본 연구의 목적은 응급구조사의 직종별 감염예방 표준주의에 대한 인지도와 이행도를 파악하여, 표준주의 이행도를 증진시켜 감염예방과 효율적인 실천방안 마련의 기초 자료를 활용하고자 시도하였다. 이러한 목적을 달성하기 위하여 지역의 종합병원과 소방안전센터에 근무하는 응급구조사로 병원 200명과 119구급대원 250명을 대상으로 설문조사를 시행하였으며, 회수된 설문지는 총 391명이었다. 본 연구의 자료 수집은 2013년 3월부터 4월까지 조사를 실시하여 표본은 지역의 종합병원과 소방안전센터에 근무하는 응급구조사를 대상으로 각 부서를 방문하여 연구의 목적을 설명하고 자기평가기입식(self-administered questionnaire) 설문지를 450부 실시하였으나 응답내용이 부실하다고 판정된 것 중 59부를 제외한 391명을 수집된 자료를 활용하였다. 자료 분석을 위하여 사용된 통계방법은 Windows용 SPSS 20.0을 이용하여 분석하였고, 대상자의 일반적 특성은 빈도와 백분율로 빈도분석, 척도의 타당도와 신뢰도를 측정하기 위하여 요인분석과 문항내적 일치도를 측정하는 Cronbach''s α 이용하였다. 또한 직종별 인지도와 이행도의 차이는 t-test 검정과 표준주의 및 감염 관리 지침 영역별 및 항목별 분석하기 위하여 IPA(Importance Performance analysis)를 활용하였다. 이 연구에서 밝혀진 결론은 다음과 같다.

1. 본 연구에 사용된 표본은 총 391명의 전국의 종합병원과 소방안전센터에 근무하는 응급구조사들이다. 이들 가운데 병원 응급구조사 중 여자가 101명 이었고, 119구급대원은 남자가189명로 병원 응급구조사의 경우 여자가 더 많았고, 119구급대원의 경우 남자가 더 많은 것을 알 수 있었다. 연령별로는 병원 응급구조사는 20대가 142명 이었고, 119구급대원은 30대가 116명으로 병원 응급구조사의 경우 20대가 많았고, 119구급대원의 경우 30대가 더 많다는 것을 알 수 있었다. 근무경력별로는 병원 응급구조사의 경우 2년 미만이 48명이었고, 119구급대원의 경우 5년 이상이 100명으로 병원응급구조사의 경우 2년 미만 경력자가 가장 많았고 119구급대원의 경우 5년 이상 경력자가 가장 많았다.
근무 중 상처의 경험의 유무와 그 횟수를 살펴보면 병원 응급구조사의 경우 상처를 입은 유경험자가 130명으로, 유경험자 130명 중 그 횟수가 3회 이하라고 답한 사람이 76명의로 더 많았다. 119구급대원의 경우 상처 무경험자가 169명이었고, 유경험자 65명 중 그 횟수가 3회 이라하고 답한 사람이 55명(85.8%)로 더 많은 것을 알 수 있었으며 이러한 결과로 병원에서 근무하는 응급구조사가 119구급대원 보다 근무 중 상처를 경험하는 일이 더 많다는 것을 알 수 있었다.
환자 처치 중 환자의 체액이나 분비물이 근무자의 상처가 있는 피부나 점막 등에 접촉한 경험의 유무에서는 병원 응급구조사중 접촉한 경험이 있는 사람이 101명로 많았으며 119구급대원의 경우 접촉 경험이 없는 사람이 133명로 더 많았으며 이 결과 값으로 상처가 있는 피부 또는 점막에 환자의 체액이나 분비물을 접촉한 경험이 더 많은 직군은 119구급대원보다는 병원 응급구조사인 것으로 나타났다. 접촉 경험자들이 접촉한 종류를 살펴보면 병원응급구조사와 119구급대원 두 직군 모두 경우 혈액이 98명과 93명으로 가장 많았다.
근무 중 환자로 부터 전염되어 감염성 질환에 전염된 적이 있는 지에 대한 질문에 병원 응급구조사 139명, 119구급대원 217명이 전염된 적이 없다고 응답하였고, 근무지로부터 병원 감염 관리 교육을 받은 적이 있냐는 질문에 병원 응급구조사 121명, 119구급대원 202명이 교육을 받았다고 답해 전반적으로 기본적인 교육이 이루어지고 있다고 보여 진다.

2. 직종별 표준주의 인지도의 차이를 분석한 결과 병원 응급구조사와 119구급대원의 인지도에 유의한 차이가 없는 것으로 드러났다.
직종별 표준주의 이행도 차이를 분석한 결과 손 위생, 보호 장비, 호흡기 감염관리에서 병원 응급구조사와 119구급대원간의 유의한 차이를 보였으며, 손 위생, 보호 장비, 호흡기 감염관리, 치료 장비 및 직원의 안전 등 모든 항목에서 119구급대원이 병원 응급구조사보다 표준주의 및 감염예방지침 이행도가 높은 것으로 나타났다.

3. 표준주의 및 감염예방지침의 인지도와 이행도 간 차이를 분석한 결과, 손 위생, 보호 장비, 호흡기 감염관리, 치료 장비 및 직원의 안전, 모든 영역에서 유의한 차이가 있었으며, 이행도보다는 인지도가 높은 것으로 나타나, 표준주의 및 감염예방지침 인지도는 높았으나 이행도는 낮았다.
직종별 인지도와 이행도의 차이를 분석한 결과, 병원 응급구조사의 인지도와 이행도의 차이는 손 위생, 보호 장비, 호흡기 감염관리, 치료 장비 및 직원의 안전 모두 유의한 차이가 있었으며, 인지도가 이행도 보다 높은 것으로 나타났다. 119구급대원 역시 인지도와 이행도의 차이는 손 위생, 보호 장비, 호흡기 감염관리, 치료 장비 및 직원의 안전 모두 유의한 차이가 있으며 인지도가 이행도 보다 높은 것으로 나타났다.

4. 표준주의 및 감염예방지침 영역별 중요도 - 만족도 분석을 실시하였고 1 사분면의 좋은 성과 지속 유지에는 손 위생, 보호 장비가 속했고 3 사분면의 점진적 개정에는 호흡기 감염관리, 치료 장비 및 직원의 안전이 속하는 것으로 나타났다. 이러한 결과 치를 병원응급구조사와 119구급대원 별 IPA 분석을 실시한 결과 1 사분면에는 119구급대원의 손 위생, 보호 장비가 속하는 것으로 나타났다. 2 사분면에는 병원 응급구조사의 손위생과 보호 장비 항목이 속하여 중점적인 개선이 필요한 것으로 드러났다. 3 사분면에는 병원 응급구조사의 치료 장비 및 직원의 안전, 호흡기 감염 관리와 119구급대원의 호흡기 감염관리가 속하여 호흡기 감염관리는 공통적으로 점진적인 개선이 필요하였다. 4 사분면에는 119구급대원의 치료 장비 및 직원의 안전 항목이 속하는 것으로 나타나 과잉 노력 지향적인 것으로 드러났다.
전체 20개 항목별 IPA 분석을 한 결과 점진적 개정이 필요한 3 사분면에는 손 위생의 1, 2, 3, 보호 장비의 8, 11, 호흡기 감염관리는 13, 15, 16, 치료 장비 및 직원의 안전에서는 17, 18, 19 항목이 나타났다. 과잉 노력 지양 4사분면에는 보호 장비의 7번 문항 ‘장갑을 벗은 후 손 위생을 수행 한다.’ 만이 있는 것으로 나타났다. 이러한 결과를 직종별로 분석하면 병원 응급구조사의 경우 점진적 개정이 필요한 항목은 손 위생의 1, 2, 4, 보호 장비의 8, 10, 11, 호흡기 감염관리 13, 15, 치료 장비 및 직원의 안전에서 17, 18, 19 항목이 나타났고, 119구급대원의 경우 점진적 개정이 필요한 항목은 손 위생 1, 2, 4, 보호 장비의 8, 11, 호흡기 감염관리의 13, 15, 16, 치료 장비 및 직원의 안전에서 17, 18, 19번인 것으로 나타났으며, 과잉 노력 지양에는 손 위행에서의 7번 항목인 것으로 나타났다.

The purpose of this study was to examine the awareness of paramedics about standard precaution against infection control by the type of occupation and their performance of it in an effort to provide some information on how to boost their performance of the standard precaution to ensure successful infection control. The subjects in this study were 319 emergency medical technicians who worked in general hospitals and 119 safety centers. Out of them, 200 emergency medical technicians worked in hospitals, and 119 emergency medical technicians worked in 119 safety centers. After a survey was conducted in April and March, 2013, the answer sheets from 391 respondents were gathered. Before the survey was conducted, the general hospitals and the 119 safety centers were visited to explain the purpose of this study, and the selected emergency medical technicians were asked to fill out the self- administered questionnaires. 450 questionnaires were handed out, and the answer sheets from 391 respondents were analyzed except for 59 ones that seemed to be incomplete. As for data analysis, the statistical package SPSS WIN 20.0 was employed. A frequency analysis was made to obtain statistical data on frequency and percentage, and factor analysis and Cronbach alpha coefficients that indicated item internal consistency were utilized to check the validity and reliability of the inventory used in this study. To look for any possible differences between awareness and performance according to the type of occupation, t-test was carried out, and IPA(importance-performance analysis) was made to find out about their standard precaution against infection control in more detail. The findings of the study were as follows:
1. The samples of this study were 391 emergency medical technicians who worked in general hospitals and 119 safety centers. Out of them, 101 emergency medical technicians were female, and 189 emergency medical technicians were male. Among the hospital paramedics, the women outnumbered the men, and the men outnumbered the women among the 119 rescue workers. By age, 142 hospital paramedics were in their 20s, and the 119 rescue workers who were in their 30s numbered 116. Among the hospital paramedics, those who were in their 20s made up the largest age group, and those who were in their 30s made up the biggest age group of the 119 rescue workers. By career, 48 hospital paramedics had less than two years of career, and 100 emergency medical technicians of the 119 safety centers had five years or more of career. The largest group of the hospital paramedics had less than two years of career, and the greatest group of the 119 rescue workers had five years or more of career.
As for experience and frequency of injury during working hours, 130 hospital paramedics had been injured. Out of them, 76 hospital paramedics was injured three times or less. In the case of the 119 rescue workers, 169 rescue workers had never been injured, and 65 had been injured. In the latter group of the 119 rescue workers, 55 rescue workers(85.8%) was injured three times or less. The hospital paramedics had been more injured during working hours than the 119 rescue workers.
Whether their wounded skin or mucosa had ever been touched by the body fluid or secretion of patients in the middle of procedure was analyzed. As a result, 101 hospital paramedics had had that experience, and 113 rescue workers of the 119 safety centers had had that experience. The hospital paramedics had more experience than the 119 rescue workers that their wounded skin or mucosa had been touched by the body fluid or secretion of patients. Concerning the type of contact, blood was the most common thing that touched wounded skin or mucosa in both groups. 98 hospital paramedics and 93 rescue workers of the 119 safety centers responded their wounded skin or mucosa had been touched by the blood of patients.
Whether they had ever been infected with any infectious disease from patients was analyzed, and 139 hospital paramedics and 217 rescue workers of the 119 safety centers replied they hadn''t. Whether they had ever received education on hospital infection control at work was analyzed, and 121 hospital paramedics and 202 rescue workers of the 119 safety centers replied they had. It indicated that basic education was properly provided overall.
2. Whether there would be any differences in awareness of the standard precaution according to the type of occupation was analyzed, and no significant differences were found between the hospital paramedics and the 119 rescue workers in that regard.
As a result of looking for any possible differences in performance of the standard precaution according to the type of occupation, there were significant differences between the hospital paramedics and the 119 rescue workers in hand hygiene, protective devices and respiratory infection control. The 119 rescue workers were ahead of the hospital paramedics in every item about the performance of the standard precaution and infection control guidelines, which was hand hygiene, protective devices, respiratory infection control, treatment equipment and employee safety.
3. Whether there would be any differences between awareness and performance of the standard precaution and infection control guidelines was analyzed, and there were significant differences in every item that was hand hygiene, protective devices, respiratory infection control, treatment equipment and employee safety. The level of their awareness was better than that of their performance, as they were well aware of the standard precaution and infection control guidelines yet didn''t comply with the two properly.
Whether there would be any differences between awareness and performance according to the type of occupation was analyzed, and there were significant differences between the awareness and performance of the hospital paramedics in every item that was hand hygiene, protective devices, respiratory infection control, treatment equipment and employee safety. The level of their awareness was higher than that of their performance. In the case of the 119 rescue workers, there were significant differences between awareness and performance in every item that was hand hygiene, protective devices, respiratory infection control, treatment equipment and employee safety as well. The level of their awareness was higher than that of their performance.
4. As a result of making an IPA of the standard precaution and infection control guidelines in detail, hand hygiene and protective devices belonged to the first quadrant that indicated the necessity of the maintenance of good performance, and respiratory infection control, treatment equipment and employee safety belonged to the third quadrant that indicated the necessity of gradual improvement. When an IPA was separately made in each of the two groups, the hand hygiene and protective devices of the 119 rescue workers belonged to the first quadrant, and the hand hygiene and protective devices of the hospital paramedics belonged to the second quadrant that indicated the necessity of immediate improvement. The treatment equipment, employee safety and respiratory infection control of the hospital paramedics and the respiratory infection control of the 119 rescue workers belonged to the third quadrant that indicated the necessity of gradual improvement. The gradual improvement of respiratory infection control was necessary in both groups. The treatment equipment and employee safety of the 119 rescue workers belonged to the fourth quadrant that indicated the necessity of the avoidance of excessive efforts.
As a result of making an IPA of the entire 20 items, hand hygiene items 1, 2 and 3, items 8 and 11 of protective devices, items 13, 15 and 16 of respiratory infection, and items 17 ,18 and 19 of treatment equipment and employee safety belonged to the third quadrant that indicated the necessity of gradual improvement. There was only item 7 of protective devices in the fourth quadrant that indicated the necessity of the avoidance of excessive efforts. The item 7 of protective devices was to fulfill hand hygiene after taking off gloves. When the results were analyzed by the type of occupation, the items that there was gradual room for improvement among the hospital paramedics were items 1, 2 and 4 of hand hygiene, items 8, 10 and 11 of protective devices, items 13 and 15 of respiratory infection control and items 17, 18, and 19 of treatment equipment and employee safety. In the case of the 119 rescue workers, the items in which gradual improvement was needed were items 1, 2 and 4 of hand hygiene, items 8 and 11 of protective devices, items 13, 15 and 16 of respiratory infection control, and items 17, 18 and 19 of treatment equipment and employee safety. The item that indicated the necessity of the avoidance of excessive efforts was item 7 of hand hygiene.