| Summary: | 碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 99 === Purpose
The purpose of this thesis is to describe the time trend of catheter-associated bloodstream infection (CA-BSI) in adult intensive care units (ICUs) at National Taiwan University Hospital (NTUH) from 2002 to 2010. Time series analysis was used to investigate the possible effects of various important infection control and quality improvement programs that conducted at different time stages on the incidence rate of CA-BSI.
Method
This is a retrospective study. The study population was patients developing CA-BSI while staying in adult ICUs at NTUH from 2002 to 2010. Patients with CA-BSI at NTUH were identified through active surveillance by infection control center during this period. Four important infection control programs, calendar time (month), season, epidemics, the central catheter utiliztion, the time delay effect and autocorrelation factors of severe acute respiratory syndrome, were treated as the independent variables. Monthly incidence of CA-BSI was treated as dependent variable. Poisson regression multivariate analysis and the models of autocorrelation were used to evaluate the potential effects of independent variables on dependent variable. A p value less than 0.05 were considered as statistically significantly.
Result
Four important infection control programs, hand hygiene campaign, Infection Control Learning Passport, CVC-care check list, and bloodstream infection bundle care, were implemented since April 2004, during July 2005 to March 2008, since August 2006, and since December 2009, respectively. Implementation of hand hygiene campaign and Infection Control Learning Passport did not decrease, but only slowed down the trend of increase the CA-BSI incidence. The CA-BSI incidence decreased to 2.59 per 1000 catheter-days (‰) in August 2006. And it was less than the lower limit of 95% confident interval of predicted value, during August 2006 to May 2008. However, it increased again (up to 5.32‰ in December 2009) thereafter. After implementation of BSI bundle care, the incidence decrease with time significantly (down to 3.56 ‰ in December 2010).
Conclusion
Our study showed that implementation of hand hygiene campaign and Infection Control Learning Passport were not sufficient to decrease the CA-BSI incidence. CA-BSI bundle care and CVC-care check list were the two significant variable associated with the decrease of CA-BSI. We conclude that promotion of CA-BSI bundle care is an important event and effective intervention to control CA-BSI.
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