An Epidemiologic Study on the Nosocomial Bloodstream Infection in Two Hospitals / 한국역학회지

PURPOSE: In this study, nosocomial bloodstream infection rate and fatality rate for 774 and 386 patients, who whose blood cultivation were obtained after 48 hours of hospitalization between March 1999 and February 2000 in two university hospitals, were sought. A distribution of etiologic agent and risk factors of the nosocoial bloodstream infection were also investigated. METHODS: This study was carried out through medical record review and a structural questionnaire. Besides registers of microbe cultivation in the department of clinical pathology and medical records of patients were checked. The nosocomial bloodstream infection was also checked through medical records of patients using the standard of CDC. Statistical analysis were performed using SAS 6.12. RESULTS: The nosocomial bloodstream infection rate in hospital K and hospital A were 3.9 and 3.5 per 1,000 discharged patients, respectively. Although the rates were increased accoding to patients' age, they were different by medical departments, showing the highest level in the ICU. The fatality rate from nosocomial bloodstream infection in hospital K and hospital A were 12.5% and 21.8%, respectively. A distribution of etiologic agent of the nosocomial bloodstream infection in hospital K was 17 cases(21.8%) of Coagulase negative staphylococcus(CNS), 12 cases(15.0%) of Staphylococcus aureus and 8 cases(10.0%) of Enterococcus spp. For hospital A, it was 14 cases925.4%) of Coagulase negative taphylococcus(CNS), 9 cases(16.4%) of Staphylococcus aureus and 7 cases(12.7%) of Klebsiella pneumoniae. While risk factors of the nosocomial bloodstream infection edentified in hospital K were ICU, intracranial injury and hospitalization period, those for hospital A were a use of the central nenous tube, intracranial injury and hospitalization period. CONCLUSION: It is expected that nosocomial bloodstream infection increases as aged group increases by the change of the population structure, as the usage of invasive instrument increases by development of new medical instrument as well as large scale hospitals. For these reasons, further studies developing countermeasures against nosocomial bloodstream infection are recommended.

Severity-Adjusted Mortality Rates: The Case of CABG Surgery / 예방의학회지

OBJECTIVES: To develop a model that will predict the mortality of patients undergoing Coronary Artery Bypass Graft (CABG) and evaluate the performance of hospitals. METHODS: Data from 564 CABGs performed in six general hospitals were collected through medical record abstraction by registered nurses. Variables studied involved risk factors determined by severity measures. Risk modeling was performed through logistic regression and validated with cross-validation. The statistical performance of the developed model was evaluated using c-statistic, R2, and Hosmer-Lemeshow statistic. Hospital performance was assessed by severity-adjusted mortalities. RESULTS: The developed model included age, sex, BUN, EKG rhythm, Congestive Heart Failure at admission, acute mental change within 24 hours, and previous angina pectoris history. The c-statistic and R2 were 0.791 and 0.101, respectively. Hosmer-Lemeshow statistic was 10.3(p value=0.2415). One hospital had a significantly higher mortality rate than the average mortality rate, while others were not significantly different. CONCLUSION: Comparing the quality of service by severity adjusted mortality rates, there were significant differences in hospital performance. The severity adjusted mortality rate of CABG surgery may be an indicator for evaluating hospital performance in Korea.