某內科加護病房搬遷前後呼吸器相關肺炎之比較分析

Comparison of the Incidence of Ventilator-associated Pneumonia before and after the Relocation of a Medical Intensive Care Unit

梁素琴(Su-Chin Liang) ； 戴玫瑰(Mei-Guei Dai) ； 黃敏瑢(Min-Jung Huang)

《感染控制雜誌》 15卷3期 (2005/06) Pp. 137-145

https://doi.org/10.6526/ICJ.200506_15(3).0001

摘要

加護病房是提供重症病患特殊醫療照護的獨立單位，呼吸器使用成爲重症病患照顧不可或缺的一部份。91年8月起某內科加護病房呼吸器相關肺炎之感染率，有逐漸增高的趨勢，其後病房搬遷，故擬對搬遷前、後可能影響加護病房呼吸器相關肺炎發生偏高之因子作初步分析，以作改善的參考依據。本研究收集91年7月至92年12月，使用呼吸器而發生呼吸道相關肺炎個案，並將92年3月前的個案定義爲搬遷前，92年4月至12月定爲搬遷後，兩組進行資料分析。結果顯示，搬遷前呼吸器相關肺炎感染率爲8.00‰（25人次），搬遷後爲7.27‰（21人次），呼吸器使用率方面，分別爲82.9%、78.5%，搬遷前後感染率與使用率皆無顯著差異。搬遷前最主要的感染菌種爲Acinetobacter baumannii (24.0%)、搬遷後A. baumannii則降爲4.8%。推論因搬遷而造成的環境改變因素，例如床數、坪數、空間配置等及對於該內科加護病房呼吸器相關肺炎感染率之影響並不顯著，但搬遷後的硬體設備、動線設計及環境清潔，皆有利於避免因交叉感染的傳播，且工作人員的行爲有可能因環境的變更而改變，故變更環境是重新架構系統性感控制度及工作人員行爲改變良好的契機。建議應深入瞭解工作人員執行各項技術時的流程，落實確實而正確的感染控制措施。

關鍵字

呼吸器相關肺炎 ； 加護病房 ； 環境因素

並列摘要

We studied factors possibly related to the incidence of the ventilator-associated pneumonia (VAP) in a medical intensive care unit (MICU) before and after its relocation. We collected data of the YAP patients over 7 months from July, 2002 till March, 2003, as ”after the relocation”. Before and after the change of the ICU into a new place, the bed numbers were both 14, the bed occupancy rates were both higher than 98%, and there were little change in ICU personnel. The space allocated for each bed became larger; and there were sinks for hand-washing for each bed, and partitions between beds in the new ICU. Infection densities in the old and the new ICU were 8.00‰(25 cases) and 7.27‰(21 cases), respectively, and the frequencies of the use of the ventilator were 82.9% and 78.5%, respectively. These differences were statistically not significant. Age, sex, length of stay in the ICU, conditions (APACHE score) before and after the relocation, and diagnosis of patients who had VAP were essentially the same statistically. The most common pathogen before the move was Acinetobacter baumannii (24.0%), and the frequency of A. baumannii isolation dropped to 4.8% in the new ICU. The addition of sinks, partitioning between beds, and larger space for each bed in the new ICU might have lessened cross contamination between cases. The behavior of personnel could also have changed because of the new environment. These might explain the drop in the incidence of the A. baumannii isolation. Environmental cultures and surveillance cultures of the personnel before and after the relocation might have produced some pertinent information for the change in the A. baumannii isolation from these patients.

並列關鍵字

Ventilator-associated pneumonia ； ICU ； environmental factor