Effects of Professional Toothbrushing and Instruction in the Elderly: A Randomized Trial / 치위생과학회지

The purpose of this study was to identify the effect of providing toothbrushing by professionals as part of oral hygiene education for the elderly. We randomly visited 12 centers in the metropolitan city and analyzed the data of 114 participants among 310 early registrants aged >65 years, who participated in the study at all 3 time points. The subjects were categorized into an experimental group (odd-numbered visits) and a control group (even-numbered visits). Oral hygiene practices were provided for both experimental and control groups, but professional toothbrushing was performed in a different manner in the experimental group. Differences in plaque index (PI) according to the subjects' general characteristics and oral health status were assessed using the t-test, and the effect of PI difference between the experimental and control groups was assessed by repeated measure two-way analysis of variance. A stepwise multiple regression analysis was used to analyze factors affecting the PI. At baseline, the mean overall PI was 61.82. In both experimental and control groups, the PI significantly reduced from the baseline (p <0.01). At 5 weeks, the experimental group showed a decrease of 27.16 points from the baseline, and the 10-week PI was similar to the 5-week PI. The control group showed a decrease of 14.87 points from the baseline, and the PI increased by 5.74 points at 10 weeks. PI-related factors were gender and self-xerostomia. The PI was lower in the female group and the group with self-xerostomia (p <0.01). It is important to select an appropriate method to educate elderly subjects on proper removal of dental plaque and to habituate correct behavior, which requires inclusion of a direct toothbrushing intervention by a specialist.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2009 through June 2010 / 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 2009 through June 2010. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) at 116 ICUs in 63 hospitals by using KONIS. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: We identified 3,965 NIs during the study period: 2,156 cases of UTIs (2,119 were urinary catheter-associated), 1,110 cases of BSIs (948 were central line-associated), and 699 cases of PNEU (410 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 4.75 cases per 1,000 device-days (95% confidence interval, 4.55-4.95), and urinary catheter utilization ratio was 0.86 (range, 0.859-0.861). The rate of central line-associated BSIs was 3.28 (range, 3.07-3.49), and the utilization ratio was 0.56 (range, 0.559-0.561). The rate of ventilator-associated PNEUs (VAPs) was 1.95 (range, 1.77-2.15), and the utilization ratio was 0.41 (range, 0.409-0.411). Although ventilator utilization ratio was lower in the hospitals with 400-699 beds than in the hospitals with 700-899 beds and more than 900 beds, the rate of VAPs were higher in the hospitals with 400-699 beds than in hospitals with 700-899 beds and more than 900 beds. The incidence of infections due to imipenem-resistant Acinetobacter baumannii increased from 43.6% to 82.5% since July 2006. CONCLUSION: The risk of acquiring VAP and CAUTI is highest in the ICUs of hospitals with 400-699 beds than that in hospitals with more beds. Imipenem-resistant A. baumannii was identified as an emerging gram-negative pathogen of nosocomial infections.

Healthcare-Associated Infection Surveillance in Small and Medium Sized Hospitals / 병원감염관리

BACKGROUND: The purpose of this study is to know the healthcare-associated infection (HAI)s in small and medium sized hospitals, less than 400 beds. METHODS: We had web based surveillance for HAIs in 27 hospitals from August to October 2010. The surveillance performed in 1-2 ICUs and 1 general ward in each hospitals by CDC definition. And for the multi-drug resistant organisms (MDROs), we reviewed all of blood culture results. RESULTS: We identified 319 HAIs among 269,436 patients days. The HAIs rate was 1.18 (CI 1.05-1.32)/1,000 patient-days. Urinary tract infection was the most common HAI (52.4%) in this study followed by pneumonia (18.9%), blood-stream infections (14.2%), surgical site infection (7.9%), and others (6.6%). There were 76.5% of device associated infections in UTI, 46.7% in BSI, and 18.3% in pneumonia. The rate of HAIs in ICU was higher than that of in general ward (4.6 vs 0.9/1,000 patient-days). However, the indwelling catheter associated urinary tract infection rate was lower in ICU (2.6 vs 4.4/1,000 device days). There were no significant differences in central line-associated blood stream infection rate (1.5 vs 1.8) and ventilator-associated pneumonia rate (3.0 vs 0.0). The common microorganisms found in HAIs were Escherichia coli (19.8%), Staphylococcus aureus (13.1%), and Pseudomonas aeruginosa (12.7%). Moreover, 90.9% of S. aureus were resistant to methicillin, and 38.2% of P. aeruginosa and 44.4% of Acinetobacter baumannii were resistant to imipenem. Total of 66 MDROs were isolated from blood culture and the result shows that the MRSA was 84.6% (56 case), carbapenmen-resistant Acinetobacter spp. was 10.6% (7 case), and vancomycin-resistant enterococci was 4.6% (3 case). CONCLUSION: The characteristics of HAIs in small and medium sized hospitals will be contributed to the decision making of governance policy for infection control and to provide comparable data for these hospitals.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2008 through June 2009 and Analysis of 3-Year Results / 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 2008 through June 2009. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 101 ICUs in 57 hospitals using KONIS. Nosocomial infection (NI) rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: We identified 3,287 NIs during the study period: 1,787 UTIs (1,772 cases were urinary catheter-associated), 917 BSIs (797 were central line-associated), and 583 PNEUs (335 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.80 cases per 1,000 device-days (95% confidence interval, 4.58-5.03) and urinary catheter utilization ratio was 0.85 (0.849-0.851). Although the urinary catheter utilization ratios were lower in the hospitals with 400-699 beds than in the hospitals with 700-899 beds and more than 900 beds, the rates of urinary catheter-associated UTIs were higher in hospitals with 400-699 beds than in the larger ones. The rate of central line-associated BSIs was 3.27 (3.05-3.51) and the utilization ratio was 0.56 (0.559-0.561). The rate of ventilator-associated PNEUs was 1.86 (1.67-2.07) and the utilization ratio was 0.41 (0.409-0.411). The rate of ventilator-associated PNEUs was lower in July 2008-June 2009 than in July 2007-June 2008 and July 2006-December 2006. CONCLUSION: It appears that the KONIS influences the reduction in the rate of device-associated infections, especially ventilator-associated PNEU; therefore, ongoing targeted surveillance and infection control strategies are needed to control device-associated infections.

Effects of Oral Care Using Chlorhexidine Gluconate on Ventilator-Associated Pneumonia in the Intensive Care Unit / 병원감염관리

BACKGROUND: This study was aimed to identify the effect of oral care using 0.1% chlorhexidine gluconate (CHG) on ventilator-associated pneumonia (VAP) in the intensive care unit (lCU). METHODS: A total of 82 ventilated patient were enrolled in this prospective clinical trial performed during the 6-month period from October, 2005 through March, 2006. oral care was performed on the patients three times a day with 0.1% CHG for the study group and with 0.9% saline for the control group. To evaluate the colonization of potential pathogens, sputum cultures were taken on the first day of ventilation and followed on days 3, 5, 7, and 14. RESULTS: The overall incidence rate of YAP was 0.359 in the CHG-treated group compared to 0.116 in the NaCI-treated group (P=0.017). Likewise, 1000 device-day incidence rate of YAP was significantly lower in the CHG-treated group than in the NaCI-treated group (P=0.0396). However, among the patients whose initial sputrm cultures were positive , both the incidence rate (P=0.114) and 1000 device-day incidence rate (P=0.361) were not statistically significant. The average time from the day of ventilation to the onset of VAP among the patients whose initial sputrm cutures were positive was 14 days in the CHG-treated group and 9 days in the NaCI-treated group, but the difference was not statistically significant (P=0.169). CONCLUSION: An oral care with 0.1% CHG was helpful in controlling VAP in the ICU patients, but the effectiveness of CHG could not be confirmed in the patients whose initial sputrm cultures were positive.