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이산화염소 투입 시스템 도입을 통한 레지오넬라 유행 종식과 환경 관리
고수령,김수영,신명진,이은실,김윤정,김홍빈,송경호,박정수,박석배,박건영,김의석 대한의료관련감염관리학회 2023 의료관련감염관리 Vol.28 No.1
Background: Close surveillance of Legionella in the plumbing systems of medical institutions is required because of the higher morbidity and mortality of nosocomial legionellosis. We experienced an outbreak of legionellosis in a university hospital, managed with a chlorine dioxide infusion system. Methods: Multiple contaminations with Legionella were reported in the annual water surveillance in June 2019. A task force was established to prevent the outbreak of legionellosis, and the entire plumbing system of the hospital was investigated. Initial measurement was done according to the action manual of the Korean Disease Control and Prevention Agency, including cleaning of hot water tanks, superheating and flushing, point-of-use management (change of showerheads and taps on washstands), and application of filters in higher-risk areas. Further shock hyperchlorination for the cooling tower and cleaning of the water tank were performed since persistent contamination was reported in these areas. Nevertheless, there was an outbreak of three presumable cases of in-hospital legionellosis. A continuous infusion of chlorine dioxide (ClO2) was planned to decontaminate the hospital’s plumbing. Equipment for ClO2 infusion was installed by May 2020, with terminal monitors of residual chlorine and a feedback system. A repeated environmental culture study was also planned. Furthermore, a preemptive surveillance system including active monitoring for patients tested with Legionella urinary antigen was developed, and a newer response manual for legionellosis was distributed. Results: Isolation of Legionella in hospital water was first noted in June 2019. Since then, Legionella has been identified in 6 out of 47 samples in five surveillances by the public health center. Furthermore, 6 out of 85 samples were reported to be positive for Legionella by inhospital water cultures. Two patients were diagnosed with nosocomial legionellosis within 3 months of the initial response. After the installation of the ClO2 continuous infusion system in May 2020, no isolation of Legionella was reported in the next two whole environmental surveillance. No further cases of bacterial inoculation or Legionella infections have been reported so far. Conclusion: The outbreak of nosocomial legionellosis was successfully terminated with the continuous infusion of ClO2 into the premise plumbing system of the hospital. Sporadic outbreaks of hospital-acquired legionellosis have continued; therefore, individualized reinforcement of the response system to prevent nosocomial legionellosis is required.
전자의무기록 팝업차트를 활용한 CRRT 관리의 질향상 활동
고수령,이안나,김기표,진호준,나기영,채동완,김세중,Go, Su-Ryeong,Lee, An-Na,Kim, Ki-Pyo,Chin, Ho-Jun,Na, Ki-Young,Chae, Dong-Wan,Kim, Se-Joong 한국의료질향상학회 2019 한국의료질향상학회지 Vol.25 No.1
Purpose: The time lag between the decision to initiate continuous renal replacement therapy (CRRT) and its actual initiation remains a major barrier in our intensive care units. We developed a CRRT pop-up chart on EMR for managing CRRT machines. Methods: This study measured time interval between the decision to prepare the CRRT machine and the actual use of the machine before and after using a CRRT pop-up chart. This study conducted a questionnaire of the medical staff to assess the changes in the quality of CRRT preparation. Results: A total of 95 patients on CRRT is analyzed. The time to find an available CRRT machine is decreased by 24.6%. The time to move a CRRT machine to the patient's bedside is decreased by 55.8%. Medical surveys of 44 nurses gave the following results. 1) The time to apprehend machines for 1 to 3 minutes is improved from 29.5% to 81.8%, and the time to apprehend machines over 3 minutes is decreased from 70.5% to 18.2%. 2) The number (6-all) of known machine locations is improved from 22.7% to 63.4%. 3) Interruption of a nurse's work due to telephone calls asking for the possession of movable CRRT equipment also is improved. Scores of 1-4 are improved from 15.9% to 41%. Scores of 5-7 are reduced from 52% to 15.9%. Conclusions: CRRT pop-up chart is shortened the time lag of CRRT machine preparation, reduced the nurse's phone workload and helped to improve the quality of CRRT care.