Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections

이경화,조난형,정수진,김미나,한상훈,송영구 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.3

Purpose: The present study aimed to evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstreaminfections (CLABSIs) in different departments of the same hospital, including the intensive care unit (ICU) and other departments. Materials and Methods: The four components of the CL bundle were hand hygiene, use of maximal sterile barrier precautions,chlorhexidine use, and selection of an appropriate site for venous access. Compliance of the CL bundle and CLABSIs were measuredfor every department [emergency room (ER), ICU, general ward (GW), and operating room (OR)]. A total of 1672 patientswere included over 3 years (August 2013 through July 2016). Results: A total of 29 CLABSI episodes (1.73%) were identified, and only 53.7% of the patients completed CL bundles. The performancerates of all components of the CL bundle were 22.3%, 28.5%, 36.5%, and 84.6% for the ER, ICU, GW, and OR, respectively. The highest CLABSI rate was observed in patients of the ICU, for whom all components were not performed perfectly. Conversely,the lowest CLABSI rate was observed for patients of GWs, for whom all components were performed. Among individual components,femoral insertion site [relative risk (RR), 2.26; 95% confidence interval (CI), 1.09−4.68], not using a full body drape (RR, 3.55;95% CI, 1.44−8.71), and not performing all CL bundle components (RR, 2.79; 95% CI, 1.19−6.54) were significant variables associatedwith CLABSIs. Conclusion: This study provides direct evidence that completing all CL bundle components perfectly is essential for preventingCLABSIs. Customized education should be provided, according to specific weaknesses of bundle performance.

산후조리원 종사자를 위한 감염관리 교육프로그램 개발과 효과

김성란,김수현,손희정,조난형,차경숙,천희경,최종림,홍혜경 대한의료관련감염관리학회 2019 의료관련감염관리 Vol.24 No.2

Background: This study was conducted to investigate the educational needs of employees in charge of practical services at postpartum care centers and to test the improvement of infection control-related knowledge after developing and implementing educational programs that reflect their needs. Methods: On the basis of research of the literature on educational requirements and consultations with researchers and experts, we developed educational programs on infection control. A total of 136 postpartum care workers participated in the program. To assess the effectiveness of the program, the degree-of-knowledge and satisfaction of the program were measured before and after the education. The educational program consisted of four themes over 200 minutes (50 minutes each). Results: After training, the participants’ overall infection control knowledge increased from 84.36 points to 89.04 points. The participants were satisfied with the program; they were satisfied with their knowledge acquisition (4.59±0.66 points), with the practical application of the content (4.59±0.65 points), and with the education program itself (4.52±0.67 points). Conclusion: As the positive effects of the educational program have been identified, the program can be extended to all postpartum care workers. Continuous development and implementation of educational programs are necessary to strengthen the capability of postpartum care workers, allowing them to effectively manage infection in the future.

유치도뇨관 관련 요로감염의 감시 자동화를 위한 알고리즘 개발과 적용

김민구,윤지현,진성준,조난형,김미나,송영구 대한내과학회 2012 대한내과학회 추계학술대회 Vol.2012 No.1

요양병원 대상 의료관련감염 감시체계 시범운영

김성란,차경숙,김재연,오보람,유현미,조난형,최종림,최지연,한시현,가혁,이미숙 대한의료관련감염관리학회 2022 의료관련감염관리 Vol.27 No.2

Background: In Korea, the older population is increasing rapidly, and the number of longterm care facilities (LTCFs) are also increasing to meet the need . LTCFs are institutions that provide medical practice to patients who need long-term hospitalization. In LTCFS, a high risk of infection or spread of infection is present in terms of the clinical characteristics of inpatients and the structural aspects of the institutions. This study is a pilot investigation of the hand hygiene and prevention surveillance system for urinary tract infections (UTIs) in LTCFs. Methods: A total of 20 LTCFs participated in the study. The status of hand hygiene and UTIs’ prevention intervention in the LTCFs was checked, and the collected data were analyzed to determine indicators such as hand hygiene compliance rate, indwelling urinary catheter usage ratio, UTIs’ rate, and UTIs’ prevention compliance rate. Results: From October 2020 to March 2021, the total hand hygiene compliance rate of participating institutions was 86.7%. The UTIs’ rate was 0.22 cases per 1,000 days, and the indwelling urinary catheter-associated UTIs’ rate was 0.78 cases per 1,000 catheter-days. The compliance rate of indwelling urinary catheter maintenance was 88.3-99.8%, where the compliance rate of fixing the indwelling urinary catheter was marked the lowest and that of keeping the urine bag below the bladder, marked the highest. Conclusion: This study provides the basic data for determining the continuous operation of the surveillance system. Additionally, the standardized indicators, which were calculated from the operation of the surveillance system, will help plan future healthcare-associated infection prevention projects for LTCFs.

국내 종합병원에서 발생한 KPC-2 생성 Klebsiella pneumoniae 집단 발생에 대한 역학 분석 연구

홍준성,박별이,김도균,김건한,이경화,조난형,정석훈 대한임상미생물학회 2020 Annals of clinical microbiology Vol.23 No.2

Background: The prevalence of carbapenemase-producing Enterobacteriaceae (CPE), especially the KPC-2-producing Klebisella pneumoniae, is rapidly increasing and becoming a menace to global public health. This study aims to present the molecular epidemiology of the KPC-2-producing K. pneumoniae isolates emerged in a tertiary hospital in South Korea and describe its clinical significance. Methods: This study included carbapenem-resistant K. pneumoniae isolates collected from a tertiary hospital from April to December in 2018. Antimicrobial susceptibility of K. pneumoniae isolates was tested using disk diffusion method. PCR and DNA sequence analyses were performed to identify the resistance genotype. In addition, the molecular epidemiology was investigated using pulsed-field gel electrophoresis (PFGE) and multilocus sequencing typing (MLST). Results: Total 100 KPC-2-producing K. pneumoniae isolates were collected, which were mainly classified into two pulsotypes according to the XbaI restriction digestion pattern by PFGE analysis (pulsotype A, n = 31; pulsotype B, n = 63). The isolates exhibiting pulsotype A belonged to ST395 and the remaining isolates exhibiting pulsotype B were attributed to ST307 by MLST analysis. Conclusion: This study investigated clinical information and molecular bacterial profiles for KPC-2-producing K. pneumoniae isolates. These findings indicate that the proper infection control activities are needed to prevent the spread of multidrug-resistant organisms such as CPE, which could cause high mortality in clinical field.

전국의료관련감염감시체계 중환자실 부문 결과 보고: 2020년 7월부터 2021년 6월

김은진,곽이경,곽선희,고수희,권오미,김의석,김진화,김태형,김택수,문희원,박선희,안진영,유소연,유현미,이상오,이유미,조난형,최영화,최평균,홍기호,이미숙,전국의료관련감염 중환자실감시체계 대한의료관련감염관리학회 2023 의료관련감염관리 Vol.28 No.1

Background: The Korean National Healthcare-associated Infections Surveillance System (KONIS) is a nationwide surveillance network established by the Korean Society for Healthcare-Associated Infection and Prevention in July 2006 to perform healthcare-associated infection surveillance using standardized methods. This report presents the annual data of the intensive care unit (ICU) module of the KONIS system between July 2020 and June 2021. Methods: We performed prospective surveillance of healthcare-associated infections (HAIs), including urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU), at 339 ICUs in 257 hospitals using the KONIS database. HAI rates and device-associated infection (DAI) rates were calculated as the numbers of infections per 1,000 patient days (PD) and device days (DD), respectively. Device utilization was calculated as the ratio (DUR) of device days to patient days. Results: A total of 4,435 HAIs were found during the study period: 1,645 UTIs (1,589 cases were urinary catheter-associated), 1,994 BSIs (1,753 were central line-associated), and 796 PNEUs (383 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 1.30 cases per 1,000 DD (95% confidence interval [CI], 1.24-1.36) and DUR was 0.74 (95% CI, 0.739-0.741). The rate of central line-associated BSIs was 2.21/1,000 DD (95% CI, 2.11-2.31) and DUR was 0.48 (95% CI, 0.479-0.481). The rate of ventilator-associated PNEUs was 0.79/1,000 DD (95% CD, 071-0.87) and DUR was 0.29 (95% CI, 0.289-0.291). Conclusion: The overall DAI rate was similar to that of the previous year’s data; however, the rate of VAP showed a trend of decline. Furthermore, all DURs were reduced. Therefore, continuous infection surveillance may reduce infection rates and device use.

전국의료관련감염감시체계 중환자실 부문 결과 보고: 2017년 7월부터2018년 6월

김은진,곽이경,김태형,이미숙,이상오,김성란,박선희,안진영,윤나라,류성렬,김의석,최지연,유현미,신명진,유소연,홍기호,문희원,조난형,손희정,김수현,최영화,김미나 대한의료관련감염관리학회 2019 의료관련감염관리 Vol.24 No.2

Background: In this report, we present annual data from the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) from July 2017 through June 2018. Methods: We performed prospective surveillance of healthcare-associated urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) at 308 ICUs in 216 hospitals using the KONIS. Healthcare-associated infection (HAI) rates and device-associated infection rates were calculated as the number of infections per 1000 patient-days (PD) and device-days (DD), respectively. Device utilization was calculated as a ratio of DD to PD. Results: A total of 4569 HAIs were found during the study period: 1530 UTIs (1476 cases were urinary catheter-associated), 2006 BSIs (1692 were central line-associated), and 1033 PNEU cases (505 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 1.16 cases per 1000 DD (95% confidence interval [CI]: 1.10-1.22) and urinary catheter utilization ratio was 0.86 (95% CI: 0.859-0.861). These results were higher than those in the previous year: 1.01 cases per 1000 DD (95% CI: 0.95-1.07) and 0.85 (95% CI: 0.849- 0.851), respectively. The rate of central line-associated BSIs was 2.29 cases per 1000 DD (95% CI: 2.18-2.40) and the central line utilization ratio was 0.50 (95% CI: 0.499-0.501). The rate of ventilator-associated PNEU cases was 0.96 cases per 1000 DD (95% CI: 0.88-1.05) and the ventilator utilization ratio was 0.35 (95% CI: 0.349-0.351). Conclusion: The overall rate of HAIs was similar to the results from the previous year; however, the rate of CAUTI increased.

전국의료관련감염감시체계 중환자실 부문 결과 보고: 2018년 7월부터 2019년 6월

김은진,곽이경,곽선희,고수희,김진화,김의석,김태형,류성렬,문희원,박선희,안진영,유소연,유현미,윤나라,이미숙,이상오,조난형,최지연,홍기호,최영화,김미나 대한의료관련감염관리학회 2020 의료관련감염관리 Vol.25 No.2

Background: In this report, we present the annual data of the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance (KONIS) System from July 2018 to June 2019. Methods: We performed a prospective surveillance of healthcare-associated urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) at 316 ICUs in 227 hospitals using the KONIS system. Healthcare-associated infection (HAI) and device-associated infection rates were calculated as the number of infections per 1,000 patient-days (PDs) and device-days (DDs), respectively. Device utilization was calculated as the ratio of DDs to PDs. Results: A total of 4,874 HAIs were found during the study period: 1,682 UTIs (1,633 urinary catheter-associated cases), 2,110 BSIs (1,769 central line-associated cases), and 1,082 PNEUs (569 ventilator-associated cases). The rate of urinary catheter-associated UTIs (CAUTIs) was 1.28 cases per 1,000 DDs [95% confidence interval (CI), 1.22-1.34], and the urinary catheter utilization ratio was 0.86 (95% CI, 0.859-0.861). The rate of CAUTIs was higher than that in the previous year [1.16/1,000 DDs (95% CI, 1.10-1.22)]. The rate of central line-associated BSIs was 2.32/1,000 DDs (95% CI, 2.22-2.43), and the central line utilization ratio was 0.51 (95% CI, 0.509-0.511). The rate of ventilator-associated PNEUs was 1.08/1,000 DDs (95% CI, 0.99-1.17), and the ventilator utilization ratio was 0.35 (95% CI, 0.349-0.351). Conclusion: The overall HAI rate was similar to that in the previous year, but the rate of CAUTIs increased. In addition, the central line utilization ratio increased; thus, intervention is necessary.

전국의료관련감염감시체계 중환자실 부문 결과 보고: 2019년 7월부터 2020년 6월

김은진,곽이경,곽선희,고수희,권오미,김의석,김진화,김태형,김택수,문희원,박선희,안진영,유소연,유현미,이상오,조난형,최평균,홍기호,이유미,이미숙 대한의료관련감염관리학회 2021 의료관련감염관리 Vol.26 No.2

Background: This report presents the annual data of the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) between July 2019 and June 2020. Methods: We performed prospective surveillance of healthcare-associated infections (HAI), including urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU), at 340 ICUs in 256 hospitals using the KONIS database. HAI and device-associated infection (DAI) rates were calculated as the number of infections per 1,000 patient-days (PD) and device-days (DD), respectively. Device utilization was calculated as the ratio (DUR) of device to patient days. Results: A total of 4,489 HAIs were found during the study period: 1,646 UTIs (1,597 cases were urinary catheter-associated); 1,964 BSIs (1,695 were central line-associated); and 879 PNEUs (470 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 1.26/1,000 DD (95% confidence interval [CI] 1.20-1.32), whereas the urinary catheter utilization ratio was 0.80 (95% CI, 0.799-0.801). The rate of central line-associated BSIs was 2.16/1,000 DD (95% CI 2.06-2.26), whereas the central line utilization ratio was 0.50 (95% CI 0.499-0.501). The rate of ventilator-associated PNEUs was 0.93/1,000 DD (95% CI 0.85-1.02), whereas the ventilator utilization ratio was 0.32 (95% CI 0.319-0.321). Conclusion: The overall DAI rate was similar to that in the previous year. In particular, the device utilization ratios were reduced. Continuous surveillance prevented an increase in the infection rate and led to a decrease in device use. A continuous infection surveillance system can reduce the infection rate.

국내 의료기관의 소독과 멸균 관리 실태

정선영(Jeong, Sun Young),최정화(Choi, Jeong Hwa),김은경(Kim, Eun Kyoung),김수미(Kim, Su Mi),손희정(Son Hee Jung),조난형(Cho, Nan Hyoung),최지연(Choi, Ji Youn),박은숙(Park, Eun Suk),박진희(Park, Jin Hee),이지영(Lee, Ji Young),최순임(C 기본간호학회 2014 기본간호학회지 Vol.21 No.4

Purpose: This study was done to investigate the status of disinfection and sterilization in healthcare facilities. Method: A survey of 193 Korean healthcare facilities was conducted from February 8 to March 7, 2013. Data were analyzed using descriptive statistics, χ2 test, Fisher"s exact test, one-way ANOVA, Scheffe with SPSS WIN 18.0. Results: Of the healthcare facilities 93.2% had specific guidelines for disinfection/sterilization, but only 47.9% had a committee on disinfection/sterilization for decision-making, less than half (42.7%) conducted regular monitoring of actual practices, while 83.9% had established procedures for recovery in case of problems with the disinfection process and 89.0% kept records and archives of disinfection practices. Cleaning process, selection of chemical disinfectants and process of disinfection and sterilization were found to be inadequate in some healthcare facilities. Perception score for adequacy of medical instruments was 8.10, environmental disinfection was 7.20, and sterilizer management was 8.45 out of a possible 10. Conclusion: Compared to larger institutions, smaller healthcare facilities had less effective disinfection and sterilization management systems, while some facilities showed inadequate practices for medical equipment and general sterilization. Better academic and state-level support is recommended for smaller facilities in order to establish a better system-wide management system.