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DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 方啟泰(Chi-Tai Fang) | |
dc.contributor.author | Ying-Chieh Liu | en |
dc.contributor.author | 劉瀅潔 | zh_TW |
dc.date.accessioned | 2021-07-10T21:44:48Z | - |
dc.date.available | 2021-07-10T21:44:48Z | - |
dc.date.copyright | 2021-02-25 | |
dc.date.issued | 2021 | |
dc.date.submitted | 2021-02-04 | |
dc.identifier.citation | Dhar S et al. Building a Successful Infection Prevention Program: Key Components, Processes, and Economics Infect Dis Clin North Am 2016;30(3):567-89. 行政院衛生福利部疾病管制署, 醫療照護相關感染監測定義. 2018. Goto M. and Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect. 2013; 19(6):501-9 Latif A et al. Eliminating Infections in the ICU: CLABSI. Curr Infect Dis Rep. 2015;17(7):491. Hallam Carole et al. “Establishing catheter-related bloodstream infection surveillance to drive improvement.” Journal of infection prevention 2018;19(4):160-166. Chopra V et al. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34(9):908-18. Chopra V, et al., The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Annals of Internal Medicine 2015;163(6):S1-S39. Entesari-Tatafi D, et al., Effectiveness of a care bundle to reduce central line-associated bloodstream infections. Med J Aust 2015;202(5):247-50. O'Neil, C, et al., A Central Line Care Maintenance Bundle for the Prevention of Central Line-Associated Bloodstream Infection in Non-Intensive Care Unit Settings. Infect Control Hosp Epidemiol 2016;37(6):692-8. Visca, P, et al., Acinetobacter infection--an emerging threat to human health. IUBMB Life 2011;63(12):1048-54. Mezzatesta, ML, et al., Enterobacter cloacae complex: clinical impact and emerging antibiotic resistance. Future Microbiol 2012. 7(7):887-902. Tamburini, FB, et al., Precision identification of diverse bloodstream pathogens in the gut microbiome. Nat Med 2018;24(12):1809-1814. 王振泰、楊采菱:台灣腸球菌臨床流行病學之演變與現況. 感染控制雜誌. 2014. 24(5): p. 256-263. Ben-David, D, et al., The association between implementation of second-tier prevention practices and CLABSI incidence: A national survey. Infect Control Hosp Epidemiol 2019;40(10):1094-1099. Rupp, ME. and Karnatak R, Intravascular Catheter-Related Bloodstream Infections. Infect Dis Clin North Am 2018. 32(4): p. 765-787. Tan, BH, et al., Asia Fungal Working Group (AFWG). Incidence and species distribution of candidaemia in Asia: a laboratory-based surveillance study. Clin Microbiol Infect 2015;21(10):946-53. Primo, MG., et al., Healthcare-associated Staphylococcus aureus bloodstream infection: length of stay, attributable mortality, and additional direct costs. Braz J Infect Dis 2012;16(6):503-9. Rhodes, D., et al., Reducing Staphylococcus aureus bloodstream infections associated with peripheral intravenous cannulae: successful implementation of a care bundle at a large Australian health service. J Hosp Infect 2016;94(1):86-91. Dandoy CE. and Alonso PB, MBI-LCBI and CLABSI: more than scrubbing the line. Bone Marrow Transplant 2019;54(12):1932-1939. Novosad, SA., et al., Pathogens causing central-line-associated bloodstream infections in acute-care hospitals-United States, 2011-2017. Infect Control Hosp Epidemiol 2020;41(3):313-319. Viscoli, C, Bloodstream Infections: The peak of the iceberg. Virulence 2016;7(3): 248-51. Diekema, DJ., et al., The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program. Antimicrob Agents Chemother 2019;63(7): e00355-19. Robineau O., et al., Management and outcome of bloodstream infections: a prospective survey in 121 French hospitals (SPA-BACT survey). Infect Drug Resist 2018;11:1359-1368. Gudiol C., et al., Bloodstream infections in patients with solid tumors. Virulence 2016;7(3):298-308. Septimus EJ. and Moody J, Prevention of Device-Related Healthcare-Associated Infections. F1000Res 2016;14(5): F1000 Faculty Rev-65. Duszynska W., et al., Device associated –health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015–2017). BMC Infect 2020;20:761. Frasca D., et al., Prevention of central venous catheter-related infection in the intensive care unit Crit Care 2010;212:14. Velasquez Reyes DC., et al., Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive Crit Care Nurs 2017;43:12-22. Pepin CS., et al., Risk factors for central-line-associated bloodstream infections: a focus on comorbid conditions. Infect Control Hosp Epidemiol. 2015. 36(4): p. 479-81. Islas-Muñoz B., et al., Bloodstream infections in cancer patients. Risk factors associated with mortality. Int J Infect Dis 2018;71:59-64. Kołpa M., et al., Incidence, Microbiological Profile and Risk Factors of Healthcare-Associated Infections in Intensive Care Units: A 10 Year Observation in a Provincial Hospital in Southern Poland. Int J Environ Res Public Health 2018;15, 112. Furuya EY., et al., Central Line-Associated Bloodstream Infection Reduction and Bundle Compliance in Intensive Care Units: A National Study. Infect Control Hosp Epidemiol 2016;37(7): 805-10. Burke C., et al., Adherence to the central line bundle in intensive care: An integrative review. Am J Infect Control 2020;19: p. S0196-6553(20)30998-6. Atilla A., et al., Central line-associated bloodstream infections in the intensive care unit: importance of the care bundle. Korean J Anesthesiol 2016;69(6):599-603. Watson CM, and Al-Hasan MN, Bloodstream infections and central line-associated bloodstream infections. Surg Clin North Am 2014;94(6):1233-44. Chaftari AM, et al., Changing Epidemiology of Catheter-Related Bloodstream Infections in Cancer Patients. Infect Control Hosp Epidemiol 2018;39(6): p. 727-729. 衛生福利部疾病管制署, 台灣醫院感染管制與抗藥性監測管理系統(THAS系統)2020年第1季監視報告. Grice, Elizabeth A, and Julia A Segre. The skin microbiome. Nature reviews. Microbiology 2011;9(4):244-53. Chuang YC, Chen YC, Chang SC, Sun CC, Chang YY, Chen ML, Hsu LY, Wang JT. Secular trends of healthcare‐associated infections at a teaching hospital in Taiwan, 1981‐2007. J Hosp Infect 2010;76(2):143‐9. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/77052 | - |
dc.description.abstract | 目的: 主要探討推動組合式照護對於全院導管相關血流感染密度之效用以及血流感染微生物之相關性。以了解基礎感控措施可預防之成效及了解目前本院面臨之挑戰。 方法: 本研究為一回溯性研究,以2011年至2015年11月30日止,臺大醫院感染管制中心前瞻性主動監測臺大醫院醫療照護相關血流感染個案為研究對象。以2013年全院推行組合式照護為自變項,醫療照護導管相關血流感染密度為依變項,利用Student’s t-test檢定、Chi-square test檢定描述性資料分析及線性回歸(Linear regression)、卜瓦松回歸(Poisson regression)檢定推論性分析資料,p<0.05視為統計顯著差異。 結果: 2013年全院推行組合式照護對於降低全院導管相關血流感染密度達統計上顯著差異,RR:0.845(0.800-0.893),p:<.0001。 主要觀察指標(Main outcome measures):2013年全院推行組合式照護對於降低全院skin flora、Environment origin ( Acinetobacter spp.、Pseudomonas aeruginosa、Enterbacter spp.)導管相關血流感染密度達統計上顯著差異, RR:0.783 (0.721-0.851),p:<.0001。 對照指標(Negative control outcome):2013年全院推行組合式照護對於降低全院gut origin (Enterococcus. spp、Escherichia coli、Klebsiella pneumonia) 導管相關血流感染密度無達統計顯著差異,RR:0.930 (0.853-1.015),p:0.1051。 結論:顯示2013年全院推行組合式照護,於全院導管相關血流感染密度及主要觀察指標有改善之成效,統計上達顯著差異。尤其加護病房成效明顯。故未來擬推動病人賦權計畫,於病房端由主要照顧者執行身體清潔及環境清潔等感管措施,以期改善一般病房導管相關血流感染率。 | zh_TW |
dc.description.abstract | Purpose: It mainly discusses the effect of promoting bundle care on the density of catheter-related bloodstream infection in the whole hospital and the correlation of bloodstream infection with microorganisms. To understand the preventable effectiveness of basic infection control measures and to understand the current challenges facing the hospital. Method:A before-after prospective study was conducted in hospital wide in a medical center in northern Taiwan from January 2011 to November 2015, which include all CLABSI. Result: In 2013, the implementation of bundle care in the whole hospital had a statistically significant difference in reducing the density of catheter-related bloodstream infections in the whole hospital, RR: 0.845 (0.800-0.893), p: <.0001. Main outcome measures: The implementation of bundle care in the whole hospital in 2013 has a statistically significant difference in the reduction of skin flora and Environment origin (Acinetobacter spp., Pseudomonas aeruginosa, Enterbacter spp.) catheter-related bloodstream infection density. RR: 0.783 (0.721-0.851), p: <.0001. Negative control outcome: The implementation of bundle care in the whole hospital in 2013 has no statistically significant difference in reducing the gut origin (Enterococcus spp, Escherichia coli, Klebsiella pneumonia) catheter-related bloodstream infection density, RR: 0.930 (0.853) -1.015), p: 0.1051. Conclusion: It shows that in 2013, the hospital implemented bundle care, and the catheter-associated bloodstream infection density and the main observation indicators have been improved in the whole hospital, and there is a statistically significant difference. In particular, the intensive care unit has achieved remarkable results. Therefore, in the future, it is planned to promote the patient empowerment plan. At the ward side, the main caregivers will implement sensory measures such as body cleaning and environmental cleaning, in order to improve the rate of bloodstream infections related to catheters in general wards. | en |
dc.description.provenance | Made available in DSpace on 2021-07-10T21:44:48Z (GMT). No. of bitstreams: 1 U0001-0202202114063900.pdf: 3532208 bytes, checksum: 889de862374bc969185ae59c861965e4 (MD5) Previous issue date: 2021 | en |
dc.description.tableofcontents | 目錄 口試委員審定書------------------------------------------------------------------------------i 誌謝---------------------------------------------------------------------------------------------ii 摘要---------------------------------------------------------------------------------------------iii Abstract-----------------------------------------------------------------------------------------v 第一章 導論 第一節 實習單位色與簡介----------------------------------------1 第二節 研究動機與目的------------------------------------------2 第三節 文獻查證------------------------------------------------3 第二章 方法 第一節 研究設計------------------------------------------------8 第二節 研究地點------------------------------------------------8 第三節 資料來源------------------------------------------------8 第四節 研究個案------------------------------------------------9 第五節 名詞定義及研究指標--------------------------------------10 第六節 感染管制介入措施----------------------------------------11 第七節 資料分析------------------------------------------------12 第三章 結果 第一節 研究個案特性分佈----------------------------------------13 第二節 單變量分析----------------------------------------------15 第三節 多變量分析----------------------------------------------17 第四章 討論 第一節 研究成效分析及討論--------------------------------------18 第二節 研究限制------------------------------------------------20 第五章 結論及建議---------------------------20 參考文獻------------------------------------21 | |
dc.language.iso | zh-TW | |
dc.title | 某醫學中心推行組合式照護對於預防導管相關血流感染之成效:2011-2015年 | zh_TW |
dc.title | Effect of a care bundle to reduce central line-associated bloodstream infections at a medical center, 2011-2015. | en |
dc.type | Thesis | |
dc.date.schoolyear | 109-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳宜君(Yee-Chun Chen),王振泰(Jen-Tay Wang) | |
dc.subject.keyword | 導管相關血流感染,組合式照護,感染管制, | zh_TW |
dc.subject.keyword | Bundle care,central line-associated bloodstream infection,infection control, | en |
dc.relation.page | 50 | |
dc.identifier.doi | 10.6342/NTU202100376 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2021-02-08 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
顯示於系所單位: | 公共衛生碩士學位學程 |
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