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| 題 名 | Nosocomial Infection in a Neonatal Intensive Care Unit--From a Viewpoint of National Health Insurance=某醫學中心新生兒加護病房之院內感染--全民健保實施前後之比較 |
|---|---|
| 作 者 | 林英智; 陳昭惠; 陳伯彥; 王德明; 遲景上; | 書刊名 | 臺灣兒科醫學會雜誌 |
| 卷 期 | 41:3 民89.05-06 |
| 頁 次 | 頁123-128+165 |
| 分類號 | 417.517 |
| 關鍵詞 | 新生兒; 院內感染; 全民健保; Neonates; Nosocomial infection; National health insurance; |
| 語 文 | 英文(English) |
| 中文摘要 | 為研究本院新生兒加護病房之院內感染情形並分析全民健保實施前後院內感染的變遷,我們回朔分析自1991年3月1日至1999年2月28日,共8年中本院新生兒科加護病房之院內感染情形。發現平均院內感染率為13.6%,全民健保實施前平均院內感染為73.9%,實施後增加至19.0%。最常發生的院內感染為血行性凝固酵素陰性的表皮葡萄球菌感染(coagulase-negative Staphylococci)。全民健保實施前最覺的血流院內感染為徽菌,實施後則發凝固酵素陰性的葡萄球菌為最常被培養出。出生體重低於1500公克的極低體重早産兒的數在健保實施後,從平均第年23.2人增加至37.0人,平均存活率也從76.3%增加至78.4%,然而院內感染率也由22.6%增加41.9%。在不同體重的早産兒院內感染者的住院天數者明顯較沒有院內感染者長(p<0.005),愈低出生體得的早産兒其住院天數也較長。本院新生兒加護病房之院內感染在全民健保實施後有明顯增加的現象,其真正的原因無原則要進一步探討。然而新生兒醫療的進步命名重症新生兒的存活率提昇發及極低體重早産兒的數目增加是主要原因之一。為使極低體重早産兒信重症新生兒的存活的存活率進一步提昇,減少併發症,及降低醫療支出,持續且加強院內感染的預防和控制是必須。 |
| 英文摘要 | In order to survey both the epidemiology of nosocomial infection in our neonatal intensive care unit (NICU) and the changing face of nosocomial infection after the introduction of National Health Insurance (NH!) in Taiwan, we retrospectively reviewed the nosocomial infections which occurred in our NICU from March 1, 1991, to February 28, 1999. We also compared the nosocomial infections from the viewpoint of NHI. The mean rate of nosocoinial infections in our NICU during these 8 years was 13.6%, and it had significantly increased after the NHI plan was implemented (from 7.9% to 19.0%). The most common type of nosocomial infection was blood stream infection (53.8%, 120 of 223 infections). Coagulase-negative Staphylococci and fungi were the two most common pathogens of nosocomial blood stream infection in our NICU, accounting for 28.1% and 24.2% of the infections, respectively. The survival rate of very low birth weight (VLBW) infants increased from 76.3% to 78.4% after the implementation of NHI However, the nosocomial infection rate of the VLBW infants had markedly increased from 22.6% to 41.9%. The total number of hospitalization days of the patients with nosocoinial infection was significantly greater than that of those without nosocomial infections (p<0.05), and the patients with the lower birth weights had longer hospital stays. The risk factors for nosocomial infection including invasive procedures, multiple and empirical antibiotics, and extremely low birth weight premature infants, remained the same, but the prevalence of nosocomial infection in the neonatal intensive care unit has changed markedly since the NHI plan began. Further investigation to determine strategies for preventing nosocomial infection in very low birth weight infants is warranted. |
本系統中英文摘要資訊取自各篇刊載內容。