某醫學中心外科加護病房使用中心靜脈導管引起院內感染之相關因素探討

Factors related to nosocomial infection of central venous catheter in surgical intensive care unit of medical center

宋佳穎(Chia-Ying Sung)

指導教授 ： 袁素娟

中山醫學大學/醫學院/護理研究所/碩士(2005年)

https://doi.org/10.6834/CSMU.2005.00066

摘要

本研究旨在探討外科加護病房中使用中心靜脈導管之病患，發生院內感染的流行病學及相關因素。研究樣本取自中部某醫學中心，自西元2004年1月至同年12月間外科加護病房之病患，共56人。本研究採立意取樣，使用結構式調查表收集資料，所收集之個案依中心靜脈導管細菌培養結果分感染組及未感染組。其結果以SPSS 10.0 for Window統計套裝軟體分析。結果顯示：流行病學方面，中心靜脈導管總感染發生率為44.1‰。感染菌株排名，第一名是鮑氏不動桿菌(Acinetobacter baumannii)，佔30.3%，第二名是抗藥性金黃色葡萄球菌(Meticillin resistant Staphylococcus aureus; MRSA )，佔21.2%，第三名是凝固酶陰性葡萄球菌(Coagulase- negative Staphylocci)，佔15.2%。導管插入總日數，感染組為14.4±5.9天，非感染組為11.6±4.8天，在統計上具顯著差異(p< .05)；在外科加護病房住院總日數上，感染組為28.4±22.0天，非感染組為14.7±16.2天，具有統計上顯著差異(p< .001)；在使用抗生素方面， 感染組平均為5.9±3.0種，非感染組平均為4.7±2.0種，達統計上顯著差異(p<.05)。以至於中心靜脈導管院內感染之相關因素依序為：老年人 (勝算比9.1倍, p=.01)、教育程度低之患者 (勝算比0.5倍,p= .01)、使用全靜脈營養液(勝算比4.0倍, p= .02)、血液培養出現感染(勝算比11.0倍,p=.04)、住加護病房總日數越久者(勝算比1.0倍,p=.04)等。此結果可提供醫護人員未來照護中心靜脈導管插管病患之參考。

關鍵字

外科加護病房 ； 中心靜脈導管 ； 院內感染 ； 導管相關感染

並列摘要

The purpose of this study is to investigate the epidemiology and the correla- tive factors of central venous catheter (CVC) infection in surgical intensive care unit. The research samples were recruited from a medical center of middle Taiwan, who was admitted to surgical intensive care unit, from January to December, 2004. This study was a purposive sampling design and the total participants were 56 patients. According to the central venous catheter (CVC) bacilli culture results, the participants were distributed into two groups. One group included 23 non-infected patients and another group included 33 patients. Data collection was used by a questionnaire and data analysis was used by SPSS 10.0 for the Window. The results showed the incidence of central venous catheter infection was 44.1‰. For the bacterium of infection, first was Acinetobacter baumannii (30.3%), the second was Meticillin resistant Staphylococcus aureus (MRSA) (21.2%), and third was Coagulase- negative Staphylococci (15.2%). There were significant differences betweens the two groups in days of using central venous catheter (infected group 11.6±4.8 days vs. non-infected group 14.4 ± 5.9 days), in the total days of hospitalization in the surgical intensive care unit ( infected group 28.4 ± 22.0 days vs. non-infected group 14.7± 16.2 days ) and in the numbers of used antibiotics (infected group 5.9 ± 3.0. vs. non-infected group were 4.7 ± 2.0)(p < .05). The significant differences in relative factors of infections for central venous catheter (CVC) were elder above 65-year-old (odd ratio =9.1, p = .01), low education level patients (odd ratio = 0.5, p = .01), used total parenteral nutrition (odd ratio =4.0, p = .02), blood cultures positive (odd ratio =11.0, p = .04) and long term stay in surgical intensive care unit (Odd ratio 1.0, p=.04). The results of this study provide an evidence-base reference to health workers who care patients with a central venous catheter.

並列關鍵字

surgical intensive care unit ； central venous catheter ； nosocomial infection ； catheter-related infection

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