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.

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.

간호사의 병원감염관리에 대한 인지도, 수행도와 심리적 임파워먼트의 관계

정연욱,이용환,유병철 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Background : High degree of awareness and performance for nosocomial infection control are very significant prevention factor of nosocomial infection which is increasing alarmingly in recent years and one of the common cause of opportunistic infection. The aim of this study was to find out the relation between degree of nurse's awareness and performance for nosocomial infection control and their psychological empowerment as a measurement tool for feeling of achievement in their hospitals. Method : We conducted a questionnaire survey during the period from August 2006 to April 2007. Investigation subjects were 262 nurses in 4 medical centers which is located in Busan. We measured nurse's awareness, performance for nosocomial infection control and psychological empowerment with questionnaire. Data analysis was performed with descriptive analysis, t-test, ANOVA and multiple regression analysis using SPSS Win(ver 12.0k) program. Result : The mean score of nurse's awareness, performance for nosocomial infection control and psychological empowerment were 4.76 ± 0.36, 4.32 ± 0.47 and 3.54 ± 0.58, respectively. The mean scores of nurse's awareness were lower than nurse's performance in total score and all subcategories. The correlation of nurse's awareness, performance for nosocomial infection control and psychological empowerment were statistically significant. The nurse's performance of nosocomial infection control was important influential factor of their psychological empowerment. Conclusion : From the result, we can concluded that nurse's awareness level was lower than nurse's performance level and nurse's performance of nosocomial infection control was important influential factor of their psychological empowerment. Therefore, methods for improving nurse's performance level are required for effective prevention of nosocomial infection and increase their psychological empowerment level.

군병원 중환자실 병원 감염률 추이분석과 민간병원 병원감염률 및 항생제 민감성 비교

송주희 ( Ju-hee Song ),이희경 ( Hee-kyung Lee ),윤선영 ( Sun-young Yoon ),남은혜 ( Eun-hye Nam ),오유리 ( Yu-ri Oh ),이진국 ( Chin-kook Rhee ) 국군의무사령부 2011 대한군진의학학술지 Vol.42 No.1

BACKGROUND: The purpose of this study was to exam the nosocomial infection rate of intensive care unit (ICU) in military hospital and to compare with civilian hospitals and past rate in military hospital. METHODS: We retrospectively surveyed the nosocomial infection rate of ICU in Armed Forces Capital Hospital (AFCH) between 2005 to 2010. We compared infection rate with the data of Korean Nosocomial Infections Surveillance System (KONIS) and AFCH in 2000. RESULT: Total 47 cases of nosocomial infections were detected during the study period. Among them, 15 cases were pneumonia, 9 were blood stream infection, and 17 were urinary tract infection. The infection rate (2.12) was significantly lower than AFCH in 2000 (15.48, P < 0.0001) and KONIS (8.40, P < 0.0001). The rate of imipenem resistant Acinetobacter was also significantly lower than KONIS (33.3% vs 82.5%, AFCH vs KONIS; P = 0.012). CONCLUSION: The nosocomial infection rate in ICU of AFCH is significantly lower than KONIS and AFCH in 2000. Further study about the nosocomial infection rate of military hospital is needed.

Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran

Salman Khazaei,Erfan Ayubi,Ensiyeh Jenabi,Saeid Bashirian,Masud Shojaeian,Leili Tapak 한국역학회 2020 Epidemiology and Health Vol.42 No.-

OBJECTIVES: Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections. METHODS: This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models. RESULTS: In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females). CONCLUSIONS: We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

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.

뇌졸중과 동반된 병원감염

한범기,이지용,이성수,김헌주 연세대학교 원주의과대학 2000 원주의대논문집 Vol.13 No.1

Prevention of nosocomial infection using oral chlorhexidine among patients undergoing cardiac surgery: a meta-analysis

( Martin Kristoffer Ogbac ),( Jose Edzel Tamayo ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Infections namely pneumonia, urinary tract infection, and wound infection can complicate post-operative outcomes of cardiac surgeries such as percutaneous coronary intervention and coronary artery bypass grafts. These preventable complications have caused significant delay in the improvement and even death in certain patients undergoing these procedures. Oral chlorhexidine has been proven to prevent nosocomial infections particularly ventilator-associated pneumonia (VAP). Certain studies have also proved its effect on the prevention of infection among non-intubated patients. In this meta-analysis, we studied the different randomized controlled trials (RCT) comparing the effect of oral chlorhexidine in the prevention of nosocomial infections among patients undergoing cardiac surgeries. Methodology: Several published RCT about the effect of oral chlorhexidine and occurrence of nosocomial infection among patients undergoing cardiac surgeries were identified using PUBMED, MEDLINE, COCHRANE, and EMBASE. The studies included were published from 1996 to 2019. The primary outcome was the incidence of nosocomial infection. Subset analysis was also made comparing the different nosocomial infections. Results: Based on this meta-analysis, it was found that oral chlorhexidine has significantly reduced the number of nosocomial infections after cardiac surgeries. Among these infections, hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), urinary tract infection, and wound infection have lower incidence in patients treated with oral chlorhexidine although only the HAP and VAP were statistically significant. The incidence of positive culture growth was also statistically in favor with oral chlorhexidine. Discussion: Nosocomial infections are deleterious complications of post cardiac procedures that can be easily prevented. With this study, it has shown that the use of oral chlorhexidine as part of the routine regimens during cardiac surgeries can significantly prevent if not lower incidence of infection.

병원내 감염 대응을 위한 공법적 고찰 - 프랑스 사례를 중심으로 -

김지영 ( Ji-young Kim ) 한국법정책학회 2018 법과 정책연구 Vol.18 No.3

최근 병원 내에서 발생한 감염 사고가 점증하는 추세에 있어서, 사회적으로 병원내 감염에 대한 관심이 증가하고 있다. 병원내 감염은 병을 치료하기 위해 방문한 의료기관에서 이환된 감염으로, 병원내 감염사고가 발생하면, 환자의 입장에서는 국가보건의료시스템 및 의료기관에 대해 강한 불신을 가질 수밖에 없다. WHO 보고서에 따르면 연간 10% 이상의 환자에게서 병원내 감염이 나타나고, 병원내 감염에 이환된 환자의 10%는 이로 인해 사망에 이르게 된다. 즉 병원내 감염은 일부 제한적인 영역에 국한되어 나타나는 특수한 문제가 아니라, 의료기술의 발전과 인구의 고령화와 결합하여 심각한 공공 보건상 위험 요인이 되고 있다. 사안의 심각성과 중대성에도 불구하고, 이 영역에서 우리나라의 대응은 아직 초보적 단계에 머무르고 있는 것으로 판단된다. “의료법”과 “감염병의 예방 및 관리에 관한 법률”에 일부 규정이 있음에도, 여전히 국가적 차원에서 현황 파악이 제대로 이루어지지 않고 있고, 병원내 감염 문제와 관련하여 의료기관은 경영상의 곤란함을 이유로 형식적으로 대응하고 있을 뿐이다. 더구나 프랑스와 달리, 병원내 감염 사고가 발생하면, 여전히 민사법적으로 이를 해결하고 있어서, 병원내 감염에 이환된 환자의 피해 구제에 있어서 문제점을 노출시키고 있는 실정이다. 무엇보다 중요한 것은 병원내 감염의 경우에 충분히 예방하고 관리하면, 발생빈도를 현격히 낮출 수 있다는 점에서 이에 대한 구체적인 대응 체계의 마련이 필요하다 하겠다. 이러한 측면에서, 병원내 감염에 대응하기 위한 의료기관과 국가가 조직적인 체계를 구축하고 있으며, 판례를 통해 확립된, 병원내 감염에 대한 의료기관의 “결과채무로서의 안전성 의무”를 입법화 하고 있는 프랑스의 사례는 비교법적으로 충분히 검토할 만한 필요성이 있다. 특히 병원내 감염이 가지는 특수성, 즉 전문성, 밀실성, 재량성에 비추어, 병원급 의료기관의 책임을 강화하고, “국가적 연대(solidarite nationale)”에 기초한 피해의 구제를 체계화 하고 있는 프랑스의 사례는 책임법제와 피해구제를 이분화 하여 접근하고 있다는 점에서 향후 우리나라 관련 판례와 법제 발전에 유의미한 시사점을 제공해 주고 있다. Etant donne que nombreux accidents de “infections nosocomiales(IN)” se sont produits en Coree, ces incidents ont suscite la vigilance de tous. Les infections nosicomiales sont les linfections contractees dans un etablissement de sante. Si les infections nosocomiales est survenues, elles constituent une menace permanente pour le bon fonctionnement des systemes de sante et ont une incidence negative sur la qualite de la prestation des services de sante. Selon Rapport de OMS, les infections nosocomiales constituent l’un des evenements indesirables les plus courants dans la prestation de soins et un probleme de sante publique majeur ayant un impact sur la morbidite, la mortalite et la qualite de vie. A un moment, au moins 10% dans les pays en developpement contracteront au moins une IN. Ces infections constituent egalement une charge economique importante au niveau social. Cependant, un pourcentage eleve des IN peut etre evite par des mesures efficaces de prevention et de controle des infections. Les infections nosocomiales ne sont plus le probleme specifique dans le domaine limite, elles provoquent une menace de sante publique en combinaison du vieillissement de la population et le developpement medical. En depit de la gravite, la prevention et de controle est en Coree a ses debuts et imperfectionne. Si la legislation coreenne a adopte certaines dispositions, ses effectivite sont sujettes a discussion. Au niveau nationale, les donnees exhaustives n’ont pas ete recensees, au niveau hospitalier, les difficultes financieres font obstacle a la prevention des infections. De ce point de vue, on peut tirer la lecon des experiences francaises. La politique et systeme francais est en train d’orienter ses efforts sur la recherche des causes et sur les traitements adaptes aux pathologies infectieuses afin, en ameliorant les connaissances sur ce phenomene, de mieux en maîtriser l’apparition et les consequences. Par adoption de la loi n° 2002-303 du 4 mars 2002 et la loi n° 2002-1577 du 30 decembre 2002, le legislateur avait pour objectifs de simplifier les regles d'indemnisation des victimes d'infections nosocomiales. Les resultats desires semblent partiellement atteints dans la mesure où le regime legal est parvenu a trouver des compromis et solutions jusque-la non realises alors qu'il demeure encore plusieurs ordres de difficultes a resoudre.

원내감염과 그 균의 약제내성

이창,김중명,김재식 慶北大學校 醫科大學 1986 慶北醫大誌 Vol.27 No.4

1985년 1월부터 동년 12월까지 경북대학교 의과대학 부속병원에 입원한 9,116명의 환자를 대상으로 Study of Efficacy of Nosocomial Infection Control(SENIC)-project Ⅲ의 algorithm for dia-gnosing infection의 방법으로 조사하여 그 성적을 다음과 같이 요약할 수 있었다. 원내감염율은 4.8%이고, 그 건수비는 5.8이었으며, 요로감염증이 41.6%으로 가장 많았으며, 창상감염(37.6%), 폐렴(14.6%), 패혈증(6.2%) 순이었다. 수술환자의 원내감염율은 6.7%이었고, 수술환자에서는 창상감염이, 비수술환자에서는 요로감염증이 매우 많았다. 남여별 원내감염비는 2.4(남 ; 309, 여 ; 130)이었는데 남자에서는 창상감염이, 여자에서는 요로감염증이 더욱 많았다. 원내감염은 내과계 영역(1.9%)보다는 외과계 영역(7.0%)이 훨씬 많았으며, 외과계 영역에서는 정형외과가 가장 많았고(18.1%), 다음이 성형외과(11.6%), 신경외과(11.5%)등의 순서였고, 내과계 영역에서는 내과에서 가장 많았다. 감염 증후별로는 정형외과와 일반외과는 창상감염이, 신경외과는 요로감염증 등이 많았다. 도뇨관 사용의 경우 원내감염의 발생은 비사용의 경우보다 3배 가까이 많았고 특히 요로감염증이 가장 많았으며, 또 기존질환이 있는 경우에 원내감염의 발생을 그 질환별로 보면 화상(30.3%)과 만성 신부전증(22.9%)이 가장 많았다. 원내감염의 원인균 549주 중 Pseudomonas Sp. 119주, Escherichia coli 73주, Acineobacter calcoaceticus 73주, Enterobacter Sp. 43주, Serratia marcescens 41주, Proteus Sp. 23주, Klebsiella Sp. 15주, Citrobacter Sp. 8주, Staphylococcus aureus 50주, Enterococcus 39주, Staphylococcus albus 23주, β-hemolytic Streptococcus 23주, Candida Sp. 15주, Aspergillus fumigatus 4주였다. gram 음성에 속하는 원내감염균의 항생제에 대한 내성획득율 50% 이상을 보면, Escherichia coli는 cephalothin, amikacin, carbenicillin, colistin, chloramphencol이었고, Pseudomonas Sp.는 The risk of nosocomial infection in Kyungpook National University Hospital patients was investigated by bacteriologic and retrospective studies from January to December, 1985. Of the 9,116 patients screened by bed-side examination, 439(4.8%) were found to be have active nosocomial inections. The incidence of nosocomial infections by clinical types was found to be highest in urinary tract (41.6%), followed by wound of 37.6% and pneumonia of 14.2%. The least frequently encountered was sepsis of 6.2%. Certain operations and urinary catheterizations, underlying diseases such as malignancy, diabetews mellitus, chronic renal failure and burn, and categories of sex and age were found to be risk factors for nosocomial infection. When nosocomial infection was classified by hospital services, the infection was more common in surgical services than in medical measures. Of the srugical services, it was most frequently encountered in the orthopedic surgery. A total of 549 strains of nosocomial pathogens were isolated. The most frequently encountered strain was Pseudomonas species 18.9%, followed by E. coli 13.3%, Acinetobacter calcoaceticus 13.3%, Staphylococcus aureus 9.1%, Enterobacter species 7.8%, Serratia marcescens 7.5%, and Enterococci 7.1%, respeceively. The antibiotic sensitivity patterns of isolates of nosocomial pathogens showed multi-drug resistance. Almost all of gram-negative bacilli were resistant to ampicillin, cephalothin and chloramphenicol. Of which, some isolates of Pseudomons species, E. coli and Acinetobacter calcoaceticus were resistant to both aminoglycosides and ce[phalosporins. The isolates of gram-positive cocci were resistant to penicillin G, moxalactam, amikacin, erythromycin, clindamycin and lincomycin. The isolation rate for methicillin resistant Staphylococcus aureus was 60%, amikacin resistant 54%, and β-lactam and aminoglycoside resistant 48%, respectively.