Incidence and Risk Factors for Ventilator-associated Pneumonia in an Intensive Care Unit of a Tertiary Hospital / 병원감염관리

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most severe form of nosocomial infection. However the actual incidence of pneumonia associated with ventilator is not known. The purpose of this study is to examine the incidence of VAP, find out related risk factors, and establish effective preventive measures. METHODS: The medical records of 172 consecutive patients, who have been admitted to the intensive care unit (ICU) from January 2005 to October 2005 and were subjected to mechanical ventilation for more than 48 hours, have been reviewed retrospectively. VAP was defined according to the definition of CDC (1992). The statistical software SPSS (version 12.0) was used to conduct descriptive and comparative analysis including Chi-square, student's t-test, and logistic regression. RESULTS: The incidence was 163 per 1,000 persons and 19.0 per 1,000 ventilator use patient-days. The significant risk factors for VAP were type of ICU (surgical ICU, OR=5.942, 95% CI=1.894-8.644) and duration of ventilator use (OR=3.603, 95% CI=1.810-7.173). VAP developed 3.04 (+/-0.88) days after initiating mechanical ventilation. Causative agents of VAP were Acinetobacter baumanii (35.2%), MRSA (18.8%), Enterobacter aerogenes (12.4%), Klebsiella pneumonia (9.4%), Staphylococcus aureus (6.3%), Burkholderia (6.3%), Serratia marcesceus (6.3%), Stenotrophomonas (3.1%), and Pseudomonas (3.1%) spp. CONCLUSION: Type of ICU (surgical ICU, OR=5.942, 95% CI=1.894-18.644) and duration of ventilator use (OR=3.603, 95% CI=1.810-7.173) were considered to increase the incidence of VAP. Further study with larger number of cases and preventive measures would be necessary to identify risk factors related to the ventilator-associated pneumonia.

The Incidence Rates and Risk Factor of Mild Injury for Two Weeks: Using Korea National Health and Nutrition Examination Survey 2001 / 예방의학회지

OBJECTIVES: This study was performed to provide the basic data for establishing countermeasures for preventing injury by analyzing the incidence rates, the risk factors, the characteristics of the injury and the utilization of medical care for mild injury that lasted for two weeks. METHODS: We examined the injury survey data among the National Health and Nutrition Survey data. The definition of mild injury that lasted for two weeks was that the injury that caused pain at least once a day for two weeks or the injury for which the usual daily activity of the injured person was severely affected. We used statistical analysis methods such as chi-square test and multiple logistic regression analysis. RESULTS: The incidence rate of injury that lasted for two weeks was 4.7 per 1,000 persons. On the multiple logistic regression, the children and adolescents (OR=3.80, 95%CI=1.63-8.84) had higher rates of injuries than the adults, and the middle and high school (OR=0.51, 95%CI=0.31-0.85) and college(OR=0.34, 95%CI=0.17-0.68) students had lower rates of injuries than the elementary school students. The unemployed (OR=0.39, 95%CI=0.20-0.73) and others (OR=0.38, 95%CI=0.21-0.70) had lower rates of injuries than the blue collar workers. The major causes of injuries were found to be falling and slipping, and the most prevalent place of occurrence was near or at home. CONCLUSIONS: A prevention program needs to be developed and continuous education must be offered to the children, adolescents and blue collar workers.

Prevalence Rates and Risk Factors of Overweight and Obesity in Children and Adolescents: Using Korean National Health and Nutrition Examination Survey 2005 Data / 한국역학회지

PURPOSE: To investigate the prevalence rates of overweight and obesty, and their associations in children and adolescents(12-18years) who were defined as normal weight, overweight , and obese. METHODS: Korean National Health and Nutrition Examination Survey 2005 raw data was utilized. The data on the 669 subjects aged 12-18 consisted of variables from the health interview survey, health examination and nutrition survey, and health consciousness behavior survey. Overweight and obesity was evaluated by established body mass index criteria. Chi-squire and Fisher exact test were performed to analyze differences among normal, overweight and obese groups according to basic characteristics and health consciousness behavior. Logistic regression was used to analyze risk factors for the overweight and obese groups. RESULTS: Overweight and obesity prevalence rates were 11.7% and 8.1%, respectively. Of the subjects from urban regions, 20% were overweight and 12.2% were obese. Of those from semi-urban regions, 10.2% were overweight and 3.8% were obese. Of those from rural regions, 9.0% were overweight and 10.1% were obese. The obesity rate in semi-urban regions were 0.38% times lower than the rural rate. CONCLUSIONS: Geographical location constitutes a risk factor for overweight and obesity, which may influence preventative and education programs aimed at schools and the general community.

A Study of Skiing and Snowboarding Injuries / 한국역학회지

PURPOSE: To calculate the injury rate of skiers and snowboarders, to document the risk factors affecting injury, and to investigate the characteristics of the cause, kind and region of injury. METHODS: A questionnaire survey was conducted at 4 major Kangwon - province ski resorts during the 2004 - 2005 winter season with 373 skiers and snowboarders. The statistical SPSS was used to analyze data that included chi-square, fisher's exact test, and multiple logistic regression. The mean mark of the safety rule by separating the skiers and snowboarders was compared between the two groups. RESULTS: The injury and wound experience rates of the snowboarders (46.5%, 34.2% respectively) were higher than those of the skiers (33.2%, 25.5% respectively). The proportion of injury and wound for the skiers was 76.7% and for the snowboarders was 73.6%. The occurrence of injuries was higher among those with ski career of 5 to 9 years (p=0.012), those with a higher level of ski skills (p=0.002), those who used the higher slope (p=0.002) and those who skied 15 to 19 times(p=0.004). Based on the results of logistic regression analysis, the significant risk factors for skiers were career, level, slope and visit number. Leg injuries accounted for 40.9% of total injuries among skiers, which was followed by arm injuries (35.9%) and head injuries (15.4%)(p=0.033). CONCLUSIONS: The study therefore emphasizes safety training for individual skiers and overall conditions of ski resorts.

Nosocomial Bloodstream Infection in Intensive Care Unit in a General Hospital / 한국역학회지

PURPOSE: Despite of the development of recent medical technology, bloodstream infection (BSI) still has significant influences on mortality and morbidity of patients admitted to the ICU. The BSI has the second most frequent site. Especially BSI in ICU have higher infection rate than general ward. This study was investigated the incidence rate of the nosocomial BSI, risk factors and bacterial pathogens of BSI in ICU for a general hospital. METHODS: This study was carried out for those 443 patients in ICU of general hospital during the period from March 2002 to February 2003. The definition for BSI was based on that of CDC. Data was collected by questionnaire, medical record review. The statistical SPSS(ver. 10.0) was used to analyze data that included chi-square, t-test and logistic regression. RESULTS: In the incidence rates of the BSI were 76.7 in 1,000 per patients, 7.0 in per 1,000 patients days and 32.1 in per 1,000 patients with central lines, 3.2 in per 1,000 cental line days. In the incidence rates of the BSI by type of ICU showed MICU 10.1, SICU 2.9 in per 1,000 patients days. The significant risk factors were identified as type of ICU(OR=5.119, p=0.001), length of stay(OR=1.039, p=0.001). The causal microbes of the BSI were CNS 35.5%, MRSA 23.6%. The bacterial pathogens of central catheter-related BSI were CNS 50%, MRSA 50%. CONCLUSION: The occurrence of ICU-acquired infection was significantly related to the increase in morbidity and mortality. Ongoing targeted surveillance and infection control strategies is necessary to control this problem.

Analysis of Studies on Colorectal Cancers Published in Korean Medical Journals Between 1967 and 2004 / 한국역학회지

PURPOSE: The study analyzed and categorized the colorectal cancers related medical journals published in Korea by the name of the journal, research materials, study method, statistical method and by content of study for the quality improvement of colorectal cancers related studies. METHODS: The authors reviewed a total of 567 colorectal cancer-related studies published in the Korean medical journals during the period 1967 and 2004 and kept in the National Assembly Library. The distribution of research materials, study method, statistical method and content of these studies were analyzed by the 5 year publication interval. RESULTS: By study period, the number of published studies steeply increase during the period between 2000 and 2004. As the research materials, hospital patients(64.6%) and In-vitro(16.6%) were the most prevalently used research materials, but health adults were the lowest research materials by only taking up 0.4%. In study methods, patient follow up studies(28.7%) and human in vitro experimental(27.9%) were prevalent, and human in vitro experimental were relatively the most popular performed studies during the years of 1990-1994. As the statistical method, life table and survival analysis(27.0%) were the mostly performed methods, and the use of statistical method was applied in nearly all studies. The contents of the studies mainly focused on the patient prognostic estimations(27.6%) of therapeutic safety & efficacy(25.6%), but only the 4.1% of risk factors studies. Among the 109 studies which analyzed the survival term 78.9% of the studies mainly used the 5 year term in the analysis of survival rates. CONCLUSION: The results of the study could be utilized as the basic data for the quality improvement of further colorectal cancers related studies.

Characteristics of Injury in a University Hospital / 한국역학회지

PURPOSE: This study was performed to provide the basic data in the establishment of preventive countermeasures for injury by analyzing the characteristics of injury, and risk factors of injury. METHODS: From 2,059 injury patients among 19,947 patients admitted between January and December, 2004 at a university hospital located in Gyeonggi-do, 500 injury patients were sampled randomly by systematic sampling. A total of 500 questionnaires was collected and used for this study. The statistical SPSS was used to analyze data that included chi-square, fisher's exact test. RESULTS: Injury patients among total admission patients was 10.3%. In both general characteristics of injury and non-injury patients, gender, age, length of stay was significant. As the cause of injury were compared with those of injury external causes, type, place, site, and time of injury were significant. As the cause of injury were compared with the characteristics of related-injury, surgery, multiple injuries, mental history, consciousness at the time emergency room visit, length stays were significant. CONCLUSION: With regard to general characteristics, injury external causes, injury-related causes, and factors such as sex, age, occupation, and educational background were related to each other. Injury does not occur by accident or unexpectedly. Therefore, if preventive attention is focused on individuals with high risk factors of injury, the incidence rate will be diminished.

The Prediction on the Behavior of Infection Control of Operating Room Nurses in Seoul: an Application of the Theory of Planned Behavior / 병원감염관리

BACKGROUND: This is a theory verification study in which the theory of planned behavior (TPB) of Ajzen is applied to predict operating room (OR) infection control behavior. The study was carried out to know the path of attitude, subjective norm, perceived behavioral control, and intention towards OR infection control behavior. METHODS: A total of 178 OR nurses working at 13 hospitals in Seoul were the subjects of this study. A questionnaire survey was performed; the data were collected from April 6 to April 19, 2005 and analyzed with t-test, ANOVA, multiple regression, and person's correlation using SPSS program. Using AMOS, the factors of TPB were analyzed with path analysis. RESULTS: The total mean of infection control behavior of OR nurses was 4.37 points out of possible 5.0, and asepsis/operating instrument sterilization had 4.69, which was the highest among all areas of infection control behavior. In case of the relation between attitude, subjective norm, perceived behavior control, and intention, there was the strongest relation of cause and effect (path coefficient 0.38, 39%). In case of intention, perceived behavior control, and behavior, the relation of cause and effect between intention and behavior was path coefficient 0.17 and behavior was path coefficient 0.19. The degree of explanation was 10%. CONCLUSION: We should try to improve environment management in behavior area, and through this study, the importance of education was verified.

The Prediction on the Behavior of Infection Control of Operating Room Nurses in Seoul: an Application of the Theory of Planned Behavior / 병원감염관리

BACKGROUND: This is a theory verification study in which the theory of planned behavior (TPB) of Ajzen is applied to predict operating room (OR) infection control behavior. The study was carried out to know the path of attitude, subjective norm, perceived behavioral control, and intention towards OR infection control behavior. METHODS: A total of 178 OR nurses working at 13 hospitals in Seoul were the subjects of this study. A questionnaire survey was performed; the data were collected from April 6 to April 19, 2005 and analyzed with t-test, ANOVA, multiple regression, and person's correlation using SPSS program. Using AMOS, the factors of TPB were analyzed with path analysis. RESULTS: The total mean of infection control behavior of OR nurses was 4.37 points out of possible 5.0, and asepsis/operating instrument sterilization had 4.69, which was the highest among all areas of infection control behavior. In case of the relation between attitude, subjective norm, perceived behavior control, and intention, there was the strongest relation of cause and effect (path coefficient 0.38, 39%). In case of intention, perceived behavior control, and behavior, the relation of cause and effect between intention and behavior was path coefficient 0.17 and behavior was path coefficient 0.19. The degree of explanation was 10%. CONCLUSION: We should try to improve environment management in behavior area, and through this study, the importance of education was verified.

Risk Factors for Surgical Site Infection among Patients in a General Hospital / 병원감염관리

BACKGROUND: Despite prophylactic preoperative managements, surgical site infection (SSI) still has a significant influence on the mortality and morbidity of surgical patients because of an increased number of immunocompromised patients, prolonged anesthesia or an increased use of various operative equipments. In the end, it leads to an increase in hospital days and medical expenses. Therefore, we tried to find out significant risk factors for SSI in a general hospital. METHODS: The study was carried out on the 1,239 patients who underwent a surgical operation in a general hospital, and the incidence rate and risk factors of SSI were analyzed. RESULTS: Among the 1,239 patients, 33 (2.7%) had SSI and the incidence rate was 26.6 per 1,000 person. Of these, 27 (81.8%) and 6 (18.2%) developed an infection before and after discharge, respectively. The influencing factors of SSI were the dirty wound, the frequency of re-operation, the duration of preoperative hospitalization, and the duration of the operation. The most common pathogen isolated from the surgical site was Staphylococcus aureus (27.2%). CONCLUSION: To prevent SSI, a professional group must be established to manage surgical sites and wounds, and the patients should be covered by strict standardized knowledge and guidance.

Korean Nosocomial Infections Surveillance System (KONIS) Report: Data Summary from July through September 2006 / 병원감염관리

BACKGROUND: THe Korean Society for Nosocomial Infection Control (KOSNIC) orfanized the Korean Nosocomial Infections Surveillance System (KONIS) to establish a nationwide database of Nosocomial infection (NI) rate in the intensive care units (ICUs) of Korean hospitals. This report is a summary of the data from July through September 2006. METHODS: The KONIS performed a prospective sruveillance for nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 76 ICUs in 44 hospitals. NI rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: A total of 846 nosocomial infections were fOlllld during the study period: 407 UTIs (397 cases were urinary catheter-associated), 204 BSIs (182 were central line-associated), and 235 PNEUs (161 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.61 cases per 1,000 device-days and urinary catheter utilization ratio was 0.83. The rate of central line-associated BSIs was 3.16 and the utilization ratio was 0.55. The rate of ventilator-associated PNEUs was 3.80 and the utilization ratio was 0.41. Although the ventilator utilization ratio was lower in the hospitals with 400-699 beds than in the hospitals with more than 900 beds, the rate of ventilator-associated pneumonia was higher in the smaller hospitals than in the larger ones. The rates of all three device-associated infections were the highest in the neurosurgical ICUs and the rates were the lowest in the surgical ICUs. CONCLUSION: This study may contribute to the development of effective strategies for NI control according to the size of hospital and the type of ICUs.

Risk Factors of Impaired Fasting Glucose and Type 2 Diabetes Mellitus: Using Datamining / 한국역학회지

PURPOSE: This study aimed to contribute to overall public health by examining the prevalence rates of impaired fasting blood glucose and type 2 diabetes mellitus and developing a model to predict high risk factors for impaired fasting blood glucose and type 2 diabetes mellitus. METHODS: The 1998 Public Health Nutrition Survey data was used for this study. Subjects were 7,702 adult at the age of 20 or over. The frequency analysis, chisquared test was performed. A decision tree was utilized to define a model designed to predict high risk factors for impaired fasting glucose and type 2 diabetes mellitus. RESULTS: The prevalence rates of impaired fasting blood glucose was 10.8% and prevalence rates of type 2 diabetes mellitus was 9.4%. The decision tree analysis exhibited that age was strong factors for impaired fasting blood glucose. HDL cholesterol and kind of economic activities were high risk factors for impaired fasting blood glucose and type 2 diabetes mellitus on those in 20s. BMI, total cholesterol level, marriage status, sex for impaired fasting blood glucose and type 2 diabetes mellitus on those in 30s. The total cholesterol level, drinking and waist size were identified as risk factors on those in 40s. BMI, education level and hypertension seemed to have an impact on those in 50s. The waist size, sex and income had an impact on those in 60s. CONCLUSIONS: This study underscores the need for the public health infrastructure to improve various health promotion programs for those who have risk factors for impaired fasting blood glucose and type 2 diabetes mellius. The implementation of effective nutrition, workout and anti-drinking programs will boost public health.

Infection of Methicillin-Resistant S. Aureus Nasal Carriage in the Community Pediatric Population / 한국역학회지

PURPOSE: Methcillin-resistant Staphylococcus aureus(MRSA) is known as a major cause of hospital acquired infection. The infection with MRSA bacteria is becoming frequent in the community because there are many people who have risk factors with low immunity. This study is intended to investigate the prevalence of MRSA in children and determine risk factors using genetic analysis. METHODS: Children aged between 3 and 7 years were recruited from six preschool institutions from Nov. 2004 to Feb. 2005 based in Seoul, Gyeonggi Province and Gyeongsang Province. A questionnaires was distributed to 1,000 parent of these children along with the letter of consent. A total of 242 questionnaires were collected and used for this study. Nasal secretion samples were collected using sterilized specimen containers and incubated in culture medium using mannitol salt agar to separate S. aureus. MRSA samples were identified through coagulase test and MICRO SCAN. PCR was performed on MRSA isolates to detect genetic sequence specific of MRSA. RESULTS: Of total 242 respondents, 16(6.6%) were found to be positive for MRSA. By residence area, 2(1.9%) out of 103 were positive in Seoul, 4(10.3%) out of 39 were positive in Gyeonggi Province and 10(10.0%) out of 100 were positive in Gyeongsang Province, showing a significant difference(p=0.037). A logistics regression was performed to evaluate the influences of variables that were significant. Gyeongsang Province had prevalence of MRSA(OR=5.520), and Gyeonggi Province(OR=5.710). Based on PCR, the distribution of genotypes of MRSA showed various patterns. But there was no difference between regions. CONCLUSIONS: MRSA infection was high in children when one of their parents were working in hospital or when one of their family members have underlying disease. This study provided evidence that the prevalence of MRSA is largely influenced by individual element such as family and health condition.

Secular Trends of Suicide Mortality in Korea / 한국역학회지

PURPOSE: This study was conducted to analysis the trends and states of suicide mortality in Korea from 1983 to 2001. METHODS: This study was based on data published in 1983-2001 from the annual report of the cause of death statistics of National Statistical Office. RESULTS: First, both of annual suicide rate and adjusted suicide rate rapidly went up in 1996 and hit the highest in 1998. Second, since 1983 only when the suicide rate was the highest in the ages 20-24 rather than other age groups, the suicides have been continuously shown to be the highest in the old age group. Third, the seasonal percentages of suicides were generally high in spring and summer, the seasons when the percentage of sunshine is relatively high, in both results for men and women. Fourth, men have most frequently committed suicide through hanging while their suicide through falling from a high site have least frequently occurred but currently tends to gradually increase. Meanwhile, women have most frequently done suicide generally by using insecticide. CONCLUSION: In Korea, the suicide rate and suicide percentage of the old people have been yearly increasing, and their suicide rate is also shown to the highest rather than those of other age groups. Therefore, it is necessary to prevent the suicide of the old people through a systematic analysis. Moreover, it is necessary to verify the risk factors and defensive factors for the suicide impulse and suicide attempt. On the basis of this, the construction of a nationwide social safety network for the national mental health is very important to find and treat the problems of the mental health to lead the people to suicide.

The Characteristics of Relapsed Patients with Pulmonary Tuberculosis Registered at Two Public Health Centers in Seoul / 한국역학회지

PURPOSE: The purpose of this study is to survey general and clinical characteristics of a group of relapsed patients with pulmonary tuberculosis, who are registered at a public health center in order to provide basic data for treatment of a patient's relapse, follow-up examination after the first treatment and health education. SUBJECT: Among 68 relapsed patients with pulmonary tuberculosis registered at two public health centers in Seoul from Jan, 1, 2002 to Dec. 31, 2002, 50 patients were selected as research subjects because they were contactable by telephone and they agreed to be a research subject. METHOD: The research carried out the structured questionnaire survey by telephone and surveyed research subjects' general and clinical characteristics, diseases except tuberculosis, drinking and smoking habit and knowledge about pulmonary tuberculosis treatment. Furthermore, the results of x-ray, whether a cavity existed or not, bacteriologic test, culture examination and drug resistance examination were examined and interval to relapse and history of dose attitude were surveyed. RESULTS: Among relapsed tuberculosis patients, male patients were 60% and they were more than women(40%). Patients over 60 were 42% most. In their occupation, 30% of them were unemployed and 50% of patients surveyed had monthly income below one million won. According to the findings in radiographic extent, most 50% of them were minimal, 44% were moderately advanced and 2% were far advanced. Patients who had cavity were 30%. According to the result in bacteriologic test, 54% showed positive smear pulmonary tuberculosis and 50.0% positive culture. According to the result in drug resistance, 24% showed drug resistance against one drug and 76% showed sensitive response. 46% had experienced medication side effects. According to interval to a relapse, 32% were relapsed less than 2 years, 14% less than 3-5 years and 54% more than 5 years. Average interval before a relapse were 11.6 years(11.6+/-11.15). There was a difference between their past regimen and their present regimen(P=0.001). The attitude towards taking a medication was assessed and they showed higher compliance with medication at present than in the past(P=0.001). In a case of smoking rate during treatment, the rate of non-smokers, who had been smokers, were higher(P=0.047). CONCLUSION: As a result, in order to prevent the disease from being relapsed and to increase the rate of treatment effectiveness, we need to make patients recognize the importance of regular follow-up examination and we should control thoroughly the patients. Furthermore, we need to provide them with more health education not to stop taking a medication earlier.