포함한 50문항에대해중앙공급실근무경력 8년이상의경력간호사 2인과감염관리전문간호사 1인으로부터타당성과필요성을각각 4점척도로평정하도록하여내용타당도지수를산출하였으며, 모두 85% 이상을유지하였다. 마지막으로설문조사대상자의이해도를평가하기위해설문항초안을본연구의대상자가아닌중앙공급간호사회대구ㆍ경북지회와광주 전라지회소속의간호사 5인을대상으로사전조사를실시하였다. 사전조사에서는이해하기어려운 내용이나수정을요하는문구를자유롭게적을수있도록하였으며, 수정을요하는문구가없는것으로나타났다. 이러한절차를거쳐개발된멸균과정에대한지식문항은초안과마찬가지로 5개범주에각범주별 10문항으로총 50문항이며, 각문항은정답인경우 1점을, 오답인경우 0점을부여하였다. 모름 으로답한경우오답으로처리하여 0점을부여하였고문항별점수가중치는두지않았다. 멸균과정에대한교육요구도문항은멸균과정에대한지식문항을그대로사용하였으며, 응답내용을 거의필요하지않다 에서 매우필요하다 의 5점척도로변경하였다. 거의필요하지않다 에는 1점을, 매우필요하다 에는 5점을부여하였으며 50문항의평균점수가 5점에가까울수록교육요구도가높음을의미한다. 본연구에서교육요구도의 Cronbach's α값은 0.989이었다. 연구도구에는멸균과정에대한지식, 교육요구도외에대상자의연령과학력, 근무부서와근무경력등, 멸균과정에대한교육, 근무기관의병상수등대상자의일반적특성과대상기관의특성등 10문항이포함되었다. 4. 자료수집방법연구를진행하기에앞서부산대학교병원임상시험심사위원회의승인을받았다 ( 승인번호 : E- 2014101). 설문지배부에앞서연구대상병원의간호부또는중앙공급실에전화로설문지배부에관한사전동의를얻은후우편또는방문하여설문지를배부하였다. 설문지의회수는우편배부시동봉된반송봉투를이용하여우편으로회수하거나연구자가직접회수하였다. 설문지는총 104부가배부되었고퇴사와부서이동등에의한대상자공석등의이유로총 88부가회수되었다. 설문지배부시에는소정의답례품을제공하였다. 자료수집은 2014년 8월부터 10월까지 2달간지속되었다. 윤리적고려를위해연구의목적과자료의익명성과비밀보장그리고자발적참여를명시한연구참여동의서를작성한후자료수집을시행하였으며, 모든개인적자료는외부로노출되지않도록하였다.
중앙공급실간호사의멸균과정에대한지식과교육요구도 73 5. 자료분석방법수집된자료는 SPSS 21.0 프로그램 (IBM, Armonk, NY, USA) 을사용하여유의수준은 0.05로하여양측검정하였다. 1) 연구대상자의제특성은빈도와백분율, 평균과표준편차로산출하였다. 2) 연구대상자의멸균과정에대한지식과교육요구도는빈도와백분율, 평균과표준편차로산출하였다. 멸균과정의각범주별지식과교육요구도의차이에대한검정은반복측정분산분석을이용하였으며, 자료가구형성가정을만족하지않아 Greenhouse-Geisser 값을이용하였다. 3) 연구대상자의제특성에따른지식과교육 요구도는분산분석과사후검정을실시하였다. Results 1. 연구대상자의제특성연구대상자의제특성은 Table 1과같았다. 평균연령은 45.1세이며, 교육수준은 3년제전문학사와 4년제학사가동일비율로각각 36.4% 이었다. 임상경력은 20년이상이 54.5% 으로가장많았으며중앙공급실경력은 1년-3년미만이 38.6% 으로가장많았다. 대상자의중앙공급실에서의지위는책임간호사나수간호사가가장많은 47.7% 이었고최근 1년간의내부교육경험을묻는질문에는전체의 70.5% 가있다고답했으며, 경험횟수는 1 Table 1. Characteristics for central supply room nurses (N=88) Characteristics Categories n % M±SD Age 39 21 23.9 40-49 37 42.0 50 30 34.1 45.13±8.04 Education 3 year college 32 36.4 4 year college 32 36.4 Master and higher 24 27.3 Total career as a nurse <10 13 14.8 (year) 10-19 27 30.7 20 48 54.5 20.34±8.62 Career in central supply <1 15 17.0 room (year) 1-2 34 38.6 3-4 15 17.0 5 24 27.3 4.83±5.45 Position Staff nurse 32 36.4 Charge nurse, head nurse 42 47.7 Team leader and higher 14 15.9 Exposure to internal None 26 29.5 education within 1 year 1 30 34.1 (time) 2 14 15.9 3 18 20.5 Exposure to external None 18 20.5 education within 1 year 1 33 37.5 (time) 2 25 28.4 3 12 13.6 Preferred type of education Standardized textbook 47 53.4 On-site continuing education 19 21.6 On-line continuing education 13 14.8 Seminar 9 10.2 Preferred time of education >4 hours 63 71.6 4 hours 25 28.4 Hospital bed size 299 26 29.5 300-699 30 34.1 700 32 36.4 565.67±332.31
74 윤지현 / 정인숙 회가 48.4% 로가장많았다. 외부교육경험은대상자의 79.5% 가있다고대답하였고, 최근 1년간의교육횟수는 1회가 47.1% 로가장많았다. 선호하는교육형태는 53.4% 가표준화된개발된교재를선택하였고보수교육, 웹기반의교육프로그램, 상설세미나순으로응답하였다. 선호하는교육시간은 71.6% 가 4시간을초과하는교육을원하였고, 4시간이하의교육시간을선호한다고응답한대상자는 28.4% 이었다. 대상자가근무하는병원의병상수는 700병상이상이 36.4% 로가장많았고, 그뒤를이어 300-699병상이 34.1%, 299병상이하가 29.5% 를차지하였다. 2. 연구대상자의멸균과정에대한지식과교육요구도 1) 전반적인멸균과정에대한지식과교육요구도연구대상자의멸균과정에대한지식과교육요구도는 Table 2와같았다. 멸균과정에대한지식은 50점만점에평균 39.58점이었다. 5개의범주중 멸균유지및불출 범주가평균 8.94점으로가장높았으며, 포장 범주가 6.82점으로지식점수가가장낮았으며, 범주간멸균과정에대한지식은통계적으로유의한차이가있었다 (F=37.96, P<0.001) 멸균과정에대한교육요구도는 5점만점에평균 4.06점이었고모든범주가평균 3.99점이상의교육요구도를보였다. 5개범주간멸균과정에대한교육요구도는통계적으로유의한차이가있었다 (F=3.17, P=0.02) 2) 문항별멸균과정에대한지식과교육요구도 (1) 문항별멸균과정에대한지식문항별멸균과정에대한지식은 Table 3과같았다. 반납과세척범주에서정답률이가장높은문항은 사용한물품의반입창구는별도로구획한다. 로 88명의대상자가모두정답인 맞음 을응답하였고, 가장정답률이낮은문항은 세척물품의종류에따라작동시간을임의로변경한다 ( 틀린문항 ) 로정답률은 37.5% 이었다. 포장 범주에서정답률이가장높은문항은 기구표면에수분이남아있는상태로포장한다 ( 틀린문항 ) 로정답률은 98.9% 이었고, 정답률이가장낮은문항은 손상의우려가있는날카로운기구는라텍스튜브 (latex tube) 로끝을보호한다 ( 틀린문항 ) 로정답률은 21.6% 이었다. 멸균기관리및멸균방법 범주에서정답률이가장높은문항은 에틸렌옥사이드 (EO) 가스멸균실에는전용배기시설을구비한다, EO가스멸균물품들은조밀하게적재한다 ( 틀린문항 ) 와 EO가스멸균물품이멸균기챔버의벽에닿지않도록적재한다 로정답률이 97.7% 이었고, 정답률이가장낮은문항은 EO가스멸균의파우치적재시플라스틱면과종이면이닿게한다 로정답률은 52.3% 이었다. 멸균표지자 범주에서정답률이가장높은문항은 보위-딕검사는비어있는멸균기에서실시한다 와 보위-딕검사결과지는확인후즉시폐기한다 ( 틀린문항 ) 로정답률은 90.9% 이었고, 정답률이가장낮은문항은 스팀멸균용생물학적표지자균주는 Bacillus atrophaeus이다 ( 틀린 Table 2. Knowledge and educational need on sterilization process (N=88) Category (number of item) Knowledge M±SD Educational need M±SD Return and cleaning (10) 7.65±1.34 3.99±0.74 Packing (10) 6.82±1.66 4.04±0.60 Sterilization method (10) 8.13±1.57 4.11±0.65 Sterilization indicator (10) 8.05±2.11 4.12±0.77 Sterilization maintenance and release (10) 8.94±1.23 4.03±0.81 Total 39.58±6.09 20.29±3.35 F (P) by category 37.96 (P<0.001) 3.17 (P=0.02)
중앙공급실간호사의멸균과정에대한지식과교육요구도 75 Table 3. Knowledge and educational need on sterilization process by each question (N=88) Question Knowledge (Correct answer, %) Educational need (M±SD) <Return and cleaning> Return room containing the used things is considered as the clean area.* 95.5 3.85±0.98 Return area for the used things is separated. 100.0 3.98±0.93 The used things are separated by contamination source. 95.5 4.11±0.93 The used things are carried by closed box. 97.7 3.97±1.00 The used disposable gloves are abrogated by a damageable wast box.* 44.3 3.97±0.81 The recommended temperature of cleaning room is 24-28 o C.* 70.5 4.00±0.66 Eye-wash station should be within a cleaning room. 89.8 4.06±0.88 In cleaning, a worker should wear personal protective equipments, 84.1 4.08±0.94 including gloves, gowns, masks, and eye protection. In hand-washing, a stopper of sink is not closed.* 50.0 3.89±0.86 In using an automatic washer, the working time of the unit can be 37.5 3.97±0.65 arbitrarily changed according to the type of patient-care devices.* <Packing> The devices are packed when the water remains on the surface of them.* 98.9 4.01±1.02 Sharp devices are packed by a pouch pack.* 72.7 3.99±0.90 The individual device within a instrument set is repacked 63.6 4.02±0.64 by a waterproof paper.* Linens are suitable for the use of package material after EO gas sterilization.* 93.2 4.02±0.77 The device with hole is horizontally laid in the instrument set. 59.1 4.13±0.64 The surface of cup-shaped device is faced up in the instrument set.* 50.0 4.11±0.67 The end or edge of a damageable sharp instrument is protected 21.6 4.02±0.86 by using latex tube.* The total weight of a sterilized instrument should be 11.3 kg 53.4 4.16±0.52 or less after packaging it. Two persons check the instrument set. 88.6 4.00±0.71 The devices are repacked when they are returned in central supply 80.7 3.95±0.76 room because of the elapsed expiration date. <Sterilization I: Sterilization method> Leave the door of the steam sterilizer open when it is not activated.* 73.9 3.95±0.73 Steam sterilization is suitable for sterilizing surgical instruments 96.6 4.03±0.89 that are not damaged by heat, steam, pressure or moisture. Within a steam sterilizer, textile products are laid at the bottom 61.4 4.19±0.60 and metal products are laid at the top.* In loading things within a steam sterilizer, the pouch is laid horizontally 61.4 4.13±0.58 on the tray.* In loading things within a steam sterilizer, concave-shaped instrument 79.5 4.09±0.65 or vessel is laid in oblique. When the eye is contaminated to E.O gas, immediate washing of the eye 94.3 4.25±0.78 by running water should be required. In E.O gas sterilization room, specified ventilation system is equipped. 97.7 4.18±0.90 In loading pouch of E.O gas sterilization, there are no gap between 52.3 4.17±0.68 the surfaces of plastic and paper. All things are densely placed within E.O gas sterilizer chamber.* 97.7 4.03±0.88 All things are placed with a gap between them and wall 97.7 4.06±0.79 of EO gas sterilizer chamber. <Sterilization II: Sterilization Indicator> Bowie-dick test is performed in the empty sterilizer. 90.9 4.19±0.95 Bowie-dick test time ranges from 3.5 to 4 minutes. 78.4 4.16±0.87 Result paper of Bowie-dick test is immediately abrogated after its confirmation.* 90.9 4.07±0.96 In wrapping a linen, internal chemical indicator is located in the midline. 87.5 4.06±0.91
76 윤지현 / 정인숙 Table 3. Continued Question Knowledge (Correct answer, %) Educational need (M±SD) All internal chemical indicators are put in the sterilized packs. 77.3 4.10±0.80 External chemical indicator is applied on common tape after fixing it.* 73.9 4.05±0.90 Biological indicator is located in the most upper portion of steam sterilizer.* 79.5 4.14±0.87 The bacterium of Biological indicator for steam sterilization 51.1 4.08±0.73 is Bacillus atrophaeus.* In sterilization of implant devices, biological indicator is used 89.8 4.16±0.83 in each sterilization cycle. In cultivation of Biological indicator, control biological indicator is used. 85.2 4.19±0.79 <Sterilization maintenance and release> A storage room of sterilized things is off-limits to visitors. 100.0 4.07±0.96 A storage room of sterilized things maintains negative pressure.* 61.4 4.00±0.93 Recording paper for temperature and humidity in a storage room 94.3 3.99±0.84 of sterilized things is immediately abrogated after its confirmation.* Hand cleaning is performed before managing the sterilized things. 97.7 4.01±0.95 The sterilized things are kept in an open cabinet.* 83.0 4.05±0.79 A storage cabinet is set up with no gap from the wall.* 88.6 4.05±0.82 Expiration date of packing is not different according to its type.* 84.1 4.13±0.86 When a thing drops on the floor, it is considered as uncleanness. 94.3 4.00±0.96 In releasing sterilized things, there is the determined order 94.3 4.05±0.91 (for example, from up to down, etc). Release recording paper for sterilized things is kept. 96.6 4.00±0.82 *Reverse coding. 문항 ). 로정답률은 51.1% 이었다. 멸균유지및불출 범주에서가장정답률이높은문항은 멸균물품보관실은외부인출입을통제한다. 로정답률은 100% 이었고, 가장정답률이낮은문항은 멸균품보관실은음압을유지한다 ( 틀린문항 ). 로정답률은 61.4% 이었다. (2) 문항별멸균과정에대한교육요구도멸균과정에대한연구대상자의문항별교육요구도는 Table 3과같았다. 반납과세척 범주에서교육요구도가가장높은문항은 사용한물품은오염원에따라구분하여수거한다 로평균 4.11점이었고, 교육요구도가가장낮은문항은 사용한물품의반납실은청결구역으로간주한다 ( 틀린문항 ) 로평균 3.85점이었다. 포장 범주에서교육요구도가가장높은문항은 포장이완료된물품은무게가 11.3 kg 이하이어야한다 로평균 4.16점이었고, 교육요구도가가장낮은문항은 중앙공급실로반납된멸균유효기간이지난물품은재포장한다 로평균 3.95 점이었다. 멸균기관리및멸균방법 범주에서교육요구도가가장높은문항은 EO가스가눈에접촉되었을때는즉시흐르는물에세척한다 로평균 4.25점이었고, 교육요구도가가장낮은문항은 스팀멸균기는사용하지않을때문을열어둔다 ( 틀린문항 ) 로평균 3.95점이었다. 멸균표지자 범주에서교육요구도가가장높은문항은 보위-딕검사는비어있는멸균기에서실시한다 로평균 4.19점이었고, 교육요구도가가장낮은문항은 외부화학적표지자는일반테이프로고정후그위에부착한다 ( 틀린문항 ) 로평균 4.05점이었다. 멸균유지및불출 범주에서교육요구도가가장높은문항은 포장재의종류에따른유효기간은동일하다 ( 틀린문항 ) 로평균 4.13점이었고, 교육요구도가가장낮은문항은 멸균물품보관실의온습도의기록지는확인후즉시폐기한다 ( 틀린문항 ) 로평균 3.99점이었다.
중앙공급실간호사의멸균과정에대한지식과교육요구도 77 3. 연구대상자의제특성에따른멸균과정에대한지식과교육요구도연구대상자의제특성에따른멸균과정에대한지식과교육요구도분석은 Table 4와같았다. 전체적인지식점수는교육수준 (F=3.35, P=0.040), 내부교육경험유무 (t=2.034, P=0.45), 내부교육경험횟수 (F=9.72, P<0.001), 외부교육경험유무 (t=3.48, P <0.001), 외부교육경험횟수 (F=8.40, P<0.001), 병상수 (F=15.88, P<0.001) 에따라유의한차이가있었다. 즉, 멸균과정에대한지식은교육수준이높을수록높아지는경향을나타내었다. 내부교육을받은경우더높고교육횟수가많아질수록지식이높아지는경향을보였으며외부교육도같은결과를나타내었다. 교육요구도는연령 (F=4.28, P=0.017) 과병상수 (F=4.82, P=0.010) 에따라유의한차이가있었다. 교육요구도는 40대에서가장높고 40대이하에서가장낮게나타났으며연령이많을수록교육요구도가높아지는경향을나타내었다. 그리고병원의병상수가많을수록교육요구도가높았다. Discussion 본연구는중앙공급실간호사들을대상으로멸균과정에대한지식과교육요구도를파악하고자시도되었다. 멸균과정에대한지식은평균 39.58 점으로 79.2% 의정답률을보였다. 다른전문분야의간호사를대상으로한감염관리지식을조사한선행연구를보면종합병원간호사를대상으 Table 4. Knowledge and educational need according to characteristics (N=88) Characteristics Categories Knowledge Educational need M±SD t or F (P) M±SD t or F (P) Age 39 a 38.76±7.31 0.41 3.76±0.96 4.28 40-49 b 40.22±5.61 (0.669) 4.26±0.40 (0.017) 50 c 39.37±5.85 4.01±0.62 a<b,c Education 3 year college a 37.97±6.06 3.35 4.05±0.67 0.89 4 year college b 39.31±6.15 (0.040) 3.96±0.83 (0.415) Master & higher c 42.08±5.43 a,b<c 4.20±0.37 Total career <10 39.69±7.15 0.97 3.80±0.99 2.15 as a nurse 10-19 38.26±5.54 (0.385) 3.96±0.68 (0.123) (year) 20 40.29±6.09 4.18±0.54 Career in central <1 38.13±5.71 0.61 4.08±0.76 0.46 supply room 1-2 39.88±6.49 (0.610) 3.97±0.76 (0.709) (year) 3-4 41.00±5.40 4.21±0.47 5 39.17±6.25 4.08±0.60 Position Staff nurse 40.50±6.93 0.76 4.07±0.92 0.02 Charge, Head nurse 38.76±5.93 (0.469) 4.04±0.42 (0.980) Team leader & higher 39.93±4.27 4.07±0.65 Exposure to Yes 40.42±5.97 2.03 4.10±0.68 0.90 internal education No 37.58±5.99 (0.045) 3.96±0.66 (0.373) Time of 1 a 38.00±5.98 9.72 3.98±0.77 1.03 internal education 2 b 39.86±6.16 (<0.001) 4.28±0.41 (0.362) (hrs) 3 c 44.89±2.49 a,b<c 4.15±0.67 Exposure to Yes 40.66±5.70 3.48 4.07±0.64 0.45 external education No 35.39±5.86 (0.001) 3.99±0.79 (0.654) Time of 1 a 38.09±5.77 8.40 4.01±0.52 1.02 external education 2 b 42.24±5.28 (<0.001) 4.04±0.86 (0.367) (hrs) 3 c 44.42±2.27 a<b,c 4.31±0.36 Hospital bed size 299 a 36.65±6.58 15.88 3.89±0.80 4.82 300-699 b 37.70±4.91 (<0.001) 3.90±0.70 (0.010) 700 c 43.72±4.27 a,b<c 4.34±0.40 a,b<c
78 윤지현 / 정인숙 로교육프로그램적용전에측정한혈액매개성감염지식의평균정답률은 59.2% [18], 간호사의피부소독에대한지식을측정한연구에서는평균정답률은 63.1% [19], 중환자실간호사를대상으로측정한감염관리지식의평균정답률은 48.7% [20], 그리고, 특수부서간호사를대상으로측정한표준주의지침에대한지식의평균정답률은 75.6% [21] 이었다. 다른전문분야간호사를대상으로한지식보다는높게나타났으나중앙공급실간호사들은멸균과정에대해서는모두알고있어야함을감안할때지속적인교육이필요함을알수있다. 중앙공급실간호사의멸균과정에대한지식점수는교육수준과병원의병상수에따라유의한차이가있었다. 교육수준이높을수록지식점수가높았으며병원의병상수가많을수록지식점수가높았다. 이는중환자실간호사를대상으로감염관리지식을측정한연구에서감염관리지식이교육수준과유의한양의상관관계를보여주는결과와도일치하였다 [20]. 병상수가많을수록다양한교육의기회가마련되어있는현실을반영한결과로유추된다. 중앙공급실간호사의멸균과정에관한지식점수는내부교육경험유무와외부교육경험유무에따라유의한차이가있었다. 최근 1년간내부교육경험이있는경우가없는경우보다지식점수가높았으며, 외부교육경험이있는경우가없는경우보다지식점수가높았다. 이는혈액매개감염에관한웹기반의교육및관리프로그램을개발하여간호사를대상으로주 1회 30분이상 3 주간교육을실시한연구에서교육을받은실험군의지식정도가대조군보다높았음을보고한연구 [22] 와중환자실간호사들은대상으로감염관리와관련된근거기반실무수행에영향을미치는요인을파악하기위해실시한연구에서감염관리지식수준이학회가입, 학술대회참석, 감염관리관련수업이수, 정기적논문읽기, 최근논문읽은시기, 웹테이터베이스활용에따라모두통계적으로유의한차이가있음을보고하면서지식의정도가각각여러형태의교육경험여부와관련이있음을보여준연구 [20] 와도일치한다. 또한한방병원간호사들을대상으로소독 과멸균에관한내용을포함한병원감염관리지식을측정한연구에서간호사들의지식이감염관리교육시간에따라통계적으로유의한차이가있다고보고한연구결과와도일치한다 [23]. 본연구에서는중앙공급실간호사의멸균과정에대한지식점수는최근 1년간내부교육경험횟수와외부교육경험횟수가많을수록지식점수가높았다. 이는수술실간호사와감염관리간호사를대상으로소독관련지식을측정했을때내부교육은통계적으로차이를보이지않았으나, 외부교육이통계적으로의미있는차이를보여연 1회이상외부교육참여를제안한바있는연구와는상반된결과를보여주고있다 [24]. 소독관련교육과는달리멸균과정에대한교육은외부교육경험의기회가적어상대적으로내부교육이지식에영향을미친것으로추측된다. 지식을측정하는문항에서정답률이높았던문항은사용한물품의반입창구구획지정, 멸균물품보관실이외부인출입통제, 멸균물품취급전손위생, EO가스멸균실전용배기시설구비등병원신임평가나의료기관인증제와관련된문항이많았다. 이러한문항들은평가에대비하기위해각병원에서의반복적인교육을실시한결과로추측된다. 반대로정답률이낮았던문항은손상의우려가있는날카로운기구의포장, 자동세척기작동시간, 기구손세척등일상적으로잘못시행하고있으나이론적근거들이필요한문항들이었다. 따라서추후멸균과정에관한교육프로그램개발시에는현장에서의례적으로행하고있는잘못된방법들에대한교육이그내용으로포함되어야할것이다. 범주별로는 멸균유지및불출 범주의지식이가장높았으며 포장 범주의지식이가장낮았다. 이는간호사가직접적으로관여한분야에서지식이높음을볼수있는데, 수술실간호사대상의소독관련지식측정연구에서수술실간호사의직접업무가아닌혈액및체액을통한감염시조치사항에서정답률이가장낮았던것 [24] 과도일치한다. 그러나중앙공급실간호사는멸균전과정의관리책임자임으로기능직이행하는업무라할지라도그에관한지식은교육과정에포함되어야할것이다. 교육요구도는 5점만점에평균 4.06점으로비
중앙공급실간호사의멸균과정에대한지식과교육요구도 79 교적높은수준이었다. 이러한결과는중앙공급실에근무하는간호사중다수는멸균과정에관련이없는부서에서이동 [10] 한다는것과함께중앙공급실이특수부서로근무자가많지않아체계적인교육을받을수있는기회가제한적일수있다. 앞에서도언급하였듯이, 실제로국내에서멸균과정에대한상설교육은없으며, 병원중앙공급간호사회에서보수교육이나학술대회를통해교육이제공되고있으나, 멸균과정의일부에국한되고있다 [11-13]. 또한, 본연구에서범주별지식수준에관계없이교육요구도가 5점만점에 3.99점에서 4.12점으로대부분이 4점대이며, 일부문항 ( 예 : 사용한물품은오염원에따라구분하여수거한다 ) 은정답률이 95% 이상임에도불구하고 4.1점이넘는교육요구도를보였다. 즉, 중앙공급실간호사는멸균과정에대해알고있음에도불구하고, 자신의지식에대한확신이부족하며체계적인교육을받고자하는것으로볼수있다. 이러한결과로부터중앙공급실간호사가참여할수있는멸균과정에대한전반적인교육과정이시급히개발될필요가있음을알수있다. 한편, 교육요구도는연령이높을수록, 병원의병상수가많을수록높았는데, 병상수가많을수록중앙공급실의역할이비중있게다루어지는현실을반영한결과로보여진다. 교육요구도가높았던문항은 EO가스노출시대처, 보위-딕검사, 생물학적표지자배양과관련한문항으로, 이들은대부분병원신임평가나의료기관인증제의평가문항으로실제현장에서각종평가에대비할수있는문항에대한교육요구도가높음을볼수있다. 중앙공급실간호사들은병원업무를함에있어실제적으로도움이되는내용이교육에포함되기를바라는것을볼수있다. 교육요구도가상대적으로낮았던문항은물품반납실, 기구손세척, 스팀멸균기사용방법과관련이있었다. 본연구에서응답자의 76.1% 가 40세이상이고가장선호하는교육형태가응답자의 53.4% 가선택한 표준화된교재 라는것을고려해본다면, 현재의교육프로그램이제한되어있어자기중심교육이가능하도록교재개발의필요성이강조되는것으로볼수있다. 또한중앙공급실간호사 들을위한멸균과정교육프로그램을개발함에있어서는일회성으로끝나거나웹기반의온라인교육은지양하는것이적절하다. 멸균과정에대한교육은비상시적으로운영되는세미나나보수교육형태에비해언제나접근이용이한표준화된개발된교재로각병원의특성에맞는상시적인교육이적합한것으로기대된다. 본연구는국내외연구동향을고려할때중앙공급실간호사를대상으로멸균과정에관한지식과교육요구도를평가하는도구를개발하고, 이를바탕으로지식과교육요구도수준을파악하였다는것은본연구의의의라고할수있다. 그러나, 연구대상이부산경남지역의중앙공급실간호사로국한되어전국의중앙공급실간호사를대표하기에는어려움이있다는제한점이있다. Summary 배경 : 본연구는이러한제한된교육프로그램하에서중앙공급실간호사의멸균과정에대한지식과교육요구도를조사하고, 추후중앙공급실간호사를위한체계적인멸균과정교육프로그램의개발에활용하고자시도되었다. 방법 : 연구대상은부산, 울산, 경남의종합병원에간호사 88명이었다. 자료수집은 2014년 8월에서 9월에걸쳐실시되었고, 연구팀에서개발한자가보고용조사도구로멸균과정에대한지식과교육요구도를조사하였다. 자료분석은 SPSS 21.0 프로그램을이용하여기술통계, t검정, 분산분석과 Scheffé 검정, 반복측정분산분석을실시하였다. 결과 : 멸균과정에대한평균지식은 50점만점에 39.58점으로, 멸균물품보관및불출 범주가 10점만점에평균 8.94점으로가장높았으며, 포장 범주가 6.82점으로가장낮았다. 멸균과정에대한지식은석사이상 (F=3.35, P=0.040), 내부교육을받은경우 (t=2.034, P=0.45), 3회이상내부교육을받은경우 (F=9.72, P<0.001), 외부교육경험을받은경우 (t=3.48, P<0.001), 2회이상외부교육을받은경우 (F=8.40, P<0.001), 700병상이상인경우 (F=15.88, P<0.001) 그렇지않은경우에비해높았다. 멸균과정에대한교육요구도는
80 윤지현 / 정인숙 5점만점에평균 4.06점이었고범주에따라평균 3.99점에서 4.12점이었다. 교육요구도는 40대이상 (F=4.28, P=0.017) 과 700병상이상인경우모 (F=4.82, P=0.010) 그렇지않은경우에비해높았다. 결론 : 중앙공급실에근무하는간호사를대상으로멸균과정에대한교육이필요하며본연구에서얻어진결과를바탕으로표준화된교재를새로이개발할필요가있다. References 1. ANSI/AAMI ST79. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. 2010. 2. Graybill-D'Ercole P. Implementing AORN recommended practices for sterilization. AORN J 2013;97:521-33. 3. Son JS, Yu IK. A study on expiration date on ethylene oxide gas sterilization products - related to storage environment. J Korean Acad Fundam Nurs 2014;21:141-50. 4. Lee JY. Standard method of sterilization process monitoring. Paper presented at: Korea Association of Central Supply Department Nurse Continuing Education; 2013 October 8; Konkuk University Medical Center. Seoul. 5. Mayhall CG, ed. Hospital epidemiology and infection control. 4th ed, Philadelphia: Lippincott Williams & Wilkins, 2012. 6. Rutala WA, Weber DJ. How to assess risk of disease transmission to patients when there is a failure to follow recommended disinfection and sterilization guidelines. Infect Control Hosp Epidemiol 2007;28:146-55. 7. Korea Association of Central Supply Department Nurse. Central supply room standard guideline (II). Seoul; Korea Association of Central Supply Department Nurse, 2010:1-65. 8. Kwon MO. Understanding of national and international hospital accreditation survey and application in central supply room. Paper presented at: Korea Association of Central Supply Department Nurse Business Process 3; 2010 October 8; Asan Medical Center. Seoul. 9. Korea Association of Operating Room Nurses. Survey for standard of sterilization in operating room. Paper presented at: Hospital Nurses Association Research Conference; 2010 June 8; Asan Medical Center. Seoul. 10. Cho IJ. Central supply room survey. Paper presented at: Korea Association of Central Supply Department Nurse conference 21th; 2012 March 20; The Catholic University of Korea Seoul ST. Mary's Hospital. Seoul. 11. Korea Association of Central Supply Department Nurse. 2012 Continuing education of Korea Association of Central Supply Department Nurse. Paper presented at: 2012 Continuing education of Korea Association of Central Supply Department Nurse; 2012. September 12; The Catholic University of Korea Seoul ST. Mary's hospital. Seoul. http://kacsdn.or.kr 12. Korea Association of Central Supply Department Nurse. 2013 Continuing education of Korea Association of Central Supply Department Nurse. Paper presented at: 2013 Continuing education of Korea Association of Central Supply Department Nurse; 2013. October 8; Konkuk University Medical Center. Seoul. http://kacsdn.or.kr 13. Korea Association of Central Supply Department Nurse. 2014 Continuing education. of Korea Association of Central Supply Department Nurse. Paper presented at: 2014 Continuing education of Korea Association of Central Supply Department Nurse; 2014. July 15; Seoul National University Hospital. Seoul. http:// kacsdn.or.kr 14. Center for Disease Control and Prevention. Guideline for disinfection and sterilization in healthcare facilities & check list. 2008. 15. Korea Association of Central Supply Department Nurse. Korean sterilization monitoring
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