일개 대학병원 신경외과중환자실에서 Clostridium difficile 관련 설사 감소를 위한 CQI활동

박은숙; 장경희; 윤영옥; 이정신; 김태곤; 여한승; 김선호; 신정원; 이경원; 김준명

추천

검색

자료유형: 학술저널

저자정보: 박은숙 (세브란스병원 감염관리실) 장경희 (연세대학교 의과대학 감염내과) 윤영옥 (세브란스병원 간호부) 이정신 (세브란스병원 간호부) 김태곤 (연세대학교 의과대학 신경외과) 여한승 (연세대학교 의과대학 신경외과) 김선호 (연세대학교 의과대학 신경외과) 신정원 (연세대학교 의과대학 임상병리과) 이경원 (연세대학교 의과대학 임상병리과) 김준명 (세브란스병원 감염관리실)

저널정보: 한국의료질향상학회 한국의료질향상학회지 한국의료질향상학회지 제8권 제1호

발행연도: 2001.1

수록면: 10 - 21 (12page)

이용수

📌

연구주제

📖

연구배경

🔬

연구방법

🏆

연구결과

초록· 키워드

오류제보하기

Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.

#C #difficile associated diarrhea #CQI activities #NCU #Infection control

참고문헌 (0)

참고문헌 신청

참고문헌이 DBpia에서 서비스 중이라면, [참고문헌 신청]을 통해 등록해보세요

함께 읽어보면 좋을 논문

논문 유사도에 따라 DBpia 가 추천하는 논문입니다. 함께 보면 좋을 연관 논문을 확인해보세요!

이 논문의 저자 정보

박은숙

소속기관 세브란스병원 감염관리실

주요연구분야 공학 > 건축공학 > 환경공학 의약학 > 의학 일반

논문수 18 이용수 330

장경희

소속기관 연세대학교 의과대학 감염내과