우리나라 병원감염관리의 실태

이성은 서울대학교 간호대학 간호과학 연구소 1993 간호학 논문집 Vol.7 No.1

In Korea, the nosocomial infection control program is not well developed. The one of the main reasons of this situation is the medical cost paying system. Under FFS(Fee for service)system, there is no incentives for doctors and hospitals to do active nosocomial infection control. On the contrary, the doctors and hospitals get more profit with nosocomial infections. And the medical ethics is too weak incentives to change the medical personnel attitudes in nosocomial infection control. Funthermore there are many misunderstandings in the nosocomial infection control practices in Korea. For examples, some ineffective nosocomial infection control methods like fogging and air culture are still adapted in many hospitals. To decrease nosocomial infection occurrence and for effective uses of medical cost, active nosocomial infection programs is needed. This study was planned to investigate the nosocomial infection program in Korea. Mailing questionnaires were sended to all general hospitals(212 hospitals) in Korea. The result was as follows; 1) 106 general hospitals (75.7%) had infection control committees and only 83 general hospitals(54.4%) had infection control committee meetings since January of 1991. 2) Only one hospital had infection control nurse. In 53 general hospitals(37.9%), infection control personnels were assigned to dual positions. 3) There were some disagreements in infection control guidlines and infection control practices. For example, in 48 general hospitals(36.9%) had 'Hand washing policy' but only 4 general hospitals used 'paper towel' for hand washing. With those results, an effective nosocomial infection control program was suggested; 1) All general hospitals should have infection control committees and the infection control committee meeting have to be opened at least 4times per year. 2) Hospitals over 300 beds should have at least one infection control nurse. 3) To activate the nosocomial infection program, the changes of the national public health policy in needed, for example, medical cost paying system.

119구급대원의 김염관리에 대한 인지도와 수행도 관계 연구

윤형완,정지연 사단법인 한국응급구조학회 2008 한국응급구조학회지 Vol.12 No.3

In order to protect Rescue 119 workers exposed on the spot from potential infection, this study identified their awareness and practices of infection control so that it could help preventing them from infection and also provide basic materials necessary for pre-hospital infection control. This study applied questionnaire survey to total 215 Rescue 119 workers at fire stations in Jeonbuk province, Jeonnam province and Gwangju city from July 14 to Sept. 14, 2006 for the benefit of data collection. The questionnaire about possible associations between awareness and practices of infection control consisted of total 46 times across 6 categories such as washing hands during emergency activities ; fluid therapy and injection ; respirator maintenance; individual hygienics ; disinfectant supplies and equipments maintenance ; and control of infectious wastes. And collected data were processed using SPSS statistic program to analyze frequency and percentage, mean and standard deviation, Pearson's correlation coefficient, t-test and one-way ANOVA. As a result, this study came to the following conclusions : In terms of awareness about infection control, our respondents showed highest awareness about infectious waste control, and also showed highest level of practices in washing hands during emergency activities. Throughout all domains, awareness means were higher than practice means. In particular, infectious waste control was the domain of significant differences between awareness and practices. In terms of associations between awareness and individual characteristics, it was found that female rescue worker group and hospital/general hospital career group (before joining the Rescue 119) showed significantly higher awareness on statistic level. In regard to associations between individual characteristics and practices, it was found that female rescue worker group showed higher level of practices than male group on statistic level. This study also analyzed correlations between rescue workers' awareness and practice of infection control. As a result, it was found that the higher awareness was in correlations with the higher practices across all 6 domains including washing hands. In addition, the higher awareness of a questionnaire item was in significantly positive correlations with the higher practice of other items. However, our respondents showed high awareness about anti-infection, but low practices in reality. This indicates necessity of devising possible solutions to improve the practices as much as awareness. Especially, it was noted that major reasons for insufficient practices of infection control guideline come from unhabituated practices and lack of supports for infection-preventing supplies and protective device (mask, etc). Hence, it is necessary to provide more infection-preventing supplies for local rescue workers sufficiently, in parallel with steady habituation of infection control. Furthermore, it is required to manage and study infection control policies even at pre-hospital step in efforts for effective infection control,

Factors associated with performance of infection control among some physical therapists

( Yoon-yee Seol ),( Mi Ah Han ),( Jong Park ),( So Yeon Ryu ) 대한물리치료학회 2016 대한물리치료학회지 Vol.28 No.2

Purpose: Infection management is important for physical therapists in order to protect patients and themselves since they often provide patient care and have physical contact with patients. This study examined the performance of infection control and associated factors among physical therapists. Methods: The study subjects were 174 physical therapists working in the G metropolitan city. The performance of infection control according to general characteristics, job-related characteristics, and infection-related characteristics were compared using t-test and ANOVA. Associations between awareness and performance of infection control were tested by correlation. Finally, multiple linear regression analyses were performed to examine the factors associated with performance of infection control. Results: Overall performance scores for personal and therapy room were 87.47±11.70 and 70.08±13.68, respectively. Both personal and therapy room infection control were lower for the degree of performance than the degree of awareness. In multiple linear regression analysis, the degree of performance at a personal level was related to current smoking status, type of charge therapy, supply of protection equipment, and awareness of personal infection control. The degree of performance of therapy room was related to injury experience in the workplace, supply of protection equipment, and awareness of therapy room infection control. Conclusion: Performance of therapy room infection control was lower than that of personal infection control. The performance was associated with the supply of protection equipment and awareness. Therefore, the degree of performance for infection control will be increased with proper supply of protection equipment in the hospital and increase the degree of awareness with adequate prevention edu-cation.

폐렴으로 입원한 소아에서 Mycoplasma pneumoniae와 Adenovirus에 의한 혼합 감염에 대한 연구

박혜경,서주영,김경희 이화여자대학교 생명과학연구소 1993 생명과학연구논문집 Vol.4 No.-

There are many reports that mixed infection of respiratory tract caused by virus and bacteria are of current interest. However, there is almost no report about the study of mixed viral and bacterial respiratory infection in Korean children. The purpose of this study was to evaluate the Mycoplasma pneumoniae and adenovirus type 3 mixed infection in hospitalized children with pneumonia, with lower respiratory tract syndrome and others. Mycoplasma pneumoniae and adenovirus infection were serologically assyed by enzyme-linked immunosorbent assay. The results showed that 31.6%(18/57) of the hospitalized children simultaneously had antibodies against Mycoplasma pneumoniae and adenovirus type 3. In particular, the mixed infection rate was high in hospitalized children who were clinically suspicious of Mycoplasma pneumoniae infection. The mixed infection pattern was the combination of primary, past and reinfection of Mycolplasma pneumoniae and adenovirus type 3. Howereve, the leading type was the combination of primary Mycoplasma pneumoniae infection and past adenovirus type 3 infection, inferring that previous adenovirus infection predisposed to Mycoplasma pneumoniae infection. It was also detected a case of simultaneous primary Mycoplasma pneumoniae infection and adenovirus type 3 reinfection. Therefore, it should be taken clinical interest about mixed viral and bacterial respiratory infection.

Factors associated with performance of infection control among some physical therapists

설윤이,한미아,박종,류소연 대한물리치료학회 2016 대한물리치료학회지 Vol.28 No.2

Purpose: Infection management is important for physical therapists in order to protect patients and themselves since they often provide patient care and have physical contact with patients. This study examined the performance of infection control and associated factors among physical therapists. Methods: The study subjects were 174 physical therapists working in the G metropolitan city. The performance of infection control according to general characteristics, job-related characteristics, and infection-related characteristics were compared using t-test and ANOVA. Associations between awareness and performance of infection control were tested by correlation. Finally, multiple linear regression analyses were performed to examine the factors associated with performance of infection control. Results: Overall performance scores for personal and therapy room were 87.47±11.70 and 70.08±13.68, respectively. Both personal and therapy room infection control were lower for the degree of performance than the degree of awareness. In multiple linear regression analysis, the degree of performance at a personal level was related to current smoking status, type of charge therapy, supply of protection equipment, and awareness of personal infection control. The degree of performance of therapy room was related to injury experience in the workplace, supply of protection equipment, and awareness of therapy room infection control. Conclusion: Performance of therapy room infection control was lower than that of personal infection control. The performance was associated with the supply of protection equipment and awareness. Therefore, the degree of performance for infection control will be increased with proper supply of protection equipment in the hospital and increase the degree of awareness with adequate prevention education.

Comparative Study of Cirrhosis Stage in Patients with HBV Infection and HBV/HDV Co-Infection in Mongolia

( O. Baatarkhuu ),( Ts. Munkhchuluun ),( B. Batsukh ),( D. Enkh-tuya ),( J. Amarsanaa ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: There are about 350 million people with HBV infection in the world.. 5% or about 15-20 million people of them are co-infected HDV. Every year an average of 7500 people are detected HDV new infection and 1,000 people die due to HDV infection in the United States. The Middle East, Pakistan, Central and Northern Asia, some areas of Africa, have high prevalence of HDV infection. North America, Northern Europe, Southern Africa and East Asia have low prevalence of HDV infection. There is 70-90%higher risk of liver cirrhosis in patients with HBV/HDV co-infection than patients with HBV infection. Comparative study of cirrhosis stage in patients with HBV infection and HBV/HDV co-infection Methods: Our study continued from January 2015 to March 2017 and we measured liver fibrosis stage in patients with HBV infection and HBV/HDV co-infection using a Fibroscan (Fibroscan 502 Touch, Echosens, Paris, France) who are controlled in Happy Veritas Clinic and Diagnostic Center. When we measured liver fibrosis stage in 5504 patients with HBV infection, 20% or 1115 of the patients is determined HDV co-infection . In our study in random sampling cases are selected 354 patients with HBV monoinfection and 177 of all patients have HBV/HDV co-infection. We selected parameters from patients medical histories in our study, such as serologic markers of HBV quantification of HBV and HDV in serum samples, blood test, liver function tests, and liver fibrosis stage. Summary statistics were perfomed using sPSS 22.0 siftware. Results: 354 patients 47.7 %(169) was men. Range with an average age of 44±17 (range 18-75 years old) were included the study. According to the comparative study in laboratory tests, ALT level was HBV - 44 (36; 51.5) and HBV/HDV co-infection 61 (39.8; 97.5), AST level was HBV - 39.1(30; 83) and HBV/ HDV co-infection - 50 (33.1; 77.8), Platelet count was HBV- 193±66 and HBV/HDV - 181±62.8. When we compared liver fibrosis stage were HBV- F0 67(37.9%), HBV/HDV-F0 57(32.2%), HBV-F1 22(12.4%), HBV/HDV-F1 17(9.6%), HBV-F2 39(22%), HBV/HDV- F2 39(22%), HBV-F3 29(16.4%), HBV/HDV-F3 41(23.2%), HBV- F4 20(11.3%) and HBV/HDV -F4 23(13%). In table 1 shows the difference of liver fibrosis by age group. Conclusions: 65.5% of all patients with HBV/HDV co-infection are from 30 to 50 years old. Liver fibrosis of patients with HBV/ HDV co-infection is a higher 11.88kPa than patients with HBV mono-infection. Our study shows that, the hepatitis is more severe in patients with HBV/HDV co-infection and the platelet count is less than HBV infection only.

중환자실에서의 병원감염에 대한 전향적 조사연구

정희진,김우주,김민자,박승철,조경환 대한감염학회 1995 감염 Vol.27 No.2

저자들은 1993년 1월부터 4월까지 고대 구로병원 중환자실에 입원한 146명의 환자를 대상으로 하여 병원감염의 발생률 및 사망률, 위험요인을 전향적 방법으로 조사하여 다음과 같은 결과를 얻었다. 1)중환자실에서의 병원감염 발생률은 총 146명의 환자중 58예로서 39.7였다. 각 부위별 병원감염은 폐렴 23예(39.7%), 기관지염 12예(20.7%), 요로 감염 8예(13.8%), 패혈증 6예(10.3%)의 순으로 나타났으며, 원인균은 MRSA 13예(27%), Klebsiella species 14예(24%)의 순으로 나타났다. 2)중환자실에서의 병원감염 발생에 영향을 미치는 위험요인으로는, 신경외과에 입원한 경우, 두부외상이 있는 환자인 경우, 쇽이나 혼수등의 심각한 상태로 내원한 경우, 항균제 사용의 기왕력이 있는 경우, 혈중 알부민의 감소, 백혈구수의 증가, 크레아티닌의 증가, 각종 침습적 조작을 사용한 경우이었다. 3)중환자실에서 병원감염에 이환된 환자들중 사망한 환자는 총 58예중 23예로서 40%에 달하는 높은 사망률을 나타내었다. 4)중환자실에서 병원감염에 이환된 환자들에서의 사망률 증가에 영향을 미치는 위험 요인으로는 내원 당시 쇼크나 혼수가 있었던 경우, 각종 침습적 조작을 사용한 경우, 중환자실 재원 기간이 길수록, 스테로이드를 사용한 경우, 진단 당시 백혈구증다증이 있었거나 혈중 크레아티닌이 증가한 경우등이었다. 5)다중회귀분석을 통하여볼때 기관내 삽관이나 기관절개등의 각종 침습적 조작의사용이나 혈중 알부민 농도의 감소 및 크레아티닌 농도의 증가등이 중환자실 병원감염에의 이환률이나 사망률증가와 깊은 연관성이 있음을 알수 있었다. 위의 관찰을 토대로 하여 볼 때, 중환자실 환자들은 39.7%의 높은 병원감염에의 이환률을 보이고, 일단 병원감염이 발생하면 40%가 사망하는 등의 심각한 결과를 초래한다. 따라서 병원감염의 현황 및 위험요인을 파악하여 적절한 경험적 항균제 치료 및 예방의 토대를 마련함으로써 병원감염의 발생을 줄일 수 있는 효과적인 대책을 수립하여야 할 것으로 사료된다. Background: Intensive care units(ICUs) probably represent the single largest identifiable source of nosocomial infection. Although nosocomial infection has become a maor health problem because of excessive morbidity, personal distress, and cost, no previous studies have clearly demonstrated the incidence of nosocomial infection and the case-attributable mortality in Korea. methods: In order to evaluate the incidence, the attributable mortality and risk factors of nosocomial infection in patients receiving intensive care, we have peformed a prospective study based on the identification of all patients who developed nosocomial infections in the ICU of Korea University Guro Hospital during a 4-month period(from January 1993 to April 1993). Result: 1)The incidence of nosocomial infections in ICU was 39.7(58 infections/146 admissions), and the percentage distribution by site was as follows: Pneumonia consitituted 39.7% of all nosocomial infecitons, tracheobronchitis 20.7%, urinary tract infection 13.8%, bacteremia 10.3%, phlebitis 6.9%, postoperative wound infection 5.2%, and others 3.4%. 2)Frequently isolated causative microorganisms of nosocomial infection were Methicllin-resistent Staphylococcus aureus(27%), Klebsiella species(24%), and Pseudomonas aeruginosa(17%). 3)The risk factors associated with nosocomial infection were long duration of ICU stay, admission to neurosurgery, thepresence of shock or coma on admission, previous use of antibiotics, use of invasive procedures, peripheral leukocytosis, low serum albumin level, and high serum creatinine level. 4)The mortality rate in patients with nosocomial infection was 40%(20 deaths/58 infections) compared with 11%(10 deaths/88 non-infected patients) in patients without nosocomial infection: attributable mortality was 22%. The risk factors that attributed to the increment in the mortality rate were the presence of shock or coma on admission, long duration of ICU stay, use of invasive procedures, and steroid, peripheral leukocytosis, and high serum creatinine level. Conclusion: Nosocomial infections are frequent problems in critical care patients and associated with considerable morbidity, mortality, and cost. In addition, use of invasive procedures, previous use of antibiotics, low serum albumin level, and high serum creatinine level are closely related risk factors of nosocomial infection in the ICU and nosocomial infection-related deaths.

병동 병원감염 환례수집 담당간호사에 의해 조사된 병원감염 감시기록의 정확도

조윤숙,김정순 대한감염학회 2000 감염 Vol.32 No.4

간호사의 주사제 사용 시 감염관리 수행도 및 관련요인

노명주,한미아,박종,류소연 한국병원약사회 2017 병원약사회지 Vol.34 No.4

Background : When nurses do not perform injections properly, it can cause fatal complications for patients depending upon the nature of the drug. The aim of this study was to investigate nurses’ performances related to infection control during injection protocols and related procedures. Methods : The study subjects were 391 nurses working in one of 3 general hospitals in“ D”and“ G” metropolitan cities. The data were collected using a self-report questionnaire data which was composed of general characteristics, work-related characteristics, health-related characteristics, infection- related characteristics, and performance of infection control during injections. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) software. Statistical analyses included descriptive analysis, t-tests, and analyses of variance (ANOVAs). A multiple linear regression was used to investigate the factors associated with the performance of infection control during injections after controlling for several covariates. Results : The overall performance score of infection control during injections was 4.56±0.38. The performance score of hand hygiene and infection control during administration were 4.45±0.47 and 4.62±0.38, respectively. The performance of infection control during injection was related to age, working unit, perceived importance of infection control for injection use, and experience of infection control education in a multiple linear regression analysis. Conclusion : The performance of infection control for injection was significantly associated with the nurses’experiences with infection control education. Therefore, in order to improve the performance of infection control during injections, it is necessary to develop a training program and continuously evaluate and monitor the training according to the changes in the infection control instruction.

신생아 중환자실의 원내 감염 추이

권혜정,김소연,조창이,최영륜,신종희,서순팔,Kwon, Hye Jung,Kim, So Youn,Cho, Chang Yee,Choi, Young Youn,Shin, Jong Hee,Suh, Soon Pal 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.6

목 적: 신생아 집중 치료술의 발달로 고위험 신생아의 생존율이 많이 개선되었지만 적극적인 침습적 시술의 증가로 신생아 사망과 이환의 주요한 원인이 되는 신생아 감염의 발생은 오히려 높아졌다. 본 연구는 신생아 중환자실에서 원내 감염의 분포 양상, 원인균, 발생 빈도 및 변화 양상 등 5년간의 추이를 알아보기 위해 실시하였다. 방 법: 1995년 1월부터 1999년 12월까지 전남대학교병원 신생아 중환자실에 입원하여 혈액, 피부, 기관내 튜우브, 카테테르, 눈, 소변, 대변, 뇌 척수액에서 시행한 균 배양 검사 상 양성으로 나온 환아들 중 선천성 감염을 제외하고 임상 증상으로 원내 감염이 의심되었던 환아들에서 원내 감염의 분포 양상과 원인균 및 혈중 감염의 빈도, 원인균, 사망률 추이에 대하여 조사하였다. 결 과 : 5년 동안 신생아 중환자실에 입원한 환아의 원내 감염률은 입원 환아 100명당 9.0례이었고, 감염소로는 혈중 감염이 32.3%로 가장 많았으며, 피부(18.4%), 기관내 튜우브(17.2%), 카테테르(10.6%), 눈(10.0%), 소변(6.1%), 대변(3.0%), 뇌 척수액(2.4%) 순이었다. 원인균은 S. aureus가 29.9%로 가장 많았고 coagulase-negative staphylococci(CONS), Enterobacter,Candida 순이었다. 감염소별 원인균은 혈중과 카테테르는 S. aureus와 CONS, 피부와 눈은 S. aureus, 기관내 튜우브는 Enterobacter, 소변은 Candida와 enterococci, 그리고 대변은 Pseudomonas와 S. aureus가 흔하였고, 다병소 감염율은 26.1%이었다. 원내 감염률은 입원 환아 100명당 1995년 9.5례에서 1999년 11.6례로 증가하였으며, 원인균으로 S. aureus 는 감소하고 CONS, Candida, Klebsiella, Acinetobacter baumannii는 증가하는 추이를 보였다. 동기간 동안 혈중 감염률은 입원 환아 100명당 3.6례였으며, CONS와 S. aureus가 가장 많았다. 혈중 감염률은 입원 환아 100명당 1995년 2.1례에서 1999년 5.2례로 증가하였는데 원인균으로 S. aureus는 감소하고 CONS, Candida, Klebsiella, Acinetobacter baumannii는 증가하는 추이를 보였고, 패혈증에 의한 사망률은 11.9%이었다. 결 론 : 신생아 원내 감염의 가장 흔한 감염소는 혈중 감염이고 원인균으로는 S. aureus가 가장 흔하며, CONS, Candida, Klebsiella, Acinetobacter baumannii에 의한 감염은 증가하는 추이이므로, 이에 대한 예방 및 치료를 위한 노력이 필요할 것으로 사료된다. Purpose : Neonates in neonatal intensive care units(NICU) have a high risk of acquiring nosocomial infection because of their impaired host defence mechanism and invasive procedures. Nosocomial infection result in considerable morbidity and mortality among neonates. This study was carried out to survey both the epidemiology of nosocomial infection in our NICU and the annual trends of pathogens. Methods : We retrospectively reviewed culture proven nosocomial infection which occurred in our NICU from January 1995 to December 1999. The data included clinical characteristics, site of infection, pathogens, and mortality. Results : Nosocomial infection rates was 9.0 per 100 NICU admissions during the five-year period. Major sites of infection were bloodstream(32.3%), skin(18.4%), endotracheal tube(17.2%), and catheter(10.6%). The most common pathogen was S. aureus(29.9%). and the others were coagulase- negative staphylococci(CONS)(14.8%), Enterobacter(12.4%), and Candida(9.0%). During the five-year period, nosocomial infection rates increased from 9.5 to 11.6 per 100 admissions with the increase of CONS, Candida, Klebsiella, and Acinetobacter baumannii. The infection rate of S. aureus decreased. Multiple episodes of nosocomial infection occurred in 26.1% of all nosocomial infections. Overall bloodstream infection rates were 3.6 per 100 NICU admissions during five years. CONS(29.1%) and S. aureus(27.1%) were the two most common pathogens. Increasing rates of bloodstream infection by CONS, Candida, Klebsiella, and Acinetobacter baumannii were observed. Bloodstream infection related mortality was 11.9%. Conclusion : The predominant pathogens of nosocomial infection in NICU were S. aureus and CONS. Bloodstream infection, the most frequent nosocomial infection, should be a major focus of surveillance and prevention efforts in NICU.