Publication: Yoğun bakım ünitesinde gelişen invaziv araç ilişkili enfeksiyonlar
Abstract
1.ÖZET Araştırma, yoğun bakım ünitesindeki invaziv araç kullanımıyla enfeksiyon gelişimi arasındaki ilişkiyi belirlemek amacıyla tanımlayıcı ve kesitsel yapıldı. Evreni 01 Temmuz – 30 Eylül 2011 tarihleri arasında bir Anestezi ve Reanimasyon Kliniğine yatan 257 hasta, örneklemi 48 saatten uzun yatan ve araştırmaya katılmayı kabul eden 173 hasta oluşturdu. Veriler “Erişkin Hasta ” ve “Erişkin İnvaziv Araç” takip formlarıyla toplandı. Enfeksiyonlar Centers for Disease Control and Prevention kriterlerine göre belirlendi. Veriler SPSS 10.0 programında yüzdelik, ortalamalar, Ki-kare ve Mann-Whitney U testleriyle değerlendirildi. Enfeksiyon hızları National Nosocomial Infections Sürveillance System’e göre hesaplandı. Türkiye Ulusal Hastane Enfeksiyonları Sürveyans Ağı (UHESA) 2011 ve National Healthcare Safety Network (NHSN) 2008 verileriyle karşılaştırıldı. Olguların %28.9’unda, 50 hastada 74 hastane enfeksiyonu gelişti. Hastane enfeksiyon dansitesi 39.2/ 1000, ventilatörle ilişkili pnömoni hızı (VİP) 41.1/ 1000, üriner kateter ilişkili üriner sistem enfeksiyonu (ÜKİ-ÜSE) hızı 6.4/ 1000 bulundu. Santral venöz kateterle ilişkili kan dolaşımı enfeksiyonu (SVKİ-KDE) gelişmedi. Enfeksiyonların %20.2’si primer KDE idi. VİP ve ÜKİ-ÜSE hızı, UHESA 2011 ve NHSN 2008 verilerine göre yüksek bulundu. Risk faktörleri (yatış süresi, solunum yetmezliği, serebrovasküler hastalık, travma, entübasyon, mekanik ventilatör, enteral beslenme, santral venöz kateter) ile enfeksiyon gelişimi arasında anlamlılık saptanırken (p<.05), yaş ve cinsiyetin enfeksiyon gelişimini etkilemediği görüldü (p>.05). VİP ve ÜKİ-ÜSE ile exitus olan hastalar arasında fark belirlendi (p=.024). Sonuç olarak; Yoğun bakımda yatan hastalarda invaziv araç kullanımı, tanı, altta yatan hastalık, yatış süresi ve diğer risk faktörleriyle birlikte enfeksiyon gelişimini etkilemektedir. Hemşirelik, invaziv araç, VİP, yoğun bakım, ÜKİ-ÜSE. 1.
Infections Associated with Invasive Device Which Occur in the Intensive Care Unit A descriptive and cross-sectional study was conducted to determine the relationship with occurrence of infection and use of invasive device in the intensive care unit. The target population of the study was comprised of 257 patients who were hospitalized in the Anesthesia and Reanimation Clinic from July 1 to September 30, 2011 and 173 patients who agreed to participate to the study. Data was collected using “Adult Patient” and “Adult Invasive Device” tracking forms. Infections were determined according to the criteria of Centers for Disease Control and Prevention. Data was examined with percentage, mean, Chi-square and Mann-Whitney U tests in SPSS 10.0 software pack. Infection rates were estimated according to the National Nosocomial Infections Surveillance System. It was compared with data obtained from Turkish National Nosocomial Infections Surveillance Network (UHESA) 2011 and National Healthcare Safety Network (NHSN) 2008. Seventy four nosocomial infections developed in 50 patients which account to 28.9% of the cases. Density of nosocomial infections was 39.2/ 1000 and it was found that ventilator associated pneumonia rate (VAP) was 41.1/ 1000 and urinary catheter-associated, urinary tract infection (CAUTI), rate was 6.4/ 1000. central line-associated bloodstream infection (CLABSI) developed. Of all infections, 20.2% was primary BSI. VAP and CAUTI, rates were higher in comparison with data obtained from UHESA 2011 and NHSN 2008. A significant relationship was found between risk factors (length of hospitalization, respiratory failure, cerebrovascular diseases, trauma, intubation, mechanical ventilator, enteral feeding, central venous catheter) and the occurrence of the infection (p<.05), while it was observed that age and gender did not influence the occurrence of infection (p>.05). A difference was found between patients who died secondary to VAP and CAUTI (p=.024). In conclusion, use of invasive device in the intensive care unit, in association with the diagnosis, length of hospitalization, underlying disease and other risk factors, influences the development of infection. Key words: Nurse care, invasive device, VAP, intensive care, CAUTI
Infections Associated with Invasive Device Which Occur in the Intensive Care Unit A descriptive and cross-sectional study was conducted to determine the relationship with occurrence of infection and use of invasive device in the intensive care unit. The target population of the study was comprised of 257 patients who were hospitalized in the Anesthesia and Reanimation Clinic from July 1 to September 30, 2011 and 173 patients who agreed to participate to the study. Data was collected using “Adult Patient” and “Adult Invasive Device” tracking forms. Infections were determined according to the criteria of Centers for Disease Control and Prevention. Data was examined with percentage, mean, Chi-square and Mann-Whitney U tests in SPSS 10.0 software pack. Infection rates were estimated according to the National Nosocomial Infections Surveillance System. It was compared with data obtained from Turkish National Nosocomial Infections Surveillance Network (UHESA) 2011 and National Healthcare Safety Network (NHSN) 2008. Seventy four nosocomial infections developed in 50 patients which account to 28.9% of the cases. Density of nosocomial infections was 39.2/ 1000 and it was found that ventilator associated pneumonia rate (VAP) was 41.1/ 1000 and urinary catheter-associated, urinary tract infection (CAUTI), rate was 6.4/ 1000. central line-associated bloodstream infection (CLABSI) developed. Of all infections, 20.2% was primary BSI. VAP and CAUTI, rates were higher in comparison with data obtained from UHESA 2011 and NHSN 2008. A significant relationship was found between risk factors (length of hospitalization, respiratory failure, cerebrovascular diseases, trauma, intubation, mechanical ventilator, enteral feeding, central venous catheter) and the occurrence of the infection (p<.05), while it was observed that age and gender did not influence the occurrence of infection (p>.05). A difference was found between patients who died secondary to VAP and CAUTI (p=.024). In conclusion, use of invasive device in the intensive care unit, in association with the diagnosis, length of hospitalization, underlying disease and other risk factors, influences the development of infection. Key words: Nurse care, invasive device, VAP, intensive care, CAUTI