원내 코로나바이러스감염증-19 전파를 막기 위한 마스크 착용의 중요성

시혜진,이재백,강현주,최민경,엄중식 대한의료관련감염관리학회 2021 의료관련감염관리 Vol.26 No.2

Background: During the COVID-19 pandemic, hospitals not only deal with COVID-19 but also try to maintain their original functions. Nosocomial transmission of COVID-19 can disrupt such functions by infecting patients and healthcare workers. We attempted to determine a method to reduce nosocomial transmission of COVID-19 by analyzing exposure events and monitoring mask-wearing rates. Methods: From February 2020 to March 2021, we collected the results of the epidemiological investigation and surveillance data for COVID-19 exposure events at a tertiary teaching hospital in Korea with 1450 beds. We monitored the rates and appropriateness of wearing masks in all areas of the hospital from October 2020 to February 2021. Baseline epidemiologic data, means of exposure, rates of wearing masks, results of surveillance, and results of exposure events were analyzed. Results: There were 63 COVID-19 exposure events and 4,267 exposed individuals. Among them, 166 were isolated for 2 weeks. There was one secondary infection in which three healthcare workers were infected from a single index case. They worked in the same office room with the confirmed patient and showed multiple risk behaviors, including removing the mask during meals. There was no secondary infection among the exposed individuals who wore masks properly. Conclusion: To prevent nosocomial transmission and provide a safe environment for all individuals in the hospital, it is highly important to wear masks properly at all times.

우리나라 병원의 소독, 세척, 멸균 등에 필요한 비용 조사 연구

시혜진,김성란,유현미,손희정,김진화,최훈화,박관준,엄중식 사단법인 대한보건협회 2021 대한보건연구 Vol.47 No.4

연구목적: 본 연구에서는 소독, 세척, 멸균은 의료감염관리의 주요 요소이지만 실제로 한국에서 비용이 얼마나 소요되는지에 대한 연구가 부족한 실정이다. 이 연구에서는 국내 의료 현 상황에서 소독, 세척 및 멸균에 필요한 비용과 그 보상방법을 계산하는 것을 주 목적으로 하였다. 연구방법: 2019년 5월 1일부터 6월 18일까지 한국 120개 병원에서 설문 조사를 시행하였다. 설문조사에는 각 병원에서 시행하고 있는 소독 및 세척의 방법과 종류, 사용되는 소독제의 양, 실제로 얼마나 자주 소독 및 세척, 멸균을 시행하는지에 대한 내용이 포함되어 있었다. 설문은 지면조사로 수행되었으며, 결과는 전문가에 의하여 분석되었다. 결과: 연구결과 38개 병원에서 설문조사에 응답하였고, 그 중 37개 병원의 결과가 분석에 사용되었다. 병원별로 차이가 있으나 평균적으로 한 환자가 하루 입원당 소독, 세척, 멸균 및 소독제 멸균용품등의 구입에 소모하는 비용은 2,341원 이었다. 상급병원에서 종합병원에 비해 2배 가량의 비용이 소요되었다. 소독제는 재원일수 1일당 916원이 소요되었다. 세척제 비용은 재원 일수 1일당 165원이 소요되었다. 세척제 비용에 재원 일수 1일당 195원이 소요되었다. 자동 소독기와 관련하여 구입비용은 평균값 22,878,210 (±16,543,798.2)원, 최소값 1,221,000원, 중간값 19,363,636원, 최대값 53,915,705원이었다. 유지 관리 비용은 재원 일수 1일당 18원이 소요되었다. 소독제 비용은 재원 일수 1일당 793원이 소요되었다. 상급종합병원 재원 일수 1일당 853원, 종합병원 재원 일수 1일당 678원이 소요되어 이 또한 차이를 보였다. 멸균기와 유지 관리 비용은 재원 일수 1일당 178원이 소요되었다. 소독과 멸균에 필요한 기타 물품(포장재, 접착물품, 라벨, 멸균확인 물품 등)은 재원 일수 1일당 269원이 소요되었다. 상급종합병원 재원 일수 1일당 301원이 소요되었고, 종합병원 재원 일수 1일당 207원이 소요되었다. 결론: 결론적으로, 소독 및 세척, 멸균에 다양한 물품과 비용이 지속적으로 소모되고 있었다. 이러한 소모 비용에 대한 적절한 보상이 이루어지는 것이 감염관리의 개선을 위하여 중요할 것으로 생각된다. Background: Disinfection, cleaning, and sterilization are major elements of medical infection control, but research on how much it actually costs in Korea is lacking. The main purpose of this study was to calculate the cost and compensation method required for disinfection, cleaning and sterilization in the current medical situation in South Korea. Methods: A survey was conducted at 120 hospitals in Korea from May 1 to June 18, 2019. The survey included the methods and types of disinfection and cleaning implemented in each hospital, the amount of disinfectant used, and how often disinfection, cleaning, and sterilization were actually performed. The questionnaire was conducted as a paper survey, and the results were analyzed by experts. Result: Thirty-eight hospitals responded to the survey, of which 37 hospitals' results were used for analysis. Although there are differences between hospitals, on average, the cost of disinfection, cleaning, sterilization, and sterilization products for one patient per patient-day was 2,341 won. The cost was about twice that of a general hospital in a tertiary hospital. The disinfectant cost 916 won per patient-day. The cleaning agent cost 165 won per patient-day. The cleaning agent cost 195 won per day of stay. Regarding the automatic sterilizer, the average purchase cost was 22,878,210 (±16,543,798.2) won, and the median value was 19,363,636 won. The maintenance cost was 18 won per patient-day. The cost of disinfectant was 793 won per patient-day. There was also a difference in the cost of 853 won patient-day spent at tertiary hospitals and 678 won per patient-day at general hospitals. The sterilizer and maintenance cost was 178 won per patient-day. Other items necessary for disinfection and sterilization (packaging materials, adhesive items, labels, sterilization confirmation items, etc.) cost 269 won per day of stay. It cost 301 won per patient-day spent at the tertiary hospital, and 207 won per patient-day spent at the general hospital. Conclusion: In this study, we were able to estimate the cost for disinfection, cleaning, sterilization. In conclusion, various items and costs were continuously consumed for disinfection, cleaning, and sterilization. It is thought that it is important for the improvement of infection control to be properly compensated for these consumption costs.

Asymptomatic Bone Cement Pulmonary Embolism after Percutaneous Vertebroplasty: A Case Report

시혜진,김성은,서원우,손성민,왕성호,박성록,이상기 대한응급의학회 2016 대한응급의학회지 Vol.27 No.3

Pulmonary embolism is a rare complication after percutaneous vertebroplasty for compression fracture. Embolization is related to cement leakage outside the treated vertebral body into the adjacent venous system. We report on a case of pulmonary embolism with bone cement in the right pulmonary artery in a 75-year-old female who had undergone percutaneous vertebroplasty 2 months before. Her simple X-ray of the spine captured polymethyl metacrylate leakage from the vertebral body, which indicated the pathophysiology of this event.

광범위 약제내성 Streptococcus pneumoniae에 의한 급성 폐렴구균 파종성 감염 1례: 뇌수막염과 화농성 관절염 동반

시혜진,백진양,정두련,김기현,백경란,강철인 대한의료관련감염관리학회 2022 의료관련감염관리 Vol.27 No.1

The emergence and spread of antimicrobial resistance threatens the successful treatment of invasive pneumococcal disease (IPD). We report a case of disseminated pneumococcal infection with meningitis, spondylitis, and septic arthritis caused by an extremely drug-resistant strain of Streptococcus pneumoniae, which was resistant to at least one agent in all classes but was sensitive to vancomycin and linezolid. The patient was treated successfully using intravenous vancomycin (1 g every 12 h) and shoulder surgery. The serotype of this isolate was 15A, a nonvaccine type, and multi-locus sequence typing (MLST) revealed ST8279. MLST analysis and antimicrobial susceptibility test revealed that the strain, SMC1710-32, belonged to ST8279, with the same molecular characteristics with drug susceptibility as extensively drug-resistant (XDR) clone 11A-ST8279 in the previous studies. These XDR pneumococcal strains, serotype 11A and 15A possessed identical molecular characteristics including multiple mutated genes involved in very-high-level resistance to various drugs. The difference in serotype was due to large scale recombination for serotype switching. Further surveillance and investigation of the serotype distribution and genotypes of XDR strains are essential to prevent their spread.

S-258 : 수년간 변화를 보이지 않던 폐 거대기포의 완전 소실 1예

시혜진,김창환,왕성호,손성민,박성락,이상기 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

거대기포는 반측 흉곽의 최소 30% 이상을 차지하는 크기의 기포를 말한다. 폐의 기포는 폐기종 환자에서 병발하는 경우가 대부분이지만, 정상 폐에서 독립적인 이상으로 나타나기도 한다. 폐의 기포는 일반적으로 시간이 지나면서 점차적으로 크기가 증가하는 경우가 많고, 장기간 크기의 변화를 보이지 않기도 하는데, 자연적인 소실을 보이는 경우는 매우 드물다. 저자들은 기저질환 없는 남자에서 수년간 변화를 보이지 않던 폐의 거대기포가 완전히 소실된 1예를 경험하여 보고하는 바이다. 51세 남자 환자가 2일 전부터 발생한 우측 흉통을 주소로 내원하였다. 환자는 15갑년의 흡연력이 있으나 내원 1개월 전부터 흡연을 중단하였다고 하고, 4년 전 요로결석으로 치료를 받은 적이 있으며, 당시 흉부단순촬영에서 우상엽에 10×9.4 cm 크기의 거대기포가 확인된 바 있었다. 환자는 기침, 객담 등의 호흡기 증상은 호소하지 않았으나 3일 전부터 열감과 근육통이 있었다고 하며, 호흡음도 이상이 없었으나 37.9도의 경미한 발열이 확인되었다. 흉부단순촬영에서는 기존에 관찰되던 거대기포 내에 공기액체층이 관찰되었다. 이에 거대기포 감염으로 진단하고 치료를 위해 입원하였다. 검사실 검사 결과 백혈구증가증은 없었으나 호중구가 84.1%였고, C-반응성 단백이 82.5 mg/L로 상승되어 있었다. 입원 후 광범위항생제 정주를 시작하였고, 입원 3일째부터 우측 흉통과 발열은 호전을 보였다. 객담 및 혈액 배양검사에서 동정되는 균은 없었고, 폐렴구균 요항원 검사나 객담의 비정형폐렴균에 대한 중합효소연쇄반응에서도 확인된 균주는 없었다. 폐기능검사 결과 1초간 강제호기량은 2.8 L (예측치 대비 80%), 강제폐활량은 3.9 L (예측치대비 82%)로 측정되었다. 환자는 1주간 정주 항생제 치료 후 퇴원하였고 경구 항생제를 2주간 추가로 복약하였다. 이후 추적한 흉부단순촬영에서 1달 뒤부터 거대기포의 크기가 점차 감소하기 시작하였다. 약 1년 후 거대기포는 완전히 소실되었고 우폐 첨부에 섬유성 반흔만을 남겼다. 환자는 현재도 외래 추적관찰 중이며 추후 폐활량의 변화를 확인하기 위해 폐기능 검사를 시행할 예정이다.

코로나19 직원감시체계를 통하여 발견된 국내 3차 병원 Campylobacter Jejuni 위장관 감염증 직원 집단 발병

시혜진,이재백,홍신희,엄중식,박윤선 대한의료관련감염관리학회 2023 의료관련감염관리 Vol.28 No.1

We identified an outbreak of Campylobacter jejunii enteritis through coronavirus infection 2019 (COVID-19), healthcare worker (HCW) symptom surveillance, which identified 15 HCWs with fever and diarrhea who were tested for COVID-19 on the same day. COVID-19 monitoring revealed that 15 employees with fever and diarrhea were tested for the virus, of whom two were hospitalized with fever, abdominal pain, and diarrhea. Stool cultures confirmed that C. jejunii was the causative agent of gastroenteritis in these patients. An outbreak of C. jejunii among HCWs was suspected, and an epidemiological investigation was initiated. The symptomatic HCWs had consumed lunch from the same cafeteria on the same day within the incubation period. Based on the results of the epidemiological investigation, 105 out of 2,173 HCWs (11 HCWs who had A-type lunch and 94 who had B-type lunch) reported symptoms of gastroenteritis, with an incidence of 4.8%. Meal B, specifically the pork dumpling, was presumed to have been contaminated. We identified a Campylobacter outbreak among HCWs through a COVID-19 HCW surveillance system. Moreover, the outbreak was first recognized through the COVID-19 HCW surveillance system. Improvements in food storage and cultural methods of food preservation are required. Increasing awareness among HCWs of the possibility of contracting various diseases other than COVID-19 when treating patients with fever is critical to the early recognition of outbreaks and prevention of missing an outbreak.

A Case of Multiple Cardiovascular and Tracheal Anomalies Presented with Wolff-Parkinson-White Syndrome in a Middle-aged Adult

시혜진,손성민,왕성호,박성록,이상기,김송이,정선영,김창환 대한의학회 2017 Journal of Korean medical science Vol.32 No.12

Congenital cardiovascular anomalies, such as dextrocardia, persistent left superior vena cava (SVC), and pulmonary artery (PA) sling, are rare disorders. These congenital anomalies can occur alone, or coincide with other congenital malformations. In the majority of cases, congenital anomalies are detected early in life by certain signs and symptoms. A 56-year-old man with no previous medical history was admitted due to recurrent wide QRS complex tachycardia with hemodynamic collapse. A chest radiograph showed dextrocardia. After synchronized cardioversion, an electrocardiogram revealed Wolff-Parkinson-White (WPW) syndrome. Persistent left SVC, PA sling, and right tracheal bronchus were also detected by a chest computed tomography (CT) scan. He was diagnosed with paroxysmal supraventricular tachycardia (PSVT) associated with WPW syndrome, and underwent radiofrequency ablation. We reported the first case of situs solitus dextrocardia coexisting with persistent left SVC, PA sling and right tracheal bronchus presented with WPW and PSVT in a middle-aged adult. In patients with a cardiovascular anomaly, clinicians should consider thorough evaluation of possibly combined cardiovascular and airway malformations and cardiac dysrhythmia.

Environmental Culture of Bacteria at the Intensive Care Unit of a Tertiary Hospital in Korea: A Consideration for Improving Medical Environmental Safety and Healthcare-associated Infection

시혜진,김정희,김남이,이재백,엄중식 대한의료관련감염관리학회 2020 의료관련감염관리 Vol.25 No.2

Background: Intensive care unit (ICU) infections cause major health and financial problems worldwide. Inanimate surfaces and environmental contamination can play a role in the crossinfection of pathogens and associated patient infection. Here, we aimed to identify the pathogens that are present in the ICUs. Methods: This study analyzed bacterial cultures on 160 environmental samples from the ICU at a tertiary hospital in Incheon. Results: From cultures of 160 samples, 407 bacteria of 38 species were isolated; of these, 109 (26.8%) were gram-negative and 298 (73.2%) were gram-positive. The common isolation sites were keyboards (38 strains), bed linen sheets (average head, waist, and foot seats) (36 strains), bedside rails (33 strains), and curtains (27 strains). The common bacteria isolated were coagulase- negative staphylococci (CNS) (222 strains, 54.5%), Acinetobacter baumannii (48 strains, 11.8%), Pseudomonas aeruginosa (33 strains, 8.1%), and Enterococcus faecium (24 strains, 5.9%). A total of 60 multidrug-resistant strains were isolated. There were multidrug-resistant Acinetobacter baumannii (MRAB) (n=32), multidrug-resistant Pseudomonas aeruginosa (MRPA) (n=2), vancomycin-resistant Enterococcus (VRE) (n=20), and carbapenem-resistant Enterobacteriaceae (CRE) (n=6). Conclusion: It was confirmed that large numbers of multidrug-resistant bacteria, such as VRE and CRE, colonized the environment in the ICU of this tertiary hospital. Taken together, the findings of this study will inform consideration of new intervention plans for in-hospital medical infection control programs in the future, especially in critical care units.

Mycobacterium avium Complex Infection-Related Immune Reconstitution Inflammatory Syndrome Mimicking Lymphoma in an Human Immunodeficiency Virus-Infected Patient

손성민,시혜진,왕성호,이상기,박소연,이진서,엄중식 대한감염학회 2018 Infection and Chemotherapy Vol.50 No.4

In acquired immunodeficiency syndrome (AIDS) patients, immune reconstitution inflammatory syndrome (IRIS) due to Mycobacterium avium complex (MAC) infection is one of the most difficult IRIS types to manage. We report an unusual case of MAC-associated IRIS. At first the patient was diagnosed human immunodeficiency virus (HIV) infection after he was admitted with pneumocystis pneumonia. After starting antiretroviral therapy he presented unmasked IRIS with MAC infection. Next, he was hospitalized with continuous loose stools and new-onset fever. Investigation included computed tomography (CT), which showed homogeneous enhancement and enlargement of the lymph nodes (LN), elevation of ferritin (>1,650 ng/mL) and lactate dehydrogenase (306 IU/L) levels, and F- fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan, which showed increased FDG uptake. These findings were highly indicative of lymphoma. We performed laparoscopic biopsy of the mesenteric LN, and the biopsy culture grew MAC. So we made a diagnosis of MAC-associated. Therefore, IRIS must be considered as a possible diagnosis when AIDS patients develop new symptoms or exhibit exacerbations of existing symptoms. Furthermore the biopsies should be conducted.

지주막하출혈 환자에서 확인된 동양안충 감염 1예

홍신희,김태훈,시혜진,엄중식,박윤선 대한의료관련감염관리학회 2022 의료관련감염관리 Vol.27 No.1

Therazia calipaeda is known to cause infections in animals and human eyes, such as dogs and cats, using fruit flies as vectors. Two white translucent thread-shaped parasites were found in the right eye of an 84-year-old man hospitalised in the intensive care unit because of a traumatic cerebral haemorrhage. Parasites were removed, the conjunctiva was washed with physiological saline, and the removed parasites were diagnosed as T. callipaeda. An ophthalmic examination was performed 1 month after parasite removal, and no additional parasites or abnormal findings in the eyes were confirmed. Considering the life cycle of Thelazia, prevention of ocular thelaziasis is to avoid environments that may be exposed to fruit flies and to keep the eyes clean from tears and sweat. Environmental management and inpatient hygiene should be given attention because infected parasites can survive in the host for a long time. In addition, careful observation of the internal and external conditions of the eye and appropriate examination are needed during the treatment of patients who are not conscious or have difficulty accurately presenting symptoms.