某教學醫院外科加護病房2005至2008年間院內感染相關因素探討

本研究目的乃探討某教學醫院外科加護病房院內感染及其影響因素。採前瞻性研究設計，由感染控制師自2005 年1 月1 日至2008 年12 月31 日，依美國疾病管制局於1988 年所提出之院內感染定義，收集外科加護病房病患資料及監測院內感染之資料加以統計分析。外科加護病房四年住院人次總共2175人次，總住院人日數為13263 人日，院內感染人數為71 人，共有81 人次感染部位，感染發生密度為6.11‰、院內感染率平均為3.7%。最主要院內感染部位為呼吸道感染（42.0%），其次為血流感染（23.4%）和泌尿道（17.3%）。最常見菌株前三名依序為Pseudomonas aeruginosa （25.6%）、Candida albicans （19.2%）、methicillin-resistant Staphylococcus aureus （14.1%）。經邏輯斯迴歸分析發現「外科加護病房住院天數6 天以上」（OR=47.04，95% CI=11.44~192.40）、「入住外科加護病房24 時APACHE II：15 分以上」（OR=2.00，95% CI=1.07~3.74）變項為預測外科加護病房院內感染之重要因素。本研究結果可提供外科加護病房護理人員了解院內感染之流行病學概況以及危險因子。

The purpose of this prospective study was to investigate nosocomial infection and its related factors in the surgical intensive care unit (SICU) at a regional hospital. Surveillance data on nosocomial infection in the SICU from Jan. 1, 2005 to Dec. 31, 2008 was collected by infection control nurse. Relevant clinical data was also collected at the same time. During the study period, there were 2,175 patients admitted to the SICU. The total number of patient-days was 13,263. Seventy-one patients acquired a total of 81 nosocomial infections with the incidence density of 6.11 per 1000 patient-days and accounting for a cumulative incidence of 3.7%. The most common nosocomial infection site in SICU was respiratory tract (42.0%), followed by the blood stream (23.4%), and urinary tract (17.3%). The top three pathogens were Pseudomonas aeruginosa (25.6%), Candida albicans (19.2%), methicillin-resistant Staphylococcus aureus (14.1%). Logistic regression analysis found that staying in SICU for 6 or more days (OR=47.04, 95% CI=11.44~192.40), and an APACHE II score (OR=2.00, 95% CI=1.07~3.74) evaluated at 24 hours after ICU admission being equal to or more than 15 points were independent risk factors for nosocomial infection in SICU. The results of this study can help nurses in the SICU to understand the current epidemiology of and risk factors for nosocomial infection.