都治關懷員的結核病認知及感染風險調查

The Study on the Perception and risks of Tuberculosis Infection among DOTS Observers

陳玫君(Mei-Chun Chen)

指導教授 ： 李素幸

共同指導教授 ： 宋瑩珠(Ying-Zhu Song)

長榮大學/健康科學學院/職業安全與衛生學系(所)/碩士(2012年)

https://doi.org/10.6833/CJCU.2012.00022

摘要

台灣於2006年開始全面實施都治計畫，根據世界衛生組織建議都治計畫是使結核病患達到完治效果的最佳方法。由於醫療人員罹患結核病的感染率是非醫療人員的2~3倍，而與結核病患密切接觸的都治關懷員，是否具備足夠的相關知識及自身防護措施等，值得重視。因此，本研究探討都治關懷員的結核病認知程度及感染危害。本研究係採橫斷式調查，以全國各縣市衛生局聘任之所有都治關懷員為調查對象，藉由結構式問卷評估都治關懷員的結核病認知、與病患接觸的工作特性、工作防護及感染現況。資料收集期間自2011年6月至7月，共回收697份有效問卷（回收率98％），並利用SPSS統計軟體完成資料分析。
本研究族群都治關懷員以女性居多（76％），平均年齡46歲，大專以上教育程度者佔三成五，五成為高中職。結果顯示都治關懷員的自我報告結核病感染危險為0.43％（3/697）。都治關懷員的肺結核認知正確率平均為85％，正確率最差的題目為「戴上外科口罩可以避免肺結核傳染風險」，僅有21.5％的都治關懷員認為這個說法不正確。女性都治關懷員的結核病認知高於男性都治關懷員(P < 0.05)；接受過結核病教育訓練的都治關懷員結核病認知優於未接受過結核病教育訓練的都治關懷員(P<0.05)；從未罹病的都治關懷員結核病認知顯著優於工作前罹病的都治關懷員(P<0.05)。
在關懷病患時，室內為主要工作地點，大多數的都治關懷員在從事關懷工作時會戴口罩，三分之二的人戴的是外科口罩，而七成三被關懷的病患在接觸時會戴口罩。MDR都治關懷員過去一年內的教育訓練時數，統計上顯著高於一般都治關懷員及一般兼MDR都治關懷員（28 vs 17 vs 20），一般兼MDR都治關懷員的接觸病患戴口罩的比例（84.4％）顯著高於一般都治關懷員及MDR都治關懷員（分別74.9％及60.7％），且統計上皆有顯著差異。
本研究都治關懷員以外科口罩做為最主要的防護具，雖然都治關懷員肺結核疾病認知大致良好，但口罩防護的知識明顯不足，因此建議各衛生單位加強其防護教育訓練。

關鍵字

都治關懷員 ； 認知 ； 結核病感染

並列摘要

In 2006, Taiwan began the DOTS program, according to the WHO, DOTS program is the best method to completely cure tuberculosis patients. Since the infection rate of tuberculosis among health care workers compared to non- health care workers would reach two to three folds high, DOTS observers who closely interact with tuberculosis patients might not have sufficient knowledge or protection to the disease. Therefore, this study aimed to investigate perception and risk of tuberculosis infection among DOTS observers. This study was conducted cross-sectionally and used nationwide DOTS observers as study population. A structured questionnaire was designed to collect information on the perception of tuberculosis, work characteristics, personal protection and infectious risk among the study subjects. Data collection period extended from June to July in 2011. Six hundred and ninety seven effective questionnaires were obtained. Data analysis was preformed with SPSS statistical package.
The study subjects aged average 46 years old, female subjects accounted for 76% of the population, half of the subjects had received high school diploma and 35% had received college education. The results showed that the infectious risk of tuberculosis was 0.43% (3/697). DOTS observers answered the perception questions with an average of 85% correct answers. Nearly eighty percent of the DOTS observers answer one perception question wrong that was the statement of “wearing surgical mask can prevent tuberculosis infection.” Female DOTS observers had better perception on the tuberculosis infection than that of male DOTS observers (P<0.05). Those who had received tuberculosis training had better perception on the tuberculosis infection than that of those who did not (P<0.05). Those who did not infect with tuberculosis before becoming DOTS observers had better perception on the tuberculosis infection than that of those who had been infected with tuberculosis before becoming DOTS observers(P<0.05).
The results also revealed that, for DOTS observers during observing patients, indoor was the primary workplace, the majority of observers would wear masks in which two thirds of the masks worn were surgical masks, and 73% of the patients would also wear masks. The statistics showed that MDR observers had received significantly higher training hours than general observers and observers who worked both as general and MDR observers (28 vs 17 vs 20). Observers who worked both as general and MDR observers compared to general observers and MDR observers reported significaly higher proportion of patients wearing masks (84% vs 75% and 61%).
In the workplace, DOTS observers used surgical masks as their primary protection. Although in general DOTS observers had sufficient perception on the infection risk, yet knowledge of mask protection was not good. Therefore, more protection traing is needed among DOTS observers.

並列關鍵字

DOTS observers ； Perception ； Tuberculosis infection

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