The effect of decontamination using quaternary ammonium chloride on the bacterial burden of hospital privacy curtains.

This quasi-experimental study aimed to identify the effect of decontamination using quaternary ammonium chloride (QAC) on bacterial burden on hospital privacy curtains. The objects were the high-touch edges of 66 polyester curtains in inpatient wards. The decontamination was performed daily (n = 22), twice-weekly (n = 22), or not performed (n = 22) for 28 days. The bacterial burden on the curtains was measured based on the number of bacteria, the proportion of curtains with >2.5 colony-forming unit/cm2 , and the proportion of curtains with multidrug-resistant organisms (MDROs). As a result, the daily or twice-weekly decontamination groups showed a significantly lower increase in bacterial burden than the no-decontamination group overall and at all four posttest times. On day 28, daily decontamination showed a lower increase in the number of bacteria (p < 0.001) and proportions of curtains with >2.5 colony form units/cm2 (p < 0.001) than the no-decontamination condition, and in the number of curtains with MDROs than twice-weekly decontamination. In conclusion, decontamination of curtains using QAC helps reduce bacterial burden, and daily decontamination is recommended up to 28 days after installation.

[CORRIGENDUM: Development of a Diabetic Foot Ulceration Prediction Model and Nomogram].

This corrects the article on p. 280 in vol. 51, PMID: 34215707.

Time to Diagnosis and Treatment of Diabetes Mellitus among Korean Adults with Hyperglycemia: Using a Community-Based Cohort Study.

OBJECTIVES: To identify the time from hyperglycemia to diabetes mellitus (DM) diagnosis and treatment, the risk factors for diabetes development, and the prevalence of comorbidities/complications in patients > 40 years of age. METHODS: This secondary data analysis study used data from the Korean Genome and Epidemiology Study. The participants comprised 186 patients who did not have diabetes at baseline, but developed hyperglycemia at the first follow-up. The average and median periods until DM diagnosis and treatment were calculated using Kaplan-Meier survival analysis. RESULTS: Of the 186 participants, 57.0% were men and 35.5% were 40-49 years old. The average time to DM diagnosis and treatment was 10.87 years and 11.34 years, respectively. The risk factors for the duration of DM were current smoking, body mass index (BMI), fasting blood sugar (FBS), and postprandial 2-hour glucose (PP2). The risk factors for the duration of diabetes treatment were current smoking, hypertension, BMI, FBS, and PP2. The development of one or more comorbidities or diabetes complications was identified at the time of DM diagnosis (36.5%) and DM treatment (41.4%). CONCLUSIONS: As diabetes complications occur at the time of DM, and early treatment can impact the development of diabetes complications or mortality, it is necessary to establish a referral program so that participants presenting with high blood sugar levels in the screening program can be diagnosed and treated in a timely manner.

Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii in a tertiary referral hospital in Korea.

OBJECTIVES: This study aimed to identify the epidemiological characteristics of patients with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii (CRE/ CRAB) isolates in a tertiary referral hospital in Korea. METHODS: We collected and analyzed data from 528 adults admitted to a tertiary referral hospital from August 1, 2018 to February 29, 2020. The CRE/CRAB isolates were confirmed as being present at the time of patients' admission or acquired during hospitalization based on their medical records. The t-test, chi-square test, or Fisher exact test and stepwise multiple logistic regression were performed. RESULTS: While the proportion of community-acquired CRE/CRAB was low (6%), 20% of CRE/ CRAB isolates were identified in patients at the time of hospitalization. The risk of CRAB isolation was positively associated with mechanical ventilator use (odds ratio [OR], 3.52; 95% confidence interval [CI], 1.96-6.33) and total parenteral nutrition use (OR, 3.64; 95% CI, 1.87-7.08). CONCLUSION: Over 20% of CRE/CRAB isolates in a tertiary referral hospital in Korea were found at the time of patients' admission. Furthermore, patients with mechanical ventilation and/or total parenteral nutrition tended to acquire CRAB more frequently. Thus, active surveillance for CRE/CRAB at the time of hospitalization is strongly required, particularly for patients who are expected to require mechanical ventilation or total parenteral nutrition.

Effect of the personal protective equipment donning and doffing program for nurses in military hospitals.

This study aimed to develop and verify the effect of a new personal protective equipment donning and doffing program for nurses in military hospitals. A total of 40 nurses (20 experimental group, 20 control group) participated in this nonequivalent control group experimental study. The new program consisted of the description of the design modification of the inner and outer boundary marks of coveralls and a video with verbal instructions and footswitch that the participants could watch at their own pace. Data collection was carried out before, immediately after, and 2 weeks after the intervention. The effects of the program on accuracy, self-efficacy, and time were analyzed using a generalized estimating equation. PPE donning and doffing accuracy, self-efficacy, and time were significantly increased in the experimental group compared to those in the control group, both immediately after and 2 weeks after intervention. As this program has been confirmed to be effective in improving PPE donning and doffing accuracy and self-efficacy, we recommend using this program for training nurses on donning and doffing of PPE.

Epidemiological Characteristics of Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae Colonization.

PURPOSE: This study identified the epidemiological characteristics, including the size and major strains, of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) and CP-CRE-related factors by comparing the characteristics of patients in the CP-CRE and non-CP-CRE groups and the CP-CRE and non-CRE groups. METHODS: This secondary data analysis study included 24 patients in the CP-CRE group, 113 patients in the non-CP-CRE group, and 113 in the non-CRE group. The size and type of CP-CRE were analyzed in terms of frequency and percentage, and CP-CRE risk factors were identified using multiple logistic regression analysis. RESULTS: The rate of CP-CRE positivity among patients with CRE was 17.5%, and the most common causative organism in the CP-CRE group was Klebsiella pneumoniae (81.8%). There were no significant differences between patients in the CP-CRE and non-CP-CRE groups. When compared with the non-CRE group, the isolation of multidrug-resistant organisms except for CRE, particularly vancomycin-resistant Enterococcus, was confirmed as a major risk factor. CONCLUSION: To prevent CP-CRE acquisition, patients with multidrug-resistant organisms require treatment with more thorough adherence to CRE prevention and management guidelines.

[Incidence and Risk Factors of Dyslipidemia after Menopause].

PURPOSE: This study was aimed at investigating the incidence and risk factors of dyslipidemia in menopausal women using a Korean community-based longitudinal study. METHODS: The subjects were 245 postmenopausal women without dyslipidemia who had participated in the Ansan-Ansung cohort study from 2001~2002 (baseline) to 2015~2016 (seventh follow-up visit). The dyslipidemia incidence was measured as incidence proportion (%) and incidence rate per 100 person-years. The predictors of developing dyslipidemia were analyzed with Cox's proportional hazard model. RESULTS: The incidence of new dyslipidemia during the follow-up period was 78.4% (192 patients), and 11.9 per 100 person-years. Mean duration from menopause to developing dyslipidemia was 5.3 years in new dyslipidemia cases. The triglyceride/high density lipoprotein (TG/HDL-C) ratio at baseline (hazard ratio = 2.20; 95% confidence interval = 1.39~3.48) was independently associated with developing dyslipidemia. CONCLUSION: Dyslipidemia occurs frequently in postmenopausal women, principally within five years after menopause. Therefore, steps must be taken to prevent dyslipidemia immediately after menopause, particularly in women with a high TG/HDL-C ratio at the start of menopause.

Social determinants related to COVID-19 infection.

This study was aimed at identifying the social determinants related to COVID-19 infection in South Korea. This secondary analysis used data from the 2020 Community Health Survey, a nationwide sample taken to understand the health status of Korean residents. The participants were 220 970 adults 19 years of age or older. COVID-19-related social determinants were age, education level, marital status, household income, hypertension, eating habits, social support, and regional income. The risk of COVID-19 infection increased in those who were under 40 years, were high school graduates or higher, were single, had a household income over US$ 4166.7, ate breakfast 5-7 times a week, had three or more helpers during COVID-19, and lived in a region with above-average income. Hypertension reduced the risk of COVID-19 infection. In conclusion, adults with high socioeconomic activity showed a high risk for COVID-19 infection, which was assumed to include only adults living in residential housing in the community. Further studies are required to include adults living in long-term care or communal living facilities, known to be frequently infected with the corona virus.

Incidence and Predictors of Cataract among People with Type 2 Diabetes Mellitus: Using Secondary Data Analysis from the Ansan Cohort of the Korean Genome and Epidemiology Study.

PURPOSE: This study investigated the incidence and risk factors of cataract in people with diabetes mellitus (DM) using data from Ansan cohort of the Korean Genome and Epidemiology Study (KoGES). METHODS: Data from a total of 329 patients with type 2 DM without cataract who participated in Ansan cohort of the KoGES from baseline survey (2001-2002) to fifth follow-up visit (2011-2012) were examined. The characteristics of the subjects were analyzed with frequency and percentage, and mean and standard deviation. Cataract incidence was measured as incidence proportion (%). For risk factors of cataract, hazard ratio (HR) and 95% confidence interval (CI) were obtained using the Cox proportional hazard model. RESULTS: The cataract incidence over a 10-year follow-up period was 19.1% (15.1 in males and 25.8 in females), and mean age at the incidence of cataract was 63.48 years (61.58 years in males and 65.31 years in females). Age (HR=1.09, 95% CI=1.05-1.13) and HbA1c (HR=1.21, 95% CI=1.07-1.37) or the duration of DM (HR=1.05, 95% CI=1.00-1.09) were found to be independently associated with cataract development. CONCLUSION: Cataract development in people with DM is common, and its likelihood increases with age, HbA1c, and the duration of DM. Considering negative effect of cataract on their quality of life and economic burden, nurses should identify people with DM at a higher risk of cataract development, and plan individual eye examination programs to detect cataract development as early as possible.

Risk assessment and classification for foot ulceration among patients with type 2 diabetes in South Korea.

AIM: This study aimed to investigate the distribution of foot conditions, the risk of foot ulceration and its associated factors in patients with diabetes. Few studies have focused on the risk of foot ulceration in patients with diabetes. METHODS: A total of 267 patients with diabetes who attended outpatient clinics in two tertiary referral hospitals were recruited from June to September 2016. The risk of foot ulceration was classified using the American Diabetes Association (ADA), International Working Group on the Diabetic Foot (IWGDF) and Scottish Intercollegiate Guidelines Network (SIGN) classification systems. The risk categories of each system were reclassified into high- (categories of 2 and 3 for the ADA and IWGDF systems and high for the SIGN system) and low-risk. RESULTS: Foot deformity was the most prevalent condition (38.2%). Among 261 patients without active ulcers, between 17.6% to 35.2% were classified in the high-risk group and overall agreement among systems ranged from .42 to .56 of the kappa statistic. Insulin treatment was consistently associated with a high-risk of foot ulceration. CONCLUSIONS: As the risk varies between systems, nurses should select a suitable classification system through validation studies and assess the risk in patients with diabetes, particularly, those receiving insulin treatment.

[Level of Complete Knowledge on Five Moments of Hand Hygiene among Nurses Working at Integrated Nursing Care Service Wards].

PURPOSE: This study aimed to identify the level of complete knowledge about hand hygiene indications among nurses working at integrated nursing care service wards. METHODS: A total of 127 nurses in eight integrated nursing care service wards completed structured sheets while observing a video based on six scenarios developed by the research team. Complete knowledge level was calculated as the percentage (%) of participants who responded correctly to all questions among participants. Complete knowledge levels according to the scenarios were calculated and compared according to general characteristics using the chi-squared test or Wilcoxon rank-sum test. RESULTS: The complete knowledge level for each scenario ranged from 7.9% (scenario 6) to 42.5% (scenarios 4 and 5), and no one had complete knowledge of all scenarios. Only 3.1% of participants demonstrated complete knowledge in more than four scenarios, and 26.0% had complete knowledge of four or more hand hygiene moments. Complete knowledge level per scenario did not differ depending on work experience at hospitals and study wards, or prior hand hygiene training in the last year. CONCLUSION: As the complete knowledge level regarding hand hygiene moment is very low, it is suggested that regular hand hygiene training should be provided to nurses using video media that reflect real nursing tasks. Thus, they can acquire complete knowledge of when hand hygiene is needed or not during complex nursing work situations.

Building and evaluating suicide attempt prediction models using risk factors.

This study identified risk factors of suicide attempts for the purpose of building prediction models and evaluating their performance. The participants of this secondary data analysis study were 11 671 adults aged 19 years or older. The prediction models consisted of risk factors identified through multiple logistic regression analysis, and performance was analyzed in terms of calibration, discrimination, and clinical usefulness. The risk factors for suicide attempts were suicide plan and suicidal ideation for males, and suicide plan and depression diagnosis for females. The prediction models constructed with these risk factors showed good calibration and discrimination, with over 0.90 of the area under the curves. At the cutoff point of 0.5%, the sensitivity of the full model was 90.9% for males and 82.4% for females. The net benefit was positive at a threshold probability under 30% for males and 40% for females. Given the acceptable performance of the suicide attempt prediction models, they can be used to assess suicide attempt risk and detect the population at high risk in the community at an early stage, with limited human resources.

[Development of a Diabetic Foot Ulceration Prediction Model and Nomogram].

PURPOSE: This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). METHODS: This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients' electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow-Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. RESULTS: The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. CONCLUSION: The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

Current Status and Associated Factors of Annual Eye Examination Among People with Type 2 Diabetes Mellitus: Using the 7th National Health and Nutrition Examination Survey.

PURPOSE: To evaluate the level of annual eye examination (AEE) and identify the associated factors among people with diabetes mellitus (DM). METHODS: A secondary data analysis was conducted using data from the Korean National Health and Nutrition Examination Survey (2016-2018). A total of 1,465 people with DM (726 men and 739 women) aged ≥40 years were included. The data were analyzed using a complex sample analysis considering a combined sampling weight of 3 years. RESULTS: In total, 29.5% and 12.0% of men and 36.3% and 24.1% of women underwent AEE and EE at the time of diagnosis of DM, respectively. The AEE rate in men was significantly higher in those who were high school graduates and above (odds ratio [OR] = 1.98), current nonsmokers (OR = 1.82), had ≥10-year duration of DM (OR = 1.75), and use insulin (OR = 2.81), and with a normal body mass index (OR = 1.68). For women, the AEE rate was significantly higher in those aged 40-64 years (OR = 1.76) and with ≥10 years of DM (OR = 1.91). CONCLUSION: The AEE rate among people with DM is unsatisfactory and needs to be improved. Health education on the importance of AEE and the application of a reminder or alarm system should be designed to promote AEE to the high-risk population showing lower levels of AEE, including those with a longer duration of DM.

Compliance with Recommendations on Work Schedule for Shift Nurses in South Korea.

BACKGROUND: A well-designed shift schedule has been reported to have a positive effect on improving health problems associated with shift work. This study aimed to identify compliance with the 17 recommendations on work schedule (WSRs) for shift nurses and related factors. METHODS: The descriptive study was conducted with 182 nurses who worked in three shifts for more than 1 year at superior general and general hospitals in three regions. Data were collected with self-administered questionnaire and 13-week work schedule tables, and analyzed with both person- and cycle-based compliance. RESULTS: Person-based compliance was 11.77 among 17 items in total. However, no one completely complied with WSRs of "no work on weekends" and which showed the lowest cycle-based compliance (22.3%). Compliance with some WSRs was related to hospital type, proportion of nurses in school and having standards on work schedule at institutional level. CONCLUSION: Compliance with WSRs of shift nurses in Korea is still unsatisfactory, and one day off after night shift and work on weekend are quite common. Hospitals should keep the standards on work schedule, monitor compliance with standards, and try to introduce modified shift systems to improve the current problems.

Sex differences in the relationship between depression and cardiovascular disease risk: a nationwide study in Korea.

OBJECTIVE: This study aimed to identify sex differences in the association between depression and the risk of developing cardiovascular disease (CVD). METHODS: A secondary analysis was conducted of data from the fifth to seventh waves (2010-2018) of the Korea National Health and Nutrition Examination Survey. The participants were adults aged 30-74 years who had no diagnosis of CVD. The CVD risk was calculated using the Framingham Risk Score algorithm. Multiple linear regression analysis was conducted to identify the association between depression and CVD risk using a complex sample design. RESULTS: The mean CVD risk was higher in males and females with current depression (14.72% vs. 6.35%, respectively) than in males without current depression (11.67% and 4.42%, respectively). Current depression showed a significant association with CVD risk after controlling for only health-related characteristics, but the significance disappeared in both males and females when demographic characteristics were additionally controlled. CONCLUSION: The presence of depression was not associated with CVD risk regardless of sex after controlling for confounding factors. Further studies are recommended to investigate the relationship between depression and CVD risk in a larger sample of both males and females with depression.

Impact of Obesity on Urinary Tract Infections in Korean Adults: Secondary Data Analysis Using Community-Based Cohort Study.

PURPOSE: This study investigated the incidence of urinary tract infection (UTI) in community-dwelling adults and identified the association between obesity and UTI. METHODS: The participants were 4,926 adults aged over 40 years who had no UTIs at the baseline survey of the Korean Genome Epidemiology Study. Obesity was defined according to the cirtieria of Korean Society for the Study of Obesity using body mass index (BMI) data. UTI was defined as those who had self-reported UTI or had either nitrite, or both leukocytes and blood in the urine dipstick test. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using a multivariate Cox proportional hazards regression analysis to identify the association between the obesity and UTI. RESULTS: The incidence proportion of UTI was 5.1%, and the incidence density per 1,000 person-years was 25.5. After controlling general characteristics, people with BMI ≥30.0 kg/m² remained 1.66 times (HR = 1.66, 95% CI = 1.06~2.60; p < .05) more likely to have UTI than those with normal weight. This trend was also present in men or people aged ≥ 60 years. Among women aged ≥ 60 years, people with BMI ≥ 30.0 kg/m² were 1.98 times (HR = 1.98, 95% CI = 1.01~3.86; p < .05) more likely to have UTI than those with normal weight. CONCLUSION: The BMI ≥ 30.0 kg/m² is a risk factor of UTIs in Korean adult men over 40 years and women aged ≥ 60 years. It is necessary to emphasize the importance of obesity management to men or women aged ≥ 60 years, specifically.

The relationship between mother-infant contact time and changes in postpartum depression and mother-infant attachment among mothers staying at postpartum care centers: An observational study.

This observational study investigated the relationship between mother-infant contact time and changes in postpartum depression and mother-infant attachment. The study population consisted of 101 mothers staying for 14 days at two postpartum care centers in Busan, Republic of Korea. Data were collected from February to March 2018 using a self-administered questionnaire that covered postpartum depression, mother-infant attachment, and included a contact timesheet. Data were analyzed using descriptive statistics, including means and standard deviations, Kruskal-Wallis tests, and multiple linear regression with bootstrapping estimation. The mean daily contact time was 5.31 ± 1.80 h. The mean postpartum depression decreased from 8.76 ± 7.10 points at admission to 5.16 ± 3.35 points at discharge. By increasing daily kangaroo mother care time by 1 h, postpartum depression was decreased by 4.02 points. However, changes in mother-infant attachment were not related to contact time. Kangaroo mother care was effective in decreasing postpartum depression among the mothers at the postpartum care centers. Nurses working at the care centers should encourage mothers to participate in kangaroo mother care programs. Further studies considering various contacts, such as baby massage or bathing, are recommended.

Development of a Nomogram for Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Among Patients in the Intensive Care Unit of a Secondary Referral Hospital.

PURPOSE: This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance. METHODS: This unmatched case-control study included 352 adult patients (55 patients and 297 controls) admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1, 2018, and September 31, 2019, in Busan, South Korea. The nomogram was built with the identified risk factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-the-large, the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity of the training set, subsets, and a new test set. RESULTS: The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were Acute Physiology and Chronic Health Evaluation II score at the time of admission, use of a central venous catheter and a nasogastric tube, as well as use of cephalosporin antibiotics. At 20.0% of the predicted CRE acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1, c-statistic was .93, sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good in the subsets and new test set. CONCLUSION: The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a similar case mix to patients in the study hospitals. Future studies need to involve more rigorous methodology and larger samples.

Level of and Related Factors to Diabetes Awareness among Diabetic Adults by Gender: Based on Data from the Korean National Health and Nutrition Examination Survey.

PURPOSE: This study aimed to determine the level of awareness about diabetes mellitus (DM) and identify the associated factors among diabetic adults in Korea by sex, using data from most recent nationwide representative survey. METHODS: Secondary data analysis was conducted using data obtained from the Korean National Health and Nutrition Examination Survey VII (2016-2018). In total, 2,026 participants (1,049 men, 977 women) aged ≥30 years with DM were included. Data were analyzed using a complex sample analysis considering the combined sampling weight for 3 years. Odds ratios and 95% confidence intervals were calculated using stepwise multiple logistic regression analysis to identify the association between DM awareness (DA) and sociodemographic and health-related factors. RESULTS: Researchers observed that 60.2% of men and 68.4% of women had DA. DA levels in both men and women were higher in those who were older, less educated, had normal weight, had hypertension and/or dyslipidemia, and had a family history of DM than in their counterparts. Having undergone a health screening in the past 2 years was associated with DA levels in men, whereas glycated hemoglobin levels of 5.7-6.4% were associated with higher DA levels in women. CONCLUSION: The level of DA is unsatisfactory. Although the DA level is slightly higher in women than in men, it needs to be improved regardless of gender. Most of the factors associated with DA levels are similar in both men and women. Nurses in the community setting should provide health education, conduct campaigns, and promote referral to medical services by targeting the high-risk groups with lower DA identified in this study.