Transcript 實證醫學文獻查證應用
實證醫學 文獻查證應用 感染管制中心 張麗珍 臨床病理科 陳玉娟 健康管理中心 曾雅玲 Klebsiella pneumoniae 2 3 4 5 Proteus mirabilis Enterobacter cloacae 6 Streptococcus group D enterococcus 97年 Acinetobacter baumannii(PDRAB) albicans 16 14 12 10 8 6 4 2 0 Candida Acinetobacter baumannii Staphylococcus aureus (MRSA) 1 Pseudomonas aeruginosa Escherichia coli Scenario 96年 7 8 9 10 PICO type :Harm P : Patients/ No infected MRSA who inpatient Problems Intervention: contact precaution Comparison: contact and droplet precautions Outcome: MRSA Infection rate 搜尋EBM • Primary Database • Secondary Database 1.PubMed 2.ACP Journal Club 2.OVID/Medline 3.Bandolier 1.Cochrane Library 4.National Guideline Clearinghouse 5.MDConsult PubMed Key words contact and droplet precautions and MRSA Level of evidence : 2 Mangini E, Segal-Maurer S, Burns J, et al: Impact of contact and droplet precautions on the incidence of hospital-acquired methicillinresistant Staphylococcus aureus infection.Infect Control Hosp Epidemiol 2007;28:1261-6. 著者做一項前瞻性研究，比較加護病房與非加護病房內， 只採接觸防護措施或採接觸及飛沫防護措施其院內MRSA感染的發生率。 文獻評讀 Critical appraisal topic 研究品質製表 作者 年度 隨機分配 盲法 退出研 究者之 描述 族群完整 的診斷檢 查步驟 結果一年 之後續追 蹤 實證等級 Ed Mangini 2007 適當 適當 不清楚 適當 不清楚 2 (CASP) - Critical Appraisal Skills Programme Screening Questions Patient / Problems :Impact of contact 1.Did the review and droplet precautions on the incidence of ask a clearlyhospital-acquired methicillinresistant focused question? Staphylococcus aureus infection. (明確的重點問題) Yes Intervention:contact precaution Comparison:contact and droplet precautions Outcome:The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection 2.Did the review include the right type of study? (正確類型的研究) Yes To identify inpatients infected or colonized with MRSA (prospective study ) (CASP) - Detailed Questions-1 3.Did the reviewers try to identify all relevant studies? Yes (試圖找出所有相關的研究) 4.Did the reviewers assess the quality of the included studies? Yes (評估納入研究的質量) 5.If the results of the studies have been combined, was it reasonable to do so? (研究的結果，已被合併，這樣做是否合理) Yes (CASP) - Detailed Questions-2 6. How are the results presented and what is the main result? (提出和主要結果是什麼) The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. (CASP) - Detailed Questions-2 6. How are the results presented and what is the main result? (提出的主要結果) The implementation of contact precautions significantly decreased the rate of hospitalacquired MRSA infection,and discontinuation of droplet precautions in the ICUs led to a further reduction. (CASP) - Detailed Questions-3 7. How precise are these results? 這些結果精確 Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infectionin the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (CASP) - Detailed Questions- 4 8. Can the results be applied to the local population? Yes 結果可否被運用在當地人口對象 9. Were all important outcomes considered?重要的結果都被考慮 Yes 文獻結論 •在高感染率的加護病房裡，採接觸和飛沫防護措 施可顯著的下降院內MRSA感染率，但在低感染率 的加護病房裡，感染率維持不變。 •雖然沒有統計上顯著差異，在加護病房內只採接 觸護措施可使院內MRSA感染率更降低，因此仍需 要更進一步的研究去了解飛沫防護措施在降低這 些院內感染所扮演的角色。 •高感染區域僅採取接觸防護措施即可顯著降低院 內MRSA感染率，這顯示出接觸防護措施在預防院 內感染MRSA扮演重要的角色。 報告完畢