의료기관 종사자의 손 위생 수행 분석

오향순(Oh, Hyang Soon) 한국산학기술학회 2015 한국산학기술학회논문지 Vol.16 No.9

의료기관 종사자의 손 위생 수행은 의료관련 감염의 전파를 예방하는 가장 효과적인 방법이다. 본 연구는 직종별 손 위생 수행 측정과 분석을 위해 세계보건기구(WHO)의 손 위생 수행 평가도구를 이용한 직접관찰방법으로 2010년 10월 25일부터 12월 31일까지 수행되었으며, SPSS 21.0으로 기술분석, 교차분석, 다중로지스틱분석을 하였다. 총 8,644 건의 손 위생 상황이 관찰되었고, 손 위생 수행률은 94.1%였으며 의사가 가장 낮았다(83.3%; OR:0.209, 95%CI:0.174-0.252). 직종별 수행률(p<0.001), WHO에서 권고하는 5개 상황(WHO’s 5Moments)별 수행률은(p<0.001) 유의한 차이를 보였으며. 간호사 (p=0.003)와 의료기사직(p<0.001)이었다. 본 연구결과 손 위생 수행률 향상을 위한 직종별 특성화된 손 위생 전략과 WHO‘s 5Moments에 따라 차별화된 전략 개발이 필요할 것으로 사료된다. Hand hygiene(HH)of the health care personnels(HCPs) was the most effective method to prevent the transmission of healthcare associated infections. This study was conducted to measure and analysis the status of the HH compliance of HCPs. Data were collected by the direct observation methods of the World Health Organizations(WHO) using WHO’s HH monitoring tool kits from 25th October to 31th December, 2010. Data were analyzed by descriptive statistics, cross analysis, multiple logistic analysis using the SPSS/PC 21 program. A total of 8,644 opportunities for HH were observed, and the overall HH compliance rate was 94.1%. HH rates of physicians was lowest(83.4%; OR: 0.209, 95%CI:0.174-0.252). HH rates were statistically different by the job titles(p<0.001), WHO’s 5 moments(p<0.001). HH rates in registered nurses(p=0.003), and medical technicians(p<0.001) were statistically different by the WHO 5Moments. Jobs specific HH strategies and WHO 5Moments should be developed to increase the HH compliances of the HCPs.

소아병원 종사자의 손 위생 수행

오향순 ( Hyang Soon Oh ) 대한소아감염학회 2015 Pediatric Infection and Vaccine Vol.22 No.3

목적: 소아병원 의료기관 종사자들의 손 위생 수행률을 계량화하고 분석함으로써 소아병원 종사자의 손 위생 수행실태에 대한 기본 자료를 구축하고자 수행되었다. 방법: 3차 의료기관이며 대학병원인 313병상 소아병원의 533명 직원을 대상으로 WHO 손 위생 모니터링 도구로 2010년도 11월 1일부터 12월 31일까지 직접관찰법으로 자료를 수집하였다. 결과: 총 관찰건수 2,999으로, 손 위생 수행률은 95.3%였고, 직종별로 간호사(97.7%), 의사(89.2%), 이송직(72.1%) (P <0.001), 부서별로 중환자실(92.5%), 외래(95.4%), 응급실(97.2%), 수술실(97.2%)이었으며(P <0.001), 의사직급별로 전임의(97.5%), 교수(93.9%), 전공의(89.7%), 인턴(80.9%)이었다(P < 0.001). 손 마찰(81.1%)을 많이 사용하였고, 손 씻기는 ‘환자 체액 노출 후’ (37.7%), ‘환자 환경접촉 후’ (28.5%)에 많이 사용하였다. 손 위생 방법은 부서별로 차이가 없었으나(P =0.083), WHO 5Moments 별로 차이가 있었다(P <0.001). 직종별 WHO 5 Moments 분포는 차이가 있었다(P <0.001).손 위생 이행 odds ratio는 의사직 0.353 (95% CI, 0.241-0.519), 중환자실 0.291 (95% CI, 0.174-0.487), 외래 0.484 (95% CI, 0.281-0.834)이었다. 결론: 손 위생 수행은 직종별, 부서별로 차이가 있었다. 직종별, 부서별로 효과적인 손 위생 교육 및 훈련 프로그램 개발이 필요하다. Purpose: The aim of study was to estimate the hand hygiene (HH) compliance of healthcare workers (HCWs) in a children’s hospital. Methods: This study was conducted in a hospital which is a tertiary and educational children’s hospital with 313 beds and 533 HCWs. Data were collected by direct observation methods from November 1, 2010 to December 31, 2010. Results: A total of 2,999 opportunities for HH were observed, and the overall HH rate was 95.3%. HH rate of the registered nurse, physicians and transferer was 97.7%, 89.2%, and 72.1%, respectively (P <0.001). Among physicians, HH rate of the fellows, professors, residents and interns was 97.5%, 93.9%, 89.7%, and 80.9%, respectively (P <0.001). HH rate in the emergency room, operation room, outpatient department (OPD), and the intensive care unit (ICU) was 97.2%, 97.2%, 95.4%, and 92.5%, respectively (P <0.001). Hand rubbing was the most frequently used (81.1%), and hand washing was frequently used in the case of ‘after body fluids exposure risk’ (37.7%) and ‘after touching patient surroundings’ (28.5%). HH methods were not statistically different from each departments (P =0.083), however, they were significantly different according to the World Health Organization (WHO) 5 Moments (P <0.001). Distributions in WHO 5 Moments by the job titles were significantly different (P <0.001). The odds ratio of physicians, ICU and OPD was 0.353 (95% CI, 0.241-0.519), 0.291 (95% CI, 0.174-0.487), and 0.484 (95% CI, 0.281-0.834), respectively. Conclusions: Compliance of HH was different by the job titles and departments. Effective custom-tailored HH programs for each job title and department need to be developed.

보건의료 교육기관에서 생물테러 관련 교육 현황조사 및 학습목표 개발

이하경,천병철,이성은,오향순,왕순주,김지희,손장욱,Lee, Ha-Gyung,Chun, Byung-Chul,Yi, Sung-Eun,Oh, Hyang-Soon,Wang, Sun-Ju,Kim, Jee-Hee,Sohn, Jang-Wook 대한예방의학회 2008 예방의학회지 Vol.41 No.4

Objectives: Bioterrorism (BT) preparedness and response plans are particularly important among healthcare workers who will be among the first involved in the outbreak situations. This study was conducted to evaluate the current status of education for BT preparedness and response in health care-related colleges/junior colleges and to develop learning objectives for use in their regular curricula. Methods: We surveyed all medical colleges/schools, colleges/junior colleges that train nurses, emergency medical technicians or clinical pathologists, and 10% (randomly selected) of them that train general hygienists in Korea. The survey was conducted via mail from March to July of 2007. We surveyed 35 experts to determine if there was a consensus of learning objectives among healthcare workers. Results: Only 31.3% of medical colleges/schools and 13.3% of nursing colleges/junior colleges had education programs that included BT preparedness and responses in their curricula. The most common reason given for the lack of BT educational programs was 'There is not much need for education regarding BT preparedness and response in Korea'. None of the colleges/junior colleges that train clinical pathologists, or general hygienists had an education program for BT response. After evaluating the expert opinions, we developed individual learning objectives designed specifically for educational institutions. Conclusions: There were only a few colleges/junior colleges that enforce the requirement to provide education for BT preparedness and response in curricula. It is necessary to raise the perception of BT preparedness and response to induce the schools to provide such programs.

여성에서 소변채집방법에 따른 소변검체의 오염율 비교

정인숙(Jeong Ihn Sook),양만길(Yang Man Gil),오향순(Oh Hyang Soon) 기본간호학회 1999 기본간호학회지 Vol.6 No.3

메티실린 내성 황색 포도구균 유행발생시 병원직원에 대한 보균자 실태 및 유행차단효과 연구

오향순,이성은,김의종,이환종,오명돈,최강원 대한감염학회 2001 감염 Vol.33 No.3

Background : Methicillin-resistant Staphylococcus aureus (MRSA) is the major pathogen of nosocomial infections. There are many reports that MRSA nasal cariers play a major role in the transmission of MRSA. We studied to assess the nasal carriage rates, therapeutic effects of nasal carriers and control of MRSA outbreak in a tertiary, acute and educational hospital. Methods : From 1990 to 1997, eight MRSA epidemics were detected and investigated for outbreak control. We surveyed the MRSA colonization of anterior nares and hands of health care workers (HCW). MRSA was identified by staphylococcal broth, mannitol-salt-agar, Muller-Hinton-oxacillin agar. To identify the permanent carriers in the HCWs, the nasal swab was done weekly for 3 weeks. Two percent povidone iodine ointment or 2% mupirocin ointment was applied topically to treat the permanent MRSA nasal carriers. Results : Of eight MRSA outbreaks, five epidemics occured in the intensive care unit, all of them occurred in surgical departments and five of them occurred in winter seasons. For eight MRSA outbreaks, 351 HCWs were surveyed. The rates of transient carriers was 10.8% (38/351) and the rates of that were 9.0% (10/111) in medical doctors (MD), 12.5% (24/192) in registered nurses (RN) and 11.4% (4/35) in aid nurses (P=0.470). The rate of permanent carrier in doctors was 1.8%, and that in RNs was 3.7% (P=0.490). After topical therapy with 2% povidone iodine ointment or 2% mupirocin ointment for permanent carriers, MRSA was not identified for 2 months follow up. Conclusion : In MRSA epidemics, the rate of the transient carrier rate of MRSA in HCWs was 10.8% and the rate of the permanent carrier was 2.6%. The difference of carrier rates in HCWs was not significant statistically. The therapy for the permanent nasal carriers in HCWs with two percent povidone iodine ointment or 2% mupirocin ointment was very effective. And MRSA outbreaks were ended and controlled for 6months follow up. (Korean J Infect Dis 33: 194∼201, 2001)

1개 大學病院의 外科에서 발생한 수술후창상 감염의 疫學的 特性 및 費用分析에 관한 연구

吳香順,金貞順 서울大學校保健大學院 1994 國民保健硏究所硏究論叢 Vol.4 No.1

Post-operative wound infections are still major problems to mortality and morbidity of the patients inspite of the improvement of medical technologies. Because of post-operative wound infections, the hospital stay became longer along with increased hospital cost. In order to study the epidemiologic characteristics of post-operative wound infection and it's health and economic impacts, the date were collected in an university hospital from July 20 to October 16, 1992. The results obtained are as follows: 1. The incidence rate of POW (Post-operative wound) infection by sex was 11.1% in man and 9.0% in woman (p= .097). The incidence rate of POW infection was varied by age: it was 16.4% among forties, 12.5% in teenages and 12.5% twenties (p= .070). 2. The incidence rate of POW infection was 9.1% in the Clean Wound, 7.4% in the Clean-contaminated Wound, 33.3% in the Contaminated Wound and 83.3% in the Dirty Wound (p= .000). 3. The incidence rate of POW infection was 8.1% in the group medicated with 1st generation antibiotics, 14.3% in the group treated with 2nd generation antibiotics whereas it was 9.5% in the group that antibiotics was not used(p= .177). 4. The incidence rate of POW infection was 9.5% in the 1st operation. Whereas it was 25.0% and 100.0% in 2nd and 3rd operation repeatedly(= .000). 5. The incidence rate of POW infection was 6.7% in the group that operation time was 1-3 hours, 13.0% in the group that it was 4-6 hours, 16.7% in the group that it was 7-9 hours and 37.5% in the group that it was over 10 hours. 6. In the distribution of microbes isolated from infected wound, Psedomonas aeruginosa was 14.0%, E. coil 10.5% and MSSA 8.7%. 7. Because of POW infection, patients's total length of hospital stay was prolonged to 25.5% days longer (p= .0223) with additionally increased cost 1,931,450 won. 8. Because of the POW infection, an estimated additional annual cost was to be more than about 3,000,000 won, being loss of annual income of the Hospital to be more than 500,000,000 won.

병원근무자에서 홍역,풍진 및 수두 항체양성률에 관한 연구

최강원,김성민,오명돈,이환종,오향순,최희정,김남중,신형식 대한감염학회 1997 감염 Vol.29 No.1

목적: 홍역, 풍진, 및 수두의 병원감염 발생위험도를 평가하고 병원근무자 예방접종지침을 고안하는데 필요한 기초자료를 얻고자, 홍역, 풍진, 및 수두에 대한 병원근무자의 항체양성률을 조사하였다. 방법: 1995년 3월 서울대학교병원 산부인과 병동과 서울대학교 어린이병원에 근무하고 있는 여성을 대상으로 홍역, 풍진, 및 수두의 감염 과거력과 예방접종 과기력을 설문조사하였다. 정맥혈을 채혈하여 효소결합면역흡착검시(Enzyme linked immunosorbent assay, Behring ??? IgG kit)로 IgG 항체를 측정하였다. 결과: 홍역, 풍진, 및 수두에 대한 항체양성률은 각각 95.6%, 87.9%, 96.2% 이었다. 연령, 감염 과거력, 예방접종 과거력에 따른 항체양성률의 차이는 유의하지 않았다. 결론: 저자 등의 연구결과는 홍역과 수두, 특히 풍진의 병원감염 위험도가 높음을 시사하며, 각 개인의 건강과 전염병의 전파를 막기 위하여 병원근무자 예방접종지침이 필요하다. Background: To assess the risk of hospital outbreak and to guide immunization policy, seroprevalences of antibody to measles, rubella, and varicella-zoster were determined in hospital personnel. Methods: A cross-sectional study of 290 workers in Seoul National University Hospital was conducted in June 1995. IgG antibody status was determined with commercially available enzyme linked immunosorbent assay(Behring ??? IgG kit). Results: Seropositive rates of measles, rubella and varicella-zoster were 95.6%, 87.9% and 96.2%, respectively. There was no statistical difference in seropositive rate according to historical information. Conclusion: These results suggest potential for hospital outbreak of measles an varicella-zoster, especially of rubella. Immunization policy will be needed in hospital personnel.

서울대학교병원에 입원한 환자에서 Vancomycin 내성 장구균의 감시 및 분자역할적 조사

이선희,박상원,김홍빈,김의석,김도마,오명돈,최강원,김의종,오향순 대한감염학회 2000 감염 Vol.32 No.4