加護中心院內感染調查分析-以屏東某區域醫院為例

Inspection Analysis of Infection Intensive Care Unit-A Reginal Hospital In Pingtang Taken For Example

鄞甄嫻(Jen-Shian Yin)

指導教授 ： 劉湘川

亞洲大學/資訊學院/生物資訊學系碩士在職專班/碩士(2009年)

摘要

本研究將收集南部某區域教學醫院加護中心住院病患資料進行研究，欲透過對感染資料的記載、分析來掌握發生的實際狀況，期望從資料庫進行挖掘與分析，去發現該醫院加護中心感染的趨勢，進行探討該院2006年-2008年間加護中心院內感染發生率、發生部位分布、菌種分佈情形、院內感染人口學分佈、院內感染個案特性及感染發生之關聯探討為研究目的，本研究架構是以感染鏈為基礎、以人為中心的院內感染管制模式進行探討，使了解該院加護中心病患院內感染發生的情形及分佈狀態，並對病患特性進行探討歸納。研究工具以該院感染管制小組的院內感染控制報表之院內感染個案之病患資料為主。資料分析方法：以描述性統計探討2006年至2008年各年度該院院內感染之感染發生率、感染發生密度、佔床率、感染部位、感染菌種之變化趨勢。院內感染之科別、性別、年紀、多重導管與泌尿道感染、血流感染、呼吸道感染等進行卡方檢定分析、獨立樣本t檢定、關聯量數、對稱性量數檢定。研究結果得知：1.該院2006年至2008年內科加護中心平均感染發生密度是7.07‰，感染發生率是3.54%；外科加護中心平均感染發生率是7.96‰，感染發生率是3.80%，研判可能與病患特性、醫院規模、加護病房規模、護理主管及醫護人員對院內感染的關心度等條件不相同而有所不同。2.加護中心院內感染發生部位以泌尿道感染為首，其次為血流感染或呼吸道感染為二、三名。3. 院內感染部位菌種之分布：2006-2008三年來內科及外科加護中心感染菌種均以黴菌（Candida albicans）之感染為首位，其菌種的分佈在內科加護中心有Klebsiella pneumoniae、Escherichia coli、Staphylococcus aureus(ORSA)、Pseudomonas aeruginosa；在外科加護病房中尚有Escherichia coli、Staphylococcus aureus(ORSA)、Klebsiella pneumoniae、Acinetobacter baumannii（MDR-AB）。4.加護中心病患特性得知該院院內感染病患的平均年齡層74.62-76.05歲。內科加護中心與外科加護中心院內感染個案的均以女性泌尿道感染高於男性且依年紀的不同而有顯著的差異。5. 院內感染個案特性及感染發生之關聯探討結果得知：（1.）「多重導管」與「年紀」有顯著關係。（2.）血流感染在科別與年紀均有顯著的不同，表示血流感染在科別與年紀有某種關聯程度存在。（3.）呼吸道感染在科別與多重管路均有顯著的不同，表示呼吸道感染在科別與多重導管有某種關聯程度存在。（4.）泌尿道感染在性別與年紀均有顯著的不同，表示泌尿道感染在性別與年紀有某種關聯程度存在。

關鍵字

院內感染 ； 加護中心

並列摘要

With collected patients’ data at the intense care unit of regional education hospital in the south, this research is intended to comprehend actual circumstances through documenting and analyzing infection records. By exploiting and analyzing the data archive, this research expects to discover the formation of the infection at this hospital’s intense care unit and is purposed with discussing domestic infection rate, occurrence distribution, fungus species distribution domestic infection demography, domestic individual infection property and relevancies among infections from 2006 to 2008. The research is framed by domestic infection control system, which is based on infection chain and centralized by individuals, to progress the exploration and gain a complete picture of domestic infection occurrence and distribution as well as conclude patients’ characteristics. The tool capitalized is patients’ record of domestic individual infection case of domestic infection control reports within the hospital’s infection control group. The approaches of data analysis are: Descriptive Statistics to discuss infection rate, infection density, bed occupation rate, infected parts and infecting bacterium species of domestic infection annually from 2006 to 2008, and Chi-Square Test, Independent Sample T Test, Measures of Association, Symmetric Measures to analyze departments, genders, ages, multiple catheters and urethra infection, blood infection and respiratory passage infection, etc of domestic infection.
The result has shown: 1. From 2006 to 2008, the medical intense care unit had a infection density of 7.07‰ and 3.54％ with infection rate while 7.96‰ of infection density and 3.80％ of infection rate with its surgical intense care unit. It reasons that the figures varies according to patients’ characteristics, hospital scales, intense care unit scales, nursing supervisors and the levels on which staff responses to domestic infection. 2. The most common infection part is urethra, followed by blood infection and respiratory passage infection.3. Bacterium species distribution of domestic infection: the infection of Candida albicans tops the chart at both medical and surgical intense care unit from 2006 to 2008, with species of Klebsiella pneumoniae、Escherichia coli、Staphylococcus aureus(ORSA) 、Acinetobracter baumannii in medical intense care unit and Escherichia coli、Staphylococcus aureus(ORSA) 、 Klebsiella pneumoniae、Acinetobracter baumannii(MDR-AB) in surgical intense care unit. 4. The domestically infected patients have a average age of 74.62-76.05. Case study from both medical and surgical intense care unit has shown that women have a higher rate of urethra infections than men and it differs over ages. 5. The exploration of relations between domestic infection individual cases and infection occurrences: (1) Multiple catheters have a profound link with age. (2) Blood infection diverges based on departments and ages, which points out blood infection connects with departments and ages at levels.(3) Respiratory infection presents variously with departments and multiple catheters, which means respiratory infection is related to departments and multiple catheters at levels. (4) Urethra infection shows differences over ages and genders, which bolsters urethra infection is related with ages and genders at levels.

並列關鍵字

hospital’s infection ； Intense care unit

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