The Status of Infection Control Nurses and Factors Affecting Infection Control Activities in Healthcare Facilities with more than 150 Beds in 2016 in KOREA / 임상간호연구

PURPOSE: The purpose of this study was to describe the status of infection control nurses (ICNs) and their activities, and to identify the factors affecting the level of infection control activities. Methods: Data were collected from 199 hospitals from June 24 to July 26, 2016. The structured questionnaires included status of infection control nurses, type and level of infection control activities. METHODS: Data were collected from 199 hospitals from June 24 to July 26, 2016. The structured questionnaires included status of infection control nurses, type and level of infection control activities. RESULTS: Most participating hospital were advanced general hospital (20.1%) and general hospital (67.8%). Among the hospitals, 86.4% had an infection control department (ICD). The average hospital work experience of ICNs was 14.62 years, and their average infection control career was for 4.94 years. Among the ICNs, 85.6% worked in full time and the average number of beds per ICN was 311.21. There were significant differences in the existence of ICD, infection control activities including surveillance, outbreak investigation, negative pressure room, hand hygiene monitoring, disinfection, and sterilization according to hospital size. The level of infection control activities was higher with more number of ICNs, ICN employment as full time, and healthcare institution accreditation status. The explanatory power was 37.5%. CONCLUSION: These results of this study which reflect infection control status of healthcare facilities with more than 150 beds in 2016 will provide baseline data to establish infection control system in small to medium sized hospitals after the Middle East Respiratory Syndrome outbreak in 2015.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2012 through June 2013 / 병원감염관리

BACKGROUND: The Korean Society for Nosocomial Infection Control (KOSNIC) ran a surveillance system, called as Korean Nosocomial Infections Surveillance (KONIS), since July 2006. Here, we report the annual data of the intensive care unit (ICU) module of the system from July 2012 through June 2013. METHODS: This is a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 161 ICUs in 91 hospitals using the KONIS system. The nosocomial infection (NI) rate was calculated as the number of infections per 1,000 patient days or device days. RESULTS: A total of 3,042 NIs were reported during the study period: 877 UTIs (854 cases were urinary catheter-associated), 1,272 BSIs (1,096 were central line-associated), and 893 PNEUs (526 cases were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 1.26 cases per 1,000 device days (95% confidence interval; 1.18-1.34) and urinary catheter utilization ratio was 0.78 (0.779-0.781). The rate of central line-associated BSIs was 2.57 (2.42-2.72) and the utilization ratio was 0.49 (0.489-0.491). The rate of ventilator-associated PNEUs was 1.64 (1.50-1.78) and the utilization ratio was 0.37 (0.369-0.371). The urinary catheter utilization ratio was lower in the ICUs of hospitals with 400-699 beds than in those of hospitals with more than 900 beds; nevertheless, CAUTIs were more common in the hospitals with 400-699 beds. The central line-associated BSI (CLABSI) rate was lower in the study period than in the previous period of July 2011-June 2012 [2.57 (2.42-2.72) vs. 3.01 (2.84-3.19)]. CONCLUSION: The CLABSI rates were lower in the study period than those in the previous years. CAUTIs were more common in the ICUs of hospitals with 400-699 beds than in those of larger hospitals.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2013 through June 2014 / 병원감염관리

BACKGROUND: In this report, we present the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2013 through June 2014. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) in 166 ICUs of 94 hospitals using the KONIS. Nosocomial infection (NI) rate was defined as the number of infections per 1,000 patient-days or device-days. RESULTS: A total of 2,843 NIs were found during the study period: 861 UTIs (846 were urinary catheter-associated), 1,173 BSIs (1,021 were central line-associated), and 809 PNEUs (498 were ventilator-associated). The rate of urinary catheter-associated UTIs was 1.21 per 1,000 device-days (95% confidence interval [CI]=1.13-1.29), and the urinary catheter utilization ratio was 0.84 (95% CI=0.839-0.841). The rate of central line-associated BSIs was 2.33 per 1,000 device-days (95% CI=2.20-2.48), and the utilization ratio was 0.53 (95% CI=0.529-0.531). The rate of ventilatorassociated PNEUs (VAPs) was 1.46 per 1,000 device-days (95% CI=1.34-1.60), and the utilization ratio was 0.41 (95% CI=0.409-0.411). In hospitals with more than 900 beds, although the ventilator utilization ratio was highest, the rate of VAPs was lower than in hospitals with 300-699 or 700-899 beds. CONCLUSION: BSIs were the most commonly reported nosocomial infections. Although device utilization ratios had increased, nosocomial infection rates did not differ significantly from those during the previous period (July 2012 through June 2013).

A preliminary study for the development of indices and the current state of surgical site infections (SSIs) in Korea: the Korean Surgical Site Infection Surveillance (KOSSIS) program

PURPOSE: We aimed to develop an effective system for surgical site infection (SSI) surveillance and examine the current domestic state of SSIs for common abdominal surgeries in Korea. METHODS: The Korean Surgical Site Infection Surveillance (KOSSIS) program was developed as an SSI surveillance system. A prospective multicenter study in nine university-affiliated or general hospitals was conducted for patients who underwent gastrectomy, cholecystectomy, appendectomy, colectomy, or proctectomy between August 16 and September 30 in 2012. Patients were monitored for up to 30 days by combining direct observation and a postdischarge surgeon survey. Data on SSIs were prospectively collected with KOSSIS secretarial support according to a common protocol. Operation-specific SSI rates were stratified according to risk factors and compared with data from the Korean Nosocomial Infections Surveillance System (KONIS) and National Healthcare Safety Network. A focus group interview was conducted with participating hospitals for feedback. RESULTS: A total of 1,088 operations were monitored: 207 gastrectomies, 318 cholecystectomies, 270 appendectomies, 197 colectomies, and 96 proctectomies. Operation-specific SSI rates determined by the KOSSIS program were substantially higher than those found in KONIS (7.73% [95% confidence interval, 4.5%-12.3%] vs. 3.4% for gastrectomies, 10.15% [95% confidence interval, 6.1%-15.2%] vs. 4.0% for colectomy, and 13.5% [95% confidence interval, 7.4%-22.0%] vs. 4.2% for proctectomy). CONCLUSION: Despite a short surveillance period and heterogenous group of hospitals, our results suggest that KOSSIS could be a useful program to enhance SSI surveillance in Korea.

Hand Hygiene Promotion in a Hospital Setting through the WHO Multimodal Hand Hygiene Improvement Strategy / 병원감염관리

BACKGROUND: This study evaluated the frequency and types of hand hygiene practices among healthcare workers directed by the WHO multimodal hand hygiene improvement strategy, and investigated the effect of hand hygiene practice on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) isolation and MRSA acquisition rate and colonization pressure. METHODS: A quasi-experimental study was performed at a tertiary care university hospital with 850 beds from January to September 2012. We assessed the hospital hand hygiene program using the WHO hand hygiene self-assessment framework. The WHO multimodal strategy was used for healthcare workers with low indexes, and the subjects were reassessed. RESULTS: Hand hygiene compliance increased significantly from a pre-intervention rate of 58.7% to 72.6% post-intervention. MRSA and VRE isolation rates decreased from 1.69 per 1000 patient days to 1.41 and from 0.17 to 0.11, respectively. In intensive care units (ICUs), hand hygiene compliance rate rose to 77.9%, with a total score of 4.16 points out of 5 being awarded for the hand hygiene method, which was higher than that for the other care units. The pre-intervention MRSA acquisition rate in the ICU decreased from 7.47% to 4.30% post-intervention. This was associated with a decrease in the MRSA colonization pressure over the intervention period (26.2% to 16.9%). CONCLUSION: The utilization of the WHO multimodal strategy for improvement of hand hygiene increased the hand hygiene compliance rate and was effective in predicting a decreased rate of cross-infection, MRSA acquisition, and colonization pressure. We conclude that the implementation of such improvement strategies is crucial to maintaining hygiene standards and reducing infection within healthcare facilities.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2011 through June 2012 / 병원감염관리

BACKGROUND: This article reports annual data of intensive care units (ICU) module of the Korean Nosocomial Infections Surveillance (KONIS) system from July 2011 through June 2012. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 143 ICUs in 81 hospitals using the KONIS system. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient days or device days. Asymptomatic bacteriuria was excluded on or after October 1, 2011. RESULTS: A total of 3,374 NIs were found during the study period: 1,356 UTIs (1,336 cases were urinary catheter-associated), 1,253 BSIs (1,091 were central line-associated), and 765 PNEUs (481 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 2.26 cases per 1,000 device-days (95% confidence interval, 2.14-2.39) and urinary catheter utilization ratio was 0.85 (0.849-0.851). The rate of central line-associated BSIs was 3.01 (2.84-3.19) and the utilization ratio was 0.52 (0.519-0.521). The rate of ventilator-associated PNEUs (VAPs) was 1.70 (1.56-1.86) and the utilization ratio was 0.40 (0.399-0.401). Ventilator and urinary catheter utilization ratios were lower in the ICUs of hospitals with 400-699 beds than those in hospitals with 700-899 beds or more than 900 beds. Nevertheless, VAPs and CAUTIs were more common in hospitals with 400-699 beds. CONCLUSION: Nosocomial infection rates were similar to the findings of those of the previous period, July 2010-July 2011. Implementation of proven infection-control strategies are needed, especially in the hospitals having fewer than 700 beds.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2010 through June 2011 / 병원감염관리

BACKGROUND: We present here the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2010 through June 2011. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 130 ICUs in 72 hospitals using KONIS. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: A total of 3,757 NIs were found: 1,978 UTIs (1,949 cases were urinary catheter-associated), 1,092 BSIs (with 932 being central line-associated), and 687 PNEUs (410 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 3.87 cases per 1,000 device-days (95% confidence interval, 3.70-4.05), and the urinary catheter utilization ratio was 0.86 (0.859-0.861). The rate of central line-associated BSIs was 3.01 per 1,000 device-days (2.82-3.21), and the utilization ratio was 0.53 (0.529-0.531). The rate of ventilator-associated PNEUs (VAPs) was 1.75 per 1,000 device-days (1.59-1.93), and the utilization ratio was 0.40 (0.399-0.401). Although both the ventilator utilization ratiosand the urinary catheter utilization ratios were lower in hospitals with 400-699 beds than thosein hospitals with 700-899 beds ormore than 900 beds, the rates of VAPsand CAUTIs were higher in hospitals with 400-699 beds than thosein hospitals with 700-899 beds or more than 900 beds. CONCLUSION: The risk of acquiring VAP and CAUTI is higher in the ICUs of 400-699 bed hospitals than in ICUs oflarger hospitals. Therefore, ongoing targeted surveillance and implementation of proven infection control strategies are needed especially for hospitals having fewer than 700 beds.

Four Children with Multidrug-resistant Acinetobactor baumanii Infections in the Intensive Care Units of a University Hospital / 소아감염

The Multidrug-resistant Acinetobactor baumanii (MDRAB) is an opportunistic pathogen. Patients with long periods of hospital stay and/or under intensive care unit (ICU) receiving invasive management are more susceptible to this pathogen. In this report, four children with MDRAB infection are reviewed and described their clinical characteristics. There had been concurrent outbreaks of MDRAB infection in adult patients in the ICU at this period of time. The first child had received a craniotomy and epidural hematoma evacuation. The second child was admitted for status epilepticus with hydrocephalus. The third child had pneumonia with status epilepticus with hydrocephalus. The fourth child had poor activity due to hypoxic ischemic encephalopathy and convulsive disorder. Except the fourth child, all had not been exposed to carbapenem prior to infection of MDRAB. That imply the cause of MDRAB infections may be associated with invasive management and prolonged hospitalization together with the previous exposure to carbapenem in our cases. We would like to emphasize the importance and minimizing the spread of hospital infection in patients under prolonged intensive care management regardless of the use of carbapenem.

The Analysis of Risk Factor and Infection Control of Carbapenem-Resistant Acinetobacter baumannii in a Medical Intensive Care Unit / 병원감염관리

BACKGROUND: An epidemiologic study was performed after the outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit (MICU) from December 2006 to May 2007. METHODS: A retrospective case-control study was performed using the medical records of the patients. The case and control patients were compared for age, gender, total length of stay in MICU, prior carbapenem use, Acute Physiology and Chronic Health Evaluation II (APACH II) score, presence of central line, effect of mechanical ventilation, and sputum suction. Environmental and hand-washing studies were performed during the outbreak. RESULTS: Ten CRAB-affected patients and 29 controls were enrolled in this study. Univariate analysis showed that the age, total length of stay in MICU, presence of central line, and prior carbapenem use were associated with the CRAB outbreak. However, multivariate analysis showed that only prior carbapenem use was associated with the CRAB outbreak (odd ratio: 8.67, P=0.01). The outbreak disappeared after implementing a combined infection control strategy, including the sequential disinfection of MICU and strict compliance with cross-transmission prevention protocols. CONCLUSION: The use of carbapenem was associated with an increased risk of CRAB infection. This study suggests that the MICU contamination and infection transmission by health-care workers played a major role in the CRAB outbreak. Novel strategies such as restricted use of broad-spectrum antibiotics, strict hand hygiene, strict isolation of the patients, and MICU disinfection may be required to prevent the CRAB outbreak.

A Case of Cardiac Amyloidosis with Complete Atrioventricular Conduction Block Treated by Permanent Pacemaker

In generalized amyloidosis, involvement of heart is not rare, but development fo severe conduction distubance in cardiac amyloidosis is a rare presentation in a clinical situation. We report the first case in Korea of cardiac amyloidosis with complete atrioventricular block, which was confirmed by endomyocardial biopsy. A 59-year-old woman was admitted due to drowsy mentality. We observed a severe atrioventricular conduction disturbance on the electrocardiogram and a marked hypertrophied ventricular wall and a granular sparkling appearance within the wall, a characteristic feature in cardiac infiltration of amyloidosis, on the echocardiography. Endomyocardial biopsy was performed and revealed extensive deposition of amorphous eosinophilic materials within the cardiac muscle cells. Polarizing illumination after Congo-red staining showed typical green birefrigence. We performed a insertion of permanent pacemaker(VVI type) for the treatment of complete atrioventricular block.

Two Cases of Cryptococcosis in Patients with Cushing's Syndrome and Diabetes Mellitus / 대한내분비학회지

Although cryptococcosis complicated with steroid therapy is well described, cryptococcosis has been rarely reported in the presence of Cushing's syndrome characterized by endogenous steroid excess. We experienced two cases of cryptococcosis in patients with Cushing's syndrome and diabetes mellitus. We describe a case of cryptococcal meningitis complicatiog Cushing's syndrome, secondary to pituitary adenoma. And another case of cryptococcal pneumonia complicatiog Cushing's syndrome, secondary to bilateral nodular adrenal hyperplasia. Before Cryptococcosis, two patients were suffered from diabetes mellitus, and they have got both adrenalectomy.

Clinical Studies on Risk Facotrs of Recurrnces after First Febrile Convulsions in Infancies and Early Childhood

The aim of this study was to evaluate the risk factors of recurrences after their first febrile convulsions in infants and young children. Dlinical studies were made on 187 cases of febrile convulsions who were admitted to the Department of pediatrics of wallace Memorial Baptist Hospital from March, 1990 to December, 1992. 1) 63 cases of 187 cases had recurrences after their febrile convulsions. Thus, the recurrence rate was 33.7%. 2) The male to female ratio was 2.1:1. And there were no significant differences in recurrence rates between sexes. 3) The recurrence rate was significantly higher in those whose initial febrile convulsions were developed before first 18 months of life than those whose initial convulsions were after 18 months of age (49.5% vs. 12.5%). 4) The time interval from initial attack to recurrence was within 12 months in 80% of cases. 5) Our study revealed that the seizure characteristics of the initial febrile convulsion are not important as predictive factors about the probability of recurrences. 6) Among the total 187 cases, family history were present in 52 cases (27.8%). And there were significantly higher recurrence rates if their families show the same history of febrile convulsion (63.5% vs. 22.2%). 7) The risk of recurrence was much higher in patients whose first febrile history of febrile convulsion at the same time.