근거 기반 간호 실무지침 수용개작: 습기 관련 피부 손상의 예방과 관리

백규원(Baek, Kyu Won),박주희(Park, Joo Hee),김민경(Kim, Min Kyung),김경선(Kim, Kyung Sun),전경옥(Jeon, Kyoung Ok),박수현(Park, Su Hyun),양원지(Yang, Weon Ji),황지원(Hwang, Ji Won) 병원간호사회 2018 임상간호연구 Vol.24 No.3

Purpose: This study was done to develop an evidence-based nursing clinical practice guideline for Moisture associated skin damage (MASD) prevention and management for patients in Korea. Methods: The guideline adaptation process was used and conducted according to the guideline adaptation manual developed by the Korean Hospital Nurses Association. It consists of three main phases and 9 modules including a total of 24 steps. Results: The adapted MASD linical practice guideline consisted of 4 sections, 8 domains and 28 recommendations. The number of recommendations in each section was: 7 on MASD assessment, 14 on MASD prevention and management, 4 on education, and 3 on organizational policy. Of the recommendations, 3.6% were marked as A grade, 28.6% as B grade, and 67.8% as C grade. Conclusion: This MASD clinical practice guideline is the first to be developed in Korea. The developed guideline will contribute to standardized and consistent MASD prevention and management. The guideline can be recommended for dissemination and utilization by nurses nationwide to improve the quality of MASD prevention and management. Regular revision is recommended.

PC/Monitior 구성 화학부품 및 제품에서 방출되는 휘발성 유기화합물의 분석

최종우,백규원,이창섭,Choe, Jong-Woo,Baek, Kyn-Won,Ri, Chang-Seop 대한화학회 2000 대한화학회지 Vol.44 No.5

Volatile organic compounds(VOCs) emitted from PC/Monitor set and chemical parts com-prising of PC/Monitor set were analyzed aran, and xylene of VOCs based on qualitative analysis. As a result of these analyses, when the Wedge Rub-ber of rubber product was heated from 60$^{\circ}C$ to 80$^{\circ}C$, the emission rate(%) of xylene was increased about 2.5 times. But it was evaluated that the left of chemical parts were not affected by temperature except Wedge Rub-ber. The results of qualitative analyses between RGA and GC-MS were a little different respectively. With quantitative analysis, concentration of xylene emitted from cabinet was measured to be maximum as 6029.3 ug/ m$^3$(1.3ppm). The concentrations of toluene, xylene, and benzofuran derived from PC/Monitor set were 10.25${\mu}g/m^3$, 690${\mu}g/m^3$, and 180 ${\mu}g/m^3$, and these concentrations were relatively high levels which can bring on the risk to human health. PC/Monitor 제품 및 구성 화학부품들로부터 방출되는 휘발성 유기화합물(volatile organic compounds, VOCs)의 종류와 시간에 따른 방출경향을 분석하였다. 잔류가스 분석기(residual gas analyzer, RGA)와 GC-MS를 이용하여 monitor제품 및 화학부품들로부터 방출되 는 VOCs를 정성분석 하였으며, 정성분석된 VOCs중 toluene,cylclohexanone, benzofuran 및 xylene에 대하여 GC-MS로 정량분석을 수행하였다. 분석결과, 고무제품인 wedge rubber은 60 $^{\circ}C$에서 80$^{\circ}C$로 상승할 때 xylene의 발생율(%)이 2.5배 가량 증가하였지만, 나머지 화학부품들은 VOCs의 방출이 온도의 영향을 별로 받지 않는 것으로 평가되었다. RGA와 GC-MS의 화학부품들에 대한 정성분석 결과는 다소 다르게 나타났으나, 정량분석결과는 cabine의 xylene 농도가 6029.3${\mu}g/m^3$(1.3ppm)으로 최고치를 나타내었고, monitor 제품에서 방출된 toluene,xylene 및 benzofuran의 농도 또한 각각 10.25${\mu}g/m^3$, 690${\mu}g/m^3$, 180${\mu}g/m^3$으로 건강상의 장해를 일으킬 수 있는 수준인 비교적 높은 수치로 나타났다.

A Prospective, Randomized, Non-inferiority Trial to Compare the Efficacy of 3% Povidone-Iodine Foam Dressing and Silver Foam Dressing in the Treatment of Pressure Injuries

박경희,백규원,김민경,주명진,Jung Won Hee,Yoon Yong-Soon 대한창상학회 2023 Journal of Wound Management and Research Vol.19 No.1

Background: As chronic wounds such as pressure injuries (PIs) are frequently colonized and can easily deteriorate into infection, it is important to reduce their bacterial load, for which antimicrobial dressings can be needed. This study aims to evaluate the efficacy of a 3% povidone-iodine (PVP-I) foam dressing compared to that of a silver foam dressing.Methods: This prospective non-inferiority study was conducted between 2016 and 2019 at three sites in South Korea. A total of 80 PI subjects were randomized to be dressed with either PVP-I foam (experimental group) or silver foam (control group) for up to 8 weeks.Results: Based on the Pressure Ulcer Scale for Healing (PUSH) tool, 25.0% of the experimental groups and 17.5% of the control groups (χ²=0.743, P=0.389) healed by more than 70%. The degree of reduction in wound size was analyzed using Image J, and the experimental and control groups decreased by 41.6%±35.3% and 49.7%±38.2% (t=–0.986, P=0.327), respectively. A Kaplan-Meier survival analysis to confirm the time to heal showed that if more than 30% of the PUSH score was healed, the time to heal was 27.0±9.3 days and 18.0±2.8 days in the two groups (χ²=3.225, P=0.073), respectively. The healing rates at 50 days were 85.8%±8.9% and 93.9%±5.7% in the two groups (P=0.073), respectively. There were no statistically significant differences between the groups in all results.Conclusion: This study demonstrated the non-inferiority of the 3% PVP-I foam dressing compared to the silver foam dressing for PI treatment.

PC/Monitor 구성 전자부품에서 방출되는 휘발성 유기화합물의 분석

이창섭,최정우,백규원,Ri, Chang Seop,Choe, Jong Woo,Baek, Kyu Won 대한화학회 2000 대한화학회지 Vol.44 No.4

PC/Monitor의 구성 전자부품으로부터 방출되는 휘발성 유기화합물(Volatile Organic Com-pounds,VOCs)를 분석하였다. Mpnitor를 구성하는 전자부품으로부터 연속으로 방출되는 VOCs의 경향을 시료챔버에 직접 연결되어있는 잔류가스 분석기(Residual Gas Analyzer,RG A)로 분석하였으며, 이들 전자부품에서 방출되는 VOCs의 성분을 RGA와 GC-MS로 분석하였다. 정성분석된 VOCs 중 소량으로 방출되거라도 불쾌한냄새와 건강상의 장해를 초래할 수 있는 toluene. xylene, cyclohexanone 및 benzofuran에 대하여 GC-MS로 정량분석하였다. 이러한 분석결과, 전자부품중 PCB(CEM-1)을제외하고 나머지 부품들은 가열시작 후 30분에서 1시간동안 toluene, xylene, cyclohexanone 및 phenol이 다량으로 연속 방출되는 경향을 나타내었으며, 거의 모든 전자부품에서 toluene, xylene, phenol, cyclohexanone 및 benzofuran 등의 물질들이측정시간 범위내에서 가장 빈번하게 방출되었다. 부품들 중 Trans가 가장 높은 VOCs의 방출농도를 보였으며, 전자부품으로부터 정량분석된 VOCs중에는 xylene의 방출농도가 550~2482 ${\mu}g/m^2$로 가장 크게 나타났다. Volatile Organic Compounds(VOCs) emitted form electronicSince toluene, xylene, cyclohexanone, and benzofuran will bring on the deleterious smell and the health risk, eventhough very small amount of these areexposed to human body, quantitative analysis was achieved by GC-MS system. As a result of these analyses, except PCB(CEM-1) of which is one of the electronic parts, the left of electronic parts represented, imme-diately form 30 minutes to 1 hour after heating, the trends that toluene, xylene, cyclohexanone and phenol were consecuticely emitted very high. and toluene, xylene, phenol, cyclohexanone, and benzofuran from most of the electronic parts were emitted very frequently within the measuring period. Finally, Trans of electronic parts showed the highest concentration of emission, and xylene(550~2482 ${\mu}g/m^2$) was the most noticeably emitting compound of VOCs.

관상동맥 조영술을 받은 환자에서 출혈방지와 안위증진을 위한 중재 효과

정연이,이정희,허은희,곽인옥,백규원,장은미,박미순,오영주,전보윤,허진연,권윤의,최화영,백목련 병원간호사회 2001 임상간호연구 Vol.7 No.2

Objective : Delayed bleeding and back pain are major concerns in who receive coronary angiography. We investigated the six different post-procedure during recovery from coronary angiography. The six post-procedures were as following: elevation of the head of the bed(flat versus 15-30 degree), application of sandbag on the puncture site(use versus no use) and prolongation of immobilization time(4 versus 8 hours). The primary goal of this study was to promote less post-procedural discomfort and therefore improve clinical outcome of coronary angiography. Design : Experimental, pretest-posttest, random assignment Sample : From July 2000 to January 2001, 102 patients underwent coronary angiography through femoral artery cardiology at Samsung Medical Center. Intervention : 1. The elevation of the head of the bed : control group(n=22) with 0 degree elevation versus the experimental group(n=20) with 15~30 degrees 2. The use of sandbag on the puncture site : control group(n=20) with sandbag versus the study group (n=20) without sandbag. 3. The duration of immobilization after angiography control group with 4 hours immobilization(n=20) versus the experimental group(n=20) with 8 hrs. Intervention 2 & 3 were cross tested. For 24hours after cardiac angiography, the nurse reported the presence of complication on the assessment tool (bleeding, hematoma formation, back pain and uninary retention) Results 1. Hemodynamic and angiographic variables were evenly distributed and the basic characteristics of study groups were similar. 2. The degree of elevation of the head of the bed, there's no significant differences in bleeding complications, low back pain and urinary discomfort in both groups. 3. For the effects of sandbag, there were no significant differences in bleeding complication, low back pain and urinary discomfort in both experimental and control group, and not related with the length of the time for immobilization 4. There was no significant difference between four and eight hour immobilization groups with no sandbag application in bleeding complication. There was significant decrease in incidence of patient's subjective discomfort and low back pain after four hour immobilization. The incidence of bleeding complications was not increased in any study groups. Therefore, we recommend shorter length of immobilization time(4 hours in our study) at patient's convenience in order to decrease patient's discomfort. The application of sandbag and the head elevation of the bed may be optional since it did not decrease immediate complications of angiography.

Policy Proposals for Infection Control in Patients with Chronic Wounds

Kyung-Chul Moon,Shin Dong Hyeok,백규원,박창식,전영준 대한창상학회 2022 Journal of Wound Management and Research Vol.18 No.3

South Korea is seeing a steady increase in its aging population. One in five people in the Republic of Korea will be at least 65 years old by 2025, putting more pressure on healthcare and social spending. Various geriatric diseases such as cancer, arthritis, and stroke are major contributors to disabilities in aging populations. Compounded with an increase in diabetes mellitus, the number of patients with pressure ulcers and diabetic foot ulcers is growing. Therefore, considerations for treating chronic wounds such as pressure ulcers and diabetic wounds are emerging as an urgent public health need in South Korea. The treatment of chronic wounds increases medical expenses, placing a significant social, economic, and practical burden on individuals. When complications related to chronic wounds occur, the patient’s quality of life deteriorates, threatening public health. Therefore, strategies for managing chronic wounds are clinically important; South Korea should begin to recognize the importance of chronic wound care. Social attention and government support with the establishment of proper medical insurance policies, as well as efficient medical expense budget execution, are essential for the management of chronic wounds. Silver has been known to inhibit infections for many centuries and is widely used around the world. Previous studies reported the clinical and cost-effectiveness of silver-impregnated dressings. The majority of randomized controlled studies found the positive effects of silver-impregnated dressings on chronic wound healing. A number of studies found that silver-impregnated dressings reduced wound healing time, dressing change frequency, the need for pain medication during dressing changes, and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia resulting from MRSA-infected wounds, thereby shortening hospital stays. Despite evidence of the positive effects of silver-impregnated dressings on chronic wound healing, medical insurance policies and government support fall far short of expectations. This is because government officials, who often lack the required knowledge and understanding of chronic wound care, impose impossibly strict regulations on the use of silver-impregnated dressings. The regulations that enable use of silver-impregnated dressings only on major burns prohibitively limit the use of silver-impregnated dressings to a few indications and low-volume uses. Currently, silver-impregnated dressings cannot be used for chronic wounds such as pressure ulcers, diabetic wounds, venous ulcers, and cancerous wounds, even though patients are willing to bear the full costs without any government subsidies. As South Korea has one of the fastest rates of population aging in the world, a continued rise in the economic, clinical, and social impacts of chronic wounds warrants a more structured approach and proportionate investment in chronic wound care. Medical expense budget providers should be encouraged to think broadly about the potential for wider cost savings in terms of reducing wound healing time, hospital stays, and nursing time by using appropriate dressings. Therefore, there is an urgent need for better communication and mutual understanding among wound specialists, policy makers, and working-level public servants on insured dressings for chronic wound care. This white paper is a policy proposal composed by senior members of the Board of Directors of the Korean Wound Management Society for chronic wound care using silver-impregnated dressings and will hopefully contribute to a better understanding of silver-impregnated dressings for chronic wound care.

간호 ∙ 간병통합서비스 병동에서의 환자참여 침상인계 프로토콜 적용 효과

이보영,박경진,임재현,송아름,연미향,송현주,전도진,백규원,장주영,최수정 병원간호사회 2022 임상간호연구 Vol.28 No.3

Purpose: The purpose of this study was to apply patient-engaged bedside handoffs in comprehensive care units, and to evaluate the effects of bedsides to nurses and patients. Methods: This study employed a cluster randomized cross-over design.Electrical Medical Record (EMR)-based handoffs and patient-engaged bedside handoffs were alternatively applied to 104 patients, who were assigned to a total of 30 clusters (nursing handoff teams) in 4 comprehensive care units at the S medical center in Seoul, and the patients evaluated each type of handoffs. A total of 139 nurses were also participated in the same units and evaluated each type of handoffs. Data were analyzed using t-test, Wilcoxon rank sum test, ANOVA, and Kruskal-Walls test. Results: The patient's satisfaction of the patient-engaged bedside handoffs was higher than that of the EMR-based handoffs (Z=-5.16, p<.001). On the other hand, the nurse's satisfaction of the patient-engaged bedside handoffs was significantly lower than that of the EMR-based handoffs (t=13.21, p<.001). There were no differences in length of the reporting time between two types of handoffs (t=-0.48, p=.634). Conclusion: Patient satisfaction with the patient-engaged bedside handoffs was higher than that of EMR-based handoffs, and nurses' satisfaction with the patient-engaged bedside handoffs was significantly lower than that of EMR-based handoffs. Future studies are needed regarding the impacts of patient-engaged bedside handoffs on the quality of healthcare by identifying the benefits of the handoffs.