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u:iHT n,tflrarradrcatifi rr,tnhJuf ltlttururn:rlrBudTHE STUDY OF RETATIONJ''' J"*"U }IICRO-ORGANIS}IS IN BURN
I{OUND AND ITS AT}IOSPHERE, BURN UNIT, RAI{ATHIBODI HOSPITAL.
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,ttl, F.A.C.P.
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* Copyright by Mahidol University
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Thesis title The study of relationship between niero-orEfanisns in burn wound and its atmosphere,
Burn unit, Ranathibodi hosPital.Nane I Prangwalai KanianaPitakDegree Haster of Science (Epideniology)Thesis Supervisory Comnittee
. ffi;:::r"I;=""""' !r'D'' DR'P'H''
llukda Trishnananda, H.D., H.P.H.(Harvard)Runpai Suksawasdi na ayuthaya, H.S.P.H.(Bio-stat ist ics )Vivat Visuthikosol, ll.D., F.A.C.S., F.I.C.S.t'l.L.Ratanasuda Phan-Urai, l{.D.
Date of Graduation 13 June- B.E.2532 (1989)
ABSTRACT.l
The incidence of nosoeomial infection in burn unit,Ranathibodi hospital is still high. This studv ained tofind the relation between micro-organisns in burn wounds and
its atnosphere.Elghty-five burn wounds from 24 patients were study
by receivinB swab culture at adnission, 24 hours, 72 hours,and 7 dayS respeetively. The results of the identificationshowed significant relation with the ident,ification fronsettle plate and room air sanpling (P<.005) onlv the first24 hours of hospitalization. Degtrees of burn was also had
relation with the ineidence of infection by relative riskand odd ratio more than 1. The length of hospitalizationhad signif,icant relation with the incidenee of infection(P<.001) only on the ?th daY.
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r-nurfrriru b rfiur {ursnrcfrrreufi$iuaffi rr,rnlrt1r4fr-n?1iliaufl?n liorItttl
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2. ltnfin,fu1ulto?tH1u1n (Nosoeonial infeetion) uil1flnn
l:nfin,fufi rfrnurin-rirunruudsfi:"uli1ulr{t?ru'Iu1fl un=l:nu"ulri }iad1ue e n - e.- yu.t .i les 4 lDe l*
rsusiln d-"'[unouu:n iutr ueu li-lu_l: r rH1u'lf, n 1i lR:u I taa,taas ln5ila1n dilv.lFltr?nf,arn1{1 -[u t:sturu.raulaa.rnn?9lu?H lan
Jt-.!i3. nnl?1il$1u 1il13 tta (Plating) nan,rrurta,lu tfi1s ltailfailo1u1rr, *uo r rta lll?1 it nlranrir r r fin trarn o ao nnrudfrocn.rn 1ii{c lnrer.tYe & € e 6
t { '4 J { . Yl{uru 1 !rlll os tnuoru 1?t13 Ita lilau lfla til1!l41ttana lil
4. nr:firuur tf,a (Swab culture) fiane:urnrfifruunrulfd.rYe , E d 9 I I u u 9rln'vrrn r r a1 I fi a r i u uia u u de l r fir r u: I ? tuu'l R tt s nn n n ? 1 x f a u R? R ! a.$ et-d, H
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l ta r! rsrt1fl r j.t u uflsn rs?r'r'lurarieutl unfi r iu n rli?rH.trtrslnin r:w{vtil'-d6. n,'r:nnalnrdsirun:cR1tlflla.l (Roon air sanplinEl) tiluiE
tlg o | -f| - qlv - Ee t
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4
tt cluylyr 2
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n ufi n ria fi'uiu1n u 1i 1fr Hr r'n a vrn n t"s nr u r,tfis lfi n r : nu r ur cfiT u $ rinc : r u uan
rrn n rtdrr fr aude . "t
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t . z nr:lauianr:orl:nfru1u:cu:1nfi'r lnru'Iu:;u; 1 tln: ;fraroosnt'lfi rfinnr:hn,faralrsuunld rhurarslt'lfr rriu 1:nna-nu rTr rHn-larnrururn
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rnrtas'lf,iitrlddnriru rdu nr:finilan rdafrliccarn tfrulna r{rurirfi'lu1: r f,n rtan a 1afi nr, f,uo"n r $adr drira 16' u nc "lunr.t n :.1 iuf,r u r Sa sir o rn 1:.r
finr{anrarn'lrin;arn rfrusnafra'liua rfalrrdfrieudur Jd rriu rfiueriu tn:cal'Iil"
sirrr rdu n:cuan-snurrnc riirornrari.oiiont.o fiarq rfrufieurrial:n1rldtfiriec riuo"ndiri'ruludr{lafirfirariecdrunorrlfr l:ndnuriau rriu 1rngit t
t, gt g nee- a# fn ,Au rilu6'u ?tsut?rl?l.rlnr:1frrir rnfia R1t6t?unlcrufdcrec n15
{ Copyright by Mahidol University
t5
vr'rugn nr:-snur nr5n1 cutdown unsnr:iniltar ror rradrinuirfi.t ol -, ; ol ar! o 6 .! d . { \u . d C J
tlju6l.l n4nnsllnunyt'l tl4lnnn'l:nn Itar4ia$nt rta tflaB'lnR uana,lnu tgai-
a,tor ild Jrivrrs arur: lnc r drufedluurieu Ins urn r: fr r fr u 1: n r,rf afi r tra 1: n
a du ri tiia r n r r u stR it tfr r fr uvrrn .r r ilr i n a ua .r u,r r fr a r o o c u nd r tta l: n riu .lusin"
.t ! g g cld Jwge E g 6 . < -t'il?ur4:a ti1!tut?tau??t tflrurjrv?l,rua,lu'l5uu uana.rnua.ronRna lR8n1{ lnaniltfifrti.o*{a'roi rfal:afi'uin rau uiarr rn riu"Iu rfianfilfifrlfr oao ,u'"uil
-t .l 'o, - , 99 s s It e y .9r
rmfiu'lr,t ru-Euc-d,luari rriu nan li na,to lrJu?r'lusut rta t5n tilctorJeuldrriu- tt gt
fi'u
z.z lnuntarnrd rfalrndrrfiT ad'luarnrdraiaad'lueiuo;aar.lt 9 e, .l alg -6 .
to t .at -t
ta, cnfiua,lann tt1l,tu1xylrrff211|6lca1nn21n l?trln?"aur!1 lrj lu?r'lit tRut't1H ta ula
.u
nnn{ lu'luuirnta.rfriecnr'hirfi'nnr:fin r f,a ld' lnu r sflrcadrrfr.:'lufrarrirn-ne d | .t rafr
t o d .lv r - { o . e'
n1r 1[a ltnaE lua1n1ftu6? ilaroscnr ]r4lnnn'llnn lta tuuatnH,lnn 16',tl
z.s lnudnirnrac rdu uro.r u.lu'l15n]rr6'uc"ur,tialn"rfianJoaan ]tR;lliln{u.l1!aar4?1nn lrn ruunu
o1n n 1rfin r*1 !r fl irr ui6'r fs r a s Jyluu n: ri r { ili v r nd In u r riu 1: n fi n r f,aar 4r C . . de -- . y! tqu- Etu t?'!nu'lu,lnn]lntn'l{a'ln1f{ }tu?1r|uR?aHua.rHvr,lu ln ]HHlr?rl [?Ritu
a) -! YU e a-tuiln.d.1982 O.l{. Lidsell ucvassca> tflx\n1rFnl}1?aHd d e I a e 6 € d 6 9.lro! luiDu 1nHuf,21ltf,rfiu6!a{an:1n'tr rfrnI:nfin rtrra'luurn[flnta.ietu'lHn1u
e t|9- . er4n.! IRTUR1:3|'InR Total hip or knee joint replacenent *it$oan
e.gr-clqve.s69r-oJoEJn 1?dn $1fiu?'l H lj2Hll tR5 ljn 113f 1nR- tuua{ 9r
,rnRmnnn{ I nta{t R tait a1n ,lrt
( U I t r ac 1 e an ai r ) t s idn : rn r r fi n r taa a a r ut n u sr nri r frn ria un'i rfilr u n rirfr'utr{De I e al ! r e
tniuR 15311nn tur,las $ ''tnn615ltR1lt1R
dalr'lufin.rt. 1983 O.l{. LidwelI rnca$c(6)'binrnr:frnuetl lnuntnrtcilfi'radrro1nli.rflE1u1nri'r.r? lb uri.r rfro rfrunrirfinnr nn
l--trt-eav.reAl{u?11|n?1l|5ll|ilU6n UaH,)it lt1R 5Cl,t?1{ I snUR 1 : rJU I rJAU! Oit U5 5E'.rR 1d ( Ai r
3v r a .eontaninatiqn )n-uaffinrtlait sepsis uana,tnfifrlInrrldlfrud:;uirlo.l'la-n:t lo6H (nean value) !4.!rctiu Air contanination liuuilrnraa.t
.l I --bacteria vt lsolate lna1nn11n.l wound wash-out a.rnu'lnltglnn,lHr4Rna - 9a
H,]nnta.f Hil?flJ
it
rl
t
i1nd1rfinu1ra{ H.A- Li1ly nasnsv"lufin.s. 1gB4<€) lpiii'u
Copyright by Mahidol University
f6
11 Dr- alqu- 6 q y 9 dtuqtu,tgvl ln:uauh rran'ln'tr,rfr 40 nu ilnnurt fulr-skin thickness burnirttt
unc }i'iun 1rgi1n-nfl\ skin graf t lncn"ileu 22 nu.trir-unr:drn-Rnru'lufrarr e.clr E - J s
sird'hfifrnn-s Laninar air-flow Tsnrlr:nn:a{ particles 1uarnrglfrrKnfis 0. 3 ;rn. ruiuu r-nuufi'uf,uru 18 nu *rlfr:-unr:sirfrn1ufiuoi1ti16-o{'nnn{ Laninar air-f low lnariarsir;nfitf;ufilrc}ilaalndr rfiuria.r tfiue,utfru n standard plenum ventilation with 20 air changes perhour itdilr"tn1ir1rii{rleunu"In rfinnr:fin,fuou.turR$stna,tn Staphylo-g
coccus aureus uo;a'lnn1i?1it plate'lufralsirdn!$3nln1:girn-nnui'rgrsalcBd-er,la.i9lltlRvlnnn{ Laninar air-flow ltilar1$la{ bacterial count uau
.urvalyryuoEn'ir fia I d r nln fi br'ln'fi n n-l L anin ar a i r - f I ow arir I iric arnrun,t{ dAfi
a,lnn.|rfrn$'llo{r Shirani unsnss(") 1uin.fl . 19g6 lnufin$r1ufilT ufi ldiuaffi r r,rn'lrrlrar? z 19 nu t }it-un.5:-n u1ru1urnad"lufra.fi t6'{tt.l|uun rilufrnd'lu r uiuu r-nuuri'uciil.ufi ldiuari-n r r,rnlrrlrafr r?g nuir lfr:-unr:insrrueurca{1u intensive care ward filrilduun rfrufinrieu florJ:1na||'ita-n:tnt: tfrnnr:fin rf,aral4''riru'lunrilurnRRo{adrririuardruvrrsafifi dobg yD ye. : A
tA e Dr Cvgo s
lt 5ou lnct u li'ir n''rr nn n 1rff n r iarrn Rs u rn 6arr ar cTi'lufi -tdiuafifi
r r,tn 1t-r|ttirt?d,fru$sar6'rurr:r:osd?uaRdni,lnruaasfiirulfiaJrsrrn
!
I
il
5OO x 20 = 10,000 nI.60 x 10,000 nl.24 x 60 x 10,000 ul.27 .3 x 103 nt. )u4x6Ox1Oa
27.3 x l0g480 cu-ft.
t
eoA,4qopvva,rRn,lrFfnu,llait au?nl nrd?ltt||(a) t{r lRFnu.l?t.ln?1r rltlu! a { rli r 1 m r fa 1ua r n r e do s vrr'ifi r fi n n r : fi n ri a Ia u n rur s ln'ril f
Tidal volume = 500 nl,
( 1 cu-ft. = 27.3 L.24 x 60 x 10,000 nl.
riufia a'lnn1:n\ursurruirrarnnuad'lufral 24 rtrTrl lanrnfinu!-are!.etauuasrfilH !o ta'la..lRrg rir'tu rri'rri'u 480 flnu,lrtnfin'lu Za f,e1ll frlriu
I u ol o a t t^'
n?1r tEltun lnu 1 :480 onuT Ffnr{n fro=vrflfinuriufin rflalfr
Copyright by Mahidol University
7
f, .lu?tlr 3
iBnr:nr r-uunr:i{s
Descriptive studYt,TidRH.|UUU
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.2 n|r5x.t Roon air sanPlinEl.z Ril5il-r KooD ar.r saEPranB li
r:i tntrcriuscsun rla'liqun:duo:i'pnr:11nr51u!ait'l nriliilcrf,rnninr:unttf
drii c'lytd r frr n r t-un .r: in nr'luurie u qriF r ran lrt'trari di {ut u vrrt,--ttltq'9"1 --ee?cn11tltlurtaintJu-nn i'oln iis { - ou lRnnu ilos ilT o 1n $ uuuuvln---
Irndnria 1:{nc.rurat-urdun uOrnhnt:il18r{1lta[ailiaun,lnnnulnuda nf,fildr1nn1r rn,ls lttalalria{nRna{as
ur n u n iriuin r : fi n, fu a a o u" nu fl ori a ur r {un r : :-n r*r 1u 1: s -ri
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-raun na icu'l1l tdouRsurnl 2529 - irll"rnu 2530
"ll?n'lnR'ruun
Copyright by Mahidol University
8
t1. UfnluZ. ra&l adnission 24 do'llll3. rad'l adnission 72 roelr.rs
4. r,tfrs adnission 7 iuc|
"d lfro rn n 1: l l{1 3 ?r., r% n. o tia I nn nal rn o tl fi u r fi uf,a l nfin r*r do
o s urr rfr n ;; ;" ; " "
; fi, f,u,in-u, fl u il r nr : 1fi or n u* J. n . d! a { rri" o i m r un h -tt'h,rfrda1u
dECqtetnanhnr: Swab eulture U,lnuglRnlil?l 1 ldiauo?t cr -olr .a:l E _ - -d o
n'lrnl?el4r tiia-luu:iu, n,tff?lllau-luaBcuu n'l5n:2111 2 ?E na
1. nnr?1.!e1u tfl1! rr%triana,lu,r: ,Sr. ,ltu,tuu Blood aElar[ns
Chocco late a6lar dl r nicilorn fra.r nn aas lnu r {rrarir fia al n : rivturnranir"1{ta,lu,n.",r%iosnt tfiaunv f otl
t c a a 6e al".rn"orun 10 on 20 plates tlncrRnet{a1ultt13 liiafrocntuun'hltr/|nau
fr'unn nfi, iu[ "n
u o n ",, ". = r Ita o s {fi uryl t ili E u r -nc ufi I n e r I u n n ri e s 1uu ri
tns rfrauld
J2. nilrnRolnrdcirun:cRlstl:a{ (Room air sanplinEt) rnial3 a dt .lqv . < - { f d
nna 1 n,rrtfi r ilu r R:-a.r fi 'ldn r n: s,r u! a.i uli" u T: nff n r t-a 1: r rururn: rl r Eunt -1.-.9- 4- -.r-:'rg-.?^.^-.--ntsn,tuRialvr'l[l:aurn 0. I pn. ua36|,t1l15nilluln:ait tu lnrJ:I1$a1n1f,Jr g d .
t 6 . d
nairu rlt tntasblnlsn'}ltnla{ 10 nninau1vlt 3 3.lcv, 6 . u -n1i?lh Room air sampling Uasfl.lnnn5{?lll9lU?H ll4ll tE'lN'l:U
gttr6
n rr in selur,rrirso ffi : T Jt]:i ln u1fr r ? R11un 1i n Ra 1 n'r rru. r-
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" ru'rnign'rcnba{'l6i'lua"ufi1d:-un.trdrl riiaudr ri.ruriruun tniivtg,t nlr$fl?
imurercninr:trnnf , $a, o"" r rsaria'lu
1l nr:finsri{un&f g-ileufinl}T{l treatments tt'ltnnuf,ioru nrnf 1nuilfii oui lfi r uduiu uas ui an rrauniEn r: :-n l+ru nud'l 0 1o d.,
n'uun fi ndefti"urn rauu flrac'o;'Ifr gn t iu io t ics'lu: ; u: 5 r-uu: n t frat3eJ
fia.r fuu a=niu"g Jl% S treptoeoccus unn a1n uuu nrauov I ilouuurn'lrH n! ait
Culture r"r,=i[tirrity test dlaro1fro1Rn11r41 culture roit blood,- - dytU1nllnn ula patheter tip n tn
il
n,rri r ncff,auc$ 2eoonu$c na
g?aH33?lrrll
1. DescriPtive statisticsdv
51H Ar I AHnunslvlT ! a6llilt
! aNSa;nn ulrl1tt an lla irgg
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lnr;ra'irs riauRsr,tral zszg - fiurnl 2530 fin"rieclud ta't:-untt:'nr*t'[uj"oriufofiu
z+sjl at riurru tg nufin rituiauas 54.2 riurailr 11 nu-nn
riuiacnc 45.b arulal{rleui:;rairr 11 iu ?1 fin r: ifi fiu 1: iu", i, n o ..,r un ldri'-r i
i-cv1j.. Scald burn 16 nu dntilufaung 66-7
'o't92. Flane burn 5 nu aRtilu:auoc 20'8'-6t
3ll. Electrie burn 2 nu f,nriiuiaua; 8.34;. Chenical burn 1 nu finrfiu{acnc 4'2
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26
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dojlf.qulf A tnalu 17 urnu$nt'lnilT ntlHnvtlurn 85 u,rnuSrn u:araHfl; 20
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tl Copyright by Mahidol University
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30
{tCJ
a1nfl1l1{l?l6 ttilulaufls
.ln.ll,litvl 5
)cclCrt--4: dtrr:ndiil liluntr,r{R 5 trlaslsn?nnan,tln'ru?3[n1?l1nslnn
Ie.eun;u1n?1rdriludralfi'rnu:1nu"liti6 SiEln test lnnlu
I
ee.rc-{"lat11 6lR it n? 1 r ar r|us r iiufau nc ! a { I ta vl}lu-[uu5 5 u1 n 1fi aT n n 15 ?l'l
eJ.lGBllating uoc Room air sampling niu rtafrnu'luurRuatnotn
ln:]llli Swab eulture
-e-aflnE$sn?1r61ilfiu6
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tlt -eoal:ra?1ildrnufi
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a 1n'R 1 l ?rR ca uvrr s cfi fi nu'i r r r% frnu'luufl H'ln 1rf fu r fafitru'luurnunain'reufrid'ldri'uadrririsarnrunrscifi (P < .005) tsfi1;'luti"{ 24
t*efuru:n rrirrfu
t-e-tn?lr|lUlllitaJU,rRltnn (DeEgree of burn) rl 3 lsRun{u
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3. lThird degree burn n ? u,tnrnnfin rfru{asac 8.2"luurnunodfio""u:uui{ttu,rn iirst deElrde burn tionro 3
I
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t.| Copyright by Mahidol University
31
1uil.ou*"iin..uruu:itlu1R Second deBqee l":." fionuo
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ulRuna rnri,nr:fin ria'lul:snt,tu,ta 3 u1Rttltflf,n riluiauoc a2.g'an4 u,rRrnnridiur"" s?.1 tinunr:finr#alnr
i
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t
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a1n n ,.| r f ,it x 2 utl|1fl r rJ I fi Ar4-ln ?1tl dllltluEl s 14?'l.l : ; u 3 I ?n.l! a ie-nlrinr*1niln1r lnR llnnn ItA lU l:{ttlE-lu'ln
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tyl''tuu
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rl
ir
. stlrjflnRr:iiunnsfra tdua$uc
-9 ;dlilsnn1t?oD il
' - 6 p. alvus 6 Y rt D I ea1n ft 1:f, n $'r
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-tu-lRUHn nnta.Jn,llf,n$'l?ru?1
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5.li] snn1rfll Swab culture !a{u,lRllalcnlsvl 1([rnru)zg rt1nu$nuia{auos 94.1 inr:finrf,alrriau rf,afinulrn
i tr A q {faun; 36 iiitrtita Staphylococeus epidernidis ?aitnitylnalfa P.
aerugino=" finc Enterobactor in 56 urnunarata{aunc 65.9 nl?oY. t sllr?{u rIa tR?
t'
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'old6a-i(a1nn11rsfi a) fi 23 1u 85 u.lnrnnr4-afaflnse. ! a t.
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epidernidisl :a{a{r,riatns ie rfrurfa Klebsiella unsiarns I€Jrilulia P. aeruginosa
5.31i nnnr:ilrt Plating tto; Roon air sanplingI rf,ainld?uu1n rilunrn Staphyloeoccps epidernidis
-0au]lnc Air baci.lli ?{u Aeinetobactor ltn= nold u.|it tonuaul
5 . 4 ; rt Rfl 1rn1n?1xfrxfrud: vra'irl r l%dnu'luufi I H1n 1Fl fu r f,a.to-sJnilu-luu,lR]t$a (6lriln51ulax 1)
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urn rn,ruu l
l
a,5. 5it nnnrtr4'rRnlrdltfluEis!r11in11ttlullt{!a{tu.|nuHfl (Degree
of burn) fi'unr: rfialtnfin rfra'Iu1:tfis'1u1f, cillfisnutad z>
I l l%onaf
t Copyright by Mahidol University
t 34
drd.llennr:rrfi 6) r,ru'ir n?1ilrurr:it!anu,tRunnxnafian-tr tfinl:nfin rfla1u1tsnu1u'lc (Nosoconial infection) frecir Relative
,.1 .EyAcAaRisk, RR. uns Odd Ratio, OR, r|1nn'i'r 1 iisdruirEsrrn nErilno.o
nan15 lnR ltnnR lio tu lt{flu1u'lnr..|nrut?l1uul
5 . 6 n nR 1ru'ln?rlfilriud:;u-irr:;cc r enrfi'frieuad'lu1:{ ilH'lu'Ifln-ui'n:rnr: rfinl:nfin rf,a1u1:inr!1urn (dx!fis,tufiui"g) "
.l r cly(e1nn'lr1itfi 7> ?rui,tisus rra,tnni?uad1ul:sfiH.ru1n fru6
n 1i 1 n n J: nfr n r ia'Iul:.r rururo Iner16[lfrurinladr I fi ficarnsunr{ dnn(P< .001) rsfi'ls'lui"{ z iund'l rrirriu $ns lionaitr4ln?'lrfixfruf,iasi'euu:lnuiBvrncauan:rarufrlfrud:cuirrndrlnunncou riluir nu'ir
lrlRelative Risk, RR. llos Odd Ratio , OR. iiuenn'ir 1 vrni
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o a t'v?o1r$Bnn152SU
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zJs dr't6'fr n 1 r fi n n 1 r er nfua d r.r o i r ds u dr ar a! a { n 1 r i {i o ; cr 11 rn u'r Jrl'If,eDyA6r6Jreuturj:{ un3llR 1!n1:rJu l rJoua an utlH.ln 1Ff lur4u?uaun tun t$o3t?SnRant'l
t-ttn r:fi n r f; a'luurnun oa as frues 16rrn
f,aun nda.r a ar i rr io-sor"o d ar oa:u }in-r il- -- { o
t - -cl - ri -f . ilunllnsil5]r1ilta{t rta-luu,rn]t3rnrn15 lrJnHu$rjfl{ liln1rlHn
e A d goe v ayD 6 u o6lr|0n6,!a{ antibiotics lua!n1nel?aH 11| lR lilUnn'lilURn.l1:n$1 BR-t J vv- 'n1l7lll Swab eulture !O.llU.|Rltglnt{fiU Ita tnUaHnit
z . o'lu?uei?ad r.r fi 1f,frn r*ru-l fr r urn r 5n r fial orn nrieuarifi r rantt'trt'tr,rfrcrlr:niufiueuldrilus b rdss $nvn1i?muriuuaarfrriesfrfir
.t6ir&e'l.ol{n r i fl n r*''r lui s E s r r or du'l i{ a 1 a n'l'h;'kisr oc: ufi ld t-n I o u I 7t''t nn .l I
t
t
{
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35
*
+
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tnt,lsn ntal nxr-aullruno t ua.it t Uu I ?o1u1u nst2H lullu! oun nloil I fiaa..E.d.l
ur1U1f,1un1rur-uilrsufrll li rf,uluri burn unit l?l1uu r4u?Hau'tvlde a
t , I . - e i t d
'Idngrc rilu ctose unit rriu fralcirtTn ICU tilufru ffne:fnr:frnureAr
rsRiln 1tilu r ilau! ait llrlH1R ,lfloH I 6l!A,u
at--eErrl-tvt'-lunrtn'rraunt{na ltj, H?eun?:fl'runnit
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z . n rt r fr ua'au""orn rruntsHs I ?f,1fi nnll'lfiurufu,u
g,. drvrrlfrnei isolate nnniinnr rfiafi'nrJrurar cross-t
infeetion lftlr rfiuialntl
t
e
..\|
Copyright by Mahidol University
1. crfinf ftfiraar, ut,?eit :-nuaua uas illsuar rl1t, " l:nfiR
,f,u$,fio1u1:o"o"u."rilrBufi " , :ur-ruiriror: ifl e.drnlfi 3, 2524 , uut 184 185.
ri - t . <--6 4 q --=--!!2 - .t,luit,lun,ttin tiiala{rarirul:nnt} ItO ll{fiU1U1ol1N1EUn
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81r" Effect of ultracleah air inrooms on deeP sepsis in the ioint afteror knee replacement : a rhndonised study"L982 ; 285 : 10.
ell et 81r" Airborne contamination of wounds
oint replacenent operations : the relationshipis rates ", J.llosp.Infect 1983 ; 4 : 111-131
y et aI ," Trial of a Lanina aii-flow enclosurethe control of infection in a burns operatinEf
ter ", Burne 1984 ; 10 : 309-312.
.2. et 8I," Effects of environment on infectionJan.121(1)rn patients ", Arch-Surg- 1986 i
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Copyright by Mahidol University
{38
rye'l u 1 u n-? a d r r d r c'll-n r n r : i i r du I l r u u ri
" = " {.t iu a ri fu n-e u rt: ri a
vSotrulrlu na
1 . {tilrl:3r|101 (Cost )- D - .l 19Z. i,laFRrarn?lHalr lR (Allowable error)
r.lede69-3. n,l,l1|tlll:Ul?u (Variance) titfi?llillyldrln$ lulal|olt{nsm1fl
rir n r r l u ul ut ,l ust'l r'l r n ua n lfr1u: ur a r i'n : r r a s firuur ( P ) 1n cu: c nrnlir-il
a'lu?ufr'r arir r o r n dn: ri a lrtfitl
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+ d2
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p + in:rrarfirur,rre - C ye
d E EOCtlltfl'ln?IHAI ln
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n'rn'lurldeu4m n,rnlrt'trafr (burn unit; 1:lruru1ot1x1;u6 nosuri ril rin- I .r t . -e -vf1R15aun.!?ul4 30 rrlr,ruu 252.8 ?tu?'lranr,ln,ri lnR lrnnR ttan.JlaHn;
65e C J - a:rvn{uU ]$anlr4un-tu p = .65
1 - p = 1 - .65 = .35d=-zn = (2\2 (-B51 -i-35)
(.2>2
= 4x.65x.35.04
= 22.75 '
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* Copyright by Mahidol University
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rcJir score fintuenrlrTC d .l.rp - i
a'ru?u rnSaJur,lE + 1450 - n tRa,lnn,l:nR lnlailclo e - t Y,d - e a
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OreCr
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firrori0raoar
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+
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o. "l3ru?Ht,lcntt- ,d ia H.N.t fifta1u n
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