流行病學在護理的應用與文獻查證

流行病學在護理的應用與文獻查證 呂筑韻 June 23, 2008

前言 • 流行病學是 “方法學” 也是 “一門學問” • 流行病學是公共衛生的基礎 • 與護理的關連 • 不同護理專科 • 實務與研究

流行病學在護理上的應用 • Community health nursing (社區衛生護理) • Infection control practice (感染控制) • Occupational and environmental health (職業與環境衛生) • 研究

社區衛生護理 • 社區衛生護理 • 公共衛生 • 護理專業 • 初段、次段、與末段預防 • 居家照護 • 學校衛生護理 • 工作場所

感染控制 • 院內感染 (Nosocomial infection) • “Infections appearing in hospitalized patients that were not present or incubating at the time of admission” (Blake, 1995, p.214) • 一般的管染管控可分為 • “Surveillance and reporting” • “Control and prevention”

Types of Surveillance • Total house surveillance • Others • Priority-directed / targeted surveillance • Problem-oriented / outbreak response surveillance • Prevalence survey / risk factors

醫院內流行病學的應用 • 院內醫護人員或病人 • 針扎 • 背痛 • 跌倒 • 其他 • Medical errors • 術後合併症 • 病人滿意度

Interdisciplinary Model for Occupational Health • Health Promotion • Health protection • Health screening • Health education Occupational Health Nurse Occupational Health Physician Life Style Programs Management • Health Surveillance • Environmental monitoring • Data collection • Safety • Ergonomics Industrial Hygiene Epidemiology Industrial Safety

Risk Assessment Process • Focus of the risk assessment • What is the purpose? • Identification of needs • Clarification of problem • Analysis of desire (desire for an exercise program) • Identification of resource • Use of resource • What is the scope of the program? • What do you intend to accomplish? • How large is the employee population? • Do you have the needed expertise? • Is the time available? • What is the cost/benefit ratio? • Areas of assessment • Employees • Work environment • Organizational resources • Health effects • Economic impact

研究 • To identify risk factor for infection control practice (ICP) • 範例: Risk factors for nosocomial bloodstream infections • A retrospective study of 205 patients was performed to identify the risk factors associated with nosocomial bloodstream infection (BSI) • The study occurred during a 5-month period in four medical–surgical intensive care units (ICUs) in Athens, Greece • Risk factors were determined using single and multivariate analyses • Thirty-five patients developed nosocomial BSI (17.1%) • The incidence density (defined as the number of new cases of BSI divided by the total of patient-days in the population studied of BSI was 14.3 per 1000 patient-days (total number of days that patients are in the ICU during the selected time period) • Three risk factors were identified: • The length of ICU stay (adjusted odds ratios (AOR) 1.052, 95% confidence interval (CI) 1.018–1.087, P=0.002) • The presence of trauma at admission (AOR 2.622, 95% CI 1.074–6.404, P=0.034) • Nosocomial ventilator-associated pneumonia (AOR 6.153, 95% CI 2.305–16.422, P=0.000)

References • Harkness, G. (1995). Epidemiology in nursing practice. Mosby: St. Louis, MO. Chapter 11-13. • APOSTOLOPOULOU, E., KATSARIS, G., & KATOSTARAS, T. (2003). Risk factors for nosocomial bloodstream infections. British journal of nursing, 12 (12), 718-26.

流行病學在護理的應用 與文獻查證