加護病房院內感染指標—影響呼吸器相關肺炎感染因素之探討

Study on Factors for Ventilator-Associated Pneumonia in Intensive Care Unit

吳肖琪(Shiao-Chi Wu) ； 陳啟禎(Chi-Chen Chen)

《台灣公共衛生雜誌》 23卷6期 (2004/12) Pp. 440-446

https://doi.org/10.6288/TJPH2004-23-06-03

摘要

利用全國健保申報住診次級資料，探討加護病房呼吸器相關肺炎(Ventilator-Associated Pneumonia, VAP)感染情形及相關因素。方法：以民國88年健保申報曾住加謢病房且使用呼吸器病患屬研究對象，以選輯斯迴歸分析其VAP感染情形與病患特質(性別、年齡、加謢病房住院天數及是否患有慢性肺部疾病)及醫院特質(權屬別、評鑑層級、總床數及加謢病房床數)間關聯性。結果：在加護病房裝置呼吸器共計申報有76,979人次，其中2,952人次爲VAP感染，感染機率爲3.53%。在病患特質中，男性(AOR,1.27;95% CI,1.17-1.38)、年齡愈大(25-44歲[AOR,1.56;95% CI,1.20-2.02], 45-64歲[AOR,1.56;95% CI,1.54-2.25],65歲以上[AOR, 2.72;95% CI,2.28-3.26 ]之VAP感染機率顯著較高；加護病房住院天數愈長(3-5天[AOR,1.91;95% CI,1.63-2.241,6-1天[AoR,4.14;95% CI,3.61-4.76], 14天以上[AOR,7.25;95% CI,6.37-8.29])與VAP感染機率有關；在髻院特質中，私立(AOR,1.67;95% CI,1.51-1.54)、評鑑層級愈低(區域醫院[AOR,2.26;95% CI,2.03-2.51], 地區教學醫院[AOR,3.15;95% CI,2.51-3.61]，地區醫院[AOR,5.54;95% CI,5.16-6.60)之醫院VAP感染機率顯著較高。結論：衛生主管機關可利用健保申報次級資料，監控加護病房VAP感染情形，並針對加護病房VAP感染相關因素，作進一步預防措施。

關鍵字

呼吸器豐關肺炎感染 ； 加謢病房 ； 院內感染

並列摘要

Using claimed data from National Health Insurance (NHI) to identify factors associated with the development of ventilator-associated pneumonia (VAP). Method: Insured patients, who received mechanical ventilation in the Intensive Care Unit (ICU) in 1999, were analyzed in this study. The relationship among VAP, patients＇ characteristics (such as sex, age, history of chronic obstructive pulmonary disease (COPD), and length of stay of ICU) and the characteristics of hospitals (such as ownership, accredited, number of general and ICU beds) were analyzed by logistic regression. Results:　There was 2952 of 76979 (3.83%) patients who developed VAP during hospitalization in ICU. The infectious rate of VAP was significantly higher in male (adjusted odds rate (AOR) 1.27, 95% CI 1.17-1.38) and elder patients (AOR of 25-44 years old was 1.56, 95% confidence interval (95% CI) was 1.20-2.02; AOR of 45-64 years old was 1.86, 95% CI was 1.54-2.25; AOR of above 65 years old was 2.72, 95% CI was 2.28-3.26). The rate of VAP was related to the longer length of stay in ICU (AOR of 3-5 days in ICU was 1.91, 95% CI was 1.63-2.24; AOR of 6-13 days in ICU was 4.14, 95% CI was 3.61-4.76; AOR of over l4days in ICU was 7.25, 95%CI was 6.37-8.29). The rate of VAP was higher in private hospitals (AOR 1.67, 95% CI 1.51-1.84). Compared with teaching hospitals, the lower hospital accreditation level was assoicated with a higher rate of VAP (AOR of regional hospitals was 2.26, 95% CI 2.03-2.51; AOR of district teaching hospitals was 3.18, 95% CI 2.81-3.61; AOR of district hospitals was 5.84, 95% CI 5.16-6.60). Conclusion: The claimed data from NHI can be used for monitoring the condition of VAP in ICU patients by the governmental institute in order to construct policy to prevent further VAP.

並列關鍵字

ventilator-associated pneumonia ； intensive care unit ； nosocomial infection

參考文獻

財團法人醫院評鑑暨醫療品質策進會網站

Cadwallader HL,Toohey M,Linton S,Dyson A,Riley TV(2001).(A comparison of two methods for identifying surgical site infections following orthopaedic surgery).

Cook DJ(1998).(Kollef MR. Risk factors for ICUacquired pneumonia).

de Irala-Estevez J,Martinez-Concha D,Diaz-Molina C,Masa-Calles J,Serrano del Castillo A,Fernandez-Crehuet Navajas R(2001).(Comparison of different methodological approaches to identify risk factors of nosocomial infection in intensive care units).

George DL(1995).Epidemiology of nosocomial pneumonia in intensive care unit patients.Clin Chest Med.