Hospital Management & N i l I f ti (1)Nosocomial Infections (1)

Khachornsakdi Silpapojakul MDKhachornsakdi Silpapojakul MDPrince of Songkla University

Hat yai ThailandHat yai, Thailand

Why do we have to pay anWhy do we have to pay an attention to nosocomialattention to nosocomial

infections?infections?

1 I id ??1. Incidence ??

2.Mortality ???

3.Morbidity ???

4.Cost ???

1.คนไทยตดเชอจากโรงพยาบาลประมาณปละ

1. 4000 คน000

2 40000 คน2. 40000 คน

3 400000 คน3. 400000 คน

2. คนไทยตายจากโรคตดเชอโ ป ปโรงพยาบาลประมาณปละ

1. 2500 คน

2. 25000 คน

3. 250000 คน

3. คนไทยตายจากโรคตดเชอในโ โรงพยาบาลมากกวาตายจากอบตเหต

1.จรง

2. ไมจรง

4. คนไทยตดเชอจากโรงพยาบาล โ ไ มากกวาตดเชอโรคไขเลอดออก

1.จรง

2. ไมจรง

5. เราสามารถลดการตดเชอจากโ ไ โรงพยาบาลได

1.จรง1.จรง

2 ไ 2. ไมจรง

Nosocomial Infections,Thailand

Nosocomial Infections:Nosocomial Infections:

How much?

J Med Assoc Thai 2005; 88 (Suppl 10): S1-9

42 hospitalsPoint prevalence surveyPoint prevalence survey

March 200118 456 patients18,456 patients.

NI point prevalence surveysNI point prevalence surveysCountry Year RateCountry Year Rate

China 2001 5 2%China 2001 5.2%

Latvia 2002 5.75%Latvia 2002 5.75%Norway 2002 5.3%y

http://www.who.int/gpsc/country_work/summary_20100430 df30_en.pdf

The number of admissions in Thailand is ~6.2The number of admissions in Thailand is 6.2 million. With a prevalence rate of 6.4%, the estimated number of nosocomial cases wasestimated number of nosocomial cases was 396,800 cases in Year 2001.

1.คนไทยตดเชอจากโรงพยาบาลประมาณปละ

1. 4000 คน000

2 40000 คน2. 40000 คน

3 400000 คน3. 400000 คน

Top ten morbidity rate of diseases under ill Th il d 2001 (2544)surveillance Thailand, 2001 (2544)

Morbidity Rate

Rank Diseases Cases Deaths(Per 100,000 Pop.)

1 Acute diarrhoea 1020377 176 1643.32 Pyrexia of unknown origin 269740 54 434.43 Dengue haemorrhagic fever 139355 245 224 43 Dengue haemorrhagic fever 139355 245 224.44 Food poisoning 138795 2 223.55 Pneumonia 135768 1057 218.66 Haemorrhagic conjunctivitis 107929 0 173.87 Influenza Chickenpox 42371 1 68.28 D 37601 2 60 68 Dysentery 37601 2 60.69 Malaria 34925 81 56.210 Chickenpox 31707 1 51 110 Chickenpox 31707 1 51.1Ref.: Annual Epidemiological Surveillance Report 2001, MOPH

4. คนไทยตดเชอจากโรงพยาบาล โ ไ มากกวาตดเชอโรคไขเลอดออก

1.จรง

2. ไมจรง

“ There are substantially more nosocomial infections each yearnosocomial infections each year than hospital admissions for either cancer or accidents and at leastfour times more than admissions forfour times more than admissions for acute myocardial infarction.”y

Nosocomial Infections:Nosocomial Infections:

Mortality?y

The number of admissions in Thailand is ~6.2The number of admissions in Thailand is 6.2 million. With a prevalence rate of 6.4%, the estimated number of nosocomial cases wasestimated number of nosocomial cases was 396,800 cases with 26,586 deaths attributable

f 2001to these infections in Year 2001.

2. คนไทยตายจากโรคตดเชอโ ป ปโรงพยาบาลประมาณปละ

1. 2500 คน

2. 25000 คน

3. 250000 คน

Top ten mortality rate of diseases under surveillance Thailand 2002 (2545)surveillance Thailand, 2002 (2545)

Diseases Cases DeathsMortality Rate

Rank Diseases Cases Deaths(Per 100,000 Pop.)

1 Pneumonia 135768 1057 1.72 Tuberculosis 30033 287 0.463 Dengue haemorrhagic fever 139355 245 0.394 Suicide by liquid substance 5241 224 0 364 Suicide by liquid substance 5241 224 0.365 Acute diarrhoea 1020377 176 0.286 Leptospirosis 10217 171 0.28p p7 Malaria 34925 81 0.138 Pyrexia of unknown origin 269740 54 0.099 Rabies 37 37 0.06

10 Encephalitis - total 430 30 0.05

Ref.: Annual Epidemiological Surveillance Report 2001, MOPH

http://www.moph.go.th/ops/thp/index.php?option=com_content&task=view&id=7&Itemid=2p p g p p p p p _

Numbers and Rates of Accidental Deaths and Injuries Thailand, 1984-2002. Wibulpolprasert Thailand Health P fil 2001 2004 htt // h th/ /h lth 48Profile 2001-2004. http://www.moph.go.th/ops/health_48

3. คนไทยตายจากโรคตดเชอในโ โรงพยาบาลมากกวาตายจากอบตเหต

1.จรง

2. ไมจรง

Causes of Death of Thai Physicians (1992-2001)

No.=262

1= Cancers (35.1%)

1.1 Hepatoma (7.6%)

2= Heart Diseases (28 2%)2= Heart Diseases (28.2%)

3=Accidents (12 6%)3 Accidents (12.6%)

4=Sepsis (3.4%)( )

5=Suicides (3.4%)Source: Sithisarankul P et al. Intern Med J Thai 2004;20:188-191

1000 post-mortem reports between 1975-19761000 post mortem reports between 1975 1976 were analysed retrospectiveiy.

In 6.3% of the patients, nosocomial infection was a contributory factor leading to death.was a contributory factor leading to death.

Nosocomial infection led to death in none of the 10 autopsiedin none of the 10 autopsied patients from the EENTpatients from the EENT Department and in none of 52 autopsied patients from the D t t f G lDepartment of Gynecology.

Year 2006, Admission Diagnoses,PSU HospitalN b f

Rank DiseasesNumber of patients

1 Senile cataract 1 1231 Senile cataract 1,123

2 Malignant neoplasm of bronchus and lung 734

3 Malignant neoplasm of breast 5763 Malignant neoplasm of breast 576

4 Malignant neoplasm of ovary 483

5 I t i l i j 4455 Intracranial injury 445

6Malignant neoplasm of liver and intrahepatic bile ducts 442

7 Malignant neoplasm of rectum 415

8 Malignant neoplasm of cervix uteri 4158 Malignant neoplasm of cervix uteri 415

9Maternal care for known or suspected abnormality of pelvic organs 385

10 Lymphoid leukaemia 331

Year 2006, Causes of Deaths, In-Patients, PSU HospitalNo of

Rank Causes of DeathsNo. of

Patients1 Malignant neoplasm of bronchus and lung 56g p g2 Acute myocardial infarction 513 Other septicaemia 384 Intracerebral haemorrhage 255 Malignant neoplasm of liver and intrahepatic bile ducts 226 Diffuse non-Hodgkin's lymphoma 207 Aortic aneurysm and dissection 188 Ch i l f il 188 Chronic renal failure 189 Chronic ischaemic heart disease 17

10 Malignant neoplasm of cervix uteri 1610 Malignant neoplasm of cervix uteri 1611 [HIV] disease resulting in 15

infectious and parasitic diseasesinfectious and parasitic diseases

Nosocomial InfectionsMorbidity-How much?Morbidity How much?

Nosocomial InfectionsEconomical Impacts-How much?Economical Impacts How much?

J Med Assoc Thai 2005; 88 (Suppl 10): S1-9

42 hospitalsPoint prevalence surveyPoint prevalence survey

March 200118 456 patients18,456 patients.

Patients on antibiotics = 48.5%

The number of admissions in Thailand is ~6 2The number of admissions in Thailand is ~6.2 million. With a prevalence rate of 6.4%, the

l h it l t f t f N Iannual hospital costs for management of N.I. was about 7 billion baht (175 million U.S. dollars).

Health Expenditure 1980-2002 (Million baht)

Wibulpolprasert S et al. Thailand Health Profile 2001-2004 MOPH p pBangkok, Thailand 2005 (ISBN: 974-465-889-4)

Allocation of Government Health Budget by Service Category 1993-2004Service Category, 1993 2004

Wibulpolprasert S et al. Thailand Health Profile 2001-2004 MOPH Bangkok, Thailand 2005 (ISBN: 974-465-889-4)

Wh i i t f tibi ti ???Why rising cost of antibiotics???

Antibiotic Resistance: PSU

MRSA

1986 1987 1988 1989

PSU 5% 15% 25% 30%PSU 5% 15% 25% 30%

Siriraj 14% 14% 23% -j

Transactions of the Royal Society of Tropical MedicineTransactions of the Royal Society of Tropical Medicine and Hygiene (2008) 102, 460—464

PSU Antibiotics: Cost/DayAmikacin 15 mg./kg q d. 262 bht.

Sulperazone 2 g. q 12 hr. 1578 bht

Imipenem 500 mg. q 6 hr. 3213 bht.

M 0 5 6 h 3780 bhtMeropenem 0.5 g. q 6 hr. 3780 bht.

Meropenem 1 g q 8 hr 4200 bhtMeropenem 1 g. q 8 hr. 4200 bht.

Ertapenem 1g. q d. 1498 bht.Ertapenem 1g. q d. 1498 bht.

Cefipeme 2 g. q 12 hr. 2088 bht.

Tazocin 4.5 q 8 hr. 1890 bht.

ตาราง สรปจานวนการสงใชยาในกลม ID restrict drug (5 ชนด)

ยา

1 ตลาคม 2546 - 31 มนาคม 2547

( ชวงกอนการส งใชโดย Computer )

1 ตลาคม 2547 - 31 มนาคม 2548

( ชวงหลงการส งใชโดย Computer)

จานวนผ ปวย

( คน )

จานวนยา

( vial )

Cost

( บาท )

จานวน

ผ ปวย

จานวนยา

( vial )

Cost

( บาท )

ยา

Cefoperazone + Sulbactam 1 g 776 5,159 1,906,354 1,760 12,163 4,798,304

Fosmicin 2 g 453 1,462 427,606 681 2,315 727,488

Meronem 500 mg 27 94 87 841 107 416 392 903Meronem 500 mg 27 94 87,841 107 416 392,903

Meronem 1 g 55 281 390,073 391 1,617 2,260,105

Tienem 500 mg 784 4,111 3,261,010 982 6,079 4,882,896

Vancomycin 500 mg 526 2,282 1,016,776 1,147 5,075 1,952,707

PSU Antibiotic Resistance : Acinetobacter

Imipenem Resistance

1997 1998 1999 2000 2001 2002 2003 2004 2005

3% 2% 4% 3% 3% 2% 9% 31% 39%

http://narst dmsc moph go th/http://narst.dmsc.moph.go.th/

Percentage of susceptible Acinetobacter baumanii , Jan - Dec 2005

I th th ti lIs there any other national impact of nosocomial infectionsimpact of nosocomial infections besides their impacts onbesides their impacts on mortality and economy???mortality and economy???

HIV & OPD T B OUTBREAKHIV & OPD; T.B. OUTBREAK

ST Vincent Hospital , Sydney , AustraliaO.P.D : Air conditioned treatment roomSeptember 1993 - One T.B. index case91 HIVs followed for 7.4 mo. ( 1-14 mo.)f f ( )3 developed T.B. with identical RFLPAll within 15 wks. of follow - up.p

Ref: Couldwell D.L. et al : AIDS 1996 , 10-521

TB Prevalence/100,000 populations: TermsTB Prevalence/100,000 populations: Terms>1,000 = TB epidemic

>100 = High risk for TB

=<10 = Low risk for TB

<1 = Entering the elimination phase<1 Entering the elimination phase

0.1 = TB eliminated

MDR –TB. OUTBREAKS- ? WHERE ?

“ E i t h i i d“ Enviroments where inmunocompromised persons are likely to be found , including health care facilities , homeless shelters and prisons. Virtually all MDR - TB. outbreaks have occurred V u y ou b e s ve occu edin settings such as these.”

Ref : Beck - sague C et al : JAMA 1992: 268 : 1280-1286

A hospital ward in Malaysiap y

An OPD. in a Thai provincial hospitalAn OPD. in a Thai provincial hospital

An OPD. in a Thai provincial hospitalp p

Is there any other example of the role of hospital as an amplification place for di ???diseases???

SARS

Second Wave of Epidemic: in the Hospitals

Nosocomial transmission wasNosocomial transmission was the primary acceleration of p ySARS infections accounting for 72% of cases in Toronto

% fand 55% of probable cases in TaiwanTaiwan.Ref : Booth CM et al JAMA 2003;289:2801-9Ref.: Booth CM et al. JAMA 2003;289:2801-9

CDC. MMWR 2003;52:461-6

EID 2004;10:782-788EID 2004;10:782 788

Thirty- one cases of SARS occurred after yexposure in the emergency room of the National Taiwan University HospitalNational Taiwan University Hospital.

Wi hi 18 h f i h“Within 18 hrs of presentation, the patient was admitted to the ICU and 3patient was admitted to the ICU and 3 hrs later was placed in an isolation

Thi 21 h i d f t t droom.This 21-hr period of unprotected contact led to128 cases of SARSresulted from transmission of the virus within this hospital (42% HCWs 28%within this hospital. (42% HCWs, 28% patients or visitors, and 30% household contacts).”

What Next???

A i Fl ????Avian Flu????

f OA chicken farm An OPD

A chicken farm A hospital ward

5. เราสามารถลดการตดเชอจากโ ไ โรงพยาบาลได

1.จรง1.จรง

2 ไ 2. ไมจรง

An Overview of the 100,000 Lives Campaign

Joe McCannonVice President and 100,000 Lives Campaign Manager

Institute for Healthcare Improvement

November 15, 2006

Some Is Not a Number… Soon Is Not a Time

The Number:100 000 Lives100,000 Lives

The Time:The Time: June 14 2006 – 9 a m ETJune 14, 2006 – 9 a.m. ET

Campaign ObjectivesCampaign Objectives

• Save 100,000 LivesE ll th 2 000 h it l i th• Enroll more than 2,000 hospitals in the initiative

• Build a reusable national infrastructure for changeg

• Complete implementation of the 6 Campaign interventions in participatingCampaign interventions in participating hospitals by January 2007.

• Focus on spread and sustainability• Focus on spread and sustainability.

Six Changes That Save Lives

• Deployment of Rapid Response Teams…at the first sign of patient decline

• Delivery of Reliable Evidence-Based Care for Acute• Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack

• Prevention of Adverse Drug Events (ADEs)…by implementing medication reconciliationimplementing medication reconciliation

• Prevention of Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle”called the Central Line Bundle

• Prevention of Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time and taking several other associated actionstime and taking several other associated actions

• Prevention of Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically

d d t ll d th “V til t B dl ”grounded steps called the “Ventilator Bundle”

The 100k Lives Campaign Scorecard

• Over 3,100 Hospitals Enrolled– Over 78% of all discharges– Over 78% of all acute care bedsOver 78% of all acute care beds

• Participation in Campaign Interventions:Rapid Response Teams: 60%– Rapid Response Teams: 60%

– AMI Care Reliability: 77%– Medication Reconciliation: 73%

S i l Sit I f ti B dl 72%– Surgical Site Infection Bundles: 72%– Ventilator Bundles: 67%– Central Venous Line Bundles: 65%– All six: 39%

• Over 85% of Participating Hospitals Are Sending IHI MortalityOver 85% of Participating Hospitals Are Sending IHI Mortality Data

Did Needless Deaths Fall?Did Needless Deaths Fall?

Additional Campaign StatusAdditional Campaign Status

• Related campaigns forming nationally and globally (Canada, Australia, Sweden, Denmark) )

• Changes in standard of care in participating facilities (over 25 hospitalsparticipating facilities (over 25 hospitals going a year without a VAP)

Sources of Optimism: H i l i h N VAP f O YHospitals with No VAP for One Year

1. Baptist Memorial Hospital Golden Triangle – Columbus, MS 2. Bay Regional Medical Center – Bay City, MI 3. BryanLGH Medical Center – Lincoln, NE [no VAP as of 3/2/06]4. Caruya Baptist Memorial DeSoto – Southhaven, MS 5. Medical Center – Ithaca, NY 6. Columbus Regional Hospital – Columbus, IN 7. Community Hospital Anderson – Indianapolis, IN [one unit has not had a VAP in two years]8. Community Hospital East – Indianapolis, IN [one ICU went 25 months with no VAP] 9 Dominican Hospital – Santa Cruz CA [no VAP since 10/12/04]9. Dominican Hospital Santa Cruz, CA [no VAP since 10/12/04] 10. Geneva General Hospital – Geneva, NY 11. McLeod Regional Medical Center – Florence, SC [ICU has gone 21 months as of April without a VAP] 12. Memorial Hermann Texas Medical Center – Houston, TX13. Oconee Memorial Hospital – Seneca, SC 14 OSF Saint Francis Medical Center Peoria IL14. OSF Saint Francis Medical Center – Peoria, IL 15. Overlake Hospital Medical Center – Bellevue, WA 16. Palmetto Health Baptist – Columbia, SC17. Passavant Area Hospital – Jacksonville, IL 18. Providence Milwaukie Hospital – Milwaukie, OR [no VAP since February 2004] 19. Ridgeview Medical Center – Waconia, MN [no VAP in 2.5 years]20. Sentara Leigh Hospital – Norfolk, VA21. Sentara Norfolk General Hospital – Norfolk, VA [one unit has not had a VAP in over two years] 22. Sentara Williamsburg Community Hospital – Williamsburg, VA 23. St. Luke’s Hospital East – Ft. Thomas, Kentucky23. St. Luke s Hospital East Ft. Thomas, Kentucky 24. St. Luke’s Hospital West – Florence, Kentucky 25. University of Rochester Medical Center/Strong Memorial Hospital – Rochester, NY 26. Upper Chesapeake Medical Center – Bel Air, MD

Sources of Optimism: Hospitals with No VAP for One Year

1. Capitol Region Medical Center – Jefferson City, MO 2. Cooley Dickinson Hospital – Northampton, MA 3 C it H it l E t I di li IN3. Community Hospital East – Indianapolis, IN 4. Community Hospital Anderson – Anderson, IN 5 East Alabama Medical Center – Opelika AL5. East Alabama Medical Center Opelika, AL 6. Immanuel St. Josephs, Mayo Health System –

Mankato, MN7. Indiana Heart Hospital – Indianapolis, IN 8. Overlake – Bellevue, WA 9 Passavant Area Hospital Jacksonville IL9. Passavant Area Hospital – Jacksonville, IL 10. South Shore Hospital – South Weymouth, MA 11. Southwestern Vermont – Bennington, VTg ,

Sources of OptimismSources of Optimism

• Pronovost Report from 70 Hospitals Working on Central Line Infections:Working on Central Line Infections:

Source: Peter Pronovost, Keystone ICU Project

Central Line Bundle ElementsCentral Line Bundle Elements

1. 1.Hand hygiene2 2 Maximal barrier precautions2. 2.Maximal barrier precautions3. 3.Chlorhexidine skin antisepsis4. 4.Optimal catheter site selection, with

avoidance of using the femoral vein for a o da ce o us g t e e o a e ocentral venous access in adult patients

5 5 Dail re ie of line necessit ith5. 5.Daily review of line necessity with prompt removal of unnecessary lines

Maximal sterile barrier includes the use of a cap, mask, sterile gown, sterile gloves, and a large sterile sheet, for the insertion of CVCs or guidewire exchange.insertion of CVCs or guidewire exchange. Maximal sterile barrier precautions

b t ti ll d th i id f CRBSIsubstantially reduces the incidence of CRBSI compared with standard precautions (e.g., p p ( g ,sterile gloves and small drapes) Category IA SuggestionSuggestion.CDC .Guidelines for the Prevention of Intravascular Catheter-Related Infections MMWR 2002;51(RR10):1-28

BMJ 2010;340:c309 doi:10.1136/bmj.c309

• Pronovost Report from 70 Hospitals Working on Central Line Infections:Working on Central Line Infections: – 1,578 lives saved – 81,020 hospital days saved– Over $165,000,000 in costs averted $ , ,

Source: Peter Pronovost, Keystone ICU Project

Songklanagarind HospitalSongklanagarind Hospital

Central intravenous catheter : PSU

• 180 procedures/month• Utilization ratio = 0.14

A d ti 7 9 th t d• Average duration = 7.9 catheter-days

Application of Collaborative Quality Improvement Programs to Reduce Incidence of Catheter-Related Bloodstream Infection

Am J Infect Control 2009;37:783-805

NHSN

อตราการตดเชอ CL-BSI, PSU Hospital พศ 2552 2553 2554 ICUs = 1.74 1.40 1.01ICUs 1.74 1.40 1.01Neurosurgical = 2.35 0.0 0.0Trauma = 0.0 4.75 0.0Trauma 0.0 4.75 0.0Total = 2.37 2.64 1.72

5. เราสามารถลดการตดเชอจากโ ไ โรงพยาบาลได

1.จรง1.จรง

2 ไ 2. ไมจรง

โ5. โรงพยาบาล ม.อ.สามารถลด ใ การตดเชอจากการใสสายสวน

t l li ใ ป 0 ไ central line ใหเปน 0 ได

1. ได

2 ยงไมได2. ยงไมได

PSU IC :ObjectivesPSU IC. :Objectives1 Reduce Infections - in patientsp - in personnels2 Cost reduction2 Cost reduction3 Research & Development4 Teaching5 Income generating5 Income generating

PSU ลดการตดเชอในผปวยPSU ลดการตดเชอในผปวย1. Surgical wound infections.1. Surgical wound infections.2.Ventilator-associated

pneumonia.3 Bl d t i f ti3. Bloodstream infection. 4 Urinary tract infection4. Urinary tract infection.

ObjectivesObjectives1 Reduce Infections - in patientsp

Goals = ???

US National Nosocomial InfectionsUS.National Nosocomial InfectionsSurveillance (NNIS) System:( ) y

Established in 1970

>300 hospitals currently participating

Standardized surveillance protocols,( i t i it (ICU) hi h i k( intensive care unit (ICU), high-risk nursery(HRN), and surgical patients.)

Reduction of Nosocomial Infections among Patients:

GOALS : NOT MORE THANTHAN

50 PERCENTILE NNIS RATE50 PERCENTILE NNIS RATEWITHIN TWO YEARS.

Standardized infection ratio of overall surgical site infection3

2

ratio Mean = 1.97

dard

ized

infe

ctio

n

Mean = 1.42Mean =0 93 Mean = 0 97

1

Stan

d Mean =0.93

Mean = 0.84

Mean = 0.97

01 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3

Quarters of the Fiscal year

2004 2005 2006 2007 2008

Quarters of the Fiscal year

ปงบฯ 2550SIR(เทา)Procedure

ปงบฯ 2551SIR(เทา)SIR(เทา)Procedure SIR(เทา)

Open Heart surgery #Appendectomy 0 66

0.84#Appendectomy 0.66

Cholecystectomy 1.86#

5.99y yColectomy 0.79C i t 1 44

0.845 52Craniotomy 1.44

Herniorrhaphy 0 565.52

#Herniorrhaphy 0.56Mastectomy 0.33 0.54

Total 0.84 1.97

Overall rate of ventilator associated pneumoniaOverall rate of ventilator-associated pneumonia

9

10

NNIS25 percentile = 2.650 percentile 4 6

6

7

8

or-d

ays

50 percentile = 4.675 percentile = 7.2

4

5

VAP/

1000

ven

tilat

o

Mean = 4.35

1

2

3

V

Mean = 1.72

Mean = 3.14

Mean = 1.65Mean = 1.30

01 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3

Quarters of the Fiscal year2004 2005 2006 2007 2008

Overall catheter-related bloodstream infection rate10

7

8

9

ays

NNIS25 percentile =2.650 percentile = 3.475 percentile = 5.1

4

5

6

I/100

0 ca

thet

er-d

a

Mean =6.20

Mean =3.52 Mean =3.57

Mean =5.70

Mean =3 21

2

3

4

CR

-BS Mean =3.21

0

1

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3

Quarters of the Fiscal year

2007 20082004 2005 2006 2007 2008

หอผปวย UTIปงบฯ 2550

UTIปงบฯ 2551

ศลยกรรมหญง 14.84ICU2 10.76

18.9410.31

ศลยกรรมประสาท 11.27ICU1 5.78

29.135.06

ศลยกรรมชาย 2 10.43ศลยกรรมชาย 1 7.77

9.2011.06

PICU 2.77RCU 20.34

9.608.40

อายรกรรมชาย1 13.22อายรกรรมหญง 12.17

5.7611.31

อบตเหต 5.46อายรกรรมชาย2 0.00

12.380.00

Total 9.41Total ICU 7.77

10.817.10

PSU Hospital, 1985- 1986

N i l I f i R 1985 1986 Th il dNosocomial Infection Rate 1985-1986, Thailand

Hospital beds Rate (%)Hospital beds Rate (%)

>700 15.2700 15.2

400 – 700 4.1

<400 2.8Ref.: Pinyowiwat W et al. National Surveillance on

Nosocomial Infection : A Pilot Study Journal of the yMedical Association of Thailand 2531 71 Suppl 1-4

Journal of Health Systems Research 2012;6:352-360