중환자실 병원감염에 대한 다기관 공동조사연구

Abstract

Purpose : The purpose of this study is to determine the risk adjusted nosocomial infection(NI) rate and distribution of NIs and their causative pathogens in adult ICU. Methods : Prospective surveillance was performed at 12 ICU´s of 5 acute care hospitals in Seoul and Kyonggi Do during a 3-months period from May to july 2002. The case finding was done by direct reviews of medical charts regularly for all patients by ICPs using CDC definitions. Results : Total NI rate was 10.18/1,000 patient-days in Medical-surgical ICU(MSICU) and 12.35/1,000 patient-days in Neurosurgucal ICU(NCU). Risk adjusted infection rate was 3.44 in indwelling catheter associated UTI. 2.12 in central line associated BSI. 3.51/1.000 device-days in ventilator associated pneumonia in MSICU. There were 3.72, 2.26, 6.06/1.000 device-days in NCU. The infection rate by ICU type showed no significant difference. The distribution of NIs were PNEU(28.99%) UTI(28.99%), BSI(18.84%) SSI(4.35%) in MSICU. and UTI(48.0%), PNEU(24.0%), BSI(14.0%), SSI(6.1) in NCU. The most commonly isolated organisms were Candid app (38.6%), Enterococcus spp.(13.4%) in UTI. Staphylococcus aureus(36.2%), P.aeruginosa(18.8%) in PNEU and Coagulase negative staphylococcus(44.1%). S. aureus(14.7%) in BSI. S. aureus(19.8%) was the most common organism from overall nosocomial infections in the ICU. and 96.3% of S. aureus were MRSA. Conclusion : Distribution of site-specific nosocomial infection and isolated organisms were similar to the results of KOSNIC(Korea society for nosocomial infection control) surveillance in 1996. However, the total infection rate and a risk adjusted infection rate at MSICU is lower than 1996´s. This decrease is considered to be a result of efforts to prevention and control nosocomial infections.