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Flexible fiberoptic bronchoscopy is a useful tool for the diagnosis and management for diseases of the airway. Although it has been known to be a relatively safe procedure; in some cases, mild complications can occur after fiberoptlc bronchoscopy. However, fatal complications such as bacteremia, pneumonia, myocardial infarction, severe obstruction of the airways, respiratory failure or death have been reported. Among them, infectious complications following flexible fiberoptic bronchoscopy occur sometimes, although most of them are self-limited. We recently experienced a case of severe Klebsiella pneumoniae pneumonia in a patient presenting with fever following flexible fiberoptic bronchoscopy, We report this case to discuss the potential complications of fiberoptic bronchoscopy with a review of literature.
Bacteremia* ; Bronchoscopy* ; Diagnosis ; Fever ; Humans ; Klebsiella pneumoniae ; Klebsiella* ; Myocardial Infarction ; Pneumonia* ; Respiratory Insufficiency

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A Prospective Study on the Incidence of Intravenous Catheter-related Complication.

Sun Ju CHOI ; Hee Jin CHEONG ; Heung Jeong WOO ; Woo Joo KIM ; Seung Chull PARK ; Chang Hyun PARK

Korean Journal of Nosocomial Infection Control.1998;3(2):101-112.

BACKGROUND: Intravenous catheter-related complication among the hospitalized patients has been increasing recently in Korea, since many hospitals has tried to save expenses by replacing the foreign-made catheter with domestic-made intravenous catheter. We studied the incidence rate of catheter-related complication and compared the incidence of catheter-related complication between domestic-made and foreign-made ones. We also studied to elucidate whether the morphologic characteristics of the intravenous catheter will effect the incidence of catheter-related complication. METHOD: From July 1 to Sept 30, 1998, we surveyed the incidence rate of intravenous catheter-related complication among the hospitalized patients in the wards of Medicine. Surgery, Obstetric, and Neonatal Intensive Care Unit in Guro Hospital, Korea University Medical center. We also compared the incidence of complication between domestic-made catheter (catheter A) and foreign-made catheter (catheter B) of three different gages (24G, 22G and 18G). The morphologic characteristics of intravenous catheters has been studied by electron microscopy. RESULT: Complication associated with use of intravenous catheter had been occurred 263 out of 459 cases (57.3%), among those cases, non-infectious complication and infectious complication were 173 cases (37.7%) and 90 cases (19.6%), respectively. Totally, catheter A group showed higher complication than catheter B group [62.0% (160/258) vs 51.2% (103/201), P=.021]. Analysis on the incidence rate of complication according to the products did not show significant differences in the noninfectious complication in every gage groups. However the infectious complication occurred higher in the domestic-made catheter A group than among the foreign-made catheter B group [(24G: 6% vs 0%, P=.026), (22G: 25.6% vs 9.6%, P=.001), (18G: 36.8% vs 13.4%, P=.002)]. Duration of catheter life did not show the difference between catheter A group and catheter B group [48.5hrs vs 50.3hrs, P=.474]. The analysis on risk factors for complication showed that catheter A group is highly related (odd ratio 1.85). The morphologic analysis of the catheter by using electron microscopy showed that the angles in the tip of the introducing needle of catheter Aand catheter Bare 60degrees and 45degrees , respectively, and the bevel between introducing needle and catheter sheath are 50degrees and 27degrees, respectively. CONCLUSION: There was a higher incidence rate of complication related to domestic-made catheter usage, which might influence increasing the period of the hospitalization and the expenses due to the complication. The study of cost effectiveness analysis needs to be performed regarding intravenous catheter-related complication. Morphologically, catheter A showed more blunt angle in the tip and transition area of the introducing needle than the angle of catheter B, which is considered to influence the higher complication incidence. It needs to improve the quality of domestic-made intravenous catheter.
Academic Medical Centers ; Catheter-Related Infections ; Catheters ; Cost-Benefit Analysis ; Female ; Hospitalization ; Humans ; Incidence* ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Microscopy, Electron ; Needles ; Obstetric Surgical Procedures ; Prospective Studies* ; Risk Factors

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Viral inactivation of disinfectant Tego-51(R).

Kyu Man LEE

Korean Journal of Nosocomial Infection Control.1998;3(2):97-100.

BACKGROUND: Tego-51(R), one of the amphoteric surfactants, has been considered as an effective disinfectant having both bactericidal and fungicidal effect. The author evaluated inactivation effect of Tego-51(R) on viruses causing disease in humans. METHODS: Influenza virus B, respiratory syncytial virus (RSV), herpes simplex virus 1 (HSV-1), adenovirus and echovirus 30 were exposed to diluted Tego-51(R) solution (1% and 0.1%) for 5, 10 and 30 minutes respectively and were inoculated onto the following cells: Influenza virus B, MDCK; RSV, HEp-2; HSV-1, HEp-2; adenovirus, Vero; and echovirus 30, RD. After incubation for 5 to 6 days, viral infection was identified with indirect immunofluorescent methods. RESULTS: Influenza virus B, RSV and HSV-1 which are enveloped viruses were inactivated after exposure of the viruses to Tego-51(R) for 5 minutes. Non-enveloped adenovirus and echovirus 30 were not inactivated after exposure for 30 minutes. CONCLUSIONS: Tego-51(R) appears to be effective in inactivation of enveloped viruses at concentrations used for disinfection of pathogenic bacteria and fungi.
Adenoviridae ; Bacteria ; Disinfection ; Enterovirus B, Human ; Fungi ; Herpesvirus 1, Human ; Humans ; Orthomyxoviridae ; Respiratory Syncytial Viruses ; Surface-Active Agents ; Virus Inactivation*

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Recent Trends in Antimicrobial Resistance in Intensive Care Units in Korea.

Yangsoon LEE ; Young Ah KIM ; Wonkeun SONG ; Hyukmin LEE ; Hye Soo LEE ; Sook Jin JANG ; Seok Hoon JEONG ; Seong Geun HONG ; Dongeun YONG ; Kyungwon LEE ; Yunsop CHONG

Korean Journal of Nosocomial Infection Control.2014;19(1):29-36. doi:10.14192/kjnic.2014.19.1.29

BACKGROUND: In general, higher resistance rates are observed among intensive care unit (ICU) isolates than non-ICU isolates. In this study, resistance rates of isolates from ICUs and non-ICUs were compared using the data generated from 20 hospitals in Korea. METHODS: Susceptibility data were collected from 20 hospitals participating in the Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR) program. Duplicate isolates were excluded from the analysis. The resistance rates did not include intermediate susceptibility. RESULTS: The most prevalent bacteria in the ICUs were Staphylococcus aureus (21%) and Acinetobacter spp. (19%), and those in non-ICU were Escherichia coli (27%) and S. aureus (14%). The resistance rates were higher in ICUs than in non-ICUs at 84% and 58% for methicillin-resistant S. aureus, 86% and 70% for methicillin-resistant coagulase-negative Staphylcoccus (CNS), 34% and 19% for vancomycin-resistant Enterococcus faecium, 38% and 19% for cefotaxime-resistant E. coli, 45% and 25% for cefotaxime-resistant Klebsiella pneumoniae, 42% and 24% for ceftazidime-resistant Enterobacter cloacae, 29% and 11% for ceftazidime-resistant Serattia marcescens, 83% and 44% for imipenem-resistant Acinetobacter spp., and 32% and 17% for imipenem-resistant Pseudomonas aeruginosa, respectively. CONCLUSION: The most prevalent bacteria in ICUs were S. aureus, CNS, and Acinetobacter spp., and high multi-drug resistance rates were observed in the Acinetobacter isolates. Therefore, infection control should be practiced in ICUs to prevent infections caused by multi-drug resistant bacteria.
Acinetobacter ; Bacteria ; Drug Resistance, Multiple ; Enterobacter cloacae ; Enterococcus faecium ; Escherichia coli ; Infection Control ; Intensive Care Units* ; Klebsiella pneumoniae ; Korea ; Methicillin Resistance ; Pseudomonas aeruginosa ; Staphylococcus aureus

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The Hawthorne Effect between Covert and Overt Observations in the Monitoring of Hand Hygiene Adherence among Healthcare Personnel at Coronary Care Unit and Cardiac Surgery Intensive Care Unit.

Jeong Hyun KIM ; Jae Sim JEONG ; Mi Na KIM ; Jeong Yun PARK ; Hye Ran CHOI

Korean Journal of Nosocomial Infection Control.2014;19(1):20-28. doi:10.14192/kjnic.2014.19.1.20

BACKGROUND: Direct observation of healthcare workers is commonly used in hospitals to investigate hand hygiene compliance. However, the hand hygiene compliance rate may increase due to the Hawthorne effect, which is the modification of behavior simply because subjects become aware that they are being observed. The objective of this study was to investigate the occurrence of the Hawthorne effect when directly observing hand hygiene compliance in intensive care unit (ICU) healthcare personnel. METHODS: A total of 87 staff members from the coronary care unit and cardiac surgery ICU of a general hospital in Seoul were included in this study: 24 residents and interns, 55 nurses, and 8 nursing assistants. Both covert and overt observations, where subjects were either unaware or aware of any direct observation, were performed on separate occasions. RESULTS: A total of 1,052 covert and 1,336 overt observations were documented over 30 and 34 occasions, respectively. Overall hand hygiene compliance was significantly higher with overt observation than with covert observation (1,041/1,336, 77.9% vs. 659/1,052, 62.6%, P<0.001). The Hawthorne effect was present in all professions and behaviors, with the exception of nursing assistants, and prior to touching a patient. CONCLUSION: Direct observation of hand hygiene compliance was associated with the Hawthorne effect when observations were made overtly and this was likely to contribute to an overestimation of compliance rate.
Compliance ; Coronary Care Units* ; Delivery of Health Care* ; Effect Modifier, Epidemiologic* ; Hand Hygiene* ; Health Personnel ; Hospitals, General ; Humans ; Intensive Care Units* ; Nursing ; Seoul ; Thoracic Surgery*

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Trends of HIV-infected Patients Operated at Single Hospital.

Mi Young KWON ; Mi Rum KIM ; Jieun KIM ; Gunn Hee KIM

Korean Journal of Nosocomial Infection Control.2014;19(1):15-19. doi:10.14192/kjnic.2014.19.1.15

BACKGROUND: As anti-retroviral therapy has improved and the life expectancy of patients' with HIV in Korea has increased, an increased number of surgical procedures have been performed in this population. Therefore, in the current study, we investigated the trend in surgery conducted on patients with HIV in our hospital over the last 5 years. METHODS: We retrospectively reviewed the medical records of HIV-infected patients who underwent surgery under general or local anesthesia at our hospital between 2005 and 2010. RESULTS: The total number of surgeries performed in HIV-infected patients in the 5-year period was 95. Of these, 23 (24%) were performed under general anesthesia and 72 (76%) under spinal anesthesia. Anorectal surgery was the most commonly performed surgery (71 cases, 76%). The postoperative complication rate was 5.3% (3 cases of pneumonia and 2 of wound infection), with general anesthesia and time to discharge being identified as contributory factors. Preoperative CD4+ T cell count was not significantly associated with complications. CONCLUSION: This study was the first to analyze the trends in surgical procedures performed in HIV-infected patients in Korea. Our study may be beneficial as a reference for clinicians who manage patients with HIV.
Acquired Immunodeficiency Syndrome ; Anesthesia, General ; Anesthesia, Local ; Anesthesia, Spinal ; Cell Count ; HIV ; Humans ; Korea ; Life Expectancy ; Medical Records ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Wounds and Injuries

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Hand Hygiene Promotion in a Hospital Setting through the WHO Multimodal Hand Hygiene Improvement Strategy.

Hee Kyung CHUN ; Mee La KIM ; Jee In HWANG

Korean Journal of Nosocomial Infection Control.2014;19(1):1-14. doi:10.14192/kjnic.2014.19.1.1

BACKGROUND: This study evaluated the frequency and types of hand hygiene practices among healthcare workers directed by the WHO multimodal hand hygiene improvement strategy, and investigated the effect of hand hygiene practice on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) isolation and MRSA acquisition rate and colonization pressure. METHODS: A quasi-experimental study was performed at a tertiary care university hospital with 850 beds from January to September 2012. We assessed the hospital hand hygiene program using the WHO hand hygiene self-assessment framework. The WHO multimodal strategy was used for healthcare workers with low indexes, and the subjects were reassessed. RESULTS: Hand hygiene compliance increased significantly from a pre-intervention rate of 58.7% to 72.6% post-intervention. MRSA and VRE isolation rates decreased from 1.69 per 1000 patient days to 1.41 and from 0.17 to 0.11, respectively. In intensive care units (ICUs), hand hygiene compliance rate rose to 77.9%, with a total score of 4.16 points out of 5 being awarded for the hand hygiene method, which was higher than that for the other care units. The pre-intervention MRSA acquisition rate in the ICU decreased from 7.47% to 4.30% post-intervention. This was associated with a decrease in the MRSA colonization pressure over the intervention period (26.2% to 16.9%). CONCLUSION: The utilization of the WHO multimodal strategy for improvement of hand hygiene increased the hand hygiene compliance rate and was effective in predicting a decreased rate of cross-infection, MRSA acquisition, and colonization pressure. We conclude that the implementation of such improvement strategies is crucial to maintaining hygiene standards and reducing infection within healthcare facilities.
Awards and Prizes ; Colon ; Compliance ; Delivery of Health Care ; Hand Hygiene* ; Humans ; Hygiene ; Intensive Care Units ; Methicillin-Resistant Staphylococcus aureus ; Self-Assessment ; Tertiary Healthcare

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Healthcare Workers' Knowledge and Attitude about Influenza Vaccination at the University Hospital.

Kyeong Sook CHA ; So Yeon YOO ; Kyung Mi KIM ; Seong Heon WIE ; Wan Shik SHIN

Korean Journal of Nosocomial Infection Control.2005;10(2):87-95.

BACKGROUND: The influenza is a contagious respiratory illness caused by influenza viruses. The primary target groups recommended for annual vaccination are healthcare workers and households which have frequent contact with persons at high risk and can transmit influenza to those persons at high risk. Members of these groups should be vaccinated against the flu so that they can avoid getting infected with continuously mutating influenza viruses. We assessed healthcare workers' knowledge and attitudes regarding influenza vaccination in order to help promote the vaccination rate. METHODS: This survey was carried out in two hospitals affiliated with the Catholic University School of Medicine, from December 2004 to January 2005. Of the 3,023 questionnaires distributed, 2,023 could be evaluated. RESULTS: The most frequently cited reason for receiving influenza vaccine was self-protection against influenza (55.4%). The most common reasons for not receiving influenza vaccine are personal health problems such as concurrent flu, pregnancy or breast-feeding (29.2%). There is no significant difference in the frequency of side effect between two groups receiving and not receiving vaccine. The most frequent side effect of influenza vaccination is flu-like syndrome; People receiving vaccine have more significant knowledge than those people not receiving vaccine about efficacy of flu vaccination, risk of influenza infection of healthcare workers and their need of flu vaccination. CONCLUSION: In order to promote the vaccination rate, education targeting people at high risk need to keep continuous and facilitate access to vaccination.
Delivery of Health Care* ; Education ; Family Characteristics ; Humans ; Influenza Vaccines ; Influenza, Human* ; Orthomyxoviridae ; Pregnancy ; Vaccination* ; Surveys and Questionnaires

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