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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 賴美淑(Mei-Shu Lai) | |
| dc.contributor.author | Hsin-hsin Chang | en |
| dc.contributor.author | 張馨心 | zh_TW |
| dc.date.accessioned | 2021-06-15T05:08:39Z | - |
| dc.date.available | 2011-10-03 | |
| dc.date.copyright | 2011-10-03 | |
| dc.date.issued | 2011 | |
| dc.date.submitted | 2011-08-18 | |
| dc.identifier.citation | 1.Graves N, Economics and preventing hospital-acquired infection. Emerg Infect Dis., 2004. 10(4): p. 561-6.
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Infection Control and Hospital Epidemiology, 2004. 25(11): p. 974-978. 6.Vanhems, P., et al., Reduction of urinary tract infections acquired in an intensive care unit during a 10-year surveillance program. European Journal of Epidemiology, 2008. 23(9): p. 641-645. 7.Wagenlehner, F.M.E., et al., Incidence of nosocomial urinary tract infections on a surgical intensive care unit and implications for management. International Journal of Antimicrobial Agents, 2006. 28: p. S86-S90. 8.Maria L.Alcaid , D.M.L., management of urinary tract infections in patients with urinary catheters. Hospital Physician, 2004. 2004. 9.陳宜君等人, 院內感染控制介入評估研究整合型計畫. 行政院衛生署疾病管制局 96 年度科技研究發展計畫 2006: p. P.5. 10.Garner, J.S., et al., CDC definitions for nosocomial infections, 1988. American Journal of Infection Control, 1988. 16(3): p. 128-140. 11.Dumigan, D.G., et al., Utilizing national nosocomial infection surveillance system data to improve urinary tract infection rates in three intensive-care units. Clin Perform Qual Health Care, 1998. 6(4): p. 172-8. 12.Emori, T.G., et al., National nosocomial infections surveillance system (NNIS): Description of surveillance methods. American Journal of Infection Control, 1991. 19(1): p. 19-35. 13.Tokars, J.I., et al., The Changing Face of Surveillance for Health Care—Associated Infections. Clinical Infectious Diseases, 2004. 39(9): p. 1347-1352. 14.衛生署疾病管制局, 院內感染監視通報系統. 97年傳染病統計監視年報, 2008: p. 40-47. 15.Klevens Rm Fau - Edwards, J.R., et al., Estimating health care-associated infections and deaths in U.S. hospitals. 2002. 16.Horan TC, G.R., Surveillance of nosocomial infections. Hospital Epidemiology and Infection Control., 2004: p. 1659-1702. 17.Horan, T., M. Andrus, and M. Dudeck, CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control, 2008. 36(5): p. 309-332. 18.行政院衛生署疾病管制局, 侵入性醫療裝置相關感染監測定義. 2009. 19.Leone, M., et al., Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Medicine, 2003. 29(6): p. 929-932. 20.Laupland, K., et al., Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. Journal of Critical Care, 2002. 17(1): p. 50-57. 21.EsclarÍN De Ruz, A.N.A., E. GarcÍA Leoni, and R. Herruzo Cabrera, Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. The Journal of Urology, 2000. 164(4): p. 1285-1289. 22.van der Kooi, T., et al., Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system. Intensive Care Medicine, 2007. 33(2): p. 271-278. 23.Saint, S., et al., Risk factors for nosocomial urinary tract–related bacteremia: A case-control study. American Journal of Infection Control, 2006. 34(7): p. 401-407. 24.Crouzet, J., et al., Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. Journal of Hospital Infection, 2007. 67(3): p. 253-7. 25.Carolyn V. Gould, M., MSCR; Craig A. Umscheid, MD, MSCE; Rajender K. Agarwal, MD, MPH;, Guidelines for Prevention of Catheter-Associated Urinary Tract Infections 2009. infection control and hospital epidemiology, 2010. april 2010, vol. 31, no. 4: p. 319-326. 26.Topal, J., et al., University HealthSystem Consortium excellence in quality and safety award series: Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. American Journal of Medical Quality, 2005. 20(3): p. 121-126. 27.Apisarnthanarak, A., et al., Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America, 2007. 28(7): p. 791-8. 28.Rosenthal, V.D., Device-associated nosocomial infections in limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC). Am J Infect Control, 2008. 36(10): p. S171 e7-12. 29.Trautner, B.W., Management of catheter-associated urinary tract infection. Current Opinion in Infectious Diseases, 2010. 23(1): p. 76-82. 30.Desforges, J.F., W.E. Stamm, and T.M. Hooton, Management of Urinary Tract Infections in Adults. New England Journal of Medicine, 1993. 329(18): p. 1328-1334. 31.Jain, M., Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Quality and Safety in Health Care, 2006. 15(4): p. 235-239. 32.Aboelela, S., P. Stone, and E. Larson, Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature. Journal of Hospital Infection, 2007. 66(2): p. 101-108. 33.Curtis, L.T., Prevention of hospital-acquired infections: review of non-pharmacological interventions. Journal of Hospital Infection, 2008. 69(3): p. 204-219. 34.McKibben, L., et al., Guidance on Public Reporting of Healthcare-Associated Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee. American Journal of Infection Control, 2005. 33(4): p. 217-226. 35.Venkatram, S., S. Rachmale, and B. Kanna, Study of device use adjusted rates in health care-associated infections after implementation of 'bundles' in a closed-model medical intensive care unit. J Crit Care, 2010. 25(1): p. 13. 36.儲德馨;張淑貞;陳美琴;黃高彬, 南部某醫學中心急診加護病房降低泌尿道感染改善方案. 感染控制雜誌, 2007. 17(1): p. 1-10. 37.Curran, E. and H. Murdoch, Aiming to reduce catheter associated urinary tract Infections (CAUTI) by adopting a checklist and bundle to achieve sustained system improvements. Journal of Infection Prevention, 2009. 10(2): p. 57-61. 38.Bagshaw, S.M.a.b. and K.B.a.b.c.d. Laupland, Epidemiology of intensive care unit-acquired urinary tract infections. Current Opinion in Infectious Diseases, 2006. 19(1): p. 67-71. 39.Misset, B., et al., A continuous quality-improvement program reduces nosocomial infection rates in the ICU. Intensive Care Medicine, 2004. 30(3): p. 395-400. 40.Rosenthal, V.D.M.D., S.R.N. Guzman, and N.M.D. Safdar, Effect of Education and Performance Feedback on Rates of Catheter‐Associated Urinary Tract Infection in Intensive Care Units in Argentina • Infection Control and Hospital Epidemiology, 2004. 25(1): p. 47-50. 41.Reilly, L.R.N.B.S.N.C., et al., Reducing Foley Catheter Device Days in an Intensive Care Unit: Using the Evidence to Change Practice. AACN Advanced Critical Care July/September, 2006. 17(3): p. 272-283. 42.Elpern, E.H., et al., Reducing use of indwelling urinary catheters and associated urinary tract infections. Am J Crit Care, 2009. 18(6): p. 535-41; quiz 542. 43.Apisarnthanarak, A.M.D., et al., Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand • Infection Control and Hospital Epidemiology, 2007. 28(7): p. 791-798. 44.楊奕農, ed. 時間序列分析(經濟與財務上之應用 第二版). 2009, 雙葉書廊有限公司: 台北市. 45.Fernandez-Perez, C., J. Tejada, and M. Carrasco, Multivariate time series analysis in nosocomial infection surveillance: a case study. Int J Epidemiol, 1998. 27(2): p. 282-8. 46.Kaier, K., et al., The impact of antimicrobial drug consumption and alcohol-based hand rub use on the emergence and spread of extended-spectrum beta-lactamase-producing strains: a time-series analysis. J Antimicrob Chemother, 2009. 63(3): p. 609-14. 47.Aldeyab, M.A., et al., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: a time-series analysis. J Antimicrob Chemother, 2008. 62(3): p. 593-600. 48.Charlson, M.E., et al., A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 1987. 40(5): p. 373-383. 49.Deyo, R.A., D.C. Cherkin, and M.A. Ciol, Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 1992. 45(6): p. 613-619. 50.林慧姬等人, 某醫學中心2004~2007年全院醫療區手部衛生運動的推行方法及成果評估. 感染控制雜誌, 2010. 20(3): p. 146-162. 51.黃心慈等人, 降低內科加護病房導尿管相關泌尿道感染之改善專案. 臺大護理 2007. 5(2): p. 110-125. 52.Kaier, K.D.V., et al., Two Time‐Series Analyses of the Impact of Antibiotic Consumption and Alcohol‐Based Hand Disinfection on the Incidences of Nosocomial Methicillin‐Resistant Staphylococcus aureus Infection and Clostridium difficile Infection • Infection Control and Hospital Epidemiology, 2009. 30(4): p. 346-353. 53.Ely, J.W., et al., An Introduction to Time-Trend Analysis. Infection Control and Hospital Epidemiology, 1997. 18(4): p. 267-274. 54.王瑞芳, 泌尿系統醫療照護相關感染之時間序列分析. 2010, 王瑞芳: 國立台灣大學，臺北市 未出版之碩士論文. p. 120. 55.National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control., 2008. 36(9): p. 609-26. 56.Prevalence of nosocomial infections in Spain: EPINE study 1990-1997. EPINE Working Group. J Hosp Infect., 1999. 43(Suppl): p. S105-11. 57.Martínez, M.P. and F.A. Lerma, From Surveillance to Prevention. Intensive and Critical Care Medicine, 2009: p. 221-236. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/46430 | - |
| dc.description.abstract | 目的:
本研究目的主要描述臺大醫院成人內、外科加護病房2002年至2010年醫療照護相關泌尿道感染密度、導尿管相關泌尿道感染密度變化趨勢。比較成人內、外科加護病房有無實施「降低導尿管相關泌尿道感染專案」及導尿管使用率及泌尿道感染密度之影響。藉由時間趨勢分析「降低導尿管相關泌尿道感染專案」及不同階段感染控制介入措施對於成人內、外科加護病房泌尿道感染密度影響。 方法: 本研究為一回溯性研究，以2002年至2010年臺大醫院感染控制中心前瞻性主動監測成人內外科加護病房導尿管相關醫療照護相關泌尿道感染個案為研究對象。分別以環境因素(導尿管使用率、SARS疫情、季節效應)及感控介入措施(手部衛生、內科加護病房降低導尿管相關泌尿道感染專案、Bundle care)為自變項，成人內外科加護病醫療照護相關泌尿道感染密度、導尿管相關泌尿道感染密度為依變項，利用卜瓦松迴歸進行多變項分析及自我相關模式分析、預測，p <0.05視為統計顯著差異。 結果: 成人內、外科加護病房由於泌尿道感染基礎期之趨勢不同、而感控介入措施及落實程度不同，故影響的結果不同。2004年4月推動「手部衛生」因素對於降低成人內科加護病房醫療照護相關泌尿道感染及導尿管相關泌尿道感染是有顯著性 (p < 0.0183)。以成人外科加護病房來看，2010年推動之「Bundle」對於降低成人外科加護病房醫療照護相關泌尿道感染及導尿管相關泌尿道感染是有顯著性。而隨著時間變化，成人內科加護病房醫療照護相關泌尿道感染密度及成人外科加護病房醫療照護相關泌尿道感染密度、導尿管相關泌尿道感染密度皆有下降趨勢。 結論: 「降低導尿管相關泌尿道感染專案」對於降低導尿管使用率有顯著影響，無論單位自主改善專案或是感控介入措施，對於成人內外科加護病房降低導尿管相關泌尿道感染都是有助益的。 | zh_TW |
| dc.description.abstract | Purpose
The purpose of this thesis is to describe the trends of incidence of healthcare-associated urinary tract infection (HA-UTI) and catheter-associated urinary tract infection(CA-UTI) in adult intensive care units (ICUs ) at National Taiwan University Hospital, from 2002 to 2010. In addition, time series analysis was used to investigate the impacts of various infection control programs on the incidences of HA-UTI and CA-UTI in adult ICUs. Method This is a retrospective study. The study population was patients developing HA-UTI, includind CA-UTI while staying in adult ICUs at NTUH from 2002 to 2010. To identified the independent factors associated with HA-UTI and/or CA-UTI, environmental factors (catheter utilization, severe acute respiratory syndrome, seasonal effects), and infection control interventions (hand hygiene, the project of reducing catheter- associated urinary tract infection, Bundle care) were treated as independent variables; incidence densities of HA-UTI and CA-UTI were treated as the dependent variable. Time series analysis using Poisson regression model was used to evaluate the potential effects of independent variables on dependent variable. A p value less than 0.05 were considered as statistically significantly. Result Because the baselin incidence rates of HA-UTI and CA-UTI were different in surgical and medical ICU, and also the infection control interventions as well as the adherence of healthcare workers to these interventons, the impact of the results are different. Since April 2004, hand hygiene campaign were implemented. It reduced the HA-UTI and CA-UTI significantly (p< 0.0183). For adult surgical intensive care unit, promotion of the 'Bundle care' intervention reduced the HA-UTI and CA-UTI significantly (p< 0.002) . Both HA-UTI and CA-UTI decrease in adult medical and surgical ICUs with time. Conclusion This study showed that the impact of various projects on reducing CA-UTI is significant, In addition, self-improvement project and infection control interventions were also helpful for decreasing HA-UTI and CA-UTI. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T05:08:39Z (GMT). No. of bitstreams: 1 ntu-100-R98847012-1.pdf: 1553150 bytes, checksum: 844599adf05e3aee37757f3a82736da1 (MD5) Previous issue date: 2011 | en |
| dc.description.tableofcontents | 誌謝-------------------------------------------------------I
中文摘要--------------------------------------------------II ABSTRACT--------------------------------------------------IV 圖目錄--------------------------------------------------VIII 表目錄---------------------------------------------------- 9第一章 緒論-----------------------------------------------10 第一節 實習單位簡介：臺大醫院感染控制中心-----------------10 第二節 研究背景與動機-------------------------------------11 第三節 現況分析-------------------------------------------12 第四節 研究目的-------------------------------------------15 第二章 相關文獻探討---------------------------------------16 第一節 醫療照護相關感染簡介-------------------------------16 第二節 醫療照護相關泌尿道感染及留置導尿管相關泌尿道感染監測定義------------------------------------------------------17 第三節 名詞定義-------------------------------------------19 第四節 醫療照護相關泌尿道感染危險因子---------------------29 第五節 預防導尿管相關泌尿道感染---------------------------31 第六節 感染控制措施及降低泌尿道感染改善策略---------------33 第七節 時間序列模型分析應用於醫療照護相關感染-------------36 第八節 疾病嚴重度判定-------------------------------------37 第三章 研究方法-------------------------------------------39 第一節 研究架構-------------------------------------------39 第二節 研究設計-------------------------------------------40 第三節 資料來源-------------------------------------------41 第四節 研究個案-------------------------------------------42 第五節 感染控制介入措施-----------------------------------43 第六節 資料分析-------------------------------------------47 第四章 研究結果-------------------------------------------53 第一節 臺大醫院2002年至2010年人口學分佈-------------------53 第二節 收案流程-------------------------------------------54 第三節 研究個案流行病學資料-------------------------------56 第四節 醫療照護相關泌尿道感染密度、導尿管相關泌尿道感染密度、導尿管使用率相關性比較--------------------------------58 第五節 成人內外科加護病房醫療照護相關泌尿道感染密度、導尿管相關泌尿道感染密度之多變項分析結果------------------------70 第五章 討論-----------------------------------------------83 第一節 階段性感染控制介入措施之影響-----------------------84 第二節「降低導尿管相關泌尿道感染專案」影響----------------86 第三節 泌尿道感染密度監測之比較---------------------------88 第六章 結論與建議-----------------------------------------90 第一節 結論-----------------------------------------------90 第二節 研究限制與建議-------------------------------------91 參考文獻--------------------------------------------------92 附錄------------------------------------------------------97 | |
| dc.language.iso | zh-TW | |
| dc.subject | 品質改善專案 | zh_TW |
| dc.subject | 醫療照護相關泌尿道感染 | zh_TW |
| dc.subject | 導尿管相關泌尿道感染 | zh_TW |
| dc.subject | 時間趨勢 | zh_TW |
| dc.subject | 卜瓦松分析 | zh_TW |
| dc.subject | 組合式感染管制介入措施 | zh_TW |
| dc.subject | 手部衛生 | zh_TW |
| dc.subject | catheter- associated urinary tract infection | en |
| dc.subject | healthcare- associated urinary tract infection | en |
| dc.subject | quality improvement project | en |
| dc.subject | hand hygiene | en |
| dc.subject | bundle care | en |
| dc.subject | poisson regression analysis | en |
| dc.subject | time trend | en |
| dc.title | 「降低導尿管相關泌尿道感染專案」對醫療照護相關泌尿道感染之影響 | zh_TW |
| dc.title | The Impact of ' Reducing Catheter Associated Urinary Tract Infections Project ' for Healthcare-Associated Urinary Tract Infection | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 99-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 陳宜君(Yee-Chun Chen),王振泰(Jaun-Tay Wang) | |
| dc.subject.keyword | 醫療照護相關泌尿道感染,導尿管相關泌尿道感染,時間趨勢,卜瓦松分析,組合式感染管制介入措施,手部衛生,品質改善專案, | zh_TW |
| dc.subject.keyword | healthcare- associated urinary tract infection,catheter- associated urinary tract infection,time trend,poisson regression analysis,bundle care,hand hygiene,quality improvement project, | en |
| dc.relation.page | 100 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2011-08-18 | |
| 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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