• Title/Summary/Keyword: Healthcare-associated Infection

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Priority Areas for National Health Care Quality Evaluation in Korea (의료의 질 평가 우선순위 설정)

  • Shin, Suk-Youn;Park, Choon-Seon;Kim, Sun-Min;Kim, Nam-Soon;Lee, Sang-Il
    • Health Policy and Management
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    • v.19 no.3
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    • pp.1-26
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    • 2009
  • Objectives : To identify target areas and set priorities among those areas identified for national quality evaluation. Methods : Target areas were identified from: i) analysis of the national health insurance claims data, mortality and prevalence data ii) various group surveys, including representatives from 22 medical specialty associations, 19 physician associations, QI staffs in hospital, civil organizations, and commissioners of Health Insurance Review and Assessment Service(HIRA) ⅲ) literature reviews and RAM(RAND/UCLA appropriateness method). The priority areas for national quality evaluation represented the full spectrum of health care and the entire life span. The criteria for selecting the priority areas were impact, improvability, and measurability. The priority areas were divided into three categories : short-term, mid-term, long-term. Results: Based on the group surveys and the data analysis, 46 candidates were selected as quality evaluation priority areas. 13 areas were selected as having a short-term priority areas: tuberculosis, community acquired pneumonia, stroke, ischaemic heart disease, diabetes, hypertension, chronic lower respiratory disease(asthma, chronic obstructive pulmonary disease), intensive care unit, emergency room, nosocomial infection, use of antibiotics, multiple medication and renal failure. This results suggested that we need to enlarge the target priority areas to the chronic diseases in short-term. Conclusions: The priority areas identified from the study will assist healthcare quality associated institutions as well as HIRA in selecting quality evaluation areas. It is required to develope and implement strategies for improving the quality of care within the next 5 years.

Patient safety practices in Korean hospitals (우리나라 병원의 환자안전 향상을 위한 활동 현황)

  • Hwang, Soo-Hee;Kim, Myung-Hwa;Park, Choon-Seon
    • Quality Improvement in Health Care
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    • v.22 no.2
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    • pp.43-73
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    • 2016
  • Purpose: The aims of this study were to assess the presence of core patient safety practices in Korean hospitals and assess the differences in reporting and learning systems of patient safety, infrastructure, and safe practices by hospital characteristics. Methods: The authors developed a questionnaire including 39 items of patient safety staffing, health information system, reporting system, and event-specific prevention practices. The survey was conducted online or e-mail with 407 tertiary, general and specialty hospitals. Results: About 90% of hospitals answered the self-reporting system of patient safety related events is established. More than 90% of hospitals applied incidence monitoring or root cause analysis on healthcare-associated infection, in-facility pressure ulcers and falls, but only 60% did on surgery/procedure related events. More than 50% of the hospitals did not adopted present on admission (POA) indicators. One hundred (80.0%) hospitals had a department of patient safety and/or quality and only 52.8% of hospitals had a patient safety officer (PSO). While 82.4% of hospitals used electronic medical records (EMRs), only 53% of these hospitals adopted clinical decision support function. Infrastructure for patient safety except EMRs was well established in training, high-level and large hospitals. Most hospitals implemented prevention practices of adverse drug events, in-facility pressure ulcers and falls (94.4-100.0%). But prevention practices of surgery/procedure related events had relatively low adoption rate (59.2-92.8%). Majority of prevention practices for patient safety events were also implemented with a relatively modest increase in resources allocated. Conclusion: The hospital-based reporting and learning system, EMRs, and core evidence-based prevention practices were implemented well in high-level and large hospitals. But POA indicator and PSO were not adopted in more than half of surveyed hospitals and implementation of prevention practices for specific event had low. To support and monitor progress in hospital's patient safety effort, national-level safety practices set is needed.

Clinical Outcomes of Diffuse Axonal Injury According to Radiological Grade

  • Lee, Hak-Jae;Sun, Hyun-Woo;Lee, Jae-Seok;Choi, Nak-Joon;Jung, Yoon-Joong;Hong, Suk-Kyung
    • Journal of Trauma and Injury
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    • v.31 no.2
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    • pp.51-57
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    • 2018
  • Purpose: Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients. Methods: From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient's MRI findings. Results: For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness. Conclusions: This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

Effects of Empowerment and Regarding Standard Precautions for Healthcare associated Infection Control in Nursing Students Experiencing Clinical Practice on Performances (임상실습을 경험한 간호대학생의 임파워먼트와 의료관련감염 관리 표준주의지침 인지도가 수행도에 미치는 요인)

  • Jung, Mi-Ra;Jeong, Eun
    • Journal of Digital Convergence
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    • v.17 no.1
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    • pp.259-267
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    • 2019
  • The purpose of this study was to examine relationships among empowerment, awareness and performance on standard precautions and identify the factors that affect performance of standard precaution in nursing students experiencing clinical practice. The data were collected from 168 nursing students who experienced clinical practice in the two colleges located Jeonnam. The data were analyzed by descriptive statistics, t-test, ANOVA, Scheffe, Pearson's correlation coefficient, and stepwise multiple regression with SPSS 20.0 program. The result of the stepwise multiple regression indicates the awareness predict 77.7% (F=579.84, p<.001) in the performance of standard precaution. Therefore, it is necessary to develop awareness of the standard precaution strategy program for improving the performance of standard precautions in nursing students experiencing clinical practice.

Development of Real-time PCR Assay Based on Hydrolysis Probe for Detection of Epichloë spp. and Toxic Alkaloid Synthesis Genes

  • Lee, Ki-Won;Woo, Jae Hoon;Song, Yowook;Rahman, Md Atikur;Lee, Sang-Hoon
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.42 no.3
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    • pp.201-207
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    • 2022
  • Fescues, which are widely cultivated as grasses and forages around the world, are often naturally infected with the endophyte, Epichloë. This fungus, transmitted through seeds, imparts resistance to drying and herbivorous insects in its host without causing any external damage, thereby contributing to the adaptation of the host to the environment and maintaining a symbiosis. However, some endophytes, such as E. coenophialum synthesize ergovaline or lolitrem B, which accumulate in the plant and impart anti-mammalian properties. For example, when livestock consume excessive amounts of grass containing toxic endophytes, problems associated with neuromuscular abnormalities, such as convulsions, paralysis, high fever, decreased milk production, reproductive disorders, and even death, can occur. Therefore, pre-inoculation with non-toxic endogenous fungi or management with endophyte-free grass is important in preventing damage to livestock and producing high-quality forage. To date, the diagnosis of endophytes has been mainly performed by observation under a microscope following staining, or by performing an immune blot assay using a monoclonal antibody. Recently, the polymerase chain reaction (PCR)-based molecular diagnostic method is gaining importance in the fields of agriculture, livestock, and healthcare given the method's advantages. These include faster results, with greater accuracy and sensitivity than those obtained using conventional diagnostic methods. For the diagnosis of endophytes, the nested PCR method is the only available option developed; however, it is limited by the fact that the level of toxic alkaloid synthesis cannot be estimated. Therefore, in this study, we aimed to develop a triplex real-time PCR diagnostic method that can determine the presence or absence of endophyte infection using DNA extracted from seeds within 1 h, while simultaneously detecting easD and LtmC genes, which are related to toxic alkaloid synthesis. This new method was then also applied to real field samples.

Evaluation of Bactericidal Capacity of Silver Ion against Bovine Mastitis Pathogens (소 유방염 원인균에 대한 은이온의 향균력 평가)

  • Seol, Jae-Won;Hur, Tai-Young;Jung, Young-Hun;Park, Sang-Youel;Kang, Seog-Jin
    • Journal of Veterinary Clinics
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    • v.27 no.3
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    • pp.252-256
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    • 2010
  • Bovine mastitis, defined as an inflammation of the mammary gland, is usually associated with bacterial infection. Thus, treatment and control of mastitis relies primarily on antimicrobial therapy. This study investigated the bactericidal actions of silver ion against causing various bovine mastitis pathogens. Minimal inhibitory concentrations (MICs), minimum bactericidal concentrations (MBCs) and bactericidal activity times and concentrations of silver ion against pathogens were determined. The effect of silver ion on bacterial morphology was studied by scanning electron microscopy (SEM). The MICs and MBCs of silver ion for various bacteria strains ranged from 1.9-15.6 ${\mu}g$/ml. SEM images indicated formation of a pit, distortion and disruption of cell walls in silver treated Staphylococcus aureus and Escherichia coli. The results demonstrate that silver ion has a bactericidal capacity against causing various pathogens of bovine mastitis and suggest that silver ions may be exploitable as a therapeutic/preventative tool of bovine mastitis.

Intestinal Parasitic Infections and Environmental Water Contamination in a Rural Village of Northern Lao PDR

  • Ribas, Alexis;Jollivet, Chloe;Morand, Serge;Thongmalayvong, Boupha;Somphavong, Silaphet;Siew, Chern-Chiang;Ting, Pei-Jun;Suputtamongkol, Saipin;Saensombath, Viengsaene;Sanguankiat, Surapol;Tan, Boon-Huan;Paboriboune, Phimpha;Akkhavong, Kongsap;Chaisiri, Kittipong
    • Parasites, Hosts and Diseases
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    • v.55 no.5
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    • pp.523-532
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    • 2017
  • A field survey studying intestinal parasites in humans and microbial pathogen contamination at environment was performed in a Laotian rural village to identify potential risks for disease outbreaks. A parasitological investigation was conducted in Ban Lak Sip village, Luang Prabang, Lao PDR involving fecal samples from 305 inhabitants as well as water samples taken from 3 sites of the local stream. Water analysis indicated the presence of several enteric pathogens, i.e., Aeromonas spp., Vibrio spp., E. coli H7, E. coli O157: H7, verocytotoxin-producing E. coli (VTEC), Shigella spp., and enteric adenovirus. The level of microbial pathogens contamination was associated with human activity, with greater levels of contamination found at the downstream site compared to the site at the village and upstream, respectively. Regarding intestinal parasites, the prevalence of helminth and protozoan infections were 68.9% and 27.2%, respectively. Eight helminth taxa were identified in fecal samples, i.e., 2 tapeworm species (Taenia sp. and Hymenolepis diminuta), 1 trematode (Opisthorchis sp.), and 5 nematodes (Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, trichostrongylids, and hookworms). Six species of intestinal protists were identified, i.e., Blastocystis hominis, Cyclospora spp., Endolimax nana, Entamoeba histolytica/E. dispar, Entamoeba coli, and Giardia lamblia. Questionnaires and interviews were also conducted to determine risk factors of infection. These analyses together with a prevailing infection level suggested that most of villagers were exposed to parasites in a similar degree due to limited socio-economic differences and sharing of similar practices. Limited access to effective public health facilities is also a significant contributing factor.

Incidence and Characteristics of Clostridioides difficile Infection in Children (소아 Clostridioides difficile 감염의 발생률 및 임상양상)

  • Jeong, Heera;Kang, Ji-Man;Ahn, Jong Gyun
    • Pediatric Infection and Vaccine
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    • v.27 no.3
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    • pp.158-170
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    • 2020
  • Purpose: We evaluated the incidence and characteristics of Clostridioides difficile infection (CDI) in Korean children. Methods: Medical records of patients aged 2-18 years and diagnosed with CDI at a tertiary hospital between 2009 and 2018 were analyzed. The patients were classified into three CDI groups: community-acquired (CA), community onset-health care facility-associated (CO-HCFA), and healthcare facility onset (HO). Results: The incidence of CDI increased from 1.00 to 10.01 cases per 10,000 admissions from 2009 to 2018 (P<0.001). As compared to the CA group, the HO group had a higher frequency of operation and malignancy as predisposing factors (40.4% vs. 0.0%, P=0.001; and 27.7% vs. 0.0%, P=0.027, respectively), frequency and number of previous antibiotic use (97.9% vs. 31.3%, P<0.001; and 2 vs. 0, P<0.001, respectively), and median postdiagnosis hospital stay (13 vs. 5 days, P=0.008). The CO-HCFA group had a lower median age and higher frequency of malignancy than the CA group (5 vs. 13 years, P=0.012; and 30.8% vs. 0.0%, P=0.030, respectively). As compared to the HO group, the CA group had a higher frequency of abdominal pain and hematochezia (56.3% vs. 10.6%, P=0.001; and 50.0% vs. 10.6%, P=0.002, respectively), inflammatory bowel disease (68.8% vs. 2.1%, P=0.001), and intravenous metronidazole treatment (37.5% vs. 2.1%, P=0.001). Conclusions: With the increasing incidence of pediatric CDI, awareness regarding its epidemiology and clinical characteristics is important to manage nosocomial infections.

Study on the Contamination of Methicillin-Resistant Staphylococcus (MRS) in a High School Environment (일개 고등학교 환경에서 메치실린 내성 포도알균의 오염도 조사)

  • Hong, Seung Bok;Baek, Yun Hee
    • Korean Journal of Clinical Laboratory Science
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    • v.49 no.4
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    • pp.420-426
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    • 2017
  • Methicillin-resistant Staphylococcus (MRS) can be colonized in various body sites and is more frequently isolated in healthcare associated persons. This study aimed to evaluate the contamination rate of MRS in a high school environment, those living with closed life style. Staphylococcus aureus was isolated from only the hands of 2 students among a sample of 28 students, and S. aureus were susceptible to methicillin antibiotics. Coagulase negative Staphylococci (CoNS) were isolated from the hands of 26 students (26/28, 92.9%), and among them, 14 (53.8%) isolates were methicillin-resistant CoNS (MRCoNS). Among the 14 MRCoNS, S. warneri was the most common (8/14, 57%) and susceptible to most $non-{\beta}-lactam$ antibiotics, such as clindamycin, erythromycin, ciprofloxacin, tetracycline, gentamicin, and vancomycin. In a culture of 31 desks, S. aureus was not isolated but CoNS were isolated from 26 desks (26/31, 83.6%), which did not harbor the mecA gene. The other bacteria isolated from the hands and desks were Micrococcus and Bacillus spp. In conclusion, methicillin-resistant S. aureus was not isolated from the hands and desks of high school students. However, the frequency of MRCoNS harboring mecA gene were high in the hands of high school students. Therefore, to prevent and to control the transfer of infection, intensifying preventive education, such as hand washing, and active surveillance systems, such as an investigation of contamination or carrier rate of resistant bacteria are necessary.