安寧病房院內感染－北部某醫學中心十年經驗

Nosocomial Infections at a Hospice in a Medical Center: A 10-year Experience

蘇世強(Shey-Chiang Su)；林哲玲(Che-Ling Lin)；王淑芬(Sheu-Fen Wang)；曲佩芬(Pen-Fen Chi)；葉淑真(Shu-Chen Yeh)；姜秀子(Hsiu-Tzy Chiang)；李聰明(Chun-Ming Lee)

安寧病房 ； 院內感染 ； hospice ； nosocomial infection

院內感染控制雜誌

12卷2期（2002 / 04 / 01）

87 - 94

繁體中文

安寧病房（Hospice）是為了照顧面臨生命末期的病患所成立的照護單位，一般而言是以癌症病人居多，雖然照護的宗旨是讓病患儘量減少痛苦及侵入性治療，但因為病患本身疾病所造成的抵抗力低下，無可避免的會遭受感染性疾病的威脅。北部某醫學中心於1990年成立了安寧病房，基於該等病房及病患照護的特殊性，為了瞭解其院內感染的情況，因此收集該病房成立十年來（1990-1999）之院內感染資料，加以整理分析。1990年至1993年期間，平均發生率為3.93%，而1994年至伯99年間的平均發生密度為2.73‰，感染率類似一般病房，而遠低於加護病房。感染部位則以泌尿道感染居首（3.7%），其次為血流感染（33.1%），二者佔所有感染部位的四分之三。感染菌種多達30種，其中最常見為Escherichia coli（28.2%），其次為Pseudomonas aeruginosa（18.3%），第三為Staphylococcus aureus（13.4%），而MRSA和MSSA約各佔一半。共有29人次（20.4%）感染是屬於多重菌種感染，其中泌尿道感染佔15人次。經分析發現，最常發生院內感染的時間是住院後3週內，其中尿管留置及病患本身抵抗力的低下，是造成安寧病房院內感染的主因。

The hospice unit in a hospital provides specialized care to patients who are in the final stage of diseases. They are mostly terminal cancer patients, and are invariably immunocompromized. The patients are given palliative therapy only and invasive procedures or treatment are avoided. Few studies of infection control and surveillance have been reported in these special wards. Mackay Memorial Hospital in Taipei set up the first hospice unit in Taiwan in 1990. We here report the result of our surveillance data obtained from 1990 to 1999 retrospectively at these wards. One hundred forty-two nosocomially infected patients were enrolled in the study. The median annual infection rate was 3.93% between 1990 and 1993, and was 2.73% between 1994 and 1999. These numbers were much lower than that of ICU. Urinary tract infections (UTIs) (43.7%) and bacteremias (33.1%) accounted for 3 quarters of all the infections. The most common organisms isolated were Escherichia coli (28.2%), Pseudomonas aeruginosa (18.3%), and Staphylococcus aureus (13.4%) . Polymicrobial infections were found in 29 (20.4%) episodes, and it occurred in 15 UTI patients. Most of the infections occurred during the first 3 weeks of hospitalization. Urinary catheter installation and patients¡¦ underlying diseases were the main causes for the development of the nosocomial infections in this study.

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