Ihn Sook Jeong

Effect of central line bundle on central line-associated bloodstream infections in intensive care units.

BACKGROUND This study was conducted in 4 intensive care units (ICUs) to investigate the effect of the central line (CL) bundle on central line-associated bloodstream infection (CLABSI). METHODS During phase 1 (baseline, from April 2009 to March 2010), active surveillance and training on hand hygiene only were conducted. During phase 2 (intervention, from April 2010 to December 2011), systemic training on the CL bundle and active surveillance and feedback with an electronic CL insertion checklist were performed. RESULTS Adherence to the CL bundle significantly increased from 0.0% in phase 1 to 37.1% in phase 2 (P < .001), but the change of CLABSI rate was insignificant for adults in ICUs. However, adherence to the CL bundle significantly increased from 0.8% in phase 1 to 20.1% in phase 2 (P < .001), and the CLABSI rate significantly decreased from 3.7 to 0.0 per 1,000 catheter-days (P = .014) for children in ICUs. CONCLUSION The higher adherence to the CL bundle was not positively correlated to a reduction in the CLABSI rate in adults, but it was related to a zero CLABSI for 18 months among children in the ICUs.

Nosocomial infection in a newborn intensive care unit (NICU), South Korea

BackgroundThis study aimed to determine the occurrence of nosocomial infections (NIs), including infection rates, main infection sites, and common microorganisms. Patients included in the study were taken from a newborn intensive care unit (NICU), in a hospital in South Korea.MethodsA retrospective cohort study was performed by reviewing chart. The subjects were 489 neonates who were admitted to the NICU, survived longer than 72 hours, and not transferred to another unit, between Jan. 1. 1995 to Sep. 30, 1999. NIs were identified according to the NNIS definition. Data were analyzed with descriptive statistics.ResultsCumulative incidence rate for NIs was 30.3 neonates out of 100 admissions, with a total of 44.6 infections. The incidence density was average 10.2 neonates and 15.1 infections per 1000 patient days. The most common infections were pneumonia (28%), bloodstream infection (26%), and conjunctivitis (22%). Major pathogens were Gram-positives such as Staphylococcus aureus and coagulase-negative staphylococci. The factors associated with NI was less than 1500 g of birth weight, less than 32 weeks of gestational age, and less than 8 of apgar score. Theres no statistical difference in discharge status between two groups, but hospital stay was longer in subjects with nosocomial infection than those without infection.ConclusionAlthough the distribution of pathogens was similar to previous reports, a high rate of nosocomial infection and in particular conjunctivitis was observed in this study that merits further evaluation.

The frequency of painful procedures in neonatal intensive care units in South Korea

This study was to evaluate the performed painful procedures among all sick neonates cared for at two university hospital neonatal intensive care units (NICUs) in the Republic of Korea. This prospective study was done with all newborns admitted to the NICUs between 1 October and 20 November 2010. Data collection was done with self-administered questionnaire by each nurse for the first 2 weeks of admission and discontinued if the neonate was discharged, transferred or died. The number of painful procedures, according to general characteristics of the neonates, were compared using Mann-Whitney U-test and Kruskal-Wallis test. Oral suctioning was the most frequently performed procedure, followed by tracheal suctioning and nasal suctioning. The number of painful procedures increased as the gestation period became shorter and birthweight decreased. In conclusion, nurses should reappraise the need for painful procedures, in particular, among neonates with a gestation period of ≤ 27 weeks and babies with ≤ 1000 g of birthweight, and execute their performance only if necessary.

[Predictors of postpartum depression: prospective cohort study].

PURPOSE This prospective cohort study was done to investigate recall bias to antepartum variables measured at postpartum periods and predictors of postpartum depression. METHODS Participants were 215 women who answered a self-administered questionnaire which included demographics, Postpartum Depression Predictors Inventory-Revised and Korean version of Edinburgh Postpartum Depression Scale at antepartum 36-40 weeks and postpartum 2 weeks and 6 weeks. Data were analyzed using kappa, and hierarchical multiple logistic regression. RESULTS Agreement between antepartum variables at both antepartum and two postpartum periods was relatively high (κ=.55-.95). Postpartum depression rates were 36.3% and 36.7% at two follow-up points. In hierarchical multiple logistic regression analysis, prenatal depression (OR=4.32, 95% CI: 1.41-13.19; OR=5.19, 95% CI: 1.41-19.08), social support (OR=1.40, 95% CI: 1.18-1.66; OR=1.27, 95% CI: 1.06-1.53) and maternity blues (OR=4.75, 95% CI: 1.89-11.98; OR=4.22, 95% CI: 1.60-11.12) were commonly associated with postpartum depression at two follow-up points. Child care stress (OR=1.85, 95% CI: 1.01-3.37) was only associated with postpartum depression at 2 weeks postpartum and pregnancy intendedness (OR=1.57, 95% CI: 1.09-2.27) was only associated with postpartum depression at 6 weeks postpartum. CONCLUSIONS The results indicate a need to apply nursing interventions such as prenatal education and counseling with families from antenatal period.

The Effect of Intravenous Infiltration Management Program for Hospitalized Children

UNLABELLED This study aimed to identify the effect of IV infiltration management program among hospitalized children. DESIGN AND METHODS This was a quasi-experimental study with history comparison group design with 2,894 catheters inserted during 3 months comparison phase and 3,651 catheters inserted during 4 months experimental phase. The intervention was composed of seven activities including applying poster, documentation of catheter insertion, parents education, making infiltration report, assessment of vein condition before inserting catheter, appropriate site selection, and documentation of catheter insertion, and assessment of peripheral catheter insertion site every shift. Data were analyzed using of X2-test, Fishers exact test. RESULTS The infiltration incidence rate was 0.9% for experimental group and 4.4% for comparison group, which was significantly different (x2=80.42, p<.001). The catheter maintenance period (p=.035) and infiltration state (p=.039) were significantly different among participants with infiltration between comparison and experimental groups. CONCLUSIONS IV Infiltration management program was founded to be effective in reducing the IV infiltration incidence rate and increasing early detection of IV infiltration. PRACTICE IMPLICATIONS Considering the effect of IV Infiltration management program, we recommend that this infiltration management program would be widely used in the clinical settings.

Use of hands-free technique among operating room nurses in the Republic of Korea

BACKGROUND The recently introduced concept of hands-free technique (HFT) currently has no recommendations or formal educational program for use in the Republic of Korea. This study evaluated the level of HFT use and investigated factors related to HFT use among Korean operating room nurses. METHOD Data were obtained through a self-administered questionnaire from 158 operating room nurses in 7 general hospitals in Busan, Republic of Korea, in April and May 2006. The questionnaire elicited information on demographics, exposure to education on HFT, attitude toward the need for HFT, concerns about exposure to bloodborne pathogens, and experience with HTF use. Multilevel multiple logistic regression analysis with generalized estimating equations was used, and adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. RESULTS We found that 56% of the participants had used HFT, and 50% had received education on HFT. The use of HFT had a significant association with both education on HFT (OR = 12.02; 95% CI = 7.50 to 19.25) and attitude toward the need for HFT (OR = 4.22; 95% CI = 2.43 to 7.35). CONCLUSION Increasing education about HFT could be the most important approach to increasing the use of HFT among Korean operating room nurses. Thus, routine teaching about HFT should be provided to these nurses.

Predictive Validity of the Postpartum Depression Predictors Inventory-Revised

PURPOSE This study aimed to investigate the predictive validity of three versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in Korea. METHODS A descriptive cross-sectional design with a self-administered questionnaire, including 43 items of the PDPI-R, using the Edinburgh Postpartum Depression Scale as the gold standard was used. Data were collected from 316 women within 6 weeks after childbirth in Busan, Korea, from August to November 2010. RESULTS The postpartum depression and postpartum depressive symptom (PDS) rate was 22.5%. The area under the curve of the receiver operating characteristic curve was .882 for the prenatal version of the PDPI-R and .927 for the full version. The sensitivity and specificity were 87.3% and 85.1%, respectively, at a cutoff point of 9.5 for the full version, and 91.5% and 66.1%, respectively, at a cutoff point of 5.5 for the prenatal version. The Hosmer-Lemeshow goodness-of-fit statistics was 3.554 (p=.829) for the prenatal version and 8.305 (p=.404) for the full version; this showed a good degree of correspondence between the estimated and observed probabilities of PDS. By age, education, and socioeconomic groups, the discrimination and calibration were generally good for both the prenatal and full versions. CONCLUSION The PDPI-R showed good predictive validity among women in Korea. It is recommended that the prenatal version of the PDPI-R be used to predict PDS for pregnant women and the full version of the PDPI-R be used for women during the postpartum period.

[Change of stages and related factors for wearing of hearing protection device among noisy workplace-workers].

PURPOSE This study was done to identify the distribution and related factors for stage of change for wearing hearing protection devices (HPDs) by workers in environments with high noise. Predictors of Use of Hearing Protection Model and Trans-theoretical Model were tested. METHODS The participants were 755 workers from 20 noisy work places in Busan and Gyeongnam. Data were collected from January to April 2008 using self-administered questionnaires, and analyzed using multiple logistic regression. RESULTS There were significant differences in social mode (OR=1.35, 95% CI: 1.06-1.73) between precontemplation/contemplation and preparation stage, in males (OR=2.36, 95% CI: 1.24-4.51), workers with high school education or less (OR=1.39, 95% CI: 1.28-2.78), shift workers (OR=1.50, 95% CI: 1.02-2.21), workers who previously worked in noisy places (OR=1.39, 95% CI: 1.20-2.34), and workers who had previous hearing examinations (OR=1.89, 95% CI: 1.25-2.85), in the social model (OR=1.59, 95% CI: 1.42-1.78), and self-efficacy (OR=1.05, 95% CI: 1.02-1.08) between workers in preparation and action stages, in length of time working in noisy work places (OR=2.26, 95% CI: 1.17-4.39), social model (OR=1.66, 95% CI: 1.33-2.08), and perceived benefit (OR=0.95, 95% CI: 0.93-0.97) between action and maintenance stage. CONCLUSION Social model was a common factor showing differences between two adjacent stages for wearing HPDs. The results provide data for developing programs to encourage workers to wear HPDs and application of these programs in work settings.

Intravenous Infiltration Risk by Catheter Dwell Time Among Hospitalized Children

Purpose: This study was aimed to examine the cumulative risk for infiltration over IV catheter dwell time by general or catheterization‐specific characteristics of pediatric patients with IV therapy. Design and methods: This secondary data analysis was done with the data of 1596 children who received peripheral IV therapy at least once during their hospital stay between August 1st and October 30th, 2011 and in June, 2013 in an academic medical center, Yangsan, Republic of Korea. The survival functions of infiltration were determined by using the Kaplan–Meier analysis. Result: The cumulative risk for infiltration had rapidly increased from 1.5% after 24 hours of catheter dwell time to 17.3% after 96 hours. The survival functions were significantly different in the medical than in the surgical department (p = .005), lower extremities than upper ones (p = .001), and use of 10% dextrose (p = .001), ampicillin/sulbactam (p < .001), vancomycin (p = .024), high‐concentration electrolytes (p = .001), and phenytoin (p < .001). Conclusion: When catheter dwell times are similar, the cumulative risk for infiltration was higher in cases wherein the patient had a risk factor. The cumulative risk for infiltration has rapidly increased after 24 hours in patients who have 10% dextrose, high‐concentration electrolytes, and phenytoin. Practice implications: The results suggest that nurses are required to assess the IV site every hour after 24 hours of catheter dwell time for the infusion of irritants for a safer practice of IV therapy. However, this monitoring time may be modified by the age of child, previous IV complications, and/or hemodynamic issues which may impact IV integrity. HighlightsCumulative risk for infiltration has increased by 1.8–2 times per 24 hours between 48 and 120 hours after the IV catheter insertion.Cumulative risk for infiltration was approximately 10% after 72 hours, 17.3% after 96 hours, and then 29.3% after 108 hours.When catheter dwell times are same, the cumulative risk for infiltration was higher in medical patients, patients who had IV catheter in their lower extremities, patients who had 10% dextrose, ampicillin/sulbactam, vancomycin, high‐concentration electrolytes, and phenytoin.

Identification of Risk Factors for Intravenous Infiltration among Hospitalized Children: A Retrospective Study.

This retrospective study was aimed to identify risk factors of intravenous (IV) infiltration for hospitalized children. The participants were 1,174 children admitted to a general hospital, who received peripheral intravenous injection therapy at least once, and had complete records. Data were analyzed with frequency and percentage or mean and standard deviation were calculated, and odds ratio (OR) from univariate and multiple logistic regressions. The number and % of infiltrations were 92 and 7.8%, respectively. IV infiltration risk factors were lower limb (OR = 1.72), phenytoin (OR = 11.03), 10% dextrose (OR = 6.55), steroids (OR = 6.21), vancomycin (OR = 4.10), high-concentration electrolytes (OR = 3.49), and ampicillin/sulbactam combination (OR = 3.37). Nurses working at children’s hospitals should consider the risk of IV infiltration for children receiving IV infusion therapy and make a preventive effort to identify IV infiltration in high-risk children at an early stage.