某醫學中心普通病房及加護中心金黃色葡萄球菌醫療照護相關感染之調查分析

Analysis of Healthcare-associated Staphylococcus aureus Infections in General Wards and Intensive Care Units in a Medical Center

金黃色葡萄球菌(Staphylococcus aureus)近年來是造成嚴重感染與醫療照護相關感染的重要致病菌之一，且有日漸增加之趨勢。本研究為2004年至2008年期間北部某醫學中心普通病房及加護中心住院病人金黃色葡萄球菌醫療照護相關感染的變化趨勢，分析內容包括發生率及感染密度、各感染部位之發生率及發生密度、病人特性及危險因子等項目。分析結果顯示5年期間普通病房及加護中心金黃色葡萄球菌醫療照護相關感染之發生率分別為0.38％、0.97％，感 染發生密度分別為0.53‰。及1.83‰。，在普通病房及加護中心抗甲氧苯青黴素金黃色葡萄球菌(methicillin-resistant S. aureus)分佈比例皆於2005年達到高峰， 比例為79.0％及92.9％，之後逐年有下降趨勢；普通病房及加護中心最常見之感染部位為血流感染。在病人特性方面，性別及年齡皆無顯著差異。感染發生個案之潛在性疾病方面普通病房個案具有心臟血管疾病、糖尿病、惡性腫瘤、慢性阻塞性肺部疾病的族群及長期臥床等狀況皆高於加護中心，且達統計學上顯著差異(p<0.05)。侵入性導管裝置的周邊靜脈導管、中心靜脈導管、導尿管、呼吸器皆達統計學上的顯著差異(p<0.0001)，在這5年分析期間，無論是在普通病房或加護中心，感染部位皆以血流感染居冠。而金黃色葡萄球菌的傳播可藉由醫療工作人員的雙手和鼻咽腔當作傳播途徑，此議題除期望醫療人員在執行醫療措施之前，尤其放置侵入性導管前，須確實遵守無菌標準操作技術外，落實個人手部衛生也是相當重要的環節。

Staphylococcus aureus has become one of the leading causes of healthcareassociated infections (HAIs) and has been responsible for increasingly severe diseases in recent years. This study analyzed S. aureus-related HAIs in general wards and intensive care units (ICUs) in a medical center located in northern Taiwan from 2004 to 2008. We evaluated the total S. aureus infection rate, overall density of infection, density by infection site, characteristics of infected patients, and risk factors for HAI. The results showed that the mean rates of S. aureus infection in general wards and ICUs in the 5-year study period were 0.38% and 0.97%, respectively. The most frequent site of infection, in both general wards and ICUs, was the bloodstream. There were no significant differences in sex or age of the infected patients. Patients in ICUs had significantly higher rates of cardiovascular diseases and diabetes, and a larger number of ICU patients were bedridden for a long time (p < 0.05). The frequency of invasive medical procedures, including peripheral and central venous catheterization, endotracheal intubation, tracheotomy, urinary catheterization, ventilator support, and total parenteral nutrition (p < 0.0001), in ICU patients was also higher. Since S. aureus can be transmitted from the hands of healthcare workers, the most effective method to control S. aureus infection is to follow standard aseptic procedures while performing medical procedures, especially during invasive catheterization. Strict adherence to hand hygiene is also recommended. Removal of catheters as early as possible and controlled use of antibiotics are also important factors for containing S. aureus-related HAIs.