• Tuberculosis and Respiratory Diseases
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• v.75 no.1
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• pp.18-24
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• 2013

Background: We investigated the prevalence of latent tuberculosis infection (LTBI) among the health care workers (HCWs) and analyzed its risk factors in South Korea. Methods: A standard questionnaire regarding the baseline demographics and risk factors for LTBI was given to each participant and tuberculin skin test (TST), QuantiFERON-TB GOLD In-Tube (QFT-GIT) assay, and chest radiography were performed. Results: A total of 493 participants, 152 (30.8%) doctors and 341 (69.2%) nurses were enrolled in eight tertiary referral hospitals. The mean age of the subjects was 30.6 years old, and 383 (77.7%) were female. Of the 152 doctors, 63 (41.4%) and 36 (23.7%) were positive by TST and by QTF-GIT, respectively, and among the 341 nurses, 119 (34.9%) and 49 (14.4%) had positive TST and QFT-GIT results, respectively. Overall, the agreement between the two tests was 0.22 by the chance corrected proportional agreement rate (kappa coefficient) in 493 subjects. Experience of working in tuberculosis (TB)-related departments was significantly associated with positive LTBI test results by QFT-GIT assay, not by TST. In multivariate analysis, only age was independently associated with increased risk of a positive TST result, while age and experience of working in TB-related departments (odds ratio, 2.29; 95% confidence interval, 1.01-5.12) were independently associated with increased risk of a positive QFT-GIT result. Conclusion: A high prevalence of LTBI was found among South Korean HCWs. Considering the association between the experience of working in TB-related departments and high risk of LTBI, QFT-GIT may be a better diagnostic test for LTBI than TST in HCWs.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.30 no.4
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• pp.353-363
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• 2020

Objectives: Occupational diseases that occur due to or aggravated by work have commonly been recognized in the manufacturing industry, but there are now more incidences happening in the service industry due to changes in the industrial structure. Health workers are exposed to direct factors and various other causes of occupational disease at work, such as physical, chemical, biological, and psyco-social factors. This study aims to identify work-related diseases affecting health workers that are recognized as occupational diseases. Methods: The research is based on the data of workers whose diseases were accepted as work-related by the Industrial Accidents Compensation Insurance, and filed by the Korean Occupational Safety and Health Agency. Amongst the approved claims during 2011 to 2015, we focused on healthcare workers and health-related workers of the Korean Standard Classification of Occupations. Descriptive statistics were performed. Results: The number of health workers(HWs) with approved work-related disease was 1,707 over 5 years. The number of healthcare workers(HCWs) excluding caregivers was 370 (21.7%) and of health-related workers (HRWs) it was 736 (43.1%). Out of HWs who were approved for their illnesses, females were 80% of HCWs and 88% of HRWs. The most common occupational disease in HWs was musculoskeletal diseases, while that of nurses was infectious disease. Conclusions: HWs are exposed to various risks from their profession and are affected by occupational diseases. It is necessary to focus on this issue and provide preventive measures.

• Pediatric Infection and Vaccine
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• v.22 no.3
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• pp.186-193
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• 2015

Purpose: The aim of study was to estimate the hand hygiene (HH) compliance of healthcare workers (HCWs) in a children's hospital. Methods: This study was conducted in a hospital which is a tertiary and educational children's hospital with 313 beds and 533 HCWs. Data were collected by direct observation methods from November 1, 2010 to December 31, 2010. Results: A total of 2,999 opportunities for HH were observed, and the overall HH rate was 95.3%. HH rate of the registered nurse, physicians and transferer was 97.7%, 89.2%, and 72.1%, respectively (P<0.001). Among physicians, HH rate of the fellows, professors, residents and interns was 97.5%, 93.9%, 89.7%, and 80.9%, respectively (P<0.001). HH rate in the emergency room, operation room, outpatient department (OPD), and the intensive care unit (ICU) was 97.2%, 97.2%, 95.4%, and 92.5%, respectively (P<0.001). Hand rubbing was the most frequently used (81.1%), and hand washing was frequently used in the case of 'after body fluids exposure risk' (37.7%) and 'after touching patient surroundings' (28.5%). HH methods were not statistically different from each departments (P =0.083), however, they were significantly different according to the World Health Organization (WHO) 5 Moments (P<0.001). Distributions in WHO 5 Moments by the job titles were significantly different (P<0.001). The odds ratio of physicians, ICU and OPD was 0.353 (95% CI, 0.241-0.519), 0.291 (95% CI, 0.174-0.487), and 0.484 (95% CI, 0.281-0.834), respectively. Conclusions: Compliance of HH was different by the job titles and departments. Effective custom-tailored HH programs for each job title and department need to be developed.

• The Korean Journal of Health Service Management
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• v.9 no.4
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• pp.33-49
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• 2015

Objectives : This study was conducted to measure the effects of healthcare accreditation (HA) on the changes in infection control (IC). Methods : Questionnaires were e-mailed to 60 hospitals from 23 October to 23 December, 2011. Data were analyzed by SPSS 12.0. Results : Finally 50 hospitals (83.0%) were enrolled in the study: Seoul area (40.0%), tertiary (76.0%), and >500 beds (98.0%). Nine hospitals (18.0%) had a full time infection control nurse[ICN] with 300 beds. Among various factors, ICN (36.0%), hospital facilities (66.0%), instruments (32.0%) and supplies (88.0%) all improved. Hand hygiene increased (53.1% vs 83.2%, p<.001), but it was continued only in 34.1% of hospitals. Healthcare-associated infection (68.4%), multi drug resistant organisms (42.1%) and outbreaks (26.3%) decreased. Reasons for difficulties in satisfying the HA standards were inadequate support which included hospital facilities, instruments, budget, and a shortage of ICNs and healthcare workers (HCWs). Conclusions : HA had effects on the IC, but they were transient. Staffing in ICN and HCW staffing, hospital facilities, instruments, and supplies all need to be improved.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.30 no.2
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• pp.124-133
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• 2020

Objectives: Mask fit is a crucial factor in preventing respiratory infections among healthcare workers. The current coronavirus(COVID-19) pandemic calls for the replacement of imported N95 medical masks with domestic N95 versions. In this study, we aimed to determine whether these masks provide proper protection. Methods: Thirty-five participants from three healthcare institutions donned four types of masks and Quantitative Fit Tests(Portacount, USA) were performed. The order of fit test for the four types of masks was randomized, and a three-minute washout period was applied between test times(2 min 29 sec) to reduce potential error stemming from physical exhaustion. Results: There were no significant differences in the Fit Factor for the four types of masks, and there were no gender differences. However, the Fit Factor significantly differed across the three healthcare institutions (p=0.007). With eight of the 35 participants passing, the pass rate with the criteria of 100 or higher was 21%. Conclusions: The mask used in this study was a new domestic N95 medical mask, and the participants were unfamiliar with how to wear it. They reported difficulties with mask fitting. In light of a previous finding that mask fit improved with frequently used masks, wearer preferred masks, or when masks that are regularly worn are used during fit training, the fact that participants were unfamiliar with the mask used in this study is a limitation that should not be overlooked.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.31 no.1
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• pp.94-104
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• 2021

Objectives: A number of medical institutions have been conducting fit tests to perform seal checks on masks. This study aimed to compare the differences fit factor before and after domestic N95 mask-wearing training through a fit-test. Methods: A survey of 59 healthcare workers was conducted regarding whether they had undergone a fit test or received training on mask-wearing. Further, the fit of two types of domestic N95 masks was measured before and after the training using a QNFT(Quantitative Fit test). The average fit factors before and after training were compared using a paired t-test. Additionally the differences in the fit test pass rate were analyzed using a McNemar test. Results: A statistically significant difference was seen between the fit factors in the fit tests conducted before and after the training (p=0.0015), as well as in the fit of the two types of masks tested (p<0.01). Thus, an improvement in mask fitting was seen after the training, even with differently fitted masks. Conclusions: Upon using a QNFT, a significant increase in the fit factors for N95 masks was observed after training compared with masks that were fitted as usual. This highlights the importance of training in mask-wearing, with the conclusion that training healthcare providers will improve the fit of masks.

• Infection and chemotherapy
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• v.50 no.4
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• pp.319-327
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• 2018

Background: Lancet-related needlestick injuries (NSIs) occur steadily in clinical practices. Safety-engineered devices (SEDs) can systematically reduce NSIs. However, the use of SEDs is not active and no study to guide the implementation of SEDs was known in South Korea. The lancet-related NSIs may be eliminated to zero incidence using a SED lancet with effective sharp injury protection and reuse prevention features. Materials and Methods: We implemented a SED lancet by replacing a conventional prick lancet in a tertiary hospital in a sequential approach. A spot test of the new SED was conducted for 1 month to check the acceptability in practice and a questionnaire survey was obtained from the healthcare workers (HCWs). A pilot implementation of the SED lancet in 2 wards was made for 1 year. Based on these preliminary interventions, a hospital-wide full implementation of the SED lancet was launched. The incidence of NSIs and cost expenditure before and after the intervention were compared. Results: There were 29 cases of conventional prick lancet-related NSIs for 3 years before the full implementation of SED lancet. The proportion of prick lancet-related NSIs among yearly all kinds of NSIs during two years before the pilot study was average 11.7% (22/188). Pre-interventional baseline incidence of all kinds of NSIs was 7.01 per 100 HCW-years. After the full implementation of SED lancet, the lancet-related NSIs became zero in the 2nd year (P = 0.001). The average direct cost of 18,393 US dollars (USD) per year from device and post-exposure medical care before the intervention rose to 20,701 USD in the 2nd year of the intervention. The incremental cost-effectiveness ratio was 210 USD per injury avoided. Conclusion: The implementation of a SED lancet could eliminate the lancet-related NSIs to zero incidence. The cost increase incurred by the use of SED lancet was tolerable.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.24 no.4
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• pp.528-535
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• 2014

Objectives: This study compares the differences of fit factors before and after training on the N95 mask. The results will be utilized to suggest the need of providing effective training on respirator use. Methods: A total of 49 study subjects were tested, comprised of nurses from a general hospital and undergraduate nursing students from a medical school. Anthropometric measurements of face length and face width were compared with the NIOSH(National Institute for Occupational Safety and Health) panel. Fit factors(FF) were measured with TSI Portacount Pro+8038 before and after on-site training regarding the proper use of respirators. The FF pass/fail criterion was set at 100. Results: Two subjects(4.1 %) passed the fit test before training on use of the N95. However, 36(73.5%) of the 49 passed the test after training. Overall the FF(GM(GSD)) was 13.4(3.2) before training, but improved to 106.6(2.1) after training, which was statistically significant. These findings suggest the efficacy of educational intervention, and the performance of the direct on-site training proved to be better than that of the traditional educational methods. Conclusions: This study showed the effect of on-site training of the N95 respirator among health care workers(HCW). Therefore, providing effective training on the use of N95 for HCWs before their work assignments will greatly reduce exposure to harmful agents. It is recommended that fit testing be mandated to check for adequate protection being provided by the given respirators.

• Journal of the Korean Society of Radiology
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• v.82 no.6
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• pp.1524-1533
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• 2021

Purpose To investigate the incidence of tuberculosis (TB) in healthcare workers (HCWs) with positive interferon-gamma release assay (IGRA) results based on chest X-ray (CXR) and CT findings and determine the role of imaging in the diagnosis of TB. Materials and Methods Among 1976 hospital personnel screened for TB using IGRA, IGRApositive subjects were retrospectively investigated. Clustered nodular and/or linear streaky opacities in the upper lung zone were considered positive on CXR. The CT findings were classified as active, indeterminate, inactive, or normal. The active or indeterminate class was considered CT-positive. Results IGRA was positive in 255 subjects (12.9%). CXR and CT were performed in 249 (99.2%) and 113 subjects (45.0%), respectively. CXR- and CT-positive findings were found in 7 of 249 (2.8%) and 9 of 113 (8.0%) patients, respectively. Among the nine CT-positive subjects, active and indeterminate TB findings were found in 6 (5.3%) and 3 (2.7%) patients, respectively. Microbiological tests, including acid-fast bacilli staining, culture, and polymerase chain reaction for TB, were negative in all nine CT-positive subjects. Empirical anti-TB medications were administered to 9 CT-positive subjects, and 3 of these nine subjects were CXR-negative for pulmonary TB.

• IMMUNE NETWORK
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• v.22 no.3
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• pp.24.1-24.12
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• 2022

Coronavirus disease 2019 (COVID-19) vaccination in immunocompromised, especially transplant recipients, may induce a weaker immune response. But there are limited data on the immune response after COVID-19 vaccination in liver transplant (LT) recipients, especially on the comparison of Ab responses after different vaccine platforms between mRNA and adenoviral vector vaccines. Thus, we conducted a prospective study on LT recipients who received two doses of the ChAdOx1 nCoV-19 (ChAdOx1), mRNA-1273, or BNT162b2 vaccines compared with healthy healthcare workers (HCWs). SARS-CoV-2 S1-specific IgG Ab titers were measured using ELISA. Overall, 89 LT recipients (ChAdOx1, n=16 [18%]) or mRNA vaccines (mRNA-1273 vaccine, n=23 [26%]; BNT162b2 vaccine, n=50 [56%]) received 3 different vaccines. Of them, 16 (18%) had a positive Ab response after one dose of COVID-19 vaccine and 62 (73%) after 2 doses. However, the median Ab titer after two doses of mRNA vaccines was significantly higher (44.6 IU/ml) than after two doses of ChAdOx1 (19.2 IU/ml, p=0.04). The longer time interval from transplantation was significantly associated with high Ab titers after two doses of vaccine (p=0.003). However, mycophenolic acid use was not associated with Ab titers (p=0.53). In conclusion, about 3-quarters of LT recipients had a positive Ab response after 2 doses of vaccine, and the mRNA vaccines induced higher Ab responses than the ChAdOx1 vaccine.