Adaptation of Isolation Guidelines for Health Care Settings / 임상간호연구

PURPOSE: This purpose of this study was to develop evidence-based practice guideline for isolation in health care settings to prevent transmission of infectious diseases utilizing guideline adaption process. METHODS: The process of guideline adaptation was performed according to the Korean hospital nurses association's guideline adaptation manual which consisted of three main phases, 9 modules, and 24 steps. RESULTS: The adapted isolation guideline consisted of introduction, overview of isolation guideline, summary of recommendations, recommendations, references, and appendices. The guideline includes 224 recommendations in 4 sections which are organizational administration, standard precautions, transmission-based precautions, and education/counselling. CONCLUSION: The adapted isolation guideline is recommended to be disseminated and utilized by nurses and clinicians nationwide to improve the isolation practices for infected or colonized patients with communicable diseases and to decrease the transmission of infections in the healthcare settings.

The Status of Infection Control Nurses and Factors Affecting Infection Control Activities in Healthcare Facilities with more than 150 Beds in 2016 in KOREA / 임상간호연구

PURPOSE: The purpose of this study was to describe the status of infection control nurses (ICNs) and their activities, and to identify the factors affecting the level of infection control activities. Methods: Data were collected from 199 hospitals from June 24 to July 26, 2016. The structured questionnaires included status of infection control nurses, type and level of infection control activities. METHODS: Data were collected from 199 hospitals from June 24 to July 26, 2016. The structured questionnaires included status of infection control nurses, type and level of infection control activities. RESULTS: Most participating hospital were advanced general hospital (20.1%) and general hospital (67.8%). Among the hospitals, 86.4% had an infection control department (ICD). The average hospital work experience of ICNs was 14.62 years, and their average infection control career was for 4.94 years. Among the ICNs, 85.6% worked in full time and the average number of beds per ICN was 311.21. There were significant differences in the existence of ICD, infection control activities including surveillance, outbreak investigation, negative pressure room, hand hygiene monitoring, disinfection, and sterilization according to hospital size. The level of infection control activities was higher with more number of ICNs, ICN employment as full time, and healthcare institution accreditation status. The explanatory power was 37.5%. CONCLUSION: These results of this study which reflect infection control status of healthcare facilities with more than 150 beds in 2016 will provide baseline data to establish infection control system in small to medium sized hospitals after the Middle East Respiratory Syndrome outbreak in 2015.

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.

The Efficacy of Nebulized Epinephrine Versus Fenoterol in Hospitalized Infants with Acute Bronchiolitis / 소아과

PURPOSE: Acute bronchiolitis is a lower respiratory tract disease, resulting from inflammatory obstruction of the small airway. The main treatment of acute bronchiolitis is supportive but, numerous investigators have examined the efficacy of beta agonist as bronchodilators. In acute bronchiolitis, mucosal edema in the bronchioles may be an important cause of airway obstruction therefore, an alpha and beta agonist might be useful in the treatment of this disease. So we examined the efficacy and safety of repeated nebulized epinephrine compared to fenoterol. METHODS: This randomized double blind study involved 106 hospitalized infants with wheezing, under one year age and acute onset of respiratory distress. They were randomly separated into two groups, and treated with either nebulized 0.1% epinephrine 0.5 mg in 3.5 mL of 0.9% saline solution (group 1; n=50) or nebulized fenoterol 0.5 mg in 2 mL of 0.9% saline solution(group 2; n=50). This therapy was repeated at six hour intervals after hospital admission. Observations were made at admission and just before, 30 minutes after nebulization. The primary outcome measures used were the degree of change in clinical scores. The secondary outcome measures used were the length of the hospital stay. RESULTS: A significant improvement in the clinical score was noted during 72 hours of hospitalization in both groups(P<0.001). But, there were no significant differences between the groups in clinical score improvement. There were no significant differences between the groups in the length of the hospital stay(P=0.055). No adverse effects were associated with nebulized therapy. CONCLUSION: There were no group differences in the effectiveness of therapy for infants hospitalized with acute bronchiolitis.

One Case of Subcapsular Hematoma with Persistent Neonatal Hyperbilirubinemia

A neonate may incur liver injury during spontaneous delivery. The liver is the organ most likely to be injured during the birth process. Breech presentation and manipulation are the most common causes of hepatic trauma. However, hepatic hemorrhage can occur in any infant, regardless of size and the type of delivery. Infants with subcapsular hemorrhage are usually asymptomatic at birth, and gross hepatic rupture from these lesions is unusual. In patient with primary rupture, major bleeding takes place immediately, explaining the high percentage of neonatal deaths with massive liver rupture. If subcapsular hemorrhage remain intracapsular with spontaneous resolution, the only treatment needed in subcapsular hemorrhage may be transfusion. We experienced one case of neonatal subcapsular hemorrhage with persistent hyperbilirubinemia. We report this case with the brief review of related literature.

A Case of Transient Hyperammonemia of the Newborn Infant

Transient hyperammonemia of the newborn is an overwhelming disease manifestated by hyperammonemic coma in ill premature infant. This recognized metabolic disorder is chiefly characterized by severe hyperammonemia in the postnatal period, a comatous state, absence of abnormal organic aciduria, normal activity of urea cycle enzymes and, usually, complete recovery. The etiology is unknown. Infant had mild respiratory distress that progressed within 48 hours to deep coma requiring ventilatory assistance and had marked hyperammonemia. The degree of neurologic impairment and developmental delay in this disorder depends on the duration of the hyperammonemic coma. So, treatment of hyperammonemia should be initiated promptly and continued vigorously. We report of a preterm infant (34+5 weeks of gestation) presenting with respiratory distress, seizure, coma, and marked elevated plasma ammonia level.

A Study on the Prevention of Nosocomial Respiratory Infection in Critical Care Nurses / 기본간호학회지

The purpose of study is to prevent Nosocomial Respiratory Infection after understand the Correlation about Recognition and Performance of Critical Nurses. Data were collected from Critical Nurses 300 persons who has worked in 14 Subsidary Hospitals of University in Seoul and the collection periode is from Nov. 1st, 1997 to Jul. 14th, 1998. There are 40 questions and constructed by 6 Domains which Hand Washing, Suction Management, Airway Management, Respiratory Instrument, Ventilation and Respiratory Intervention. Also, the Data were analized with SPSS program. The obtained results are as follows ; (1) The Mean of Recognition for Prevention of Nosocomial Respiratory Infection is 4.649 and by Domains, Respiratory Intervention(4.758), Suction Management (4.669), Airway Management(4.660), Hand Washing(4.651), Ventilation(4.605) and Respiratory Instrument(4.561) according to the Mean. (2) The Mean of Performance for Prevention of Nosocomial Respiratory Infection is 3.991 and by Domains, Respiratory Intervention(4.498), Airway Management (4.107), Hand Washing(4.084), Suction Management(3.898), Respiratory Instrument (3.860) and Ventilation(3.690) according to the Mean. (3) In the Correlation of Recognition and Performance for the Prevention of Nosocomial Respiratory Infection, Hand Washing(r=0.755, p=0.000), Airway Management(r=0.724, p=0.000), Respiratory Intervention(r=0.693, p=0.000) are mentioned significant correlation level. The Performance is good whenever the Recognition is high for Respiratory Instrument(r=0.143, p=0.054) but it's not significant level and Suction Management and Ventilation has no Correlation. (4) In Normal Properties, The Recognition is good(p<0.05) when Nurses has plenty Clinical Career, Attendance of the Education and Exclusive Nurse for the Respiratory Infection is in Hospital. The Age is not significant correlation level statistically but represent a little correlation. The Performance is good(p<0.05) when Elder Age, Attendance of the Education and the plenty Clinical Career is not significant correlation level statistically but represent a little correlation. Another properties has no menas. According to the results, Suggestion is as follows ; (1) Required Education to advance Recognition and Performance about Prevention of Nosocomial Respiratory Infection for a little clinical career of Nursing and younger Nurses. (2) It needs to analyze Performance about Prevention of Nosocomial Respiratory Infection by observation of research worker.