流行病學(xué)在護(hù)理的應(yīng)用與文獻(xiàn)查證.ppt

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 “一門學(xué)問” 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?？?實務(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)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) 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(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 Promotion Health protection Health screening Health education,Health Surveillance Environmental monitoring Data collection Safety Ergonomics,Occupational Health Nurse Occupational Health Physician Life Style Programs,Industrial Hygiene Epidemiology Industrial Safety,Management,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(fàn)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 medicalsurgical 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) 1.0181.087, P=0.002) The presence of trauma at admission (AOR 2.622, 95% CI 1.0746.404, P=0.034) Nosocomial ventilator-associated pneumonia (AOR 6.153, 95% CI 2.30516.422, P=0.000),References,Harkness, G. (1995). Epidemiology in nursing practice. Mosby: St. Louis, MO. Chapter 11-13. APOSTOLOPOUL