• International Journal of Advanced Culture Technology
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• 제6권3호
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• pp.211-215
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• 2018

Ventilator-associated pneumonia (VAP) is a lung infection that develops in patients receiving mechanical ventilation. VAP contributes to about 50% of hospital-acquired pneumonia in ICU settings. One of the recommendation of the Institute of for Healthcare Improvement ventilator bundle is HOB elevation. HOB elevation affects shearing forces and makes higher risk for pressure injury development. Pressure injury (PI) is localized damage to the skin over a bony prominence. PI prevention guidelines recommend that HOB positioning should be lower to reduce risk for PI development which contradicts VAP prevention guidelines for the HOB between 30 and 45 degrees for ICU patients. This presents a care dilemma and tension. The purpose of this study was to perform a secondary data analysis using cumulative electronic health record data in order to determine the association of HOB elevation with VAP and PI in ICU patients. A secondary data analysis was conducted to determine whether HOB elevation is associated with VAP and PI. HOB elevation was not likely to be associated with VAP prevention whereas it was likely to be related to PI development. This is somewhat contrary to popular data and publications. Prospective cohort study is desired to inform us in an evidence-based fashion what actually is optimal HOB elevation for ventilated patients in ICU settings.

• Journal of Korean Medical Science
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• 제33권48호
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• pp.295.1-295.7
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• 2018

Background: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. Methods: This study was conducted in the emergency department of a medical college-affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. Results: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378-46.651), hospital days (4-7 days; aOR: 7.246; 95% CI: 3.229-16.261), duration of antimicrobial exposure (1-3 days; aOR: 1.976; 95% CI: 1.137-3.436), and age (aOR: 1.025; 95% CI: 1.007-1.043). Conclusion: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.

• Infection and chemotherapy
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• 제50권4호
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• pp.287-300
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• 2018

Pneumonia is the leading cause of morbidity and mortality, particularly in old adults. The incidence and etiologic distribution of community-acquired pneumonia is variable both geographically and temporally, and epidemiology might evolve with the change of population characteristics and vaccine uptake rates. With the increasing prevalence of chronic medical conditions, a wide spectrum of healthcare-associated pneumonia could also affect the epidemiology of community-acquired pneumonia. Here, we provide an overview of the epidemiological changes associated with community-acquired pneumonia over the decades since pneumococcal conjugate vaccine introduction.

• 의료관련감염관리
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• 제21권2호
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• pp.50-56
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• 2016

ESBL을 생성하는 균주에 의한 요로 감염에서 카바페넴 계열 이외의 항생제를 사용할 수 있는 지를 후향적으로 평가한 연구이다. 만약 in vitro 결과에서 감수성이 있다면 사용이 가능하다는 결과이나 환자의 중증도가 높다면 실패할 수 있음을 강조하였다. 이번 연구 결과를 바탕으로 전향적 연구를 기대해 본다.

• 성인간호학회지
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• 제24권2호
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• pp.119-129
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• 2012

Purpose: The purpose of this study was to test hand hygiene behavior model of hospital nurses, based on theory of planned behavior. Methods: Data were collected from 253 nurses from four university hospitals for the period of December 2010 to January 2011. Data were analyzed using of SAS (ver.9.1). Fitness of the study model was identified with SAS PROC CALIS. Results: The overall fitness was $x^2$=57.81 (df=13, $p$ <.001), GFI=.99, AGFI=.99, CFI=.95, NFI=.93. The variance of actual implementation of hand hygiene by predictor variables was 11.0% and the variance of intention to hand hygiene was 53.5%. Variable that had a direct effect on hand hygiene behavior was intention. Perceived behavior control and attitude affected hand hygiene behavior indirectly. Control belief had a direct effect on perceived behavior control and had an indirect effect on intention and behavior. Behavioral belief had a direct effect on attitude and an indirect effect on intention and behavior. Conclusion: The study provides basic information for understanding nurses' hand hygiene behavior. Further testing of the model will indicate which variables can contribute to improved hand hygiene.

• 동서간호학연구지
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• 제28권2호
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• pp.132-141
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• 2022

Purpose: This study aimed to investigate intensive care unit (ICU) nurses' actual and perceived glove uses for preventing healthcare associated infection. Methods: We observed nurses' donning glove by occasions and adherence to guideline for glove uses in four ICU in a single hospital. Total of 378 cases were observed from August 16 through October 6, 2020. Sixty one nurses of 66 nurses observed responded to a self-reported questionnaire about perceived glove use and knowledge of glove use. Data analysis was performed using descriptive statistics. Results: The number of observed episodes for glove use was 277. Although the highest numbers of occasions of wearing gloves was contact precaution, the compliance rate was 72.1%. The rates of donning gloves were low in the insertion and removal of peripheral venous catheters, blood glucose testing and blood sampling, which were at risk for exposure to blood. We observed misuse of wearing gloves even when they were not required. Results showed that the majority of non-compliance with glove use were a failure of performing hand hygiene before and after glove use and a failure of changing gloves between procedures on the same patient. The participant's knowledge of glove use was high. Conclusion: Based on the results, it is necessary to provide ICU nurses with education and reinforcement of proper glove uses for infection control.

• 중환자간호학회지
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• 제15권3호
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• pp.75-87
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• 2022

Purpose : This retrospective investigation study aimed to determine the predictive validity of superficial surgical site infection assessment tools by measuring the risk score at the surgical site. Methods : This study included patients hospitalized to the general surgery department of a Hospital from January 2021 to December 31, 2021. The inclusion criteria were age ≥19 years, general abdominal surgery under general anesthesia, and hospital stay longer than 2 days. Patients who had undergone transplantation were excluded. Results : Tool validity results showed that tools including surgical time and operative procedure were more accurate than previously developed tools, with a sensitivity of 71.1%, specificity of 71.4%, positive prediction of 12.3%, negative prediction of 97.8%, and area under the curve of 0.743 (95% confidence interval, 0.678~0.745). The tool's cut-off score was 15, and the risks of infection was increased by 6.14 times at or above this cut-off point. Preoperative hair removal period, surgical wound classification, surgery time, body temperature on the second day after surgery, drainage tube type, and suture type affected the risk of infection at the surgical site. Conclusion : The incidence of healthcare-associated infections has been declining in the past decade; however, surgical site infections still account for a considerable proportion. Therefore, early identification of high-risk groups for surgical site infection is crucial for reducing the incidence of surgical site infection using appropriate management.

• 대한임상검사과학회지
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• 제48권2호
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• pp.130-136
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• 2016

제주지역 종합병원 감염관리 현황을 조사하여, 병원감염관리 실태와 문제점을 파악하고자 하였으며 감염관리의 중요성을 인식시키고 감염관리 실무자로서 임상병리사의 역할 방안을 모색하기 위하여 제주특별자치도 제주시와 서귀포시에 위치한 종합병원 7개 기관을 대상으로 감염관리 현황을 설문지를 통하여 조사하였다. 제주지역 의료기관의 감염관리는 모든 기관이 감염관리실을 운영하고 전담인력을 구성하고 병원감염관리지침을 보유하고 수행하는 우수한 점을 보였지만, 대부분의 기관이 간호사 1인 구성의 감염관리실을 운영하여 전담인력 확보 및 미생물 관련 배양 판독, 다제내성균의 출현빈도, 감염통계 등 미생물 검사에 대한 내용을 보고 받는데 많은 부분 어려움을 호소하였다. 이에 감염관리의 실질적인 업무를 담당할 수 있는 임상병리사가 의료법 시행규칙에 있는 감염관리에 경험과 지식이 있는 사람으로 충분한 자질과 경험이 있다고 생각되며 감염관리실을 운영함에 있어 감염관리간호사와 미생물에 전문적인 지식을 갖춘 임상병리사(감염관리임상병리사)가 전담자로서 업무를 수행한다면 지금보다 더욱 발전된 감염관리실 운영이 될 것으로 보이며, 향후 감염관리를 제대로 하기 위해서는 전국적으로 종합병원을 비롯한 취약한 중소병원의 감염관리에 대한 전폭적 지원과 감염관리 전문 의료시스템 도입이 중요한 과제라 사료된다.

• Pediatric Infection and Vaccine
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• 제22권3호
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• pp.131-135
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• 2015

Since April 2012, more than 1,600 laboratory-confirmed human infections with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported, occurring primarily in countries in the Arabian Peninsula; the majority in Saudi Arabia. The MERS outbreak in Korea, which began in May 2015 through the importation of a single case who had recently traveled to Bahrain, the United Arab Emirates, Saudi Arabia, and Qatar. As of November 28th, 186 secondary and tertiary cases had been reported; 38 deaths, mainly associated with underlying chronic illnesses, were reported. One case was exported to China and has been recorded as the first MERS case in China. Thirty-seven confirmed cases were associated with the index case, who was hospitalized from May 15 to May 17. Emergency room at one of the nation's largest hospitals had been affected by hospital-to-hospital and intra-hospital transmissions of MERS-CoV, resulting in an outbreak of 90 infected patients. The vast majority of 186 confirmed cases are linked to a single transmission chain associated with health facilities. The median age of patients is 55 years, with a range of 16 to 87 years. The majority (61%) of patients are men. Twenty-five (14%) of the cases involve healthcare workers. The overall median incubation period was six days, but it was four days for secondary cases and six days for tertiary cases. There has been no evidence of airborne transmission and sustained human-to-human transmission in communities. Intensified public health measures, including contact tracing, quarantine and isolation of all contacts and suspected cases, and infection prevention and control have brought the MERS-CoV under control in Korea. Since 4 July no new cases have been reported.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권1호
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• pp.61-69
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• 2022

Purpose: Studies in adults have shown an increasing incidence of Clostridioides difficile infection (CDI) in patients hospitalized with acute pancreatitis (AP). There is lack of epidemiological data on CDI and its impact on hospitalized pediatric patients with AP. Methods: We analyzed the National Inpatient Sample and Kids' Inpatient Database between the years 2003 and 2016 and included all patients (age <21 years) with a primary diagnosis of AP using specific International Classification of Diseases codes. We compared clinical outcomes between children with CDI and those without CDI. Our primary outcome was severe AP and secondary outcomes included length of stay and hospital charges. Results: A total of 123,240 hospitalizations related to AP were analyzed and CDI was noted in 0.6% of the hospital. The prevalence rate of CDI doubled from 0.4% (2003) to 0.8% (2016), p=0.03. AP patients with CDI had increased comorbidities, and also underwent more invasive surgical procedures, p<0.05. AP patients with CDI had a higher in-hospital mortality rate and increased prevalence of severe AP, p<0.001. Multivariate regression models showed that CDI was associated with 2.4 times (confidence interval [CI]: 1.91 to 3.01, p<0.001) increased odds of severe AP. CDI patients had 7.24 (CI: 6.81 to 7.67, p<0.001) additional hospital days while incurring $59,032 (CI: 54,050 to 64,014, p<0.001) additional hospitalization charges. Conclusion: CDI in pediatric patients with AP is associated with adverse clinical outcomes and increased healthcare resource utilization. Further studies are needed to elucidate this association to prevent the development of CDI and to improve outcomes.