101

7.

2012.

26

1992/6-

1991/5-1992/6
1991-06
02-25433535 3091
hideko@ms1.mmh.org.tw

1
2
3
4

1
2
3


Populous Institutions


Populous Institutions

INFECTION PREVENTION
PROGRAM
SURVEILLANCE
INFECTION PREVENTION
EDUCATION

ISOLATION

PATIENT CARE POLICIES

DEPARTMENT POLICIES

BLOODBORNE PATHOGENS

TUBERCULOSIS

EMPLOYEE HEALTH

10

PERFORMANCE IMPROVEMENT

()

()

1/3
infectious agent

reservoir

2/3
vector

2/3
host

3/3
infection

contamination

..

1/2
direct transmission

2/2
indirect transmission

1/4

2/4

3/4

(1)
(2)
(3)

4/4

: , , /

Figure 1. Health-care system of the past, 1970-1980

Special Issue
Infection Control and Changing Health-Care Delivery Systems
William R. Jarvis
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Figure 5. Model for comprehensive surveillance and

prevention of health care-associated adverse
events in the United
States.

1/2

2/2

(
2007)

1/2

70-90

2-5

1/2

2.7-32.7%
10.7-20.1%

1000


1.

2.

1/2

(Smith&Rusnak,
1997)

2/2

1.(Smith&, 1998)



2.( 2004)

3.

40-60%

(nosocomial
infection)

(healthcare-associated infection, HAI)

,
,

Serratia spp.
Klebsiella spp.
P.aeruginosa

endogenous flora

1/2


(
)


()


(),

(),


(opportunity)

(indication)

2/2

20

30

5
1.
2.
3.
4.
5.


,
40%

72%

70%

40%

Figure 5. Model for comprehensive surveillance and

prevention of health care-associated adverse
events in the United
States.

--
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()
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AB
:

4/5
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http://iss.cdc.gov.tw/LoginOrgInfect.ASP

http://iss.cdc.gov.tw/data/IRS/
.doc
:

2/3

()

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()(:

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:

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()
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()
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(Standard
Precaution)

(Standard precaution)
(universal precaution)
1. ()
2. ((
) )
3.
4.
5.
6.
7.
8.
9.
:

:

(6-12 times/hr
exchanges)
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:


Invasive Haemophilus influenzae
meningococcal disease influenza

1.
Recommendations For Application Of Standard Precautions For
The Care Of All Patients In All Healthcare Settings

1.
2.
3.
4.

2.

*
///

(standard precautions)

(airborne precaution)

(contact precaution)

(droplet precaution)

1. (universal precaution)

2.
3.

4.

(
(
)
)

1. 5m
2. ()

(6-12
times/hr exchanges)

()

10

10

20

7
6

30 40

60
4

3
2

70

80

90 100


1.
2.
3.

(lntraIuminal lnfection)

(Extraluminal lnfection)



()
()

(1)
1/2

(1)
2/2

(2)
1/2

1:100

(2)
2/2

(3)
1/2

2,000CC

(3)
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(
C
)


46

5

6


()

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38

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(8)
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(3)
(4)
(5)
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(7)
(8)

Scabies

0.220.18mm
0.4 0.3mm

(Burrows)

3-4
8-15

1/2

(
)

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(24)

()

1/2

sulfur ointment 510

Eurax creamlotion()

MesulphenMitigalScalphen

2/2
25%Benzyl benzoate lotionBB lotion

Gamma benzene hexachloride creamScabi

1224

1/3

2/3

3/3

:
--
--

--

3/3
:
--
--

--

Routine surveillance activities detect an unusual microbial isolates, a cluster of cases, or an apparent
increase in the usual number or incidence of cases; when a diagnoses an uncommon disease; or
when an alert physician nurse, or laboratory worker notices a cluster of cases.

case,

cases

PseudoOutbreak

Pseudo-outbreaks occur when there is

a real cluster of false infections or a
false cluster of real infections.

Ref The role of the laboratory in outbreak investigation, quick reference to outbreak
investigation and control in health care facilities. P223

?
Approximately 2 to 4 percent of
nosocomial infections occure as part of
epidemics

4%
96%

outbreak
nosocomial inf.

Ref:
1.Haley, R.W., et al. How frequent are outbreaks of nosocomia infection in community hospital? Infect. Control 6:233,1985.
2.Wenzel, R.A., et al. Hospital acquired infections in intensive care unit patients: An overview with emphasis on epidemics. Infect. Contril 4:371,1983.

Comparison of types of infections and pathogens

involved in endemic and epidemic infections (NNIS,1986-1990)
Type of infection

() Endemic Infection (%) () Epidemic investigation

(%)

UTI ()

37

Surgical wound Ifection

17

10

Pneumonia ()

16

12

Cutaneous infection

13

Bacteremia ()

11

20

Meningitis ()

<1

18

Hepatitis

<1

Other

12

10

Total

100

100

Gastroenteritis ()

Ref: Hospital infection

,P588

Comparison of types of infections and pathogens

involved in endemic and epidemic infections (NNIS,1986-1990)

() Endemic
Infection (%)

() Epidemic
investigation (%)

Pathogen

E. Coli

13.8

<1

Enterococcus

10.7

<1

11.2
11.2

5
16

Proteus

3.9

<1

Klebsiella

6.2

Enterobacter

6.3

Group A streptococcus

0.2

Serratia

1.7

Hepatitis

<1

<1

Coagulase-(-)staphylococci

9.7

<1

Candida species

7.1

Mycobacteria

<1

Other

15

48

Total

100

Staphylococcus aureus
Pseudomonas

100
Ref: Hospital infection ,P588

The initial evaluation

Verify the diagnosis of reported cases before initiating an outbreak investigation

Evaluate the severity of the problem
Conduct a retrospective review to identify other cases.
Develop a line-listing of cases.
Review the existing data; determine if a potential problem exists.

Cases
,


PRELIMINARY INVESTIGATION

The IP (and others as assigned), is designated as the investigation

coordinator. He or she will review the charts of the involved
patients and determine that an epidemic exists. The investigation
coordinator, director of nursing, administrator, and medical
director will confer and prepare a preliminary plan of investigation
including the following

/COMMUNICATIONS

The IP will ensure that the following individuals are notified

concurrently with the preliminary investigation and advised
at reasonable intervals of the progress of the investigation:
attending physicians, the DON, medical director,
administrator, and others as needed.


IMMEDIATE CONTROL

:
1. ()
2. ()
3. ,

Reasonable immediate control measures will be put into effect.

Such measures might include but are not limited to isolation,
removal of common suspected sources of personnel from patient
contact, or immediate inservice training in certain Infection
Prevention techniques.


ANALYSIS OF DATA

The data collected in the preliminary investigation are

reviewed by the investigators to determine whether a
common source of infection, break in technique, etc., can
be implicated as the cause of the epidemic. A
preliminary written report will be prepared.


FURTHER INVESTIGATION

If the cause of the infection is not evident as a

result of the above investigation, expert
consultation will be sought. Reporting of the
potential outbreak will be done to public health as
required by law.

1.,
2.

1.
2.???


CONCLUSION OF INVESTIGATION

The investigation is continued at least as long as there are

cases of the infection occurring above the endemic level.

, ,

A final written report of the investigation, outlining findings

and recommendations, is prepared by the investigation
coordinator and issued to the Infection Prevention
committee, others participating in the investigation,
attending physician(s), director of nursing, and others as
needed.