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流行病學在護理的應用與文獻查證

呂筑韻June 23, 2008

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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

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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

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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

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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”

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Types of Surveillance

• Total house surveillance

• Others– Priority-directed / targeted surveillance – Problem-oriented / outbreak response

surveillance– Prevalence survey / risk factors

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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

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Interdisciplinary Model for Occupational Health

Health Promotion•Health protection•Health screening•Health education

Health Surveillance•Environmental monitoring

•Data collection•Safety

•Ergonomics

Occupational Health NurseOccupational Health Physician

Life Style Programs

Industrial HygieneEpidemiology

Industrial Safety

Management

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Risk Assessment Process Focus of the risk assessment

A. What is the purpose?1. Identification of needs2. Clarification of problem3. Analysis of desire (desire for an exercise program)4. Identification of resource5. Use of resource

B. What is the scope of the program?1. What do you intend to accomplish?2. How large is the employee population?3. Do you have the needed expertise?4. Is the time available?5. What is the cost/benefit ratio?

Areas of assessment– Employees– Work environment– Organizational resources– Health effects– Economic impact

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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)

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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.