頁籤選單縮合
題名 | 膀胱鏡檢查導致院內泌尿道感染群突發=An Outbreak of Genital-Urinary Tract Nosocomial Infection Caused by Cystoscopy Examination |
---|---|
作者 | 劉秋琴; 秦登峰; 謝士明; 黃崇昌; Liou, Chu-jin; Chyn, Deng-feng; Shyh, Shieh-ming; Huang, Chung-chang; |
期刊 | 臺灣泌尿科醫學會雜誌 |
出版日期 | 20020900 |
卷期 | 13:3 2002.09[民91.09] |
頁次 | 頁124-128 |
分類號 | 419.38 |
語文 | chi |
關鍵詞 | 綠膿桿菌; 泌尿道感染; 院內感染; Pseudomonas aeruginosa; Urinary tract infection; Nosocomial infection; |
中文摘要 | 研究目的:利用流行病學分析膀胱鏡於檢查導致院內泌尿道感染群突發的可能感染原因,並且提出改善之道。 材料與方法:自1997年8月22日至27日,陸續發現有五名泌尿科病房之住院病人得到泌尿道感染,經院內感染定義判定為院內感染個案,將流行期與流行前期之感染情形,經卡方檢定測試後,具統計學上之顯著差異(p<0.05),所以確定為一次群突發事件。由個案之資料分析及流行病學調查發現,上述病人均有接受體外電震波腎臟碎石術及置放雙J輸尿管導管。所有個案皆無置放導尿管,惟從多位病人之尿液和導管尖端分離出綠膿桿菌,其抗生素感受性試驗型式與指標病例尿液所分離之綠膿桿菌相同。此指標病例是一名因腎臟感染有膿瘍且曾使用過同一支膀胱鏡之病人。 結果:深入調查發現感染源極可能為未徹底清洗及浸泡足夠時間高層次消毒劑之膀胱鏡。此事件發生後,強制規定膀胱鏡使用後,均予以去污染、徹底清洗、浸泡高層次消毒劑達三十分鐘後,再使用無菌蒸餾水沖洗並晾乾,方能給病人使用。爾後蹤二個月,未再發現有任何因上述手術而遭受感染的個案。 結論:院內感染可以因為人為的疏失,以及對醫療器材之消毒與滅菌觀念不足而引起。本研究即因為病人使用後之膀胱鏡未能有效消毒而造成病人泌尿道感染,雖然及時找出原因並且徹底改善之。未來應建立標準操作程序及加強醫護人員醫療器材之消毒與滅菌觀念,以根除因內視鏡消毒不全再次導致病人感染。 |
英文摘要 | OBJECTIVE: To analyze the source of infection for an outbreak of genital-urinary tract nosocomial infection caused by cystoscopy examination, and also provide effective control measures to stop the outbreak. MATERIALS AND METHODS: From August 22 to August 27, our hospital has gathered and labeled 5 urological hospitalized patients to have acquired nosocomial urinary tract infection. From epidemic and pre-epidemic phase of infection course through Chi-squre test, the difference was statistically significant (p<0.05), so , it was considered outbreak event. After analysis and epidemiological investigation, it was found that all of the patients have received extra-corporial shock wave lithotripsy and double j ureteral tube insertion. Through cases had no previous indwelling urethral cathterization, but were screened out from all urine and indwelling catheter tip culture and antibiotic susceptibility pattern, which isolated the same labeled group of multiple drug-resistant Pseudomonas aeruginosa, this was trace from one particular case of renal abscess which have used the same cystoscope as the others. RESULTS: After thorough investigation, it was found out that the source of infection could by due to improper washing and insufficients time of high level disinfectant soaking procedure of the instrument. After this outbreak, a strict supervision of handling of used cystoscope, which include removal of secretion, thorough washing, high level disinfectant soaking for more than 30 minutes, rinsing with aseptic distilled water, and drying procedure were observed before the next patient can to use the instrument. Surveillance for such infection was followed up for 2 months, no additional case of post-operative patient was reported to have acquired the same nosocomial infection. CONCLUSIONS: Nosocomial infection can be resulted from insufficient disinfection for medical equipment and personal mistake. This study have shown that patients get nosocomial infection due to contaminated cystoscopy. We should establish the standard operating procedures and enhance their concept about disinfection in order to reduce such infection. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。