병동 병원감염 환례수집 담당간호사에 의해 조사된 병원감염 감시기록의 정확도

조윤숙,김정순 대한감염학회 2000 감염 Vol.32 No.4

병원감염 사건에서 사실상 증명책임 전환의 필요성 및 그 근거로서 안전배려의무에 관한 검토

유현정 대한의료법학회 2014 의료법학 Vol.15 No.2

의료소송에서 과실 및 인과관계의 증명과 관련하여 병원감염 사례에 관한 판결들을 분석한 결과 의료소송에서 증명책임 완화법리는 병원감염사건에서 사실상 그 도입취지에 따른 기능을 제대로 하지 못하고 있었다. 또한 병원감염이 발생하였다는 사실만으로 바로 과실이 추정될 수 없다는 것이 판결의 주류적인 태도로, 병원감염 관련 과실 및 인과관계 추정을 위한 간접사실에 비해 추정을 부정하는 간접사실이 압도적으로 많았다. 이와 같이 다른 의료사건에 비하여 특히 과실을 추정할 수 있는 간접사실 자체를 증명하기 어려운 병원감염 사건의 경우, 판결의 주류적 태도는 병원감염 발생으로 인한 손해의 분담을 사실상 환자 측에 전가하는 문제가 있다 할 것이므로, 손해의 공평․타당한 분담을 그 지도 원리로 하는 손해배상제도의 이념에 비추어 기존의 증명책임 완화법리나 사실상 추정론에 비해 환자 측의 증명책임을 의료소송의 다른 분야에 비해 대폭 완화하기 위한 법 해석이나 이론적 방법을 강구할 필요성이 있다. 이와 관련하여 병원감염사건에서 안전배려의무가 증명책임 전환근거가 될 수 있는지 여부에 관하여 검토한 결과, 병원감염 사건에서 안전배려의무인 ‘병원감염 방지의무’는 통상의 신의칙에 기한 안전배려의무가 아닌 진료계약에 기한 종된 급부의무에 해당하며, 이의 위반시 진료계약 위반이 되나, 급부의무 자체에서 증명책임 전환의 논리적 필요성이 도출된다고 볼 수는 없으므로, 병원감염 사건에서 안전배려의무, 즉 진료계약상 병원감염 방지의무 단독으로 증명책임을 전환할 근거가 되기는 어렵다고 판단되었다. 그러나 병원감염 사건에서 증명책임 전환의 필요성, 감염관리의무를 부과하고 있는 의료법의 취지, 당사자 사이의 공평․타당한 손해의 분담을 이상으로 하는 우리 손해배상제도의 이념에 비추어 적어도 의료법상 고도의 감염관리의무가 부과된 일정 규모 이상의 종합병원의 경우 병원감염으로 환자의 신체나 건강, 생명의 침해가 초래된 때에는 그 감염에 관하여 의료법 및 진료계약상 요구되는 감염방지의무를 다하여 자신에게 과실이 없음을 입증하지 못하는 한 의료기관은 그 감염으로 인한 손해배상책임을 부담한다고 보아야 할 것이며, 병원감염 사건에서 환자 측의 증명책임을 논란의 여지없이 전환하기 위해서는 독일과 같이 병원감염 사건에서 과실에 대한 법률상 추정 규정을 둠으로써 입법론적으로 해결하는 것이 필요하다 할 것이다. As results of analyzing judicial precedents about infection in hospitals in connection with mistakes and causality in medical litigations shows that the Mitigation of Law Principles To Prove responsibility in medical litigation has not been able to play its role compared to its intended purposes. And Major sentiment from those judgments is that a mistake can’t be proved only by the fact that certain infection in hospital occurred in connection with hospital infection. Therefore, the number of indirect facts to deny estimation is overwhelmingly high. Like this, especially for hospital infection which is difficult to prove indirect facts themselves to estimate mistake, major sentiment from those judgments have a problem that impute sharing of losses caused by hospital infection to patient. In accordance with the Principles of equitable and proper sharing of losses, it’s required to prepare legal interpretation and theoretical methods to largely mitigate patient’s responsibility to prove medical mistakes compared to other medical litigations in connection with existing Mitigation of Law Principles To Prove responsibility and conventional theory of estimation. In connection with this, the results of review that duty of safety management in hospital infection cases can be the base of conversion of proving responsibility, the duty that prevent hospital infection, corresponding the duty of safety management in hospital infection is not conventional duty of safety management based on duty of good faith but secondary obligation of medical contract. The breach of duty preventing hospital infection is the violation of medical contract, but there is no logical necessity that convert proving responsibility from the obligation of contract itself. Therefore, the duty of preventing hospital infection from the obligation of medical contract, corresponding the duty of safety management in hospital infection cases cannot be the base of conversion of proving responsibility alone. But, it’s still required to conversion of proving responsibility in hospital infection, we need further studies on cases of Germany which applies legal estimation of proving responsibilities in hospital infection.

병원감염의 효율적인 관리체계 개발연구

김봉수,이영신,양숙자,김홍빈,유재일,심수경,김경희,김혜원 국립보건연구원 2000 국립보건원보 Vol.37 No.-

병원감염 사건에서 증명책임 완화에 관한 입법적 고찰 - 개정 독일민법을 중심으로 -

유현정 대한의료법학회 2015 의료법학 Vol.16 No.2

병원감염 사례에 관한 판결의 주류적 태도는 병원감염 발생으로 인한 손해의 분담을 사실상 환자 측에 전가하는 문제가 있다고 판단되므로, 손해의 공평․타당한 분담을 그 지도 원리로 하는 손해배상제도의 이념에 비추어 환자 측의 증명책임을 대폭 완화하기 위한 방법을 강구할 필요성이 있다. 이와 관련하여 진료계약을 민법상 전형계약으로 규정하고, 병원감염과 같은 의료 측이 전적으로 지배할 수 있었던 경우에는 일반적 진료상 위험이 실현된 때 진료자의 오류가 추정된다고 명문으로 과실추정규정을 둔 독일민법을 검토하였다. 진료계약은 매우 빈번하고 광범위하게 일반 국민의 실생활에서 체결되고 있으며, 그로 인한 분쟁도 다양하게 발생하고 있으므로, 진료계약을 독일과 같이 민법의 전형계약으로 규정함으로써 계약 내용과 분쟁 발생 시 증명책임 등에 관해 규율할 필요성이 있다. 병원감염 사건의 경우 법률에 의해 과실을 추정하고, 병원감염 예방을 위한 노력을 철저히 시행한 기관에 한하여 병원감염 사고로 인한 손해가 발생한 경우 그 비용을 지원하도록 사회보험을 통한 제도적 보완이 필요하다고 생각되며, 향후 이에 관한 면밀한 연구와 검토가 요구된다. Owing to causes such as population aging, increased use of various medical devices, long-term hospitalization of various patients with reduced immune function such as cancer, diabetes, and organ transplant patients, and the growing size of hospitals, hospital infections are continuing to increase. As seen in the MERS crisis of 2015, hospital infections have become a social and national problem. In order to prevent damage due to such hospital infections, it is necessary to first strictly implement measures to prevent hospital infections, while, on the other hand, providing proper relief of damage suffered due to hospital infections. However, the mainstream attitude of judicial precedents relating to hospital infection cases has been judged to in fact shift responsibility over damages due to hospital infections on the patient. In light of the philosophy of the damage compensation system, whose guiding principle if the fair and proper apportionment of damages, there is a need to seek means of drastically relaxing the burden of proof on the patient’s side relative to conventional legal principles for relaxing the burden of proof, or the theory of de facto estimation. In relation to such need, the German civil code (Bürgerliches Gesetzbuch), which defines contracts of medical treatment as typical contracts under the civil code, and has presumption of negligence provisions stipulating that, in cases such as hospital infections which were completely under the control of the medical care providers, if risks in general medical treatment have been realized which cause violations of the life, body, or health of patients, error on the part of the person providing medical care is presumed, was examined. Contracts of medical treatment are entered into very frequently and broadly in the everyday lives of the general public, with various disputes owing thereto arising. Therefore, it is necessary to, by defining contracts of medical treatment as typical contracts under the civil code, regulate the content of said contracts, as well as the proof of burden when disputes arise. If stipulations in the civil code are premature as of yet, an option may be to regulate through a special act, as is the case with France. In the case of hospital infection cases, it is thought that ‘legal presumption of negligence’ relating to ‘negligence in the occurrence of hospital infections,’ which will create a state close to equality of arms, will aid the resolution of the realistic issue of the de facto impossibility of remedying damages occurring due to negligence in the process of occurrence of hospital infections. Also, even if negligence is presumed by law, as the patient side is burdened with proving the causal relationships, such drastic confusion as would occur if the medical care provider side is found fully liable if a hospital infection occurs may be avoided. It is thought that, alongside such efforts, social insurance policy must be improved so as to cover the expenses of medical institutions having strictly implemented efforts to prevent hospital infections in the event that they have suffered damages due to a hospital infection accident, and that close future research and examination into this matter will be required.

판지를 이용한 입원실 위생 수납가구 개발에 관한 연구 - 상두대 개발을 중심으로 -

이낙현,김미숙 한국가구학회 2016 한국가구학회지 Vol.27 No.4

Recently, the hospital infection has emerged as a major concern in the media. In everyday life, but not good if the infection refers to infection with the population living in the hospital. The case with which the equipment is used in a hospital if the person mediating and mediated, patients sometimes with the pathogen causing the disease to their patients. disease in our country for some time, and Mers is finished, large hospitals are taking place is a change in hygiene and operating systems. The Mers is spreading visits and influenced the patient or patient care. And the hygiene to limit the visiting hours for hospital infection prevention and stabilization of the patient. The infection, especially infection among patients and patients but a number of factors, from the emergency room or intensive care unit of frequent hospital contacts between patients with infection and of course, furniture for storing multiple people to use in the ward also become a source of infection. Hospital, another patient is a Cabinet that used to accept the next patient will cause a secondary infection and the role of infectious agents. Therefore, the general public will have a nervousness in the hospital, also medical care needed to avoid the problem occurred. This study examines such issues for the Cabinet of the hospital with a secondary infection is concerned, eco-friendly and hygienic storage furniture and one-off development that will help to improve the hospital environment for research purposes.

A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward

Park, Jinyoung,Lee, Jae-Yeol,Hwang, Dae-Seok,Kim, Yong-Deok,Shin, Sang-Hun,Kim, Uk-Kyu,Song, Jae-Min Korean Association of Maxillofacial Plastic and Re 2019 Maxillofacial Plastic Reconstructive Surgery Vol.41 No.-

Background: The purpose of this study was to review the clinical features of oromaxillofacial infections in patients presenting to a hospital emergency ward, to identify the key factors affecting the requirement for hospitalization, and the potential risk factors predisposing to a prolonged length of hospital stay. Methods: A retrospective medical record review of the 598 patients treated for oromaxillofacial infection from 2013 to 2017 at the oral and maxillofacial surgery department, Yangsan Pusan National University Hospital, was conducted. The following information was collected from each patient: sex, age, past medical history, site of infection, etiology, admission or outpatient care, level of C-reactive protein (mg/dL), fascial spaces involved, treatment method, and duration of hospitalization. Chi-squared tests were used to identify risk factors, which were further analyzed using multivariable logistic regression. Results: A total of 606 patients were eligible for inclusion in the study, of which eight were excluded due to having incomplete charts; thus, 598 patients were included: 55% were male, mean patient age was 47.1 ± 19.9 years, and 12.9% of patients were diabetic. Furthermore, 71.2% of patients had infection originating in the mandible; the most common tooth of origin was lower posterior, and 29.8% of patients were hospitalized. Risk factors for hospital admission were elderly patients with concurrent disease, elevated C-reactive protein level, and multiple-space infection in the oromaxillofacial area. The duration of hospitalization was correlated with both diabetes and age. Conclusions: The requirement for hospital admission is determined by the severity of the infection; even severe infections, once treated with appropriate surgery, have no relation to the length of hospital stay. The important risk factors for increased duration of hospitalization are diabetes mellitus and older age. The understanding of risk factors associated with a prolonged hospital stay during the treatment of oromaxillofacial infection will aid in treatment planning as well as highlight the importance of adequate diabetes control in patients at risk of such infection.

종합병원 병동에서 국지적 감염 통제의 전역적 감염 예방 효과에 관한 연구

김서영,권지훈 대한건축학회지회연합회 2018 대한건축학회연합논문집 Vol.20 No.3

본 연구의 목적은 종합병원의 병동 내 이용자 간 감염에 주목하여 국지적 공간에 감염 통제를 했을 때 전역적 공간의 감염 예방 효과를 알아보는 것이다. 이를 위해, 기능별 면적, 간호사와 방문객의 이동 동선 체계를 도출하였다. 감염 노출 빈도가 집중되는 지점을 도출하기 위해 병원 내 보균자에게 노출될 가능성을 고려한 공간 분석을 실시한 후 도출한 지점을 중심으로 국지적인 감염 통제 공간으로 설정하였다. 설정한 감염 통제 공간 내에서는 감염 노출의 가능성이 감소되도록 설정하였다. 국지적 감염의 통제 공간을 설정하기 전과 후의 감염 노출 빈도를 비교 분석하였다. 또한 평균의 차이를 검정하기 위해 대응 표본 t-test를 수행하였다. 그 결과, 간호사와 방문객의 이동 동선이 혼잡한 부분에 감염의 노출 가능성이 높게 나타났다. 분석 대상 병원에서 중복도 형태가 이중 복도 형태보다 감염에 노출되기 쉬운 형태이며 이중 복도 형태는 간호 접수대 중심으로 감염 예방이 이루어지고 중복도 형태일 경우에는 감염 노출 빈도가 집중되는 공간에 이루어져야 할 것으로 판단되었다. 비교적 감염에 노출되기 쉬운 공간 구조의 형태라도 국지적 감염 통제 공간을 적용함으로써 감염 노출 빈도가 감소했다. 대응 표본 t-test의 결과, 국지적 감염 통제의 적용 전과 이후에 평균이 통계적 유의 수준 하에서 차이가 있는 것으로 나타났다. 이는 국지적인 감염 통제 공간을 적용함으로써 전체 공간에서 보균자의 이동으로 인한 감염에 노출될 가능성이 낮아질 수 있다는 것으로 판단할 수 있었다. The purpose of this study is to identify the effects of infection prevention in the global space when infection control is placed in local spaces, paying attention to the inter-user infection in the ward of the general hospital. For this purpose, the space by function, the moving system of nurses and visitors was derived to know the space composition of the hospital. To derive the point where the frequency of infection was concentrated, a spatial analysis was performed considering the possibility of exposure to carriers in the hospital, and a local infection control space was established based on the point derived. Within the established infection control space, the likelihood of infection exposure is reduced. The frequency of infection exposure before and after establishing a controlled space for local infections was compared. As a result, the movements of nurses and visitors were highly likely to be exposed to infections in congested areas. In the hospital to be analyzed, the Middle corridor type was more likely to be exposed to infection than the double corridor type. and It may be judged that the Double corridor type should be in a space where infection prevention is centered on the nurse station and, in the case of Middle corridor type, infection exposure frequency is concentrated. Even in the form of a spatial structure that is relatively susceptible to infection, the frequency of infection exposure was reduced by applying local infection control spaces. The Paired T-test t-test showed that the mean differs under the statistical significance level before and after the application of local infection control. This could be judged that the application of a local infection control space would reduce the likelihood of exposure to infections caused by the movement of carriers in the entire space.

아동병원간호사의 병원감염관리에 대한 지식, 인지도 및 실천도

주애란,백형원 인문사회 21 2022 인문사회 21 Vol.13 No.3

아동병원간호사의 병원감염관리에 대한 지식, 인지도 및 실천도주 애 란*ㆍ백 형 원** 요약: 본 연구는 아동병원간호사의 병원감염관리에 대한 지식, 인지도 및 실천도를 파악하여 이를 근거로 병원감염관리 교육프로그램 개발을 위한 기초자료를 제시하기 위해 시도된 서술적 상관관계 조사연구이다. 연구 결과, 아동병원간호사의 병원감염관리 인지도와 실천도의 관계가 양의 상관관계를 나타내므로 현재보다 감염관리에 대한 인지도와 실천도를 높일 수 있도록 병원감염 예방을 위한 전문화된 감염관리 교육이 정기적으로 필요하겠다. 향후 본 연구는 신규간호사 교육프로그램에서 손씻기 영역을 강화하고, 중견급 간호사 외 간호인력, 환자와 보호자를 대상으로 하는 포괄적인 병원감염관리 교육프로그램 개발에 기초자료로 활용될 것으로 기대된다. 핵심어: 아동병원간호사, 지식, 인지도, 실천도, 병원감염관리 □ 접수일: 2022년 5월 11일, 수정일: 2022년 6월 10일, 게재확정일: 2022년 6월 20일* 주저자, 서영대학교 간호학과 교수(First Author, Professor, Seoyeong Univ., Email: jgorae@daum.net)** 교신저자, 인천재능대학교 보건의료행정과 교수(Corresponding Author, Professor, Incheon Jaeneung Univ., Email: canreg@daum.net) Correlations Among Knowledge, Awareness, and Performanceof the Hospital Infection Control in Children’s Hospital NursesAeran Joo & Hyungwon Baek Abstract: This study is a descriptive correlation research study attempted for the development of hospital infection control education programs based on the knowledge, awareness, and practice of nurses at children’s hospital. The results of this study reveal that awareness was related to practice of hospital infection control among nurses at children’s hospital. Therefore, it is necessary to regularly provide opportunities for practical education and develop relevant programs to improve the performance of hospital infection control. This study is expected to be used as basic data to strengthen the hand washing area in the new nurse education program and to develop a comprehensive hospital infection control education program for nursing personnel, patients and caregivers other than mid-level nurses. Key Words: Hospital, Nurses/Pediatric, Health Knowledge/Attitudes/Practice, Awareness, Cross Infection/Prevention & control

신생아 병원감염에 관한 의료과실의 판단과 무과실 보상에 관한 고찰

백경희(Baek, Kyoung Hee) 부산대학교 법학연구소 2018 법학연구 Vol.59 No.2

신생아 병원감염은 의료적 차원과 사회복지 차원에서 여러 가지 특수성이 있다. 먼저 의료적 차원에서, 신생아 병원감염은 병원관리에 해당하는 병원감염 사례의 하나로 파악해야 하고, ‘신생아’의 특성상 면역력이 취약하고 성인과 달리 ‘소아과’라는 전문 영역에서 진료를 받게 된다. 다음으로 사회복지 차원에서 우리나라와 같은 심각한 저출산현상을 겪고 있는 상황에서는, 출산 장려에 못지 않게 태어난 아이들이 건강하게 자랄 수 있도록 하는 소아 건강 문제의 일환으로, 신생아 관리는 국가적인 문제가 되고 있다. 전자의 특수성은 신생아 병원감염에 있어서 의료과실이나 인과관계의 유무를 판단함에 있어서도 발현된다. 후자의 특수성은 분만 사고에 대한 무과실 보상이 법제화된 것처럼, 신생아에게 발생한 병원감염 사고에 대하여도 이러한 제도를 확장하여 적용할 수 있는지의 논의가 제기된다. 신생아 병원감염과 관련하여 의료진의 의료과실이 있는 경우 신생아에게 발생한 악결과에 대하여 의료진 측에서 과실책임을 부담하게 되는 것은 당연하다. 그러나 만약 신생아 병원감염에 대하여 의료진의 의료과실이 없다고 밝혀질 경우에 그 악결과를 온전히 신생아 측이 부담하도록 하는 것은 사회적 인식에도 부합하지 않는다. 따라서 현행 의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률에서의 의료사고 보상사업의 대상으로 무과실의 신생아 병원감염 사고를 포섭할 필요가 있다. The Neonatal hospital acquired infection has various characteristics in terms of medical and social welfare. First, in terms of medical care, neonatal hospital acquired infection must be identified as one of the hospital acquired infection cases that correspond to hospital management. Unlike adults, ‘newborn’ has weak immunity and receives treatment in the specialty area of ‘pediatrics’. Secondly, in the social welfare period, in the age of low fertility such as Korea, the neonatal care is becoming a national problem as a part of the child health problem that enables the children born as well as the birth incentives to grow healthy. The peculiarity of the former is also manifested in judging whether there is medical malpractice or causality in neonatal hospital acquired infection. The latter is argued as to whether the system can be expanded and applied to hospital acquired infections caused by neonatal infections. In the case of a medical malpractice of medical staff related to neonatal hospital acquired infection, it is natural that the medical staff will be liable for the negligent consequences of the infant. However, if a neonatal hospital acquired infection is found to be free of medical malpractice, it is not in line with social awareness to ensure that the neonatal side is fully responsible for the consequences. Therefore, it is necessary to include neonatal hospital acquired infection of no fault liability as a target of the The Medical Accident Compensation System under The Act of Medical Malpractice Damage’s Relief and Mediation for Medical Dispute Resolution.

Factors Affecting the Performance of Healthcare-Associated Infections (HAIs) control - Focus on Empowerment and Awareness of General Hospital Nurses

Jeoung-Mi Kim,Young-In Han 국제문화기술진흥원 2019 International Journal of Advanced Culture Technolo Vol.7 No.3

The aims of the study to investigate the relationship between awareness, empowerment and performance of healthcare associated infections (HAIs) control and to identify factors influencing performance of HAIs among general hospital nurses. Data were collected from 230 nurses in two general hospitals in B city, with the questionnaire of an empowerment, awareness and performance of infection control tool. The data were analyzed by t-test, one-way ANOVA, Pearson's correlation coefficient and multiple regressions. The performance of infection control was significantly correlated with empowerment and awareness of infection control. The empowerment had a positive correlation with an awareness of infection control (r= .233, p <.001) respectively. The infection control performance was influenced by infection control awareness, empowerment and number of annual job training, which explained 42.2% of the performance of infection control. Infection management performance of general hospitals nurses is affected not only by infection awareness but also by empowerment and job education. Therefore, it suggests that HAIs management program could develop for the nurses and provide empowerment with job training to improve the management and performance of HAIs, also to reinforce via constant support by the hospital.