전국의료관련감염감시체계 중환자실 부문 결과 보고: 2020년 7월부터 2021년 6월

김은진,곽이경,곽선희,고수희,권오미,김의석,김진화,김태형,김택수,문희원,박선희,안진영,유소연,유현미,이상오,이유미,조난형,최영화,최평균,홍기호,이미숙,전국의료관련감염 중환자실감시체계 대한의료관련감염관리학회 2023 의료관련감염관리 Vol.28 No.1

Background: The Korean National Healthcare-associated Infections Surveillance System (KONIS) is a nationwide surveillance network established by the Korean Society for Healthcare-Associated Infection and Prevention in July 2006 to perform healthcare-associated infection surveillance using standardized methods. This report presents the annual data of the intensive care unit (ICU) module of the KONIS system between July 2020 and June 2021. Methods: We performed prospective surveillance of healthcare-associated infections (HAIs), including urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU), at 339 ICUs in 257 hospitals using the KONIS database. HAI rates and device-associated infection (DAI) rates were calculated as the numbers of infections per 1,000 patient days (PD) and device days (DD), respectively. Device utilization was calculated as the ratio (DUR) of device days to patient days. Results: A total of 4,435 HAIs were found during the study period: 1,645 UTIs (1,589 cases were urinary catheter-associated), 1,994 BSIs (1,753 were central line-associated), and 796 PNEUs (383 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 1.30 cases per 1,000 DD (95% confidence interval [CI], 1.24-1.36) and DUR was 0.74 (95% CI, 0.739-0.741). The rate of central line-associated BSIs was 2.21/1,000 DD (95% CI, 2.11-2.31) and DUR was 0.48 (95% CI, 0.479-0.481). The rate of ventilator-associated PNEUs was 0.79/1,000 DD (95% CD, 071-0.87) and DUR was 0.29 (95% CI, 0.289-0.291). Conclusion: The overall DAI rate was similar to that of the previous year’s data; however, the rate of VAP showed a trend of decline. Furthermore, all DURs were reduced. Therefore, continuous infection surveillance may reduce infection rates and device use.

전국의료관련감염감시체계 중환자실 부문 결과 보고: 2015년 7월부터 2016년 6월

곽이경,최영화,최준용,유현미,이상오,김홍빈,한수하,이미숙,김효열,김성란,김태형,박선희,유소연,최평균,은병욱,신명진,최지연,구현숙,어영,유진홍 대한의료관련감염관리학회 2017 의료관련감염관리 Vol.22 No.1

Background: In this report, we present the annual data of the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) from July 2015 through June 2016.Methods: We performed a prospective surveillance of healthcare-associated urinary tract infection (UTI), bloodstream infection (BSI), and pneumonia (PNEU) at 178 ICUs in 103 hospitals using KONIS surveillance system. Healthcare- associated infections (HAI) rates were calculated as the numbers of infections per 1,000 patient-days or device-days. Results: A total of 2,608 HAIs were found during the study period: 718 UTIs (702 cases were urinary catheter- associated), 1,236 BSIs (1,058 were central line-associated), and 654 PNEUs (389 were ventilator-associated). The rate of catheter-associated UTIs (CAUTI) was 0.88 cases per 1,000 device-days (95% confidence interval [CI, 0.82-0.95]) and urinary catheter utilization ratio was 0.84 (95% CI, 0.839-0.841). The rate of central line-associated BSIs (CLABSI) was 2.20 (95% CI, 2.07-2.33) per 1,000 device-days and the utilization ratio was 0.51 (95% CI, 0.509-0.511). The rate of ventilator-associated PNEUs (VAPs) was 1.00 (95% CI, 0.91-1.11) per 1,000 device-days and the utilization ratio was 0.41 (95% CI, 0.409-0.411). The ventilator utilization ratio was lower; however, VAPs were more common in the ICUs of hospitals with 700-899 beds (1.23 [95% CI, 1.07-1.42]) than in those of hospitals with more than 900 beds (0.87 [95% CI, 0.71-1.06]).Conclusion: Compared with the previous year, the device utilization ratio was similar but the rate of VAP was significantly decreased.

전국의료관련감염감시체계 중환자실 부문 결과 보고: 2019년 7월부터 2020년 6월

김은진,곽이경,곽선희,고수희,권오미,김의석,김진화,김태형,김택수,문희원,박선희,안진영,유소연,유현미,이상오,조난형,최평균,홍기호,이유미,이미숙 대한의료관련감염관리학회 2021 의료관련감염관리 Vol.26 No.2

Background: This report presents the annual data of the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) between July 2019 and June 2020. Methods: We performed prospective surveillance of healthcare-associated infections (HAI), including urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU), at 340 ICUs in 256 hospitals using the KONIS database. HAI and device-associated infection (DAI) rates were calculated as the number of infections per 1,000 patient-days (PD) and device-days (DD), respectively. Device utilization was calculated as the ratio (DUR) of device to patient days. Results: A total of 4,489 HAIs were found during the study period: 1,646 UTIs (1,597 cases were urinary catheter-associated); 1,964 BSIs (1,695 were central line-associated); and 879 PNEUs (470 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 1.26/1,000 DD (95% confidence interval [CI] 1.20-1.32), whereas the urinary catheter utilization ratio was 0.80 (95% CI, 0.799-0.801). The rate of central line-associated BSIs was 2.16/1,000 DD (95% CI 2.06-2.26), whereas the central line utilization ratio was 0.50 (95% CI 0.499-0.501). The rate of ventilator-associated PNEUs was 0.93/1,000 DD (95% CI 0.85-1.02), whereas the ventilator utilization ratio was 0.32 (95% CI 0.319-0.321). Conclusion: The overall DAI rate was similar to that in the previous year. In particular, the device utilization ratios were reduced. Continuous surveillance prevented an increase in the infection rate and led to a decrease in device use. A continuous infection surveillance system can reduce the infection rate.

전국의료관련감염감시체계 중환자실 부문 결과 보고: 2018년 7월부터 2019년 6월

김은진,곽이경,곽선희,고수희,김진화,김의석,김태형,류성렬,문희원,박선희,안진영,유소연,유현미,윤나라,이미숙,이상오,조난형,최지연,홍기호,최영화,김미나 대한의료관련감염관리학회 2020 의료관련감염관리 Vol.25 No.2

Background: In this report, we present the annual data of the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance (KONIS) System from July 2018 to June 2019. Methods: We performed a prospective surveillance of healthcare-associated urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) at 316 ICUs in 227 hospitals using the KONIS system. Healthcare-associated infection (HAI) and device-associated infection rates were calculated as the number of infections per 1,000 patient-days (PDs) and device-days (DDs), respectively. Device utilization was calculated as the ratio of DDs to PDs. Results: A total of 4,874 HAIs were found during the study period: 1,682 UTIs (1,633 urinary catheter-associated cases), 2,110 BSIs (1,769 central line-associated cases), and 1,082 PNEUs (569 ventilator-associated cases). The rate of urinary catheter-associated UTIs (CAUTIs) was 1.28 cases per 1,000 DDs [95% confidence interval (CI), 1.22-1.34], and the urinary catheter utilization ratio was 0.86 (95% CI, 0.859-0.861). The rate of CAUTIs was higher than that in the previous year [1.16/1,000 DDs (95% CI, 1.10-1.22)]. The rate of central line-associated BSIs was 2.32/1,000 DDs (95% CI, 2.22-2.43), and the central line utilization ratio was 0.51 (95% CI, 0.509-0.511). The rate of ventilator-associated PNEUs was 1.08/1,000 DDs (95% CI, 0.99-1.17), and the ventilator utilization ratio was 0.35 (95% CI, 0.349-0.351). Conclusion: The overall HAI rate was similar to that in the previous year, but the rate of CAUTIs increased. In addition, the central line utilization ratio increased; thus, intervention is necessary.

전국의료관련감염감시체계 중환자실 부문 결과 보고: 2017년 7월부터2018년 6월

김은진,곽이경,김태형,이미숙,이상오,김성란,박선희,안진영,윤나라,류성렬,김의석,최지연,유현미,신명진,유소연,홍기호,문희원,조난형,손희정,김수현,최영화,김미나 대한의료관련감염관리학회 2019 의료관련감염관리 Vol.24 No.2

Background: In this report, we present annual data from the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) from July 2017 through June 2018. Methods: We performed prospective surveillance of healthcare-associated urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) at 308 ICUs in 216 hospitals using the KONIS. Healthcare-associated infection (HAI) rates and device-associated infection rates were calculated as the number of infections per 1000 patient-days (PD) and device-days (DD), respectively. Device utilization was calculated as a ratio of DD to PD. Results: A total of 4569 HAIs were found during the study period: 1530 UTIs (1476 cases were urinary catheter-associated), 2006 BSIs (1692 were central line-associated), and 1033 PNEU cases (505 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 1.16 cases per 1000 DD (95% confidence interval [CI]: 1.10-1.22) and urinary catheter utilization ratio was 0.86 (95% CI: 0.859-0.861). These results were higher than those in the previous year: 1.01 cases per 1000 DD (95% CI: 0.95-1.07) and 0.85 (95% CI: 0.849- 0.851), respectively. The rate of central line-associated BSIs was 2.29 cases per 1000 DD (95% CI: 2.18-2.40) and the central line utilization ratio was 0.50 (95% CI: 0.499-0.501). The rate of ventilator-associated PNEU cases was 0.96 cases per 1000 DD (95% CI: 0.88-1.05) and the ventilator utilization ratio was 0.35 (95% CI: 0.349-0.351). Conclusion: The overall rate of HAIs was similar to the results from the previous year; however, the rate of CAUTI increased.

KONIS 운영방식 개선을 위한 국가별 의료관련감염 감시체계 운영방식에 대한 문헌 조사

김탁,은병욱,홍기호,최희경,김성란,한수하,최영화,엄중식,이미숙 대한의료관련감염관리학회 2020 의료관련감염관리 Vol.25 No.1

Background: In many countries, surveillance systems are being operated to reduce healthcare- associated infections. In Korea, the Korean National Healthcare-Associated Infections Surveillance System (KONIS) has been established and operated by the Korean Society for Healthcare-Associated Infection and Prevention as a national research project. However, the current operating system has limitations and needs reform. Methods: Upon reviewing the literature, we investigated the current status of the operating systems of healthcare-associated infection surveillance in other countries. After sharing this literature review, which was gathered using Google and PubMed, the Delphi survey was conducted on the authors, who are experts on infection control and prevention. Results: The governments of the United States, Japan, Taiwan, United Kingdom, France, and Germany fund and operate surveillance systems. The Canadian government provides a private organization with funding to operate the surveillance system. One surveillance network is operated by a private consortium in which private medical institutions from various continents, such as Latin America and Africa, participate. In a Delphi survey, the authors responded that continuity∙sustainability, and the reliability and confidentiality of data are key factors in operating surveillance systems. Additionally, eight of nine authors thought that the government should operate the KONIS. Conclusion: In most countries, healthcare-associated infection surveillance systems are directly operated by the government. For the continuous and stable operation of the KONIS, the government should consider transitioning to a government-operated system.

우리나라 의료 관련 감염 감시체계

최영화 대한의사협회 2018 대한의사협회지 Vol.61 No.1

The Korean Society for Healthcare-associated Infection Control and Prevention ran a nationwide database of healthcare associated infection surveillance system. Korean National Healthcare-associated Infections Surveillance System (KONIS) is a nationwide surveillance network to perform of healthcare associated infection surveillance using standardized methods. Intensive care unit surveillance was begun on July 2006 and SSI module was added in 2007. The enrollment criteria of intensive care unit surveillance were general hospitals over 400 beds with infection control practitioner and doctors in 2006 but the criteria were expanded to over 200 beds size hospitals in 2016. Overall 70.5% hospitals were included in 2017. All tertiary care hospitals were enrolled. Less than 300 beds hospitals accounted for 59%. KONIS validation study has been performed from 2008 biennially. Future directions of KONIS include expansion of participating hospitals and multicenter intervention modules and new modules for special units such as neonatal intensive care units.

Affecting factors on performance of nursing students regarding prevention and control education of healthcare associated infection

Kyongeun Lee 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): This study was the first stage in the research to develop a simulation education program using virtual reality devices to strengthen the healthcare associated infection control and prevention competency of nursing students. It aimed to examine nursing students’ knowledge, awareness, and performance of prevention and control of healthcare associated infections and investigate the factors affecting the nursing students’ standard precautions for the prevention and control of healthcare associated infections. Method(s): Data collection was conducted form third and fourth year nursing students from nine universities in five regions across South Korea. The data were collected from December 1 to 31, 2019. The questionnaire consisted of measuring tools for general characteristics, knowledge, awareness, and performance of medical related infections. Of the questionnaires 189 returned. 28 questionnaires with insufficient answers were excluded. For final analysis 161 questionnaires were analyzed using independent t-test, Pearson’s correlation coefficient, and multiple regression analysis using SPSS/WIN 20.0 version and STATA 13.0 software. Result(s): Mean score of knowledge, awareness, and performance of prevention and control of healthcare associated infections of nursing students were 25.16±2.01(Min=19.0, Max=29.0), 4.73±0.27(Min=4.0, Max=5.0), 4.47±0.47(Min=3.1, Max=5.0), respectively. We found that only knowledge(t=-4.01, p<.001) between grades was statistically significant. Our finding also showed significantly positive correlation between awareness and performance of standard precautions(r=0.23, p<.01). Multiple regression analysis revealed that awareness of standard precautions(β=0.240, p=.021) and exposure to infectious agents(β=-0.179, p=.003) affected nursing students’ performance of standard precautions, accounting for 12% of the variance. Conclusion(s): Our results revealed that education on prevention and control of healthcare associated infection does not just entail knowledge transfer; rather, awareness regarding the healthcare associated infection control is also required to improve nursing students’ performance. Therefore, awareness for prevention and control of healthcare associated infection needs to be adequately emphasized while designing educational programs for nursing students in South Korea.

의료관련감염 소송 판례 분석 : 2011년부터 2016년까지의 소송 자료를 중심으로

우연희,김소윤 한국의료법학회 2022 한국의료법학회지 Vol.30 No.1

This study was conducted to identify the current status of litigation related to the healthcare-associated infection and the causes of accidents, and to suggest measures to prevent recurrence. Quantitative and qualitative analysis were performed on 94 medical litigation judgments related to healthcare-associated infections from 2011 to 2016. In the final analysis, the average duration of litigation was 4.12 years. As for the status of litigation, the most common case was the completion of the first trial (61 cases, 64.9%). As a result of the final judgment, there were 60 cases (63.8%) of partial wins, and the average amount of damages was 57,498,339 won. The most common negligence that resulted in damages was violation of the duty of care (55 cases, 58.5%), and in the analysis by type of the defendant medical institution, the most common was a clinic(52 cases, 55.3%). The judgment was classified into infection control system and infrastructure, and infection control activities before and after healthcare-associated infections occurred, and as a result of qualitative analysis, medical disputes by unlicensed persons and violation of the duty of care by medical personnel for infection control were found. In order to reduce litigation related to healthcare-associated infections, strengthening of infection control capabilities of healthcare providers, and strengthening of infection prevention and control systems and infrastructures of individual medical institutions should be prioritized. For this, it will be necessary to provide legal basis and support at the national level, and to establish an organic cooperative system with academic societies and functional groups. 본 연구는 의료관련감염 관련 소송의 현황과 사고의 원인을 파악하고 재발 방지를 위한 방안을 제시하기 위해, 사건번호가 2011년에서 2016년까지 의료관련감염과 관련된 의료소송 판결문 94건을 계량 분석 및 질적 분석을 하였다. 최종 분석된 의료관련감염과 관련된 소송의 평균 소요기간은 4.12년이었고, 소송 진행 현황의 경우, 1심 종료(61건, 64.9%)가 가장 많았다. 최종심 판결로는 원고 일부승이 60건(63.8%)건이 많았다. 확정된 손해배상 금액은 평균 57,498,339원이었다. 손해배상의 주요과오는 주의의무 위반(55건, 58.5%)가 많았고, 피고 의료기관 종류는 의원(52건, 55.3%)이 가장 많았다. 판결문을 감염관리 체계 및 인프라, 의료관련감염의 발생 전·후 감염관리 활동으로 분류하여, 질적 분석을 한 결과 의원급 기관에서의 무면허자 의료행위 등 감염관리 인프라 부족과 의료인의 감염관리와 관련된 주의의무 위반 등이 의료소송의 주요한 원인으로 파악되었다. 의료관련감염 관련 소송을 줄이기 위해서 의료인의 감염관리 역량이 강화되어야 하고, 의료기관의 감염관리 체계와 인프라가 강화되어야 할 것이다. 이를 위해서는 관련 법적 근거가 마련되어야 하고 학회 및 직능단체와의 유기적인 협력체계를 구축이 필요할 것이다.

접촉성 감염환자 흉부검사 시 의료관련감염 예방에 대한 연구

이상원(Sang-Won Lee),김동진(Dong-Jin Kim),이배원(Bae-Won Lee) 대한방사선과학회(구 대한방사선기술학회) 2018 방사선기술과학 Vol.41 No.4

This study proposes measures and methods to reduce healthcare associated infections by comparing and analyzing the bacterial contamination level before and after putting on personal protective equipment (PPE) on the test equip-ment and the contact infected patients getting chest PA projections. Among the 50 inpatients who were diagnosed with C. difficile, MRSA, and VRE, 28 patients who were instructed to undergo chest PA projection and follow-up were chosen, The 3 parts that come in contact with the detector, chin, chest, and hands, were designated for all, and the bacterial contamination level before and after disinfection and before and after putting PPE was determined. Statistical analysis was performed using Medcalc version 14, and quantitative analysis was performed using paired student t-test, with statistical significance being noted at p<0.05. Results for the comparison of the mean values before and after disinfection of the detector, chin (3.000), chest (2.000), and hands (3.430), showed that the number of bacteria after disinfection was lower than it was before disinfection. Analyzing for each part before and after disinfection, there were statistically significant differences for the chin, chest, and hands (p<0.01). Results for the comparison of the mean values before and after putting on PPE, chin (2.202), chest (2.140), and hands (4.213), showed that the number of bacteria after putting on PPE was lower than it was before putting on PPE. Analyzing for each part before and after putting on PPE, there were statistically significant differences for the chin, chest, and hands (p<0.03). As a result, it was confirmed that the number of bacteria after putting on PPE was lower than it was before putting it on. In the future, expanding the research scope for contact infected patients will establish standards for quarantine guidelines depending on the way it spreads, and contribute to the prevention of healthcare associated infections.