중환자실에서 클로르헥시딘 목욕이 다제내성균 획득과 의료관련감염에 미치는 영향 Effect of daily chlorhexidine bathing on healthcare-associated infections and the acquisition of multidrug-resistant organisms in an intensive care unit원문보기
배경: 중환자실 환자들은 질병의 중증도가 높고 잦은 침습적 처치와 장기간의 항생제 사용으로 인해 자신의 정상 상주균이 병원균으로 변하거나 외부 병원균에 노출되어 감염 발생의 기회가 많아지고 있다. 이를 예방하기 위한 새로운 중재 방법으로 2% 클로르헥시딘 침상목욕이 추천되고 있다. 이에 본 연구에서는 내과중환자실에 입원한 환자에게 매일 2% 클로르헥시딘 침상목욕을 적용하여 ...
배경: 중환자실 환자들은 질병의 중증도가 높고 잦은 침습적 처치와 장기간의 항생제 사용으로 인해 자신의 정상 상주균이 병원균으로 변하거나 외부 병원균에 노출되어 감염 발생의 기회가 많아지고 있다. 이를 예방하기 위한 새로운 중재 방법으로 2% 클로르헥시딘 침상목욕이 추천되고 있다. 이에 본 연구에서는 내과중환자실에 입원한 환자에게 매일 2% 클로르헥시딘 침상목욕을 적용하여 다제내성균 획득과 의료관련감염 발생에 미치는 영향을 검증하고자 하였다.
방법: 무작위 대조군 사후 실험설계 연구로 연구 대상은 울산광역시 소재 U대학교병원 내과중환자실에 2017년 6월 3일부터 2017년 8월 31일까지 입원한 환자를 난수표를 이용하여 무작위 배정하였으며, 실험군 47명 대조군 44명으로 총 대상자 수는 91명이다. 실험군에게는 2% 클로르헥시딘 침상목욕을 매일 시행하였으며, 대조군에게는 기존 침상목욕을 3일 마다 시행하였다. 자료수집은 전자의무기록을 통해 수집하였으며, 실험군과 대조군의 다제내성균 획득률과 의료관련감염 발생률 차이는 χ2 test 와 Fisher’s exact test를 이용하여 분석하였다.
결과: 다제내성균 획득은 2% 클로르헥시딘 침상목욕을 제공받은 실험군에서 6건, 기존 침상목욕을 제공 받은 대조군에서 15건 획득하였고, 이를 중환자실 재원일수 1,000일 기준으로 환산하였을 때 다제내성균 획득률은 실험군 11.2건, 대조군 24.1건으로 실험군에서 12.8건이 적었으며, 이는 통계적으로 유의한 차이를 보였다(p=.016). 의료관련감염은 2% 클로르헥시딘 침상목욕을 제공받은 실험군에서 2건, 기존 침상목욕을 제공 받은 대조군에서 7건 발생하였고, 이를 중환자실 재원일수 1,000일 기준으로 환산하였을 때 의료관련감염 발생률은 실험군 3.7건, 대조군 11.2건으로 실험군에서 7.51건이 적었으나, 통계적으로 유의한 차이는 없었다(p=.084).
결론: 본 연구결과에서 2% 클로르헥시딘 침상목욕이 다제내성균 획득률 감소에 효과적인 것으로 확인되었다. 따라서, 다제내성균 예방을 위하여 2% 클로르헥시딘 침상목욕이 효율적인 간호중재로서 실무에 활용되기를 기대한다.
배경: 중환자실 환자들은 질병의 중증도가 높고 잦은 침습적 처치와 장기간의 항생제 사용으로 인해 자신의 정상 상주균이 병원균으로 변하거나 외부 병원균에 노출되어 감염 발생의 기회가 많아지고 있다. 이를 예방하기 위한 새로운 중재 방법으로 2% 클로르헥시딘 침상목욕이 추천되고 있다. 이에 본 연구에서는 내과중환자실에 입원한 환자에게 매일 2% 클로르헥시딘 침상목욕을 적용하여 다제내성균 획득과 의료관련감염 발생에 미치는 영향을 검증하고자 하였다.
방법: 무작위 대조군 사후 실험설계 연구로 연구 대상은 울산광역시 소재 U대학교병원 내과중환자실에 2017년 6월 3일부터 2017년 8월 31일까지 입원한 환자를 난수표를 이용하여 무작위 배정하였으며, 실험군 47명 대조군 44명으로 총 대상자 수는 91명이다. 실험군에게는 2% 클로르헥시딘 침상목욕을 매일 시행하였으며, 대조군에게는 기존 침상목욕을 3일 마다 시행하였다. 자료수집은 전자의무기록을 통해 수집하였으며, 실험군과 대조군의 다제내성균 획득률과 의료관련감염 발생률 차이는 χ2 test 와 Fisher’s exact test를 이용하여 분석하였다.
결과: 다제내성균 획득은 2% 클로르헥시딘 침상목욕을 제공받은 실험군에서 6건, 기존 침상목욕을 제공 받은 대조군에서 15건 획득하였고, 이를 중환자실 재원일수 1,000일 기준으로 환산하였을 때 다제내성균 획득률은 실험군 11.2건, 대조군 24.1건으로 실험군에서 12.8건이 적었으며, 이는 통계적으로 유의한 차이를 보였다(p=.016). 의료관련감염은 2% 클로르헥시딘 침상목욕을 제공받은 실험군에서 2건, 기존 침상목욕을 제공 받은 대조군에서 7건 발생하였고, 이를 중환자실 재원일수 1,000일 기준으로 환산하였을 때 의료관련감염 발생률은 실험군 3.7건, 대조군 11.2건으로 실험군에서 7.51건이 적었으나, 통계적으로 유의한 차이는 없었다(p=.084).
결론: 본 연구결과에서 2% 클로르헥시딘 침상목욕이 다제내성균 획득률 감소에 효과적인 것으로 확인되었다. 따라서, 다제내성균 예방을 위하여 2% 클로르헥시딘 침상목욕이 효율적인 간호중재로서 실무에 활용되기를 기대한다.
Background: The incidence of infection for patients in intensive care units (ICU) has been on the rise. As patients suffering from highly severe diseases receive more and more frequent and invasive treatments along with extended use of antibiotics, their normal resident bacteria can become pathogeni...
Background: The incidence of infection for patients in intensive care units (ICU) has been on the rise. As patients suffering from highly severe diseases receive more and more frequent and invasive treatments along with extended use of antibiotics, their normal resident bacteria can become pathogenic. Another reason for the increase is that these same patients are being exposed to pathogenic bacteria from external sources. A new method to prevent these infections, 2% chlorhexidine bed bathing, has been proposed. Therefore, this study applied the 2% chlorhexidine daily bed bathing protocol to patients in a medical intensive care unit, and verified the effect of this bathing on healthcare-associated infection and the acquisition of multidrug-resistant organisms.
Method: The study was a randomized controlled-group of posttest-only design, and it was carried out on a total of 91 patients (experimental group of 47 patients and control group of 44 patients). These patients were all admitted to the medical intensive care unit at a university hospital located in Ulsan Metropolitan City between June 3, 2017 and August 31, 2017. The study was randomized using a table of random numbers. The 2% percent chlorhexidine bed bathing was carried out daily on the experimental group, and traditional bed bathing was carried out every three days on the control group. The data was collected through electronic medical records, and the differences between the experimental group and the control group were analyzed using a χ2 test and Fisher’s exact test.
Results: The In the experimental group (which had the 2% chlorhexidine bed bathing), multidrug-resistant organisms were found in six (6) patients. However, in the control group which had the traditional bed bathing, 15 patients were found to have multidrug-resistant organisms. The difference was statistically significant(p=.016) Then, calculations made using the criterion of 1,000 days of hospitalization in the ICU indicated that acquisition of multidrug-resistant organisms in the experimental group was 11.2 patients, and 24.1 patients in the control group. Healthcare-associated infections occurred in two (2) patients of the experimental group (which had the 2% chlorhexidine bed bathing), and in seven (7) patients of the control group (which had the traditional bed bathing). The difference was not statistically significant (p=.084). Calculations made using the criteria of 1,000 days of hospitalization in the ICU indicated Healthcare-associated infections incidence was 3.7 patients in the experimental group, and 11.2 patients in the control group.
Conclusion: The results of this study confirmed that 2% chlorhexidine bed bathing was effective in reducing the acquisition of multidrug-resistant organisms. Therefore, it is expected that 2% chlorhexidine bed bathing will be used as an effective nursing intervention to reduce the acquisition of multidrug-resistant organisms.
Key Word: Intensive Care Unit, 2% Chlorhexidine, Bed Bathing, Acquired Multidrug-Resistant Organism, Healthcare-Associated Infection
Background: The incidence of infection for patients in intensive care units (ICU) has been on the rise. As patients suffering from highly severe diseases receive more and more frequent and invasive treatments along with extended use of antibiotics, their normal resident bacteria can become pathogenic. Another reason for the increase is that these same patients are being exposed to pathogenic bacteria from external sources. A new method to prevent these infections, 2% chlorhexidine bed bathing, has been proposed. Therefore, this study applied the 2% chlorhexidine daily bed bathing protocol to patients in a medical intensive care unit, and verified the effect of this bathing on healthcare-associated infection and the acquisition of multidrug-resistant organisms.
Method: The study was a randomized controlled-group of posttest-only design, and it was carried out on a total of 91 patients (experimental group of 47 patients and control group of 44 patients). These patients were all admitted to the medical intensive care unit at a university hospital located in Ulsan Metropolitan City between June 3, 2017 and August 31, 2017. The study was randomized using a table of random numbers. The 2% percent chlorhexidine bed bathing was carried out daily on the experimental group, and traditional bed bathing was carried out every three days on the control group. The data was collected through electronic medical records, and the differences between the experimental group and the control group were analyzed using a χ2 test and Fisher’s exact test.
Results: The In the experimental group (which had the 2% chlorhexidine bed bathing), multidrug-resistant organisms were found in six (6) patients. However, in the control group which had the traditional bed bathing, 15 patients were found to have multidrug-resistant organisms. The difference was statistically significant(p=.016) Then, calculations made using the criterion of 1,000 days of hospitalization in the ICU indicated that acquisition of multidrug-resistant organisms in the experimental group was 11.2 patients, and 24.1 patients in the control group. Healthcare-associated infections occurred in two (2) patients of the experimental group (which had the 2% chlorhexidine bed bathing), and in seven (7) patients of the control group (which had the traditional bed bathing). The difference was not statistically significant (p=.084). Calculations made using the criteria of 1,000 days of hospitalization in the ICU indicated Healthcare-associated infections incidence was 3.7 patients in the experimental group, and 11.2 patients in the control group.
Conclusion: The results of this study confirmed that 2% chlorhexidine bed bathing was effective in reducing the acquisition of multidrug-resistant organisms. Therefore, it is expected that 2% chlorhexidine bed bathing will be used as an effective nursing intervention to reduce the acquisition of multidrug-resistant organisms.
Key Word: Intensive Care Unit, 2% Chlorhexidine, Bed Bathing, Acquired Multidrug-Resistant Organism, Healthcare-Associated Infection
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