流行病學(xué)在護(hù)理的應(yīng)用與文獻(xiàn)查證

1、流行病學(xué)在護(hù)理的應(yīng)用與文獻(xiàn)查證,呂筑韻June 23, 2008,前言,流行病學(xué)是 “方法學(xué)” 也是 “一門(mén)學(xué)問(wèn)”流行病學(xué)是公共衛(wèi)生的基礎(chǔ)與護(hù)理的關(guān)連不同護(hù)理?？茖?shí)務(wù)與研究,流行病學(xué)在護(hù)理上的應(yīng)用,Community health nursing (社區(qū)衛(wèi)生護(hù)理)Infection control practice (感染控制)Occupational and environmental health (職業(yè)與環(huán)境衛(wèi)

2、生)研究,社區(qū)衛(wèi)生護(hù)理,社區(qū)衛(wèi)生護(hù)理公共衛(wèi)生護(hù)理專業(yè)初段、次段、與末段預(yù)防居家照護(hù)學(xué)校衛(wèi)生護(hù)理工作場(chǎng)所,感染控制,院內(nèi)感染 (Nosocomial infection)“Infections appearing in hospitalized patients that were not present or incubating at the time of admission” (Blake, 1995, p.214

3、)一般的管染管控可分為“Surveillance and reporting”“Control and prevention”,Types of Surveillance,Total house surveillance OthersPriority-directed / targeted surveillance Problem-oriented / outbreak response surveillancePreva

4、lence survey / risk factors,醫(yī)院內(nèi)流行病學(xué)的應(yīng)用,院內(nèi)醫(yī)護(hù)人員或病人針扎背痛跌倒其他Medical errors術(shù)後合併癥病人滿意度,Interdisciplinary Model for Occupational Health,Health PromotionHealth protectionHealth screeningHealth education,Health Surveill

5、anceEnvironmental monitoringData collectionSafetyErgonomics,Occupational Health NurseOccupational Health PhysicianLife Style Programs,Industrial HygieneEpidemiologyIndustrial Safety,Management,,,,,,,,,,,,,,,,,Ris

6、k Assessment Process,Focus of the risk assessmentWhat is the purpose?Identification of needsClarification of problemAnalysis of desire (desire for an exercise program)Identification of resourceUse of resourceWhat

7、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 assessmentEmployees

8、Work environmentOrganizational resourcesHealth effectsEconomic impact,研究,To identify risk factor for infection control practice (ICP)範(fàn)例: Risk factors for nosocomial bloodstream infectionsA retrospective study of 205

9、 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, Greec

10、eRisk factors were determined using single and multivariate analysesThirty-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

11、-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 (adjus

12、ted 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

13、.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 nosoc