근관절건강학회지제 22 권제 1 호, 2015 년 4 월 J Muscle Jt Health Vol. 22 No. 1, 40-47, April, 2015 ISSN 1975-9398 (Print) ISSN 2288-789x (Online) http://dx.doi.org/10.5953/jmjh.2015.22.1.40 응급실간호사의감염노출예방행위수행정도와영향요인 안진선 1) 김연하 2) 김민주 2) 1) 인제대학교부산백병원, 2) 동아대학교간호학과 Performance of Preventive Actions to be Exposed to Infection in Emergency Nurses and its Influencing Factors Ahn, Jin Seon 1) Kim, Yeon Ha 2) Kim, Minju 2) 1) Inje University, Busan Paik Hospital, Busan 2) Department of Nursing, Dong-A University, Busan, Korea Purpose: The purpose of this study was to identify factors influencing on performance of preventive actions to be exposed to infection in emergency nurses. Methods: Participants were 200 emergency nurses working in a regional emergency medical center, 4 local emergency medical centers, and 5 local emergency medical facilities in B city. The data were analyzed with descriptive statistics, independent t-test, ANOVA, Scheffe s test, Pearson s correlation coefficients, and stepwise multiple regression analysis using SPSS/WIN 21.0 programs. Results: There was no difference in performance of preventive actions to be exposed to infection by socio-demographic and job-related characteristics. The results of stepwise multiple regression analysis showed that levels of perception of preventive actions to be exposed to infection (β=.40, p<.001) and protective environment on exposure to infection (β=.22, p<.001) were significantly associated with performance of preventive actions, explaining 26.3% of the variance. Conclusion: In conclusion, improving performance of preventive actions to be exposed to infection is important to protect emergency nurses from exposure to infection. Thus, efforts to enhance protective environment on exposure to infection and to improve perceptions of preventive actions to be exposed to infection are necessary to improve the performance of preventive actions in emergency nurses. Key Words: Emergency nurses, Infection, Prevention, Performance. 서론 1. 연구의필요성최근의학기술의발달과함께질병의조기발견과치료가가능해지면서평균수명이증가하는반면침습적시술의확대와항암제및면역억제제의사용, 다약제내성균의증가로병원감염은전세계적으로중대한건강문제로대두되고있다 (Korean Society for Nosocomial Infection Control, 2008). 이를반영하듯 2010년부터는보건복지부가실시하는의료기관 인증평가에서감염관리를중요사항으로다루면서환자를위한감염노출예방뿐만아니라의료종사자의감염노출예방에도그관심이높아지고있다 (Jeong, 2011; Kim, 2013). 병원이라는특수한환경에서근무하는의료종사자는감염병환자또는보균자와직접접촉할기회가많고, 환자에게서유래된각종검체와오염된의료기구및환경, 오염된공기등에자주노출되는감염의위험성이높은집단이다 (Ahn, Lee, & Song, 2010). 의료종사자의감염노출은병원의다른직원이나환자에게감염을전파할위험이있을뿐만아니라중증에서사망까지이르는신체적정신적피해를초래하며, 직장 주요어 : 응급실간호사, 감염, 예방, 수행 Corresponding author: Kim, Yeon Ha Department of Nursing, Dong-A University, Dongdaesin-dong 3ga, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-2674, Fax: +82-51-240-2920, E-mail: ke386091@naver.com - 본연구는제1저자안진선의석사학위논문을수정하여작성한것임. - This work is a revision of the first author s master s thesis from Dong-A University. Received: Mar 12, 2015 / Revised: Apr 5, 2015 / Accepted: Apr 9, 2015 c 2015 Korean Society of Muscle and Joint Health http://www.rheumato.org
응급실간호사의감염노출예방행위수행정도와영향요인 과가정생활그리고대인관계의변화와더불어검사및치료비용부담과근무제한으로인한경제적손실등을초래하여의료종사자개인의건강뿐만아니라조직에도부정적인영향을미친다 (Ahn et al., 2010). 2005년한국산업안전보건공단 (Korea Occupational Safety and Health Agency [KOSHA]) 의자료에따르면우리나라의료종사자의 30.1% 가감염에노출된경험이있는것으로나타났다. 특히간호사는환자들과의접촉이가장빈번하며혈액을취급하는경우가많고실제로모든병원업무에참여하므로다른종사자들보다더욱감염에노출될가능성이높다 (Kim, Choi, Kang, & Lee, 2005; Park, 2003; Stein, Makarawo, & Ahmad, 2003). 2009년산업안전보건연구원 (Occupation Safety and Health Research Institute [OSHRI]) 의자료에따르면, 국내의주사침상해는연간 100병상당 10.5건, 직원 100명당 4.07건이었고직종별로간호사가 63% 로가장많은것으로나타난바있어간호사의감염노출에대한예방이시급한것으로사료된다 (OSHRI, 2010). 응급실에서근무하는간호사의경우, 대상자의건강상태에대한정확한정보가없는상태에서직접적인간호를제공하는경우가많으며환자의감염성질환여부가확인되지않은상태에서오염된공기와혈액 체액등에노출될수있기때문에응급실간호사는감염노출의위험이더높다하겠다. 게다가응급상황이많아분주한응급실특성상보호장구사용지침을준수할만큼의시간적여유가없거나, 보호장구의사용이응급시술및처치에방해가된다는이유로감염예방행위를잘수행하지않는경우가많다 (Association for Professionals in Infection Control and Epidemiology, 2013; Jo, 2007; Jo & Yu, 2001). 간호사의감염관리수행정도를조사한선행연구에서감염노출예방과관련된인식이수행도에긍정적인영향을미치는요인으로확인되었다 (Ahn, 2002; Choi & Park, 2002; Kim & Kang, 2010; Lee, Kim, Lee, & Ham, 2012; Parmeggiani, Abbate, Marinelli, & Angelillo, 2010; Suh & Oh, 2010). 또한응급실간호사를대상으로한연구 (Park, Shin, Lee, & Kim, 2008) 에서도감염관리에대한인식은응급실간호사의감염노출예방행위수행도에긍정적인영향을미치는것으로나타났다. 감염노출예방행위실천을위해서는간호사의감염노출예방과관련된인식뿐만아니라물리적환경또한중요한역할을한다. 이미여러선행연구에서, 간호사는시간부족, 업무과다, 시설및장비부족등으로인해감염노출예방행위를수행하기어렵다고보고한바있다 (Choi, 2005; Jo, 2007; Song, 2000). Park 등 (2008) 의연구에따르면보호구가충분히지급되고감염관리지침서가구비된경우에예방행위의수행정도가높게나타났다. 이와유사하게 Yang (2011) 의연구에서도보호장비제공, 원내감염전담인력배치등의환경적측면이응급실간호사의예방행위수행에영향을미치는요인으로파악되었다. 지금까지선행된감염노출예방행위수행과관련된연구는주로일반간호사를대상으로하였으며 (Choi, 2005; Jo & Yu, 2001; Kim, 2001; Kim, 2010; Oh, 2005; Song, 2000), 감염노출의위험이높은응급실간호사를대상으로한연구는매우부족한실정이다. 또한 2010년의료기관인증평가실시로인해감염관리에대한교육이강화되고감염과관련된병원의환경에도변화가있었을것으로예상되면서간호사의감염노출예방행위인식정도와방어환경이수행정도에미치는영향에대해조사할필요가있을것으로사료된다. 따라서본연구는응급실간호사의감염노출예방행위수행정도를확인하고감염노출예방행위수행정도에영향을미치는요인을파악함으로써응급실간호사의감염노출을예방할수있는효과적인감염관리시스템을구축하는데필요한기초자료를제공하고자한다. 2. 연구목적본연구는응급실간호사의감염노출예방행위수행정도에영향을미치는요인들을파악하여, 효율적인감염노출예방행위관리를위한기초자료를제시하고자한다. 이를위한구체적인목적은다음과같다. 대상자의감염노출예방행위에대한수행정도와인식정도, 감염노출방어환경정도를파악한다. 대상자의일반적특성, 직무관련특성과관련된감염노출예방정도를파악한다. 대상자의감염노출예방행위에대한수행정도와인식정도, 감염노출방어환경간의관계를파악한다. 대상자의감염노출예방행위수행정도에영향을미치는요인을파악한다. 연구방법 1. 연구설계본연구는응급실간호사의감염노출예방행위에대한수행 Vol. 22 No. 1, 2015 41
안진선 김연하 김민주 정도와인식정도, 감염노출방어환경정도를파악하고감염노출예방행위수행정도에영향을미치는요인을조사하는서술적조사연구이다. 2. 연구대상본연구는 B광역시에소재하는 1개의권역응급의료센터, 4 개의지역응급의료센터, 5개의지역응급의료기관에근무하는간호사중연구에대한설명을듣고, 서면으로동의한간호사를대상으로하였다. 대상자수는 G*Power 3.1 프로그램을이용하여유의수준.05, 효과크기.15, 검정력.90을기준으로회귀분석을위한예측변수가 14개인경우총 166명이산출되었으며, 탈락률 10% 를감안하여 200명을대상으로하였다. 방어환경측정도구를바탕으로하여연구자가응급실간호사의감염노출에대한방어환경에관한내용으로수정 보완하여사용하였다. 이도구를응급실간호사에게적용하기위해감염전문간호사 1인, 감염관리전담간호사 1인, 응급실경력이 10년이상인간호사 1인을대상으로내용타당도 (Index of Content Validation, CVI) 를검증받은결과전체문항의 CVI 값이.80 이상으로나타나집단의합의가이루어진것으로나타났다. 이도구는총 11문항으로구성되었으며, 5점 Likert 척도를사용하여 전혀그렇지않다 1점에서 매우그렇다 5점으로답하도록구성되었다. 점수가높을수록감염노출방어환경이양호함을의미한다. Han (2009) 의연구에서신뢰도 Cronbach s 는.89였으며, 본연구에서 Cronbach s 는.85였다. 3. 연구도구 4. 자료수집및방법 1) 감염노출예방행위수행정도감염노출예방행위수행정도는 Park (2003) 이개발하고 Yang (2011) 이수정 보완한감염노출예방행위측정도구를도구개발자에게사용허락을받은후사용하였다. 이도구는총 11문항으로구성되었으며, 5점 Likert척도를사용하여 전혀그렇게하지않는다 1점에서 항상그렇게한다 5점으로답하도록구성되었다. 점수가높을수록감염노출예방행위의수행정도가높음을의미한다. Yang (2011) 의연구에서신뢰도 Cronbach s 는.87이었으며, 본연구에서 Cronbach s 는.75였다. 2) 감염노출예방행위에대한인식정도감염노출예방행위에대한인식정도는 Park (2003) 이개발하고 Yang (2011) 이수정 보완한감염노출인식정도측정도구를도구개발자에게사용허락을받은후사용하였다. 이도구는총 11문항을구성되었으며, 5점 Likert 척도를사용하여 전혀그렇지않다 1점에서 매우그렇다 5점으로답하도록구성되었다. 점수가높을수록감염노출인식정도가높음을의미한다. Yang (2011) 의연구에서신뢰도 Cronbach s 는.96이었으며, 본연구에서 Cronbach s 는.82였다. 자료수집기간은 2014년 8월 1일부터 8월 31일까지이며, 자료수집방법은각병원의간호부와응급실을방문하여연구의목적을설명하여허락을받은후대상자에게연구의목적을설명하고설문지를배부하여작성하도록하였다. 설문지작성에는약 10분정도시간이소요되었다. 작성된설문지는밀봉된봉투에넣어보관후연구자가직접수거하였으며, 설문에응한대상자에게는소정의선물을제공하였다. 5. 윤리적고려본연구의윤리적고려를위해 D대학에서기관생명윤리위원회 (Institute Review Board, IRB) 의승인을받은후시행되었다. 대상자에게연구의목적과필요성을설명하였으며, 연구참여시대상자의익명성과비밀보장및연구에따른불편함에대하여설명하고참여도중언제든지참가동의를철회할수있음을설명하였다. 연구자는연구참여에대한사전동의서를받고개인정보는익명으로하였으며정보보호를위해코드로대상자의정보를식별하였다. 6. 자료분석 3) 감염노출에대한방어환경감염노출에대한방어환경은감염노출과관련된시설, 장비구비, 방어행위를유도할수있는행정적지원을의미하며본연구에서는 Han (2009) 이방사선종사자를대상으로개발한 수집한자료는 SPSS/WIN 21.0 프로그램을이용하여통계처리하였다. 구체적인분석방법은다음과같다. 대상자의일반적특성. 감염노출예방행위수행정도와인 42 Korean Society of Muscle and Joint Health
응급실간호사의감염노출예방행위수행정도와영향요인 식정도, 감염노출에대한방어환경은기술통계를사용하여분석하였다. 대상자의일반적특성에따른감염노출예방행위수행정도는 t-test, ANOVA 로분석하였다. 사후검증은 Scheffe s test 를실시하였다. 대상자의감염노출예방행위수행정도와인식정도, 방어환경의상관관계는 Pearson s correlation coefficients 를사용하여분석하였다. 대상자의감염노출예방행위수행정도에영향을미치는요인은단계적다중회귀분석 (stepwise multiple regression analysis) 으로분석하였다. 연구결과 1. 대상자의일반적특성과직무관련특성대상자중여성은 89.5% 이며 25~30세사이의연령군이 49.0% 로가장많았다. 결혼상태는미혼인자가 78.0% 였으며, 교육수준은 3년제졸업인자가 48.0%, 4년제졸업인자가 43.0% 인것으로나타났다. 응급실경력은평균 4.37년이며일반간호사가 90.0% 인것으로나타났다. 대상자중 800병상이상의병원에서근무하는경우가 61.5% 로나타났다. 대상자의 84.5% 는감염관리교육을받은경험이있으며, 41.5% 가감염성질환에노출된경험을가진것으로나타났다. 대상자의대부분이병원에감염관리전담간호사가있다고답하였으며또한감염노출관리지침서를보유하고있다고응답하였다 (Table 1). 대상자의일반적특성과직무관련특성에따른감염노출예방행위수행정도를분석한결과, 응급실간호사의예방행위수행정도는대상자의성별, 연령, 결혼상태, 교육정도, 응급실근무경력, 직위, 병상규모, 감염관리교육경험여부, 감염성질환에노출된경험여부, 감염관리전담간호사유무및감염노출관리지침서보유여부에따라통계적으로유의한차이가없는것으로나타났다 (Table 1). Table 1. Performance of Infection Prevention by Socio-demographic and Job-related Characteristics Characteristics Categories n (%) or M±SD Gender Age (year) Marital status Education Male Female <24 25~30 31 Unmarried Married 3-year college Bachelor Master 21 (10.5) 179 (89.5) 41 (20.5) 98 (49.0) 61 (30.5) 156 (78.0) 44 (22.0) 96 (48.0) 86 (43.0) 18 (9.0) (N=200) Performance of infection prevention t or F or r p M±SD 4.31±0.32 4.38±0.41 4.43±0.45 4.32±0.40 4.43±0.36 4.36±0.41 4.42±0.34 4.37±0.39 4.36±0.40 4.48±0.40-0.78.435 1.72.181-0.78.434 0.74.477 ER experience 4.37±4.20 -.01.932 Position Number of beds Education about infection Experience of exposures to infection Presence of infection specialized nurse Protocol on infection control r value. Staff nurse Charge/head nurse <800 800 Yes No Yes No Yes No Yes No 180 (90.0) 20 (10.0) 77 (38.5) 123 (61.5) 169 (84.5) 31 (15.5) 83 (41.5) 117 (58.5) 191 (95.5) 9(4.5) 185 (92.5) 15 (7.5) 4.37±0.41 4.45±0.30 4.43±0.42 4.34±0.38 4.38±0.39 4.34±0.43 4.39±0.36 4.36±0.42 4.39±0.40 4.22±0.46 4.38±0.41 4.40±0.40-0.80.425 1.50.133 0.52.598 0.54.588 1.21.228-0.19.853 Vol. 22 No. 1, 2015 43
안진선 김연하 김민주 2. 감염노출예방행위에대한수행정도및인식정도, 감염노출에대한방어환경감염노출예방행위수행정도와인식정도및감염노출에대한방어환경은 Table 2와같다. 감염노출예방행위수행정도는 5점만점중평균 4.38점으로나타났다. 감염노출예방행위에대한인식정도는 5점만점중평균 4.76점으로나타났다. 또한감염노출에대한방어환경정도는 5점만점중평균 3.99 점으로나타났다. 3. 감염노출예방행위수행정도와인식정도및감염노출에대한방어환경간의관계 수행정도와관련이있는것으로나타난감염노출에대한방어환경과예방행위에대한인식정도를독립변인으로하여다변량회귀분석을실시하였다 (Table 4). 본모형은각변수들의잔차분석을위한 Durbin-Watson 값이 1.91로서로독립적인것으로판단되었고, 분산팽창지수 (Variance Inflation Factor, VIF) 가 1.11로 10 이하로나타나다중공선성문제가없는것으로나타났다. 응급실간호사의감염노출예방행위수행정도에미치는영향요인은감염노출예방행위에대한인식정도 (β=.40 p<.001) 과감염노출에대한방어환경 (β=.22, p<.001) 이유의한예측변수로나타났으며, 이들변수는감염노출예방행위수행정도의 26.3% 를설명하였다 (F=35.18, p<.001). 감염노출예방행위수행정도와인식정도및감염노출에대한방어환경간의관계는 Table 3과같다. 감염노출예방행위수행정도는감염노출에대한방어환경 (r=.34, p <.001) 과감염노출예방행위에대한인식정도 (r=.47, p<.001) 와양의상관관계가있는것으로나타났다. 4. 감염노출예방행위수행정도에영향을미치는요인감염노출예방행위수행정도에영향을미치는요인을파악하기위해수행정도를종속변인으로하고, 단변량분석에서 논의본연구는응급실간호사의감염노출예방행위수행정도에영향을미치는요인을규명하여효율적인감염노출예방행위관리를위한기초자료를제시하고자시행되었다. 본연구의결과감염노출예방행위수행정도에영향을미치는요인으로감염노출예방행위에대한인식정도와감염노출에대한방어환경이확인되어다음과같이논의하고자한다. 본연구에서나타난응급실간호사의감염노출에대한예방행위수행정도는 5점만점에 4.38점으로동일한도구를사용 Table 2. Levels of Performance of Infection Prevention, Protective Environment, and Perception of Infection Prevention (N=200) Variables Min Max M±SD Performance of infection prevention Perception of infection prevention 2.27 5.00 4.38±0.40 3.36 5.00 4.76±0.34 Protective environment 2.09 5.00 3.99±0.59 Table 3. Relationship among Performance of Infection Prevention, Protective Environment, and Perception of Infection Prevention (N=200) Variables Protective environment Perception of infection prevention Performance of infection prevention r(p).34 (<.001) Protective environment r(p).47 (<.001).31 (.001) Table 4. Factors Influencing in Performance of Infection Prevention (N=200) Variables B SE β p (Constant) 1.56.35 <.001 Perception of infection prevention 0.47.08.40 <.001 Protective Environment 0.15.04.22 <.001 R 2 =.263, F=35.18, p<.001 44 Korean Society of Muscle and Joint Health
응급실간호사의감염노출예방행위수행정도와영향요인 한 Yang (2011) 의연구에서나타난 4.35점과유사하였다. 특히, 주사바늘을포함한날카로운물건을관리하는데있어서높은수행도를보이는것으로나타났다. 종전의주사바늘관리에대해낮게나타난 Park (2003) 의연구와는차이를보이는것이다. 이러한변화는 2010년질병관리본부에서발표한응급실감염관리지침에의료종사자좌상사고예방및업무상감염노출에대한부분이강조되면서수행정도가높아진것으로보인다. 그에반해에어로졸을생성하는처치시보호구착용은수행정도가가장낮은것으로나타났는데이는 Yang (2011) 의연구에서도날카로운물건관리에서는높은수행도를보인반면에어로졸을생성하는처치시보호구착용에서는낮게나타난결과와유사하다. 응급상황에서인공호흡기, 기관내삽관등의에어로졸을생성하는응급처치시행할때가운, 보호안경등의감염노출을예방하는보호장구착용은간호사의우선순위에서밀려나는경우가많은것으로사료된다 (Kim & Kang, 2010; Park et al., 2008; Yoon & Sung, 2009). 응급실의환경적특성으로전염성질환을포함한다양한질병을가진환자나혹은대상자의질병력을모르는상태에서처치가이루어지는경우가많기때문에간호사스스로를보호하기위한보호구착용을포함한감염노출예방을위한노력을적극적으로이행해야할것이다. 감염노출에대한예방행위인식정도는수행정도에영향을미치는요인으로파악되었다. 본연구와유사하게여러선행연구에서감염과관련된간호사의인식이수행에긍정적인영향을미치는것으로나타난바있다 (Choi & Park, 2002; Kim et al., 2005; Lee, 2012; Lee & Kim, 2002;Parmeggiani et al., 2010; Suh & Oh, 2010). 본연구에서감염노출에대한예방행위인식정도는 5점만점에 4.76점으로높게나타났다. 감염노출예방행위에대한인식정도는 2004년의료기관인증평가이후의무적인감염관리자체교육시행되면서감염예방의중요성과방법에대한지속적인교육이이루어지면서향상된것으로보인다 (Kim, 2010). 선행연구 (Center for Disease Control and Prevention [CDC], 2001; Choi, 2005; Lee, 2006) 에서감염관리교육경험이있는대상자의예방행위수행정도가높은것으로나타났는데본연구의대상자의경우 84.5% 가감염관리교육을받은경험이있는것으로나타났다. 또한본연구에서특히감염노출예방행위수행정도와유사하게주사침과같은날카로운물품관리와관련된인식은높게나타난데반해에어로졸을생성하는처치시보호구착용과관련된인식은낮게나타났다. 여러선행연구에서도감염노출에대한인식중주사침찔림예방에대한인식정도가높은것 으로나타나본연구와유사하였다 (Lee et al., 2012; Park et al., 2008; Yoon & Sung, 2009). 주사침과같은날카로운물품에대한관리는감염관리에서많이강조되고교육이이루어진반면, 에어로졸을생성하는처치시보호구착용과같은항목들은다소소홀히다루어져왔다. 따라서에어로졸을생성하는처치시보호구착용과같이소홀히행해지고있는예방행위에대한인식을향상시킬수있는노력이필요하다. 감염노출에대한방어환경은감염노출에대한예방행위수행정도에영향을미치는요인으로파악되었다. 감염노출에대한방어환경이좋을수록간호사의감염노출예방행위의수행정도가높아지는양상을보였다. 본연구에서응급실간호사의감염노출에대한방어환경정도는 5점만점에서 3.99점으로나타나전반적으로양호한것으로보인다. 2010년질병관리본부에서발표한응급실감염관리지침에서의료종사자의좌상예방및업무상감염노출에대한부분이강조되면서방어환경에도변화가있었을것으로예상되나기존에감염노출에대한방어환경정도를조사한연구가없어비교하기어렵다. 감염노출에대한방어환경을구체적으로살펴보면, 감염노출예방행위수행정도에서가장수행정도가높았던주사침과같은날카로운물품관리는감염노출방어환경에서도높게나타났다. 손상성폐기물관리와관련된수행도의향상에는손상성폐기물전용용기를처치대나투약카트등간호사가쉽게접근할수있는다양한장소에비치하는것과같은환경적개선이이루어지면서나타난결과라볼수있겠다. 또한본연구에는감염노출에대한방어환경중감염노출방어를위한다양한보호장구구비나직원의감염노출에대한병원관리자의관심과관리, 그리고정기적인정기검진제공등이비교적양호한것으로나타났지만, 소독이나멸균장비의부족과보호장구의부적절한위치, 시설과기자재의부족등의항목에서는낮게나타났다. 의료기관인증평가실시와응급실감염관리지침의발효로인해감염노출을예방하기위한환경개선과병원조직의감염관리에대한관심이증가하고있는추세이지만여전히감염노출예방행위를수행하기에는다소부족한것으로보인다. 본연구에서손상성페기물관리에대한간호사의수행도가높은이유는이를쉽게사용할수있는환경적요건과조직의분위기가반영된결과라볼수있다. 비록감염노출을예방할수있는보호장구구비나시설이확충되었다고하더라도물품의배치나시설의구조가쉽게이용할수없게되어있거나혹은물품의공급이원활하지않은경우실제적으로감염노출예방을위해이러한물품이나시설을사용하는데는어려움이있을것으로보인다. 따라서구비된보호장구나물 Vol. 22 No. 1, 2015 45
안진선 김연하 김민주 품을실제로사용할수있도록간호사실가까운곳에비치하고, 충분한수와다양한종류의보호장구를지속적으로공급할수있는체계적인방어환경을구축하고자하는병원행정가들의의지가필요한것으로사료된다. 본연구에서는결혼유무, 병상규모, 감염교육유무, 학력, 경력, 노출경험유무, 감염관리지침서보유등일반적특성과직무관련특성에따른감염노출예방행위수행정도에는유의한차이가없었다. Park 등 (2008) 의연구에서는감염노출관리지침서보유, 감염관리부서및담당자유무가수행도에영향을미치지않았지만 Yang (2011) 의연구에서병상규모, 원내감염전담인력여부가감염예방실천행위에영향을미치는것으로나타난바있다. 그러나본연구의경우대상자의대부분이병원에감염관리전담간호사가있다고답하였으며또한감염노출관리지침서를보유하고있다고응답하였다 (Table 1). 이는 2010년의료기관인증평가실시로감염관리가평가의중요한지표가되면서나타난변화라고볼수있겠다. 이상과같이응급실간호사의감염노출예방행위수행정도에감염노출예방행위에대한인식정도및감염노출방어환경이영향을미친다. 응급실의환경적특성상전염성질환을포함한다양한질병을가진환자나혹은대상자의질병력을모르는상태에서처치가이루어지는경우가많아감염에노출될위험이높은집단이다. 따라서감염으로부터스스로를보호하기위해예방행위를적극적으로실행해야한다. 손상성폐기물관리와같이지속적인교육과관심으로개선된행위가있는반면에어로졸을생성하는처치시보호구착용과같은예방행위는수행도가낮아여전히응급실간호사들은감염노출의위험에있다. 따라서보다포괄적인감염노출예방교육이이루어져야하며보호장비나시설에대한편이성과접근성을고려한물품공급과배치가필요한것으로보인다. 결론응급실의환경적특성상전염성질환을포함한다양한질병을가진환자나혹은대상자의질병력을모르는상태에서처치가이루어지는경우가많아감염에노출될위험이높은집단이다. 이런감염으로부터스스로를보호하기위해서는예방행위를적극적으로실행해야한다. 따라서본연구는응급실간호사의감염노출예방행위수행정도에영향을미치는요인들을파악하여, 효율적인감염노출예방행위관리를위한기초자료를제시하고자시도되었다. 응급실간호사가감염노출예방행위를수행하는데있어서간호사의인식과감염노출에 대한방어환경이중요한역할을하는것으로확인되었다. 특히에어로졸을생성하는처치시보호구착용과같은예방행위는여전히그수행도가낮아여전히응급실간호사들은감염노출의위험에있다. 따라서응급실간호사의감염노출예방행위수행정도를높이기위해서는간호사의인식을향상시키기위한다양하고체계화된교육방법의개발과지속적인교육이이루어져야하며보호장비나시설에대한편이성과접근성을고려한물품공급과배치등구비된보호장구나물품을실제로사용할수있는환경적조건이마련되어야할것이다. REFERENCES Ahn, J. Y., Lee, Y. M., & Song, J. H. (2010) A study on performance level for universal precautions on blood-borne infections among nurses in hospitals. Journal of Korean Academic Society of Nursing Education, 16(1), 92-100. http://dx.doi.org/10.5977/jkasne.2010.16.1.092 Ahn, M. J. (2002). Hand washing related factors of hand washing practice by nursing personal in critical care unit. Unpublished master s thesis, Yonsei University, Seoul. Association for Professionals in Infection Control and Epidemiology (APIC). (2013). Guide to infection prevention in emergency medical services. Washington, DC; Author. Center for Disease Control and Prevention [CDC]. (2001). Updated U.S public health service guidelines for the management of occupational exposure to HBV, HCV, HIV and recommendations for postexposure prophylaxis. CDC MMWR, 50(11), 1-67. Choi, A. L. (2005). Recognition and performance of the clinical nurses about the management of nosocomical infection. Unpublished master s thesis, Ewha Womans University, Seoul. Choi, M. A., & Park, K. S. (2002). A study on the level of recognition of the clinical nurses about the management of nosocomial infection. Journal of Korean Academic Society of Nursing Education, 8(2), 314-324. Han, E. O. (2009). A protective behavior model against the harmful effects of radiation for radiological technologists in medical centers. Unpublished doctoral dissertation, Ewha Womans University, Seoul. Jeong, E. H. (2011). Awareness and performance for standard precautions among outpatient clinics nursing staffs in a university-affiliated hospital. Unpublished master s thesis. University of Ulsan, Ulsan. Jo, G. R. (2007). Influencing factors on the compliance about standard precautions among ICU and ER nurses. Unpublished master's thesis, Seoul National University, Seoul. 46 Korean Society of Muscle and Joint Health
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