| 摘要: | 摘 要
研究目的 由於公衛醫療環境與教育水準提升，社會人口快速老化，台灣已邁入高齡化社會，老人福利機構(長期照護、安養、養護機構)倍數增加，長期照護機構的院內感染議題日顯重要。本研究目的係探討台灣榮民醫療體系護理之家院內感染住民特性、院內感染情形、感染後就醫情形與醫療資源耗用及預後的分布及相關，並找出重要預測因子，期望可以提供相關單位與機構，擬定政策時參考。
研究方法 本研究以回溯性方式調查北中南區各一所退輔會榮院護理之家，收集2005年(1月1日至12月31日)，由各榮院感控人員所收案的214位院內感染住民(每位平均被收案1.7次，標準差±0.8)，總計369筆的收案件數，研究者依自行設計的護家、感染住民、菌株培養調查表，親至三家醫院收集相關資料，每個感染案件自收案日起追蹤三個月，以定量研究方法分析推論。
研究結果 感染住民住院天數愈長、ICU相較一般病房、急診相較門診、醫療裝置數愈多、感染數愈多，其住院申報點數愈高；住院天數愈長、ICU相較一般病房、感染數愈多、急診相較門診，其住院藥費愈高；住院天數愈長、急診相較門診、感染數愈多、ICU相較一般病房，其住院抗生素費愈高；整體而言，年齡、醫療裝置數、感染數、就醫類別、病房別與住院天數是影響感染住民醫療資源耗用的重要預測因素；在預後方面，急診就醫是導致感染收案三個月後死亡的主要預測因素。
研究建議 分為三項：針對政府單位，建議長期照護機構比照醫療機構明確訂定感染管制人力及收案定義，建立監督機制及品管指標監測系統，以提升長照機構之安全與品質；針對榮院體系，建議感控人力再行評估，加強護理記錄及登錄住民每月ADLs以利清楚了解住民長期居住之健康狀況；對未來研究者，建議可以前瞻性研究方法，進行住民感染前後ADLs之變化情形比較。
ABSTRACT
Purposes With the improvement of the public health and educational level, the general people in Taiwan live longer. The long-term care facilities (LTCFs) have been rapidly growing because Taiwan has stepped into the aging society, and the problem of nosocomial infections (NIs) in LTCFs has been becoming more and more important. The purpose of this study was to elucidate important risk factors and define the demographic and clinical of infected residents, to investigate the situation of NIs, medical care, consumption of medical resources and prognosis among infected residents who live in the nursing homes of veterans hospitals (VHs) in Taiwan. These findings may provide reference for related organizations while drafting the policy. Methods The quantitative investigation method was used for analysis and deduction. Data were retrospectively collected from 3 nursing homes of VHs in northern, central and southern Taiwan from January 1 to December 31, 2005. Three hundred and sixty-nine NIs among 214 infected residents (average 1.7±0.8 infections per residents) were investigated. Each patient is then followed up for a three-month period. Results The findings show that, by rank of, duration of hospital stay, admitted into intensive care unit (ICU), emergency room (ER) visit, numbers of invasive devices, and numbers of NIs are positive correlated with insurance claim points for hospitalization. In addition, duration of hospital stay, admitted into ICU, numbers of NIs, and ER visit are positive correlated with higher drug expenditure for hospitalization. Duration of hospital stay, ER visit, numbers of NIs, and admitted into ICU are positive correlated with costs of antibiotics for hospitalization. In general, age, number of invasive devices, ER visit, admitted into ICU and long hospital stay are the major factors related to the medical resource expenditure. After a three-month following period, it is found that ER visit is the major factor related to the death of residents with NIs. Suggestions We suggested that, First, the government should legislate a clearly surveillance criteria for LTCFs with regards to infection control improve the care safety and quality of LTCFs. Second, the VH health system should reevaluate the manpower of infection control personnel, and enhance the quality of nursing records as well as ADLs documentation of their residents. Third, a prospective study regarding the change of ADLs in these aged-residents needs to be in the furtue. |
