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研究生:臧麗琳
研究生(外文):Li-Lin Tsang
論文名稱:台灣地區護理之家院內感染管制現況及相關危險因子探討
論文名稱(外文):Current status and risk factors of nosocomical infection among nursing homes in Taiwan
指導教授:黃璉華黃璉華引用關係
指導教授(外文):Lian-Hua Huang
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:1999
畢業學年度:87
語文別:中文
論文頁數:1
中文關鍵詞:護理之家院內感染盛行率相關危險因子
外文關鍵詞:nursing homenosocomial infectionprevalencerelated risk factors
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中文摘要
近年來社會大眾對於醫療照護品質的要求日益提高,國內醫療給付制度的改變,全民健保的衝擊,使得醫療照護品質的確保與改善成為現今的趨勢,其中以院內感染發生率被公認是非常重要且適用的品質指標。在護理之家相繼的成立之下,為確保其照護服務品質,故有必要對國內護理之家院內感染管制現況進行瞭解。
本研究目的乃針對台灣地區護理之家院內感染管制現況、盛行率及相關危險因子做一調查,瞭解其感染管制的現況及院內感染發生情形,以作為護理之家發展院內感染預防及管制上之參考。研究對象乃以中華民國長期照護協會印製的台閩地區長期照護機構名冊(1998年版)所列的護理之家(成立時間>1年)共計31家及其住民為對象,分層隨機抽樣醫院附屬型護理之家及獨立型護理之家共抽取13家,615位住民;以盛行率調查法,每一護理之家需時2-7天,並依據美國1991年McGeer等人發表的長期照護院內感染定義標準收案。
結果發現615位住民其總入住人日數為227,465日,共計發生院內感染1,559人次,平均感染率為每千住院人日6.85次。其中以「泌尿道感染」次數最多(476人次) ;其次為「下呼吸道感染」(346人次)、「感冒徵候群」(228人次)及「蜂窩組織炎/軟組織/傷口感染」(155人次),平均感染率分別為2.09‰、1.52‰、1‰與0.68‰。從住民人口學資料、健康狀況、醫療護理等變項以對數迴歸分析結果,進入模式中者之變項因素有「日常活動功能」、「入住總日數」、「復健治療」、「傷口皮膚治療及護理」、「抗生素」和「輸出入量記錄」等六項醫療護理項目,即日常活動功能依賴程度愈高、入住總日數愈長者、接受復健治療、傷口皮膚治療及護理、抗生素和輸出入量記錄等醫療護理項目愈多者,愈有得院內感染的傾向,推估其相對危險性(odds ratio)分別為0.651(95%信賴區間:0.54-0.78)、1.885(95%信賴區間:1.51-2.36)、1.880(95%信賴區間:1.09-3.25)、22.570(95%信賴區間:13.10-38.88)、21.225(95%信賴區間:4.99-90.28),其他變項因素則未進入模式中。總計本模式解釋造成院內感染之病因比率(attributable proportion)的85.37%。
護理之家院內感染管制現況方面,有效問卷為12家,這12 家受調機構有7家(58.3%)設有感染管制政策,其中6家屬醫院型態之護理之家,均是使用所屬醫院的感控政策;有3家(25%)設有感控護士(均為兼任),而其花在感控的工作上每週為1-8小時,且這三位兼任感控護士均未曾受過感控訓練;僅4家(33.5%)有持續地收集感染資料。在感控及無菌技術執行上,獨立型態與醫院附設有所不同;在阻力上,以「機構缺少真正具有感染經驗與訓練的護士」佔第一位,其次為缺少指導者。由醫療照護上看出,機構負責人或護理長對於感染管制知識仍有待加強。
ABSTRACT
As people hope to get higher medical care quality after medical payment system change and the impact of health insurance make medical care quality improvement (MCQI) become current tendency. Nosocomial infection rate is considered the most important and appropriate indicator of MCQI. In order to insure the nursing homes’ care quality, it is important to know the result of their nosocomial infection control.
This research purpose is to investigate the nosocomial infection, prevalence and related risk factors of the nursing homes in Taiwan; thus they can develop their nosocomial infection control form by this research findings.
This research subjects are 31 nursing homes (founded over 1 year) listed in “The Long-Time Care Facilities’ Roll of R.O.C.”(1998) and people who lived there, 13 nursing homes and 615 people who lived there are collected by “ Definitions of infection for surveillance in long-term care facilities(1991) via cluster randomization. 2-7days were taken to investigate every nursing home.
From the result we found out, the 615 residents were hospitalized for 227,465 days in total, 1,559 person-times were infected in hospitals, the average infection rate is 6.85 per 1000 resident days. 476 person-times were infected with „urinary tract infection“, the most frequently; the second is with „lower respiratory tract infection“ (346 person-times), „common cold syndromes“ (228 person-times) and cellulitis/soft tissue/wound infection“ (155 person-times), the infection rates are 2.09‰, 1.52‰, 1‰ and 0.38‰ separately. We analyzed the finding via logistic regression and according to the variable factors: resident demographic data, state of health and medical treatment etc. In the model there are the following six medical treatment items: “activities of daily living, ADLs“, “total resident days“, “rehabilitation treatment“, “treatment and nursing of wound skin“, “antibiotic“ and “record of input-output quantity“. That is to say, a persons who depends on the everyday action functions more, were hospitalized longer and under more items of rehabilitation treatment, treatment and nursing of wound skin, antibiotic and record of input-output quantity, therefore he has more opportunities to be infected. The odds ratios are estimated to be 0.651(95% confidence interval: 0.54-0.78), 1.885(95% confidence interval: 1.51-2.36), 1.880(95% confidence interval: 1.09-3.25), 2.570(95%confidence interval: 13.10-38.88) and 21.225(95% confidence interval: 4.99-90.28). The other variable factors are excluded from the model. The attributable proportion of nosocomial infection, which was caused by the model, is 85.37%.
For the nosocomial infection control in nursing homes, we investigated twelve nursing homes. Seven nursing homes (58.3%) are running with the infection control policy, six are on hospital-base, the others run with the infection control policy of the hospital which one belongs to. In three nursing homes nurses are placed in charge of infection control (all are part-time), who spend 1-8 hours per week on the work of infection control, and the three nurses were never trained for infection control. Only four collect the information concerning infection continuously. The nursing homes on community-based are different from on the hospital-based in the execution of infection control and germfree technique, the first obstruction of execution is “short of the nurses with experience and training for infection control“, the second is “short of instructor“. From the nursing treatment we can learn that the person in charge or the chief nurse should gain the knowledge of infection control.
第一章 緒論
第一節 問題的重要性
第二節 研究動機
第三節 研究目的
第二章 文獻查證
第一節 院內感染
第二節 院內感染監測
第三節 護理之家院內感染相關性研究
第四節 長期照護機構院內感染定義
第三章 研究設計
第一節 研究架構
第二節 名詞界定
第三節 研究假設
第四章 研究方法
第一節 研究對象
第二節 研究工具
第三節 研究工具信度與效度之檢定
第四節 研究步驟
第五節 資料處理與統計分析
第五章 研究結果與討論
第一節 護理之家院內感染管制現況分析
第二節 住民個人屬性、健康狀況和醫療照護分析
第三節 院內感染及各部位感染之盛行率
第四節 院內感染個案特徵之研究分析
第五節 護理之家院內感染個案單變項危險因子分析
第六節 護理之家院內感染個案多變項危險因子分析
第七節 各部位感染個案單變項危險因子分析
第六章 結論與建議
第一節 結論
第二節 研究限制與建議
第三節 研究應用
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