Hand-to-face contact behaviors during indoor activities in daily life among Korean adults: an observational pilot study using videotaping / 한국역학회지

OBJECTIVES@#Hand-to-face contact (HFC) is the major route for the self-inoculation of pathogens. This study aimed to describe the characteristics of HFC behaviors among Korean adults during indoor activities. @*METHODS@#Thirty participants were enrolled in the study, and 2 hours of videotaped data were collected from each participant. Contact data were recorded by examining the frequency and duration of HFC on the videos. Three training sessions were conducted for 2 readers to ensure the accuracy and reliability of videotape reading. Re-reading and verification of selected video data were performed to confirm intrapersonal and interpersonal validity. Contact exposure (CE) was determined by multiplying the contact frequency (CF) by the contact duration (CD) to quantify the intensity of contact during the observation time (2 hours). @*RESULTS@#A total of 3,007 HFCs (1,305 mucous membrane contacts and 1,702 non-mucous membrane contacts) were observed for 60 person-hours. The median CF (person/2 hr) of the mucous membranes (eye; 4.0, nose; 15.5, mouth; 16.5) was 39.5/person and the median total CD was 177.0 sec/person. The median CE (frequency-duration/sec/person) was 5,795.0 (mouth: 1,356.0, nose: 600.0, eye: 57.5). @*CONCLUSIONS@#This study showed that the mouth and nose were the most frequent exposure sites for HFC. Avoiding habitual HFC, awareness of self-inoculation by HFC, and vigorous hand hygiene should be strengthened to prevent the spread of infections.

Characteristics of hand-to-environment contact during indoor activities in daily life among Korean adults using a video-based observation method

Objectives@#The aim of this study was to describe the characteristics of hand-to-environmental contact (HEC) and to identify the factors influencing HEC behavior in Korean adults’ indoor daily life. @*Methods@#Thirty participants were enrolled from January 14 to February 12, 2018 after providing informed consent for being videotaped. Data were collected by recording their indoor daily lives for 2 hours, resulting in 4,732 HEC cases. To ensure the accuracy and reliability of the HEC readings, 3 training sessions were conducted for the videotape readers. Rereading and verifying randomly selected data ensured the validity of intra- and inter-reader readings. @*Results@#The most frequent contact items were phones, papers, computer accessories, and furniture surfaces. The contact density (frequency-duration/min) was highest for category II (items occasionally shared by others, 56.8), followed in descending order by category I (items for individual use, 35.9), and category III (public use items, 3.4). Significant differences in contact density were found according to participants’ demographic characteristics. @*Conclusion@#As mobile phones were the most frequent contact item, regular and strict mobile phone cleansing or disinfection strategies are needed, in addition to preventative measures taken for category II and III items. Avoiding sharing personal items with others, refraining from unnecessary HEC, and maintaining strict hand hygiene are recommended.

Hand-to-face contact behaviors during indoor activities in daily life among Korean adults: an observational pilot study using videotaping / 한국역학회지

OBJECTIVES@#Hand-to-face contact (HFC) is the major route for the self-inoculation of pathogens. This study aimed to describe the characteristics of HFC behaviors among Korean adults during indoor activities. @*METHODS@#Thirty participants were enrolled in the study, and 2 hours of videotaped data were collected from each participant. Contact data were recorded by examining the frequency and duration of HFC on the videos. Three training sessions were conducted for 2 readers to ensure the accuracy and reliability of videotape reading. Re-reading and verification of selected video data were performed to confirm intrapersonal and interpersonal validity. Contact exposure (CE) was determined by multiplying the contact frequency (CF) by the contact duration (CD) to quantify the intensity of contact during the observation time (2 hours). @*RESULTS@#A total of 3,007 HFCs (1,305 mucous membrane contacts and 1,702 non-mucous membrane contacts) were observed for 60 person-hours. The median CF (person/2 hr) of the mucous membranes (eye; 4.0, nose; 15.5, mouth; 16.5) was 39.5/person and the median total CD was 177.0 sec/person. The median CE (frequency-duration/sec/person) was 5,795.0 (mouth: 1,356.0, nose: 600.0, eye: 57.5). @*CONCLUSIONS@#This study showed that the mouth and nose were the most frequent exposure sites for HFC. Avoiding habitual HFC, awareness of self-inoculation by HFC, and vigorous hand hygiene should be strengthened to prevent the spread of infections.

Characteristics of hand-to-environment contact during indoor activities in daily life among Korean adults using a video-based observation method

Objectives@#The aim of this study was to describe the characteristics of hand-to-environmental contact (HEC) and to identify the factors influencing HEC behavior in Korean adults’ indoor daily life. @*Methods@#Thirty participants were enrolled from January 14 to February 12, 2018 after providing informed consent for being videotaped. Data were collected by recording their indoor daily lives for 2 hours, resulting in 4,732 HEC cases. To ensure the accuracy and reliability of the HEC readings, 3 training sessions were conducted for the videotape readers. Rereading and verifying randomly selected data ensured the validity of intra- and inter-reader readings. @*Results@#The most frequent contact items were phones, papers, computer accessories, and furniture surfaces. The contact density (frequency-duration/min) was highest for category II (items occasionally shared by others, 56.8), followed in descending order by category I (items for individual use, 35.9), and category III (public use items, 3.4). Significant differences in contact density were found according to participants’ demographic characteristics. @*Conclusion@#As mobile phones were the most frequent contact item, regular and strict mobile phone cleansing or disinfection strategies are needed, in addition to preventative measures taken for category II and III items. Avoiding sharing personal items with others, refraining from unnecessary HEC, and maintaining strict hand hygiene are recommended.

Development of a Social Contact Survey Instrument Relevant to the Spread of Infectious Disease and Its Application in a Pilot Study Among Korean Adults / 예방의학회지

Objectives@#This study aimed to develop a valid social contact survey instrument and to verify its feasibility for use among Korean adults. @*Methods@#The Delphi technique was used to develop an instrument to assess social contacts, which was then applied in a cross-sectional pilot study. A panel of 15 medical professionals reviewed the feasibility and validity of each item. The minimum content validity ratio was 0.49. Thirty participants used the developed measure to record contacts during a 24-hour period. @*Results@#After a systematic review, the survey instrument (parts I and II) was developed. Part I assessed social contact patterns over a 24-hour period, and part II assessed perceptions of contacts in daily life and preventive behaviors (hand hygiene and coughing etiquette). High validity and feasibility were found. In the pilot study, the 30 participants had a combined total of 198 contacts (mean, 6.6 daily contacts per person). The participants’ age (p=0.012), occupation (p<0.001), household size (p<0.001), education (p<0.001), personal income (p=0.003), and household income (p<0.001) were significantly associated with the number of contacts. Contacts at home, of long duration, and of daily frequency were relatively likely to be physical. Assortative mixing was observed between individuals in their 20s and 50s. Contact type differed by location, duration, and frequency (p<0.001). @*Conclusions@#The developed social contact survey instrument demonstrated high validity and feasibility, suggesting that it is viable for implementation.

Research Trends of Articles Published in the Journal of Korean Clinical Nursing Research from 2000 to 2017: Text Network Analysis of Keywords / 임상간호연구

PURPOSE: The aim of this study was to identify the research trends of articles published in the Journal of Korean Clinical Nursing Research from 2000 to 2017 by a text network analysis using keywords. METHODS: This study analyzed 600 articles. The R program was used for text mining that extracted frequency, centrality rank, and keyword network. RESULTS: From 2000 to 2009, keywords with high-frequency were ‘nurse’, ‘pain’, ‘anxiety’, ‘knowledge’, ‘attitude’, and so on. ‘Pain’, ‘nurse’, and ‘knowledge’ showed a high centrality. ‘Fatigue’ showed no high frequency but a high centrality. Keywords such as ‘nurse’, ‘knowledge’, and ‘pain’ also showed high frequency and centrality between 2010 and 2017. ‘Hemodialysis’ and ‘intensive care unit’ were added to keywords with high frequency and centrality during the period. CONCLUSION: The frequency and centrality of keywords such as ‘nurse’, ‘pain’, ‘knowledge’, ‘hemodialysis’, and ‘intensive care unit’ reflect the research trends in clinical nursing between 2000 and 2017. Further studies need to expand the keyword networks by connecting the main keywords.

Knowledge, Perceptions, and Self-reported Performance of Hand Hygiene Among Registered Nurses at Community-based Hospitals in the Republic of Korea: A Cross-sectional Multi-center Study / 예방의학회지

OBJECTIVES: To assess the nurses' hand hygiene (HH) knowledge, perception, attitude, and self-reported performance in small- and medium-sized hospitals after Middle East Respiratory Syndrome outbreak. METHODS: The structured questionnaire was adapted from the World Health Organization's survey. Data were collected between June 26 and July 14, 2017. RESULTS: Nurses showed scores on knowledge (17.6±2.5), perception (69.3±0.8), self-reported HH performance of non-self (86.0±11.0), self-reported performance of self (88.2±11.0), and attitude (50.5±5.5). HH performance rate of non-self was Y1 =36.678+ 0.555X1 (HH performance rate of self) (adjusted R2=0.280, p < 0.001). The regression model for performance was Y 4=18.302+0.247X 41 (peception)+0.232X 42 (attitude)+0.875X 42 (role model); coefficients were significant statistically except attitude, and this model significant statistically (adjusted R2=0.191, p < 0.001). CONCLUSIONS: Advanced HH education program would be developed and operated continuously. Perception, attitude, role model was found to be a significant predictors of HH performance of self. So these findings could be used in future HH promotion strategies for nurses.

Current Status of Infection Prevention and Control Programs for Emergency Medical Personnel in the Republic of Korea / 예방의학회지

OBJECTIVES: Emergency medical personnel (EMPs) are pre-hospital emergency responders who are at risk of exposure to infections and may also serve as a source for the transmission of infections. However, few studies of infection control have specifically addressed EMPs in the Republic of Korea (hereafter Korea). The goal of this study was to assess the current status of infection prevention and control programs (IPCPs) for EMPs in Korea. METHODS: A cross-sectional survey was conducted to quantitatively assess the resources and activities of IPCPs. A total of 907 EMPs in five metropolitan cities completed a structured questionnaire from September 2014 to January 2015. The data were analyzed using descriptive statistics, multi-response analysis, and the chi-square test. RESULTS: The mean age of the participants was 34.8+/-15.1 years. IPCPs were found to have weaknesses with regard to the following resources: the assignment of infection control personnel (ICP) (79.5%), hand hygiene resources such as waterless antiseptics (79.3%), the use of paper towels (38.9%), personal protective equipment such as face shields (46.9%), and safety containers for sharps and a separated space for the disposal of infectious waste (10.1%). Likewise, the following activities were found to be inadequately incorporated into the workflow of EMPs: education about infection control (77.5%), post-exposure management (35.9%), and the decontamination of items and spaces after use (88.4%). ICP were found to have a significant effect on the resources and activities of IPCPs (p<0.001). The resources and activities of IPCPs were found to be significantly different among the five cities (p<0.001). CONCLUSIONS: IPCPs for EMPs showed some limitations in their resources and activities. IPCPs should be actively supported, and specific IPCP activities for EMPs should be developed.

Hand Hygiene Compliance of Healthcare Workers in a Children's Hospital

PURPOSE: The aim of study was to estimate the hand hygiene (HH) compliance of healthcare workers (HCWs) in a children's hospital. METHODS: This study was conducted in a hospital which is a tertiary and educational children's hospital with 313 beds and 533 HCWs. Data were collected by direct observation methods from November 1, 2010 to December 31, 2010. RESULTS: A total of 2,999 opportunities for HH were observed, and the overall HH rate was 95.3%. HH rate of the registered nurse, physicians and transferer was 97.7%, 89.2%, and 72.1%, respectively (P<0.001). Among physicians, HH rate of the fellows, professors, residents and interns was 97.5%, 93.9%, 89.7%, and 80.9%, respectively (P<0.001). HH rate in the emergency room, operation room, outpatient department (OPD), and the intensive care unit (ICU) was 97.2%, 97.2%, 95.4%, and 92.5%, respectively (P<0.001). Hand rubbing was the most frequently used (81.1%), and hand washing was frequently used in the case of 'after body fluids exposure risk' (37.7%) and 'after touching patient surroundings' (28.5%). HH methods were not statistically different from each departments (P=0.083), however, they were significantly different according to the World Health Organization (WHO) 5 Moments (P<0.001). Distributions in WHO 5 Moments by the job titles were significantly different (P<0.001). The odds ratio of physicians, ICU and OPD was 0.353 (95% CI, 0.241-0.519), 0.291 (95% CI, 0.174-0.487), and 0.484 (95% CI, 0.281-0.834), respectively. CONCLUSIONS: Compliance of HH was different by the job titles and departments. Effective custom-tailored HH programs for each job title and department need to be developed.

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.

Risk Stratification-based Surveillance of Bacterial Contamination in Metropolitan Ambulances

We aimed to know the risk-stratification-based prevalence of bacterial contamination of ambulance vehicle surfaces, equipment, and materials. This study was performed in a metropolitan area with fire-based single-tiered Basic Life Support ambulances. Total 13 out of 117 ambulances (11.1%) were sampled and 33 sites per each ambulance were sampled using a soft rayon swab and aseptic containers. These samples were then plated onto a screening media of blood agar and MacConkey agar. Specific identification with antibiotic susceptibility was performed. We categorized sampling sites into risk stratification-based groups (Critical, Semi-critical, and Non-critical equipment) related to the likelihood of direct contact with patients' mucosa. Total 214 of 429 samples showed positive results (49.9%) for any bacteria. Four of these were pathogenic (0.9%) (MRSA, MRCoNS, and K. pneumoniae), and 210 of these were environmental flora (49.0%). However, the prevalence (positive/number of sample) of bacterial contamination in critical, semi-critical airway, semi-critical breathing apparatus group was as high as 15.4% (4/26), 30.7% (16/52), and 46.2% (48/104), respectively. Despite current formal guidelines, critical and semi-critical equipments were contaminated with pathogens and normal flora. This study suggests the need for strict infection control and prevention for ambulance services.

Education of Bioterrorism Preparedness and Response in Healthcare-associated Colleges - Current Status and Learning Objectives Development / 예방의학회지

OBJECTIVES: Bioterrorism (BT) preparedness and response plans are particularly important among healthcare workers who will be among the first involved in the outbreak situations. This study was conducted to evaluate the current status of education for BT preparedness and response in healthcare-related colleges/junior colleges and to develop learning objectives for use in their regular curricula. METHODS: We surveyed all medical colleges/schools, colleges/junior colleges that train nurses, emergency medical technicians or clinical pathologists, and 10% (randomly selected) of them that train general hygienists in Korea. The survey was conducted via mail from March to July of 2007. We surveyed 35 experts to determine if there was a consensus of learning objectives among healthcare workers. RESULTS: Only 31.3% of medical colleges/schools and 13.3% of nursing colleges/junior colleges had education programs that included BT preparedness and responses in their curricula. The most common reason given for the lack of BT educational programs was 'There is not much need for education regarding BT preparedness and response in Korea'. None of the colleges/junior colleges that train clinical pathologists, or general hygienists had an education program for BT response. After evaluating the expert opinions, we developed individual learning objectives designed specifically for educational institutions. CONCLUSIONS: There were only a few colleges/junior colleges that enforce the requirement to provide education for BT preparedness and response in curricula. It is necessary to raise the perception of BT preparedness and response to induce the schools to provide such programs.

An Outbreak of Epidemic Keratoconjunctivitis by Adenovirus Type 8 in a Neonatal Intensive Care Unit

PURPOSE: Epidemic keratoconjunctivitis (EKC) caused by adenovirus is a highly contagious disease, which has been reported as outbreaks involving adults in the community. However, there has been no report on EKC outbreak by adenovirus in a neonatal intensive care unit (NICU) in Korea. Aims of this study were to investigate the EKC outbreak by adenovirus type 8 in NICU and to confirm an effectiveness of polymerase chain reaction (PCR) for diagnosis. METHODS: Conjunctival swab or nasopharyngeal aspirate specimens were taken from all patients and tested by viral culture and PCR. Adenovirus serotype was determined by sequencing of PCR product of selected region of hexon gene using the virus isolates or specimens. RESULTS: An outbreak of EKC occurred which was involving 12 preterm infants in the NICU of the Seoul National University Children's Hospital between July 12th and August 1st, 2005. Three hospital staffs and one family member of the neonate were also affected. Adenovirus was detected in 12/12 (100%), 6/11 (54.5%) by PCR and virus culture, respectively. Eleven PCR-positive neonates were identified as serotype 8 by sequencing. The first affected 4 babies have had routine ROP (retinopathy of prematurity) examinations one week ago. While previous outbreaks were sustained for a few months, the event in our unit was controlled without complications in 3 weeks. CONCLUSION: We analyzed the EKC outbreak by adenovirus type 8 in NICU. Adenovirus serotype was identified by PCR and sequencing with high sensitivity for the first time in Korea, so we suggest this method can be very useful for rapid diagnosis and infection control.

Preoperative Nasal Carriage of Methicillin-Resistant Staphylococcus aureus and the Risks of Nosocomial Infection in Cardiac Surgery Patients / 병원감염관리

BACKGROUND: This study was conducted to investigate whether the preoperative nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) was a risk factor for surgical site infections and nosocomial infections in open heart surgery patients. METHODS: From June 10, 2002 to October 30, 2002, data were collected by prospective surveillance carried out by infection control nurses. Nasal swabs were taken from patients (N= 106) on the day before surgery. The swabs were incubated in staphylococcal broth for 24 hours, and then it was incubated on mannitol salt agar for 24 hours. Muller-Hinton agar supplemented with oxacillin (6 microgram/mL) was used to identify MRSA. RESULTS: Among the study patients (N=106), four(4/106, 3.8%) were identified as MRSA carriers and nine (9/103 , 8.7%) developed nosocomial infections, including three patients (3/103 , 2.9%) who had postoperative mediastinitis Preoperative nasal carriage of MRSA was not associated with nosocomial infections nor surgical site infections (P>0.05). However, the length of hospital stay prior to nasal swab or surgery was found to be associated with MRSA carriage (OR=1.108, 95%CI: 1.026-1.197) or nosocomial infections (OR=1.087, 95%CI: 1.017-1.161). Additionally, the patients with nosocomial infections were more likely than those without to stay in the hospital for a longer period after surgery (P<0.00l). CONCLUSION: Preoperative nasal carriage of MRSA by the patient was not identified as a risk factor for surgical site infection and nosocomial infections in open heart surgery.

The Present Situation of Infection Control Professionals, Organization, and Activities in Korean Acute Care General Hospitals / 병원감염관리

BACKGROUND: It has been more than 15 years since infection control was first introduced in Korea, but there is little information available on the status of infection control program in the country. METHODS: Included in the study were 139 acute care hospitals with more than 300 inpatient beds. A questionnaire, modified from US SENIC (Study on the Efficacy of Nosocomial Infection Control) and Canadian RICH (Resources for Infection Control in Canadian Acute Care Hospitals) survey, was mailed to the hospitals in the winter of 2003. RESULTS: Ninety-eight (70.5%) of 139 hospitals responded. There was an average of 1.2 (SD, 0.7) Infection Control Practitioners (lCPs) in each hospital and 95.7% were nurses and only 56.5% of the ICPs worked as full-time. The 71.4% of the hospitals had a position for Infection Control Doctor. All hospitals had an Infection Control Committee, which met an average of 3.7 (SD, 1.7) times a year. The 85.7% of the hospitals performed surveillance, but only 31.6% were monitoring surgical site infections. Review of microbiology data was the most common method for case-finding. More than 90% of the hospitals had infection control policies and guidelines, but an adherence to the policies and guidelines was not monitored regularly. CONCLUSION: This study reports the first comparable profile of infection control program of general acute care hospitals in Korea. Although the foundation for infection control program appears to have been established, there is the need for a further increase in the number of ICPs, the standardization of the surveillance method, and the promotion of adherence to the infection control guidelines.

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.

The Nationwide Surveillance Results of Nosocomial Infections along with Antimicrobial Resistance in Intensive Care Units of Sixteen University Hospitals in Korea, 2004 / 병원감염관리

BACKGROUND: This study was to evaluate a nationwide nosocomial infection rate and antimicrobial resistance in intensive care units(ICUs) in Korea. METHODS: The study was carried out at 16 university-affiliated teaching hospitals from July through October 2004. We performed a prospective multicenter study to investigate nosocomial infection rates, device-associated infection rated, and causative pathogens and their antimicrobial resistance. RESULTS: The urinary tract was the most commonly involved site. Nosocomial infection rate was 12.48 in medical. ICU (MICU), 9.59 in medical surgical ICU (MSICU), 14.76 in surgical ICU (MSICU), and 11.60 in other lCU. Device-associated infection rates were as follow: 1) rates of urinary catheter-associated urinary tract infection were 4.26 in MICU, 3.17 in SICU, 4.88 in MSICU, and 5.87 in other ICU; 2) rates of central line-associated bloodstream infection were 3.24 in MICU, 1.56 in SlCU, 2.36 in MSICU, and 1.78 in other ICU; 3) rates of ventilator-associated pneumonia were 3.61 in MlCU, 13.05 in SICU, 1.68 in MSICU, and 4.84 in other lCU. Staphylococcus aureus was the most frequently identified microorganism in this study; 93% of S. aurues were resistant to methicillin; 17% of Pseudomonas aeruginosa isolated were resistant to imipenem; 11% of Enterococcus faecium and 18% of Enterococcus faecalis showed resistance to vancomycin. Over a half of Acinetobacter spp, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli showed resistant to fluoroquinolone. Conclusion: This study shows the seriousness of antimicrobial resistance and the importance of infection control in the lCU in Korea. This study should provide a theoretical strategy to enforce the infection control.

Epidemic Investigation of Pyrogenic Reactions caused by Contaminated Intravenous Products / 병원감염관리

PURPOSE: This study was conducted to investigate the epidemic pyrogenic reactions that occurred hospital-widely in 51 patients on 30-31 Mar. 1995 at a tertiary, educational, and acute care hospital. METHODS: The remained intravenous (IV) drugs and IV fluids that were infused to patients (N=51) who developed pyrogenic reactions were cultured and tested pyrogenic matter. Pyrogenic test was done by Limulus Amebocyte Lysate (PyrotellRMA,USA). RESULTS: IV normal saline 50 cc bottles (AAXSAT and AAX5AV) those were collected being used from case patients, and new bottles stocked in the drug storage were positive to pyrogenic test. Used normal saline collected from case patients were cultured coagulase-negative Staphylococus. Moreover the company, manufacturer of these fluids reported the positive pyrogenic test on these IV fluids (AAXSAT and AAX5AV). CONCLUSION: This epidemic was a pyrogenic reaction for infused the intrinsic contaminated fluid with pyrogen. We could prevent not the additional pyrogenic reactions in study hospital but national wide epidemics to apply the rapid and well-designed epidemic investigation and infection control.

National Survey on the Current Status of Infection Control Nurses and Their Activities in General Hospitals with More Than 300 Beds / 병원감염관리

PURPOSE: This study was conducted to analyse the activities and status of infection control nurses (ICNs) and the trends of them since the first full-time ICN had been appointed in 1991. METHODS: Questionaries were mailed to 164 general hospitals with more than 300 beds. 85 hospitals were responded (51.8%) from 17June to 11 November 2003. RESULT: Full-time ICN was employed in 37.5%, 88.8% hospitals employed only one ICN regardless full-time or part-time ICN. ICNs spent time on surveillance (40.7%), teaching (29.4%), and meeting et al (30.3%). Surveillance was practice (67.5%), but surgical site surveillance was done in 12.1%. Personal characteristics and IC activities were significantly different between full-time and part-time ICNs. No of ICNs were increased by the national regulation and policy making. ICNs have improved the efficacy of infection control (IC) and abolished many wasteful ICs, The intensity of surveillance and the number of hospitals keep on hospital environmental control guidelines were increased. CONCLUSION: The number of ICNs was lower than 1980s' recommendation. The regulation on the ratio of ICN to beds should be added. The general features and activities of ICNs have been improved since 1991. However, to step up IC, the reward and support systems for ICN should be established.

National Survey on Nurses' Knowedge of Infection Control in General Hospitals and Analysis of Variables to Impact on Their Knowledge / 병원감염관리

BACKGROUND: The ultimate goal of hospital infection control is to decrease the hospital infections. The change of hospital infections were depended closely to the healthcare workers' infection control practice keeping the infection control polices as recommendations. This study tried to measure the knowledge of nurses about the evidence based guidelines of hospital infection control to analysis the variables to impact on their knowledge, and to identify whether evaluation indexes for hospital infection effect on their knowledge. METHODS: Questionnaire survey was done nationally to 32 general hospitals over 300 beds from August 4, 2003 to the end of December. Only 12 hospitals that over about 10% of total nurses participated in this survey were included in this analysis. Statistical analyses were done using SPSS 12.0 for Windows PC (Chicago, IL, USA). RESULTS: The mean scores of hospital evaluation indexes of 12 hospitals were in mid range, and the scores of nurses' knowledge about the hospital infection control guidelines were in mid range. By multiple regression analysis and univariate analysis, nurses' knowledge of infection control was found to be strongly associated with every year attendance on infection control education. Hand hygiene evaluation index, infection control for health care workers index and total sum of evaluation indexes were significant to the nurses' knowledge. CONCLUSION: The significant variable to the nurses' knowledge of hospital infection control was identified as an annual education attendance. The education about hospital infection control should be done mandatory to nurses' education programs every year.