Actual Disinfection and Sterilization Control in Korean Healthcare Facilities / 기본간호학회지

PURPOSE: This study was done to investigate the status of disinfection and sterilization in healthcare facilities. METHOD: A survey of 193 Korean healthcare facilities was conducted from February 8 to March 7, 2013. Data were analyzed using descriptive statistics, chi2 test, Fisher's exact test, one-way ANOVA, Scheffe with SPSS WIN 18.0. RESULTS: Of the healthcare facilities 93.2% had specific guidelines for disinfection/sterilization, but only 47.9% had a committee on disinfection/sterilization for decision-making, less than half (42.7%) conducted regular monitoring of actual practices, while 83.9% had established procedures for recovery in case of problems with the disinfection process and 89.0% kept records and archives of disinfection practices. Cleaning process, selection of chemical disinfectants and process of disinfection and sterilization were found to be inadequate in some healthcare facilities. Perception score for adequacy of medical instruments was 8.10, environmental disinfection was 7.20, and sterilizer management was 8.45 out of a possible 10. CONCLUSION: Compared to larger institutions, smaller healthcare facilities had less effective disinfection and sterilization management systems, while some facilities showed inadequate practices for medical equipment and general sterilization. Better academic and state-level support is recommended for smaller facilities in order to establish a better system-wide management system.

Epidemiological Characteristics and Scale for Needlestick Injury in Some University Hospital Workers / 대한산업의학회지

OBJECTIVES: Based on multicenter research among tertiary hospitals in Korea, it was our intention to effectively contribute to the prevention of needlestick injuries by understanding the current state of the incidence rate of needlestick injuries and the related epidemiology with respect to medical institution and worker's characteristics. METHODS: Ten hospitals were selected, with the research performed from July to September 2007. Data on cases of needlestick injuries were collected by hospital infection-controlling centers using a specifically developed website and a partially modified self-writing questionnaire based on the Exposure Prevention Information Network (EPINet). RESULTS: During the study period, a total of 327 needlestick injury cases were reported, with an incidence of 10.56 cases per 100 patient beds per year. The existence of source of infection could not be confirmed in one third of the needlestick injuries. There were 4.07 incidences per 100 employees per year. The job with the highest incidence was medical doctor interns (18.66 cases), followed by clinical laboratory workers (7.12 cases) and registered nurses (6.66 cases). CONCLUSIONS: There was no difference in number of incidences according to the number of beds. The highest number of cases occurred in the registered nurse-group, but the incidence rate per healthcare worker was the highest in the medical doctor intern-group. Therefore, it is important to conduct research to identify the risk of the incidence with respect to different risk-groups. As a result of this research, it is suggest that a protective policy is required relating to needlestick injuries, regardless of the number of beds and potential cause of infection.

Risk Factors for Neurosurgical Site Infections after Craniotomy: a Nationwide Prospective Multicenter Study in 2008 / 병원감염관리

BACKGROUND: Neurosurgical site infection may have serious sequelae, especially that occurring after craniotomy. A nationwide prospective multicenter study was performed in Korea to determine the incidence and risk factors for surgical site infections (SSI) after craniotomy. Methods: We collected demographic data, clinical and operative risk factors for SSI, and information regarding the antibiotics administered for the patients who underwent craniotomy in 17 hospitals between July and December of 2008. All the data were collected using a real-time web-based reporting system. RESULTS: Of the 1,020 patients who underwent craniotomy, 31 (3%) developed SSI, including 4 with superficial incisional SSI, 2 with deep incisional SSI, and 25 with organ/space SSI. The SSI rate was predicted on the basis of the National Nosocomial Infections Surveillance (NNIS) risk index. The SSI rate of 3.1%, 3.3%, and 1.8% were ascribed NNIS scores of 0, 1, and 2, respectively. The independent risk factors for SSI identified were postoperative cerebrospinal fluid leakage (odds ratio, 12.13; 95% confidence interval, 4.54-32.42) and preoperative Glasgow coma scales score < or =8 (odds ratio, 2.35; 95% confidence interval, 1.07-5.18). Third generation cephalosporins were the most frequently (in 65.6% of the cases) used for prophylaxis. CONCLUSION: A multicenter SSI surveillance system for craniotomy was first established in Korea. The NNIS risk index was not effective in identifying the patients at risk. We required to further analyze a large number of SSI cases to correctly identify the risk factors for SSI after craniotomy.

A Study on the Recognition and Performance of Nursing Students' Hand Washing / 병원감염관리

BACKGROUND: The purpose of this study is to inquire into the recognition and performance of nursing students' hand washing and propose basic data for upright recognition and performance as reserve nurses. METHODS: A survey was carried out from September 1 to September 14, 2008 by first distributing questionnaires to 550 nursing collage students attending three-year-course or four-year-course colleges in Daegu. Of all the questionnaires later collected, only the copies received from the students, who were in their last year of college(416 copies), were used for analysis. RESULTS: The recognition and performance of their hand washing averaged 3.49 and 4.08 points, respectively, showing that the level of recognition was higher than that of performance. In addition, the four-year-course nursing college students showed higher recognition level compared to the three-year-course nursing college students. However, the result was vice versa for the performance level. CONCLUSION: It is necessary for nursing students, as reserve nurses, to receive an education to improve the recognition and performing level of hand washing.

Three-Year Follow-up of an Outbreak of Serratia marcescens Bacteriuria in a Neurosurgical Intensive Care Unit

We report on the investigations and interventions conducted to contain an extended outbreak of Serratia marcescens bacteriuria that lasted for years in a neurosurgical intensive care unit (NSICU). A case-control study was performed to identify the risk factors for S. marcescens acquisition in urine. In case patients, urine sampling for tests and central venous catheterization were performed more frequently before the isolation of S. marcescens. Case patients were more frequently prescribed third-generation cephalosporins. Adherence to hand antisepsis was encouraged through in-service educational meetings and infection control measures, especially concerning the manipulation of indwelling urinary catheters, were intensified. The outbreak persisted despite the reinforcement of infection control measures. However, no patient has newly acquired the organism in the NSICU since December 2004. Multiple factors, including inadequate infection control practices and inappropriate antimicrobial usage, possibly contributed to the persistence of this S. marcescens outbreak. Healthcare workers should consistently follow infection control policies to ensure quality care.

Three-Year Follow-up of an Outbreak of Serratia marcescens Bacteriuria in a Neurosurgical Intensive Care Unit

We report on the investigations and interventions conducted to contain an extended outbreak of Serratia marcescens bacteriuria that lasted for years in a neurosurgical intensive care unit (NSICU). A case-control study was performed to identify the risk factors for S. marcescens acquisition in urine. In case patients, urine sampling for tests and central venous catheterization were performed more frequently before the isolation of S. marcescens. Case patients were more frequently prescribed third-generation cephalosporins. Adherence to hand antisepsis was encouraged through in-service educational meetings and infection control measures, especially concerning the manipulation of indwelling urinary catheters, were intensified. The outbreak persisted despite the reinforcement of infection control measures. However, no patient has newly acquired the organism in the NSICU since December 2004. Multiple factors, including inadequate infection control practices and inappropriate antimicrobial usage, possibly contributed to the persistence of this S. marcescens outbreak. Healthcare workers should consistently follow infection control policies to ensure quality care.

Improved Reporting Rate of Notifiable Communicable Diseases through a Disease Code-Based Surveillance and In-House Electronic Reporting System / 병원감염관리

Background: Reporting rate of notifiable communicable diseases has been assumed to be low in Korea. To encourage timely reporting of notifiable communicable diseases and to improve the reporting process by the Infection Control Unit, a disease code-based electronic surveillance and in-house electronic reporting system was developed and implemented in February 2003. We evaluated the reporting rates of notifiable communicable diseases before and after the implementation of the electronic reporting- system. METHODS: The electronic reporting system, which was integrated to the computerized physician order entry system, was designed to monitor KCD-4 codes at the time of every order entry. Whenever the system recognized the predetermined codes of notifiable communicable diseases, it generated an alert box to recommend reporting: and then a physician could fill up an electronic report form, which was collected and faxed to the local public health authority by the Infection Control Unit. Reporting rate of notifiable communicable diseases in 2002, when the conventional paper-based reporting system was used, was assumed comparing the number of cases reported actually and that of cases identified to be reported by reviewing the medical records and electronic database. RESULTS: From March to July 2003, 181 cases with tuberculosis and 14 with other communicable diseases were reported whereas 106 and 9 cases were reported respectively for the same 5-month period in 2002. Reporting rate using the conventional reporting system in 2002 was assumed to be 61% and 39% respectively. Conclusions: Using a disease code-based electronic reporting system, reporting of notifiable communicable diseases could be improved compared with conventional paper-based reporting system.