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