某教學醫院外科加護病房2005至2008年間院內感染相關因素探討

Factors of Nosocomial Infection in a Teaching Hospital Surgical Intensive Care Unit Between2005 and 2008

楊淑溫(Shu-Wen Yang) ； 鍾玉珠(Yu-Chu Chung) ； 張秀雯(Hsiu-Wen Chang) ； 陳應盛(Ying-Sheng Chen) ； 陳梓泓(Tzu-Hung Chen)

《台灣醫學》 15卷6期 (2011/11) Pp. 585-592

https://doi.org/10.6320/FJM.2011.15(6).02

摘要

本研究目的乃探討某教學醫院外科加護病房院內感染及其影響因素。採前瞻性研究設計，由感染控制師自2005年1月1日至2008年12月31日，依美國疾病管制局於1988年所提出之院內感染定義，收集外科加護病房病患資料及監測院內感染之資料加以統計分析。外科加護病房四年住院人次總共2175人次，總住院人日數為13263人日，院內感染人數為71人，共有81人次感染部位，感染發生密度為千分之6.11、院內感染率平均為3.7%。最主要院內感染部位為呼吸道感染（42.0%），其次為血流感染（23.4%）和泌尿道（17.3%）。最常見菌株前三名依序為Pseudomonas aeruginosa （25.6%）、Candida albicans （19.2%）、methicillin-resistant Staphylococcus aureus（14.1%）。經邏輯斯迴歸分析發現「外科加護病房住院天數6天以上」（OR=47.04，95%CI=11.44～192.40）、「入住外科加護病房24時APACHE II：15分以上」（OR=2.00，95% CI=1.07～3.74）變項為預測外科加護病房院內感染之重要因素。本研究結果可提供外科加護病房護理人員了解院內感染之流行病學概況以及危險因子。

關鍵字

外科加護病房 ； 院內感染

並列摘要

The purpose of this prospective study was to investigate nosocomial infection and its related factors in the surgical intensive care unit (SICU) at a regional hospital. Surveillance data on nosocomial infection in the SICU from Jan. 1, 2005 to Dec. 31, 2008 was collected by infection control nurse. Relevant clinical data was also collected at the same time. During the study period, there were 2,175 patients admitted to the SICU. The total number of patient-days was 13,263. Seventy-one patients acquired a total of 81 nosocomial infections with the incidence density of 6.11 per 1000 patient-days and accounting for a cumulative incidence of 3.7%. The most common nosocomial infection site in SICU was respiratory tract (42.0%), followed by the blood stream (23.4%), and urinary tract (17.3%). The top three pathogens were Pseudomonas aeruginosa (25.6%), Candida albicans (19.2%), methicillin-resistant Staphylococcus aureus (14.1%). Logistic regression analysis found that staying in SICU for 6 or more days (OR=47.04, 95% CI=11.44~192.40), and an APACHE II score (OR=2.00, 95% CI=1.07~3.74) evaluated at 24 hours after ICU admission being equal to or more than 15 points were independent risk factors for nosocomial infection in SICU. The results of this study can help nurses in the SICU to understand the current epidemiology of and risk factors for nosocomial infection.

並列關鍵字

surgical intensive care unit ； nosocomial infection