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I{OUND AND ITS AT}IOSPHERE, BURN UNIT, RAI{ATHIBODI HOSPITAL.

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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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a a:oaH{11AE5lrll|1tn

e c 4 6.r c-ran11n1:nn rt8!tritu.lnl]Bn uR!-lt lrJu

ta{tuu?Haun t1,

Y ! gJ, vIfl lnruna lil

n"nriilrflafinut>6. I

,nH.lu,ln !fiirltu

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ae--arEelqDDfr n u1 n.r n2 1$5lx nuE5s t4T 1{ I tA ylnu-luu1lR 3l3t dnn n?1l|iau

.: ll.6{{o€cdu:rc,rR1fl!a{uu?uaun lrnn tt{ lnr!a{ t1.,rflu1u1nt.rx.l6u6o o e - d -t -i - r A G -

gofunirila clu fiur d'ua:rr f dn6nnri a n r : r fi n T: nfi n r fia "lu tr: c

EysutHaun 1un til tx]turrll

ll

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e Copyright by Mahidol University

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t

crrfi qru'Iunrri{s

d9ea.-o4J6t1 . xh?1rdlll{uFl 314?T it t uR! a it ! t a?lilll tuu'lRtt 3l onn n?1r:aun?n

n-u r fa fr nuluu: : urn 1f, ! a { $i?HafiA r ran lrtlrai r as 1: I tu 1u1ni 111Ert6It

- e u ae I e ! 52 . xn?1x6lrfiu6n ul 3t4?'l{ n?1rl ulll{ ! a{ u'ln$91 nn un 11 I n R l: n

-Jnnfl l[a tu ltintH,ru.rfla . i n e r l fil r{u dn-u: c u'i r { I ; H s I

" a 1 ddd ? H ua u :-n u1 rie a d'lu 1: s

'u tl

?rr'lu1nfrun r: t fi n 1:4fi n r iia1u1: I nu rurn

1. udeuafifi n,tnlrt1rafi (burn unit) fiarariruraislasuctunf,nu-a <

t -t- de 4 e.- olq

d,tstnr fr.rxururnr,tr,truR lnnmr; riluraafrrircfiinfinin (close unit) fi

r-nurfrriru b rfiur {ursnrcfrrreufi$iuaffi rr,rnlrt1r4fr-n?1iliaufl?n liorItttl

frn rfidunssrcl-!^-

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

e't<{rq-esuieutrr rfl'ls !;a1ntn,trounnsttun riadaJuJcodJe.DJ5. n,15 11113]tn3$En ItA naennrru"lalu lfl'rs Ita Mau tu tn:ail

.lod*qau (incubator) y|asr/|4$ 37 algelznltH6l u'tu 24-49 t? tr|{ n'lluunt ou-o

t g

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

I nunradrJtadiu:lu'ln'1fi -[uur r?$rnoit n ,tivr'r?aH n 1iRRa1n1flH1unlsR1l*J e .i{ ol- ..-- l- .1,^ .^4^^.tg.

n ral Iosfial'lin :yn.tln 5a.! fi-rr! u1R 0 . 8 pn . resfr a{ ilftl t nias-ha 1frarn rgcirun:snrrnldn ro hn:riaurfi

I

a Copyright by Mahidol University

4

tt cluylyr 2

-- cJ GJ I9r n{1un 1i?aEr I nE?! a{l

1:nfin ria1u1:rnu1u1fl(s ) r,m'lgfr.l1tnfin rf,ail rfinrrriflrieun,rualv ao6 .

r4nit a1n nr u t? m 1: I ilcruT o unv ltnriutilfi ad'Iu: ; uc f,n fir"Iunaiu: n iur ir 1i1u1: { fi u"l u1n n 1 r ldrn r ira a tl oc 1fiiui r n *s u e n fi a lri'l n ? n1 u1u 1r !ilH 1 u1nt4i a o r n n'r fr u? B I a { fr 16 r ri u r iao r n 1uor1fi I a I fr rir u l r r fi nin e : -nn

;F"i";; r4r" ir." "ueurnfi

Td n r:nn, f,uu"o r fi nr"u J6'in1u 6t,' t r,,n fr a

c,J<

1 n1l$?ll Ita lRunlil

1. I n'r:f,lfc1ncn:l a r o o c fi n ti a'lu: c u'i r I n-efiir u dr u fu t a It!

t

r i u n r: ra!ufi ui au ur fiuRr r or 1fiuri fuungn-u aroo;fi nri aorn unnur,rSol rn

no,.,uruil1fin rr in r+r r iu nnyrfn:rtfrrirufi nnan-u1u1nu 1ri 1frfi el -la fi or o

u", fu o. n niur r n uradr luu-s n udu ld iiu, utu o" r ur n1fin e: nur ur afii? H t4o1 u

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

fo-tii r infi afi r fiudn cr, rqrdo dai;tufrnrffiin r:u niJ vs u 6 - C d- E '

'lr t a tnu-|n $ 1 I tr Ril a uu t ilUn tu$n; ti 1friun 1l r rl6uulu: ;u; t rnr i'u6l1l R25

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

r f,afr arofin , *afrrrr"1u1n1ilrfid'Ifi rFn dulfrririlsruranufiuliv! A .tflGl?r ldan''r?u

.t<e2 nrrun: tia lRHaar.l

e0u2 . 1 n1t5l1l9l6l?11{aal| r faarofi nria'kilnraefi'u r $aair r f,rt as

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


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


7

f, .lu?tlr 3

iBnr:nr r-uunr:i{s

Descriptive studYt,TidRH.|UUU

o

9eaf,nr$|'n"afl1€.

n

n?n uaslfiiu''l,d

5sH3l?nx?ln

r-nql|f,nu,l

lr9al5n$1 tuuu2u'l

I0a 9 t

3ril?ra{Rf,1?tlt

.-j

nnr9tnu'lc3nat

a9.r-d-

?IU?HTJR LN'?

at

b 6D

n1lrnil5s1n3lgtaIarn[a{uu?l

'B

u,lnBalnnnn"it

rirulfrntru'irnuru,rnu€alil

{t

r: rfrufradrs tfaornu,tn$3ln'If,ifr swa$ culturer: rfiun-tadrs rf;atrnutiu,ln,t sIfr 2 if fia

. 1 n1121.!r1u,""",fu tPlating) ]i_t

.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

rh u-un-rie C c c lfr iun r t iie u ur I if a ! a { U'l n u 3l f, t'l I tlu: s H !'1 n 1 rtrf

itali0

fradIsd1f,1unrri{cn{r i r fru{ri""dHi,uqri6 r unnmliaure'r'-''- -^i=-t runlrlnita{1r{ilc1u'lf,l1r1Eu6'Iuiel2lnl|1 lul,lu2Dalt r

-raun na icu'l1l tdouRsurnl 2529 - irll"rnu 2530

"ll?n'lnR'ruun


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-

_t r'e 1l I

" 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


t+

'jl: ;,.,,i , :a;, .

., :l:..;.t,: ,.;t

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i$: . :;i. i:.:,1..1, +.

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. -:'"ii. . .:. ,],,i:i,r4'q

,

1,., :,t,,.:ltr,.$$'''

{v-.--z. Analytic statistics -lox*lsnnulrl,| lillaulnuux'|

--r)|ea-al-!:-t----.--n'''jni111ifufrud uiOhrr.l$nnri1;it!s!;?uU: tta-lndonins.rnu'lfr1ttlsnre, o ,.,,,,,

-- :n1:2$g i":

. rrJa ln,rdnir| 1!

- Si6n teet.lrea-; n1:rilr.rfinfrnd (Relati;ve Risk , (R, ) '

::1

- Sarr*rulnld (odd Rat,io , oR. ) .' 'l

:. *$

\.:.

'i!;?.

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.., :'{-:l-t;;,.;"''". o,+-

. i;:l

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l.'..' ''q l

, ,'.p.r:#-i,;"+i

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*;:4.

t': E.". t,

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10

o.l

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HnEo{n15i{u

*.

I cl -efin rxwfir'tur al il: gr rn : frnrn rt?1 u

I

<"ttofr r)

iq " -!- '! e '' rfiau lnuntnrtrfrudaornnttilnuriounnnanu lrlu 1?a'lu1u E

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

)

Slfln,lln'l Sltahi culture

l

ao|r-tuuu,lRlt9lanrn,1:na

t?

t

nr.,'i"lo"ou"ourufriio*rriorun 85 urRunn

,f,u (Infecteb nound> 29 urn$elnr,liaiauo: 34.1 in 56 u1n$3lnnn

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26

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cd6al& -eutalt A lnn!il 33 u'lnl]4oQ,lnu"tnl|floyl{n4xR 85 u1nllgfl t45ataHn3 39.84. ilu:cuc zz f,eful finr:hnrfa1u1rsilD1u'lnaaJU.lnrnauia

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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qn4t

{ol.4olrr4'lonrllnfi 4 u6nlnerlfilfrudtal Itoilnu'luu,tRBelnnu Itovlfil.t-luu5:H1n1f,

ahttun n1il1;Hs t 1R1fin'luun

.l .lease yl $!ln?l

.l't3Hs t?fl1?lylrr Snab culture2A" rt! ?2 t\ - z iI

- q.d d Yrd d *t-ra1r tnn ll Hr 1l tllll

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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

.l1lHg 11n,lnfl'r

E .t o C J-n5{vrz iauoc ntit?13

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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

?5 urnunn llrfinnr:fin tr'a'lu1t{fiu1u'lo 49 urnunofin lfru{aunc 65.3dii .an .26 urnrstavriaiauac g4.z }inunr:finrfra1nr ,

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Gu lture n-uisHg renrilfrueuai1u1:snHT U,taoll

31f, Swab culture!a{u,lR119lfl

rgE3 r'rnrfiad1ult I tururaru

z0nu. iouas 721u. iaunv ziu iaunc

+ inr:fin rfa r*r (A) ss 47 .L LT sr .8 4 7 .L

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ornnr:nn5laun1it6lfifi1nui6 Sign test nu'ir:;uc tenrd4-deutl

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is

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6s fiu6s n:u1frir arlz r "n.iloTrte

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, fa lul:.inEir u'ln nru{rfuiilri"u"i*vrr I afi fi 'lus' ?r r :uc z iufu lu,c

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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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'

E.t5.21r nnnr:nt Swab eulture !aitu.lRtlslnnl{?l 2,3

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33

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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)

.lrtal6dvlaeir (ornnr:rln 5) ru?1 tianrrJ tuu:5!1R1Flrn?1r5lililU6nu

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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 34

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,.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

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.l r cly(e1nn'lr1itfi 7> ?rui,tisus rra,tnni?uad1ul:sfiH.ru1n fru6

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lrlRelative Risk, RR. llos Odd Ratio , OR. iiuenn'ir 1 vrni

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'lu1:snururn

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

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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

1. !u,tR!osndlfinr+rI

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

..\|


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

li -!Ad l" - ttn?unrl:nfin rfa " , 1:a-nn tfla1u3. slun- n1$li4n , " 5l!dR$1nunl r

, n1.t t?ril1 r 1:sf,lria-ns:6lriu 2523

u5:8l1Ufllllt

I

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

6 J Eon15nn ]itan1.!a1n1d - n1r6llr5?a 1[a'lua'ln1ff " ,

, nt{ tul{1 , 1:lf,Irio-n$isllt-H ?,52g.

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8. auintt

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" = " {.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

zzp (1-p)n=

+ d2

q

.lIIA n ; SrrU?Un?AB1.lt

z r irza1nn15'ls z -distributiondlJlsll,llll z = 2 lNa o( = .05

p + in:rrarfirur,rre - C ye

d E EOCtlltfl'ln?IHAI ln

.9U'UAt 1n n 1 : 9lR t*1 H A Ur4fl it n.i a n r 1 fl 1 I r n R tt n n a t t a I a { u1Rlr g Ra?'l rt a u

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 '

rfufra das'll"orueufr'rad'rr Jiriaunir 28 nu irocfla narrcfunr:o 6e alvg J 6 t E Ygdnul?aH $fl:gtafl lnasill=Hnn rilun')nau!a{noNrl:3t1nl?litl,lln ln


3g{

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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

l41t 1 b[ {r n ? u ilr nr n ? 1 il 6llr ruE$ ac til il n ? 1 x dil fl uE

n = Q\U?Ufi?AU1.l

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2

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n,llnisa,lHn?11|nIa!n2ltil56lA.JRAl| n:3I1gH'lslIa r = c = 2

/-aR 1t I nlHl|n',ll,.|{t ? I nl,.|sl,l

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ctraz=S=

+

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Rz

Orr

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Otz

Ozzt Xz

t?ll Cz

2.1 n,rrrdurfirfrnd (Relative Risk, RR.)

nCr

6lntJ

RR. = Or rCz

OreCr

't Copyright by Mahidol University

-.Jont16?u tR!n

a-<qtt aJ

f:..n. :n.

:. .i{:

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firrori0raoar

--r ll I

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a-9<n,.|tiuagH ltn

6atl1. rJlc?nn?1r rsurJ"u

2. n'l$l,ni{uocn?rrf;uinra.itu.tRrtitn (Degree of burn) . . .

-lo3. ?6?n$'lfic1u,ln

-Da4. nC!a{n'llUT Ur,l'l ttAa,lnU.lRllfln (Swab culture)

a99nlul,fu.ira{ru1R[$n ]lrnru 24nu. 72nu. 7tu?

.l$HAn 1

.l]t$avt 2

5. Hnn,ll?1.1tfl1u tfi1; lfa (Agar plate ) 'luui t?gur{d?cQffi rrarllfl'tuicttaRn 1 ...tt Copyright by Mahidol University

ffi43

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d

aR?l 5t.d

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6. $nn1lilrl ,$,oon air sanP1in$

t dlio-r,ru""7. Antibiotrict r

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9. Fina1 diragnosis9. 1 !f o inf ection.9.2 Con4r:nity acquired infection-9.3 Nosqreonial inf ection.

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the study of relationship between microorganisms in burn...

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