某區域教學醫院加護病房內個人房與開放式床位之院內感染探討

Surveillance of Healthcare associated Infections on a Single Room Area and an Open Single-Space Area at Intensive Care Unit

加護病房內的硬體設計常與院內感染有關，本研究主要目的在於了解加護病房之個人房與開放式床位在院內感染的差異。研究設計以區域教學醫院加護病房為基礎之前瞻性調查；研究時間自96年1月至12月止，凡住進綜合加讓病房個人房（A）區與開放式床位（B）區的病患皆為研究對象。研究結果顯示，A 區院內感染密度平均為8.7‰；B區10.9‰。A區院內感染率平均為4.1，B區6.4%；P值 = 0.056。A區院內感染部位前三名依序為血流感染 （1.4%）、下呼吸道感染 （1.2%） 及泌尿道染 （1.0%）；B區為下呼吸道感染（ 2.3%）、血流感染 （2.0%） 及泌尿道感染 （1.5%）。A區最常見之感染菌種依序前三名為綠膿桿菌 （16 .7%）、金黃色葡萄球菌 （12.5%） 及黴菌 （12.5%），B區為金黃色葡萄球菌 （24.6%）、綠膿桿菌 （12.3%） 及黴菌 （10.5%）。兩區之院內部位感染及常見菌種發生率比較，均未達統計差異。本研究結論，在不分析病房型態下，加護病房內無論個人房或開放式床位的設計，未顯著影響院內感染率。（感控雜誌 2009;1 9:354-61）。

Interior design of intensive care unit (ICU) has associated with healthcare associated infection. In order to discover the difference in infection rates between a single room area and an open single-space area at ICU, we conducted a hospital-based prospective surveillance study of all patients admitted to a single room area (A) and an open single-space area (B) of the general ICU at a referral teaching hospital in Taoyuan from January 2007 to December 2007. During the study period, the density of healthcare associated infection in areas A and B was 8.7‰ and 10.9‰, respectively. Infection rates of areas A and B were 4.1% and 6.4%, respectively, p value=0.056. The most frequent types of healthcare associated infections in area A were bloodstream infection (1.4%), followed by lower respiratory tract infection (1.2%), and urinary tract infection (1.0%). In area B, the most frequent types of infections were lower respiratory tract infection (2.3% ), followed by bloodstream infection (2.0%), and urinary tract infection (1.5%). A total of 81 isolated microorganisms were identified, of them, 24 isolates in area A, and 57 in B. The most frequently pathogens in area A were Pseudomonas aeroginosa (16.7%), followed by Staphylococcus aureus (12.5%) and fungi (12.5%). In area B, the most frequent pathogens were Staphylococcus aureus (24.6%), followed by Pseudomonas aeroginosa (12.3%), and fungi (10.5%). There were no Significant differences in sites of infections as well as causative microorganisms between area A and B. In conclusion, this study suggests that the incidences of healthcare associated infections will be similar either in a single room or an open single-space area in the ICU. (Infect Control J 2009;19:354-61).