병원감염관리 : 제18권제1호 2013 7 Korean J Nosocomial Infect Control 2013:18(1):7-14 원저 http://dx.doi.org/10.14192/kjnic.2013.18.1.7 임신부의호흡기감염예방지식과이행정도 윤성원 1 ㆍ김옥선 2 청운대학교간호학과 1, 수원과학대학교간호학과 2 Pregnant Women s Knowledge and Compliance about Prevention of Respiratory Infection Sung Won Yoon 1, Og Son Kim 2 Department of Nursing, Chungwoon University 1, Hongseong-gun, Department of Nursing, Suwon Science College 2, Hwaseong, Korea Background: Respiratory infection in pregnancy can cause various side effects and affect the fetus. Therefore, efforts to prevent infection during pregnancy are essential. This study investigated knowledge and compliance regarding the prevention of respiratory infection among pregnant women. Methods: A survey was conducted on May 10, 2012 on 300 pregnant women who attended a maternity school education program in a tertiary care hospital. The responses of 259 women were collected and analyzed. Results: Only 2 women (0.8%) had been educated about respiratory infection prevention methods, while 106 (40.9%) experienced respiratory infection during pregnancy. The mean score of respiratory infection prevention knowledge was 11.63 out of 15 points (percentage of correct answers: 77.5%). The mean score for compliance to respiratory infection prevention was 32.34 out of 52 points (percentage of practice: 62.19%). Knowledge and compliance were found to be positively correlated. Conclusion: Although many pregnant women experience respiratory infection during pregnancy, few have opportunities to be educated about prevention. Thus, the positive correlation between knowledge and compliance highlights the need for respiratory infection prevention education programs. Keywords: Compliance, Infection, Knowledge, Pregnant woman, Respiratory Introduction 여성은임신과더불어수많은생리적변화와면역체계의변화를경험한다. 일반적으로임신부의감염은그렇지않은여성보다질병중증도가높으며, 입원기간연장, 사망률증가에도영향을미치는것으로알려져있다 [1,2]. Rasmussen 등 [2] Received: June 15, 2012 Revised: February 18, 2013 Accepted: March 8, 2013 Correspondence: Og Son Kim, Department of Nursing, Suwon Science College, San 9-10, Botong-ri, Jeongnammyeon, Hwaseong 445-742, Korea Tel: 031-350-2476, Fax: 031-350-2429 E-mail: oskim-icp@hanmail.net 에의하면 1957년아시아에서인플루엔자가유행할때미숙아출산, 중추신경계손상혹은태아사망등을포함한합병증이증가하였다. 이와같이일부임신부의호흡기감염은질병과정중에경험하는증상으로인한신체적불편감뿐아니라태아에게영향을미칠수있다 [1-5]. 호흡기감염은감염균이포함된비말이대화나기침시에다른사람의호흡기로직접전파되거나오염된환경을통한간접적인방법으로임산부의호흡기로전파될수있다. 풍진, 수두, 인플루엔자등은비말이나공기를통해전파되는대표적인호흡기감염질병으로서임신한여성이이런질병에노출될경우임신한여성이나태아에게심각한문제를유발할수있으므로노출후
8 윤성원 / 김옥선 감염을예방하기위한면역글로불린투여등과같은적절한조치가권고되며 [6], 호흡기감염을유발하는질병에노출되지않도록감염예방교육과실천이무엇보다중요하다. 호흡기감염을예방하기위해서는손위생실천, 호흡기감염환자와가능한한접촉하지않기, 호흡기분비물이튈수있다고판단될때즉상대방이기침시호흡기에티켓을지키지않을경우임산부는적절한호흡기보호가필요하다 [7,8]. 또한임신중호흡기감염으로인해임신한여성과태아가빠질수있는감염위험을줄이기위하여임신전가임기여성에게권장되는예방접종으로홍역, 볼걸이, 풍진, 수두, 독감등이있다. 이중홍역, 볼걸이, 풍진, 수두는임신이확인된후에는접종할수없다 [4-6]. 독감의경우바이러스의변이때문에매년예방접종을하도록하며, 임신중에도예방접종을적극권장하고있다. 현재질병관리본부 (Korea Centers for Disease Control and Prevention, KCDC) 에서는임신부를인플루엔자우선접종권장대상자로분류하고, 임신부의예방접종을권고하고있다 [8]. 임신부의호흡기감염예방과관련하여국내에서수행된연구들은인플루엔자예방접종률과인식에대한일부연구들이있으며 [9,10], 호흡기감염예방에대한지식이나일상생활에서의감염예방행위에대한연구는찾아보기어렵다. 이에호흡기감염예방에대한지식정도와예방행위이행정도를파악하고, 지식정도와예방행위이행정도사이의상관관계를확인함으로써임신부를대상으로한호흡기감염예방행위증진을위한교육프로그램개발의필요성을확인하고, 교육프로그램개발에필요한기초자료를제공하고자본연구를시행하였다. 본연구의세부목적은다음과같다. 첫째, 연구대상자의일반적특성을파악한다. 둘째, 임신부의호흡기감염예방지식과이행정도를파악한다. 셋째, 임신부의일반적특성과이에따른호흡기감염예방지식과이행정도를파악한다. 넷째, 호흡기감염예방지식과이행정도간의상관관계를파악한다. Materials and Methods 1. 연구대상서울시에소재하는상급종합병원에서 2012년 5월산전관리교육에참여한임신부중연구참여에동의한임신부를대상으로편의추출하였다. 연구대상자수는 G* power program 3.1.3 (Franz Faul, University Kiel, Kiel, Germany)[11] 을이용하여상관관계분석을위한표본수를구하였다. 표본수계산은효과크기중간인 0.3, 유의수준 0.05, 검정력 0.95, 양측검증을할경우최소 134명이필요하였다. 이를근거로무응답을고려하여임신부 300명에게설문지를배부하였으며, 이중연구참여에동의하고성실히설문에응답한 259명의자료를분석에이용하였다. 2. 연구도구자가보고식설문지를이용하여자료수집을하였으며, 설문지는문헌고찰 [6,7,10,12,13] 을기초로호흡기감염예방지식, 예방행위이행정도, 일반적특성에대한내용으로구성하였다. 호흡기감염예방지식은손위생 3문항, 예방접종 3문항, 격리주의 5문항, 건강관리 4문항을포함한총 15문항으로개발하였다. 각각의문항을읽은후맞음, 틀림, 모름중에하나를선택하도록하였다. 호흡기감염예방이행정도는손위생 3문항, 예방접종 3문항, 격리주의 3문항, 건강관리 4문항을포함한총 13문항으로 항상그렇게한다, 거의그렇게한다, 거의그렇게안한다, 항상그렇게안한다 중하나를선택하도록하였다. 개발한지식과이행정도측정문항은간호대학교수 1인과감염관리전문간호사 1인이내용검토후수정보완하였다. 지식측정문항은정답을 1점, 오답과모름은 0점으로처리하였으며, 이행정도측정문항은 항상그렇게한다 4 점, 거의그렇게한다 3점, 거의그렇게안한다 2점, 항상그렇게안한다 1점으로배점하였고, 점수가높을수록이행정도가높은것을의미한다. 개발된지식측정문항은 Cronbach s α= 0.60이었으며, 이행측정문항의 Cronbach s α= 0.68이었다.
호흡기감염예방지식과이행 9 3. 자료수집절차자료수집을위해조사대상병원담당부서를방문하여연구의목적, 설문지의내용, 자료수집절차에대해설명을한후사전허락을받았다. 자료수집은 2012년 5월 10일산전관리특강에참여한임신부들에게설문지를배부하였고, 설문지의맨첫장에연구의목적을설명한후설문에동의하는경우에동의란에표시한후설문을하도록하였다. 설문에동의하지않는경우에는설문을작성하지않아도되도록하였으며, 어떠한불이익도없고, 모든조사내용은익명으로처리되고연구목적으로사용된다는것을설명하였다. 작성한설문지는특강이끝나고귀가할때수거하여분석에이용하였다. 4. 자료분석자료분석은 SPSS Windows (Ver. 18.0, SPSS Inc., Chicago, USA) 를이용하였다. 대상자의일반적특성은빈도와백분율, 평균과표준편차를이용하였으며, 호흡기감염예방지식과이행정도는평균과표준편차로산출하였다. 대상자의일반적특성에따른호흡기감염예방지식과이행정도는 t-test와 ANOVA 로분석하였으며, ANOVA 에서유의한변수는 Scheffe를이용하여사후검정하였다. 지식과이행정도간의상관관계는 Pearson s correlation coefficient로분석하였다. Results 1. 대상자의일반적특성임신부의연령은평균 30.38세였으며, 84.9% 는자녀가없었다. 대상자의평균임신기간은 26.85 주였으며, 임신 3기가 57.1% 로가장많았고, 학력은전문대학이상이 87.6% 였다. 임신후호흡기감염을앓은경험이있다 고응답한경우는 40.9% 였으며, 호흡기감염예방교육경험은대부분없었으며, 있다고답한경우는 2명 (0.8%) 에불과하였다 (Table 1). 2. 호흡기감염예방지식임신부의호흡기감염예방지식은 15점만점 Table 1. Characteristics of the subjects Characteristics N (%) Mean±SD Age (yr) 30.38±2.95 25 14 (5.4) 26-30 121 (46.7) 31-35 117 (45.1) 36 7 (2.7) Number of children 0.17±0.41 No children 220 (84.9) One child or more 39 (15.1) Gestation period 26.85±7.68 1st trimester 14 (5.4) 2nd trimester 97 (37.5) 3rd trimester 148 (57.1) Education High school 32 (12.4) College/University 191 (73.7) Graduated school 36 (13.9) Economic status High class 59 (22.7) Middle class 183 (70.7) Low class 17 (6.6) Experience of respiratory infection during pregnancy Yes 106 (40.9) No 153 (59.1) Experience of respiratory infection prevention education Yes 2 (0.8) No 257 (99.2) Abbreviation: SD, standard deviation. 에 11.63점 ( 정답률 77.5%) 이었다. 세부영역별지식점수는건강관리부분이 4점만점에 3.47점 ( 정답률 86.8%) 으로가장점수가높았으며, 다음으로격리주의가 5점만점에 4.17점 ( 정답률 83.4%) 이였다. 호흡기감염예방을위한예방접종이 3 점만점에 2.02점 ( 정답률 67.3%) 이였으며, 손위생부분이 3점만점에 1.88점 ( 정답률 62.7%) 로점수가가장낮았다 (Table 2). 3. 호흡기감염예방이행정도 호흡기감염예방이행정도는 52점만점에 32.34점이었다. 세부영역별이행정도점수는손위생이 12점만점에 8.47점으로이행정도가가장높았으며, 호흡기감염예방을위한예방접종이행정도는 12점만점중 6.12점, 격리주의이행정도는 12점만점중 7.17점, 건강관리이행정도
10 윤성원 / 김옥선 Table 2. Knowledge of respiratory infection preventio Subscale Items Mean±SD Hand hygiene I wash hands after going outside even my hands are clean. 0.98±0.10 I prefer to wash hands with water only (no soap). (reverse) 0.88±0.32 When I wash hands, I rinse hands after rubbing hands 5 seconds (up to 9 seconds). 0.01±0.13 (reverse) Subtotal 1.88±0.38 Vaccination Influenza vaccination is discouraged during pregnancy because it can affect the 0.47±0.50 fetus. (reverse) Receiving rubella vaccination before pregnancy is encouraged because rubella can 0.92±0.26 affect the fetus. Receiving chickenpox vaccination before pregnancy is encouraged because 0.61±0.48 chickenpox can affect the fetus. Subtotal 2.02±0.83 Isolation precaution I cover my nose and mouth when people cough around me. 0.95±0.21 When there is flu going around, a flu pandemic, I wear a mask to crowded places. 0.95±0.21 I prefer to have a distance more than 90 cm to avoid splashing particle who cough 0.92±0.26 in front of me. I prefer to cover my nose and mouth when people cough around me. 0.93±0.25 I take distance with preschoolers that have just had rubella/chickenpox vaccination. 0.41±0.49 This is because rubella/chickenpox can be contagious for about four weeks after vaccination. Subtotal 4.17±0.89 Health I prefer to go to the hospital when I have respiratory tract symptoms such as 0.93±0.25 management coughing, sneezing and stuffy nose. There is no relationship between sufficient rest and prevention of respiratory 0.81±0.39 infection. (reverse) There is no relationship between nutritional diet and prevention of respiratory 0.86±0.33 infection. (reverse) There is no relationship between regular exercise and prevention of respiratory 0.86±0.34 infection. (reverse) Subtotal 3.47±0.97 Total 11.63±2.04 Abbreviation: SD, standard deviation. 는 16점만점중 10.58점이었다 (Table 3). 4. 임신부의일반적특성에따른호흡기감염예방지식과이행정도의차이임신부의나이, 자녀수, 임신기간, 최근 1년이내호흡기감염여부에따른호흡기기감염예방지식점수는모두통계적으로유의한차이를보이지않았다. 또한호흡기감염예방이행정도의차이도임신부의학력과나이를제외한일반적특성에따른차이는없었다. 다만임신부의학력에서는대학원이상이 34.78점으로전문대학과대학교 32.45점, 고등학교 28.94점보다높았다 (F=11.68, P<.001). 그러나나이는집단간에는유의한수준이었으나사후검정을시행하였을때는 집단간에유의하지않았다 (Table 4). 5. 호흡기감염예방지식과이행정도간의상관관계호흡기감염예방지식과이행정도간에는양 (positive) 의상관관계가있었다 (r=.254, P<.001). 세부영역별로지식과이행간의상관관계는손위생 (r=.125, P=.044), 예방접종 (r=.169, P=.006), 격리주의 (r=.234, P=.000), 건강관리 (r=.309, P<.001) 모두양의상관관계가있었다 (Table 5). Discussion 임신부는생리적, 면역학적변화로인하여다
호흡기감염예방지식과이행 11 Table 3. Compliance of respiratory infection prevention Subscale Items Mean±SD Hand hygiene I wash hands after going outside. 3.55±0.63 When I wash hands, I only wash hands with water (no soap). (reverse) 3.13±0.81 When I wash my hands, I rinse hands after rubbing them for about 5 seconds 1.78±0.65 (up to 9 seconds). (reverse) Subtotal 8.47±1.03 Vaccination I had the influenza vaccination last winter (or autumn). 1.95±1.15 I had the rubella vaccination before pregnancy. 2.44±1.38 I had the chickenpox vaccination before pregnancy. 1.72±1.09 Subtotal 6.12±2.60 Isolation precaution I cover my nose and mouth when people cough around me. 2.77±0.94 I try to avoid going to crowded place in order to prevent infection. 2.24±0.79 To prevent respiratory infections, I try not to touch my nose, or mouth with hand 2.14±0.75 when I m outside. Subtotal 7.17±2.03 Health I go to hospital when I have respiratory tract symptoms such as coughing, sneezing 2.61±0.80 management and stuffy nose. I do have a sufficient rest to prevent respiratory infections. 2.80±0.70 I pay attention to the nutritional diet to prevent respiratory infections. 2.64±0.73 I exercise regularly to prevent respiratory infections. 2.51±0.71 Subtotal 10.58±2.30 Total 32.34±5.21 Abbreviation: SD, standard deviation. Table 4. Knowledge and compliance of respiratory infection prevention by characteristics Characteristics Knowledge Compliance Mean±SD F/t P Mean±SD F/t P Age (yr) 25 10.42±2.20 2.62.051 30.71±4.33 2.82.039* 26-30 11.84±2.25 31.90±5.04 31-35 11.49±1.77 32.69±5.38 36 12.42±1.27 37.00±4.43 Number of children No children 11.60±2.04-0.56.576 32.53±5.05 1.61.161 One child or more 11.80±2.08 31.26±6.00 Gestation period 1st trimester 11.86±1.03 0.14.872 31.00±6.01 2.42.091* 2nd trimester 11.66±1.95 33.22±5.22 3rd trimester 11.58±2.18 31.89±5.08 Education High school 10.94±2.56 2.15.119 28.94±4.33 11.68 <.001 College/University 11.70±1.94 32.45±4.91 a<b,c Graduated School 11.83±2.04 34.78±6.02 b<c Economic Status High class 11.92±2.55 1.17.314 32.88±5.56 2.33.099* Middle class 11.58±1.82 32.93±5.09 Low class 11.12±2.32 29.82±4.92 Experience of respiratory infection during pregnancy Yes 11.49±1.84-0.88.378 32.08±5.29-0.64.520 No 11.72±2.17 32.51±5.17 *No difference in post-hoc analysis. Abbreviations: SD, standard deviation; F, ANOVA; t, independent t test; a, high school; b, college/university; c, graduate school.
12 윤성원 / 김옥선 Table 5. The Correlation between knowledge and compliance of respiratory infection prevention Compliance Hand hygiene Vaccination Isolation precaution Health management Compliance total Hand hygiene r=.125 (P=.044) Abbreviation: r, Pearson correlation coefficient. Vaccination r=.169 (P=.006) Knowledge Isolation precaution r=.234 (P=.000) Health management r=.309 (P<.001) Knowledge total r=.254 (P<.001) 양한호흡기감염에민감하다 [1,14]. 본연구에참여한임신부의 40.9% 가임신후호흡기감염을경험하였다. 15년간국내 1개병원을방문한임신부를대상으로호흡기감염을조사한 Cheung 등 [15] 의연구에서는 100,000명당 68명의임신부가임신과관련하여폐렴과결핵치료를받았다고보고하였다. 그러나임신부는폐렴이나결핵과같은중증도가높은호흡기감염보다는감기나상기도감염과같은중증도가비교적낮은호흡기감염이흔히발생한다. Lain 등 [16] 의보고에따르면조사기간 1주일동안임신부의 2.5% 에게서감기나상기도감염이발생하였으며, 본연구에서는임신후호흡기감염을경험했다고응답한경우가 40.9% 로높았으며, 이는본연구에서는조사시기까지의임신기간전체를포함하기때문이다. 본연구에서확인되었듯이임신부는호흡기감염을흔히경험하므로임신부와태아의건강을위하여감염예방을위한노력이필요하다. 호흡기감염예방을위해서는감염예방법에대한올바른지식제공이필요하다. 본연구에서호흡기감염예방에대한교육을받은경험이있는임신부는대상자의 0.8% 로대부분의대상자들이교육을받은경험이없었다. 그러나호흡기감염예방에대한지식은정답률이 77.5% 였다. 임신부의호흡기감염예방지식에대한보고가거의없어미취학아동을둔여성의감염예방지식을조사한 Lee와 Kwon [17] 의보고와비교하 여보면, 미취학아동을둔여성의감염예방지식은정답률이 81.1% 로본연구보다높았다. 영역별로는손씻기가 91.1% 로가장높았고, 격리및매개체관리영역이 77.1% 로가장낮았다. 이는손위생지식이가장낮고격리주의지식이가장높게보고된본연구의결과와는차이가있었다. 두연구간차이를보인주요이유는 Lee와 Kwon [17] 의연구에서는손을씻어야하는경우에대한문항구성이이루어진반면본연구에서는손위생의구체적인방법에대한문항들로구성되어이에대한임신부의지식이부족했기때문으로생각된다. 외출후집에돌아왔을때는손위생이필요하다는것은알고있었으나비누를사용해야하는지, 어느정도의시간동안손을씻어야하는지에대한구체적인지식은부족하였다. 그러므로임신부를대상으로호흡기감염에대한교육프로그램을개발할때는구체적인예방행위에대한정보제공이필요하며, 특히감염예방행위중가장기본이된다고볼수있는손위생과예방접종에대한부분의점수가비교적낮은편이었으므로이들에대한필요성과구체적인예방방법에대한정보를제공할수있도록계획되어야할것이다. 호흡기감염예방이행정도는 52점만점에 32.34점으로 62.2% 의이행률을보여, 지식정답률이 77.5% 로지식은있으나이행정도는낮은것으로나타났다. 미취학아동을둔여성의감염예방실천정도가 4점만점에 3.18점으로 79.5%
호흡기감염예방지식과이행 13 의이행률을보였고, 영역별로는손씻기가가장이행률이높았던연구 [17] 와본연구를비교하면, 임신부의감염예방실천정도는다소낮은편이며, 하부영역중손위생의실천율이가장높은것은본연구와일치하였다. 본연구에서손위생에대한지식은낮으나실천율이높은것은손위생은다른예방행위보다일상생활에서흔히실천하는행위이기때문에비록지식은낮지만실천율이높게나타났을수있다. 또한예방접종은지식에비해이행정도가낮은반대의결과를보였으며, 예방접종률이낮은것은태아에게영향을미칠것같이생각하는안전성에대한염려가영향을미쳤기때문으로생각된다 [10]. 임신부를대상으로독감예방접종과접종을하지않은이유를조사한연구에서는임신부의 19% 가인플루엔자백신을접종을했으며, 임신부가독감예방접종을하지않은이유로 52.9-67.0% 가백신이안전하지않다고생각하기때문이라는보고가있다 [18]. 임신부에게인플루엔자예방접종이안전하지않다는것은잘못된생각이며, 국내의질병관리본부에서도현재임산부를우선접종대상자로분류하여예방접종을권유하고있다. 그러므로예방접종에대한부적절한인식을바꿀수있는교육과홍보가필요하다. 본연구에서임신부의호흡기감염예방지식과이행정도가나이, 자녀수, 임신기간, 임신후호흡기감염경험에따른차이가없었고, 학력에따른이행정도만이차이가있었다. 이는미취학아동을둔여성의감염예방지식과이행정도연구에서자녀수에는차이가없으나학력에서차이를보인다른연구결과와는부분적으로일치하며 [18], 입원아동을둔보호자의병원감염예방지식과실천정도연구에서는나이, 학력간지식과이행정도에차이를보이지않아학력간이행정도에차이를보인본연구와부분적으로일치하였다 [13]. 본연구에서일반적특성에따른지식과이행정도의차이가거의없었던것은본연구의지식과이행측정도구가특정호흡기감염이아닌전반적인호흡기감염에대한내용이었기때문에도구에대한신뢰도가높은않았던점을고려할수있다. 그러나임신한여성들의호흡기감염을예방하기위해서는본연구를포 함한다수의연구에서일반적으로지식과이행정도사이의상관관계를보이므로 [18-20] 교육이나홍보등을통한올바른지식을제공하기위한노력들이필요할것으로사료된다. Summary 배경 : 임신부의호흡기감염은다양한합병증을유발하고, 태아에게도영향을미칠수있으므로적절한감염예방이필요하다. 이에임신부들의호흡기감염예방지식과예방행위이행정도를파악하고자본연구를시행하였다. 방법 : 상급종합병원 1곳의산전관리교육에참여한임신부 300명에게 2012년 5월 10일설문지를배부하고회수한 259명의자료를분석에이용하였다. 결과 : 임신부 259명중 2명 (0.8%) 만이호흡기감염예방교육을받은경험이있었으며, 임신후호흡기감염을 40.9% 가경험했다. 호흡기감염예방지식은 15점만점에 11.63점 ( 정답률 77.5%) 이었으며, 감염예방이행정도는 52점만점에 32.34점 ( 이행률 62.19%) 이었다. 호흡기감염지식과이행정도간에는양의상관관계가있었다. 결론 : 임신중호흡기감염을경험한대상자들이많았으나호흡기감염예방에대한교육은거의이루어지고있지않았다. 또한호흡기감염예방지식과이행사이에는상관관계가있으므로임신부들의호흡기감염예방을위한지식제공을위해교육프로그램개발이필요하다. References 1. Brito V, Niederman MS. Pneumonia complicating pregnancy. Clin Chest Med 2011;32: 121-32. 2. Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008;14:95-100. 3. Dodds L, McNeil SA, Fell DB, Allen VM, Coombs A, Scott J, et al. Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness
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