以風險計分法評估晚期癌症患者人工血管相關血流感染發生

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題名:	以風險計分法評估晚期癌症患者人工血管相關血流感染發生 Risk Score Predictors of Bloodstream Infection Associated with Permanently Implantable Venous Port in Advanced Cancer Patients
作者:	李盈慧 Lee, Ying-Hui
貢獻者:	醫務管理學研究所
關鍵詞:	感染控制品質;風險因子計分;人工血管相關血流;感染 Quality of infection control;Risk score;port-A bloodstream associated infection
日期:	2015-12-10
上傳時間:	2021-01-07 11:50:43 (UTC+8)
摘要:	背景：為提升醫療品質的進步一直是許多醫療機構持續且不間斷在進行的措施，「醫療照護相關感染」(healthcare-associated infection, HAI)品質控制不佳將會導致病人疾病嚴重程度、住院天數、費用與致死率增加，晚期癌症患者長期置入人工血管(Port-A catheter)，發生導管相關血流感染(Port-A bloodstream associated infection, PABSI)率為每1000導管日約為0.1至1.0，有研究發展屬於PABSI的風險因子計分法(Risk score)預測發生率，晚期癌症患者為PABSI的高風險群且兩者存活率相同；佔PABSI 30%感染率的革蘭氏陽性菌已有感控方式，但佔PABSI 46%感染率的革蘭氏陰性菌仍無法得到有效防治，因此運用風險因子計分法於臨床預測晚期癌症患者發生PABSI勢必要的醫療品質改善措施。目的：1.以風險因子計分評估第四期(晚期)實體癌症患者人工血管導管相關血流感染(PABSI)的發生。2.探討第四期(晚期)實體癌症患者疾病惡化是否增加人工血管導管相關血流感染(PABSI)發生。方法：收集北部某醫學中心2012年2月到2012年7月期間，已裝置人工血管的晚期癌症住院患者兩次時間點的風險因子計分。初次風險因子計分是在病患在2012年第一天入院時間點為基準點；第二次風險因子計分，持續追蹤患者至發生PABSI為二次收集時間點，若在最後發生PABSI感染，則在2012年間未發生感染者則根據最後一位感染者為二次收集點，以成對樣本t檢定及3D Table curve迴歸統計方式檢定前後兩次風險因子計分的差異性，以及風險計分的預測力。結果：研究將研究樣本分為三組，PABSI感染組、其他血流感染組以及無感染組。結果顯示，1.PABSI感染組與無感染組初次風險因子計分有顯著差異(p<0.01)；2.發生PABSI感染組、無感染組的初次風險因子計分對照二次風險因子計分有顯著差異(p<0.01)；3.3D Table curve迴歸統計的Adjust R2=0.178，代表模型的解釋力達17%。結論：1.風險因子計分方式可預測晚期癌症患者PABSI的發生，高計分者也會影響整體存活期；2.提供臨床預防醫療照護相關感染的品質策略，提供臨床評估高風險族群的參考、提供臨床評估侵入性治療的適合度。 Background: A lot of healthcare organizations are working relentlessly to improve the quality of their healthcare. Poor control of healthcare-associated infection (HAI) can lead to the increase of disease severity, hospital stay, medical expense and mortality of the patients. Furthermore, end stage cancer patients who are receiving port-A catheter for long term treatment are also prone to HAI. In addition, port-A bloodstream associated infection (PABSI) rate is approximately 0.1 to 1.0 per 1000 insertions. Studies had predicted the incidence rate of PABSI by using risk score; they also found that the survival rate for patient with end stage cancer and patient with high risk for PABSI are quite similar. Moreover, gram-positive bacterial infection which holds up to 30% of PABSI rate is found to be controllable. However, there is still no preventive method for gram-negative bacterial infection. Therefore, using risk score is a necessary method to understand and minimize the incidence of PABSI and thus improve quality of healthcare system. Purpose: 1. To measure the PABSI rate in stage 4 cancer patient using risk score method. 2. To measure the association between PABSI and complication of disease in stage 4 cancer paper using risk score method. 3. To explore the association between the demographic characteristics of the patients and PABSI using risk score method. Method: The data was collected in a medical center located at northern part of Taiwan from February to July, 2012. The risk scores were collected twice for patient with port-A catheter; the admission of the patient was set for the baseline and the second time was recorded when the patient was diagnosed with PABSI or discharged from the hospital without being infected. T-test and 3D table curve regression were used to measure the risk score for first and second recording. Result: 1. The risk score for PABSI positive group and negative group were significantly different (p<0.01); 2. The risk score for the baseline score of PABSI negative and positive group were significantly different (p<0.01). 3. 3D table curve regression shows that the Adjust R-square was 0.17.8 and the explanatory power of the model was 17%. Conclusion: 1. Risk scoring systems can predict the occurrence of advanced cancer patients PABSI high scoring were also affects overall survival; 2. Providing clinical preventive health care-associated infections quality strategy to provide clinical assessment of high-risk groups of reference, providing clinical assessment invasive treatment of fitness.
描述:	碩士指導教授:邱瓊萱委員:許駿委員:簡麗年
資料類型:	thesis
顯示於類別:	[醫務管理學系暨研究所] 博碩士論文

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