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題 名 | 影響外科加護病房院內感染之危險因素分析=Analysis of Risk Factors Affecting Nosocomial Infection in Surgical Intensive Care Unit |
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作 者 | 劉建良; 翁夢璐; 潘芳靜; 劉存厚; 李怡增; 蔡瑞貞; | 書刊名 | 院內感染控制雜誌 |
卷 期 | 9:1 1999.02[民88.02] |
頁 次 | 頁19-29 |
分類號 | 419.38 |
關鍵詞 | 院內感染; 感染率; 危險因素; 外科加護病房; Nosocomial infection; Infection rate; Risk factors; Surgical Intensive care unit; |
語 文 | 中文(Chinese) |
中文摘要 | 以現代醫療科技的進步,尚無法完全避免院內感染的發生,而加護病房則是院內感染發生率最高的醫療單位;而且不同型態的加護病房,其院內感染的發生率與感染部位的分佈不盡相同。院內感染的發生受到許多因素的影響,其中包括病人本身、醫療人員、硬體環境等多重因素的交互作用。為了解外科加護病房院內感染的發生率,受到那些因素的影響,我們調查從民國85年1月到民國87年6月三十個月期間,外科加護病房院內感染的發生率,將之與同期間科加護病房的床位周轉資料及護理人力資料比較做迴歸分析,以期找出影響院內感染發生率的外在危險因素。我們也調閱院內感染發生率最高的五個月份(85年12月,86年8、9、11月,87年5月)�堙A所有外科加護病房病人的病歷,以期找出影響病人發生院內感染的危險因素。三十個月期間的平均總院內感染率為千分之24.4;其中以血流感染、泌尿道感染、下呼吸道感染與外科傷口感染最多,分別為千分之6.5、5.7、5.3與4.2。從各種病床、人力資料中,用簡單迴歸分析篩選出和總院內感染率可能有關的因素為平均住院日、總病人數、病房轉入人數與急診住入人數比(p=0.002、0.004、0.02);但是用複迴歸分析則發現只有總病人數是有有意義的獨立因素(p=0.02)。用複迴歸分析也發現泌尿道感染和總病人數有關(p=0.03),而外科傷口感染和長假護理人數有關(p=0.02)。從病人的病歷分析發現,影響病人發生院內感染的危險因素包括重複多次手術、血清白蛋白值、糖尿病、年齡、APACHE II分數、使用呼吸器、病人從病房轉入、插中央靜脈導管、手術麻醉時間。 |
英文摘要 | Patients in intensive care units (ICU) have higher nosocomial infection (NI) rates than those on the general wards, while different types of ICU have their specific site distributions and rates of NI. There are many factors affecting the occurrence of NI, these include that of patient, personnel and environmental factors and their interactions. We investigated the NI rates in a surgical ICU, during the period from January, 1996 to June, 1998, and associated their relation-ship with the bed turn-over rate and the nursing manpower at the same unit using the regression method. We also reviewed the charts of each patients admitted to this ICU during the five months with the greatest gross NI rates (Dec. 1996, Aug. Sep. Nov. 1997, May 1998), collected patient's demographic and clinical data at the time of admission to the ICU, then analysed these data with the chi-square and the t test trying to find out significant risk factors for the admission. The average gross NI rates was 24.4 per 1,000 patient-days. The major sites affected were bloodstream, urinary tract, lower respiratory tract and surgical wound, with the site-specific infection rates of 6.5, 5.7, 5.3 and 4.2 per 1,000 patient-days, respectively. The average length of stay, total patient numbers (TPN) and sources of patients (those transferred from general wards versus those admitted from the emergency room) were found to be correlated with the gross NI rates by simple regression, while multiple regression revealed that only TPN was the significant independent factor (p=0.02). As to the site-specific infection rates, multiple regression revealed that the urinary tract infection rate was correlated witt TPN (p=0.03), while the surgical wound infection rate was correlated with the number of nurses with long vacation (p=0.02). The analysis of patient's data revealed that repeated operations, serum albumin level, DM, age, APACHE II score, usage of ventilator, patients transferred from general ward, insertion of CVP line and time of operation/anesthesia were all significant risk factors of NI. |
本系統中英文摘要資訊取自各篇刊載內容。