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Appraisal Quality qf Care in Patients with llematclogic Disease
DuringProtectivelsolaticnandLowResistant
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Copyright by Mahidol UniversityCopyright by Mahidol University
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Bhesis Title Appraisal Quality of Care in patlents
u'ith Hematologic Disease During
Protective lsolation and Low Resistant
Iiiiss Pattama Prasertprasart
Master of Sclence (IVursi:U)
Department of l{ursing
Faculty of Ii,liedicine Ranrathibod.i Hospital
l,{iss Suthapun Jittipun
i'{ovember 15, 1983
(
Author
Degree
Department
Faculty
L{aj or Ad.visor
Date of thesls Defense
Abstract
The purposes of thls stucly were to 1) evaluate the
quality of protectlve j-solation care that the immuno compromised
patie:rts which were admitted received. z) to foIlow up the
problems of infection encountered by these patients durj:rg
these period and the changes in neutrophils count including
r,'he compllcations through out the study. The subject of
thls study lvere 5 patients lvlth 2 cases of aplastlc anemia
and 3 cases of acute myeloid leukemia vrdro had neutrophils
count less than looo/nn3 and total leukocytes count lessI
t]nan Jooo/mm' and vrere in protective isolation room infemale
medlcar ward" r, male medical ward r and rr, Ramathibodi
Hospital, Ifahidol Uni-versity during periocl of April ]O -Jwre 25 , 1983. The Criterla apprai-saI quality of nursing
care were modified. from the stand.ard of care developedCopyright by Mahidol UniversityCopyright by Mahidol University
P
by Infectious Control Committee, Ramathibooi Hospital, and
fron llteratures. The, i:rvestigator collected the data daily
from 7.00 Airl. - 12,00 AIi. and 1.00 PIiI. - 6.00 Pl,,i. A11 patients
were studied in protective isolation rooms, for 14 consecutive
days or less if the patlents were belng discharged or were dead.
The quality of nursi-ng care was based on Carter's standard. of
nursi-ng ca"re.
The present study revealed that in the first criterion
whi-ch concerned about preparing and utillzing the protective
isolation room and the second criterion vihich concern5:rg about
the technique and procedur.es d.elivered. to tlie patients were
rated as moderate in only one patient and the others four were
rated as unsatisfaciorlr. B activities of nurslr:g ca.re in the
first criterion and. 10 activities in the second should bc improved.
The third crlterlon which concerncd. about t}:e care of patients'
personal hygiene was rated as good and as moderate in 2 patient
and. the others three were unsatisfact"ory. Nursing care in 6
activitles should be improvecl. Finally the fourth criterion
concernirig about the care of patiunt vl"ith fever arr.d infection
vras observed ; I patients were rated as good, the others tuo
were unsatlsfactor;', there vrere tv,rc activities should. be
i-mproved. liJhen consld.erly the process of nursing care in the
4 criterlas, 2 patients Yrere rated as moderate, the others
three were unsatisfactory.;
Copyright by Mahidol UniversityCopyright by Mahidol University
The infections and complications which the immuno
compromised. patients encountered during stayed in the
protective isolailon room 1,vere oral mucosal infection in
a1l I patients, wound and skin lnfectlon in I patients,
respiratory tract inf'ection in 2 patients, parasitic
infection in 2 patierrts, urinary tract and central nervous
system infection in one patient.
I
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6 Utatignant Lymphoma, "Sciences, VoI .258, I,io.2 (^o.ugust , 1974), pp.98_99.
?-Carol Singer, Mark H. Kaplan, and Donald.ItBacteremia and Fungemia complicating }feoplasticThe American Journal of l{edicine, yol-.52, No.!pp,71L-717.
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ii aunr u'['u r1 {n1uru1 r nr t r"[ r] rfi nrtira'lu:rrn tra yn r y r rr1 y 0 1ir1,, {urr,,^ ii,re]TJ n, vudlefifl unv r fi nnr r fi n, ff ,fiu u., rJ.{ffo r un xum rvrh tru:r otfi r 6 u
(ciria) 'iur,uui,rr tr fiu'.,rru'h doou *iuo ilu rdol, n?1rr1 ri,lru,h r irl,tu fir* rr ri i r fl rrnr rfi n, dul r.i. u6u orrf n r r fi nu. i,irur,, f o uiuui,. r r,rd o.:
1"ruru 360 11u,nui. rfinnrrfin rf,a'lut*rdt.rr, n':iinr+rfr,r.adotu^.uruoi."',^Y '.i^ x. x-rluluvr\:liiln lLa v ui,lfrn r friilu r r uyil r flufiimL , y]J10r 15i.2,3
4. nr r'Iil rrd i nrn, iruar [ ]i, to\in 1 r, dru, * na"[ nil r{n-ui. on.u(uost Defense t{echanism) lflutq,,n1f ruA\rfrfO.fltnur'lu1u1nd{ "l( i'4as s ive Rad i o the
"rpy )'luii rrr,, f o, f,.i.fi ,r. rdi r r-,, ui fnr. J ruf,t_. ,i
i.:frinur rflloih'iffunl rflrr?.r,u^Ju* f ..:lurrryr-iuirr,fhyrnal{ .ir,i.iiruTI
1' Bod.ey, Bolivar,2
.t'e1O and 3odey,
3-_-Bodey, Bolivar,
and I'ainsteinl ep.cit., pp.l-96-197,
Loc , c j-t.
and tr'ainstein, Loc. cit.
Copyright by Mahidol UniversityCopyright by Mahidol University
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l'JU lz t'tLJ r.aUliguuIhe[I,0[1Ur.dj Lurdul r\ r.r c a- -- -,"" -v-H rrrgstur4ul r'-ru BtL n*uulri.r*,JgsuuntJBUJ B0t nunt"0c$1r-du3uuuul$ t'0uktlu.nrtc,Ub3lfrt;ulluuEt-{$uLLJn1N3lf;6ntpfi
trTuH J l"uL),mnjl,l \u ,tr l ugg uut E, tlt uk*rilt i r,t,-,l Ldr,rr l rJr.dt uuNun N*,r,, r rurrr bfr I r In,
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Lr-h4purx,*gr ru'
oJL l 1., gt uutd u 1 t4t €ttl]
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ru[uurfiuyitot Ir
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rii1l,",,ns- r, ffi :;ffi iJ "ffffil 3;':ffi :lt'ouBuut\tJflu.tt ourrru?rruur&2u,
lln]^suuruonrurjfriu rurglr,E q.lnguJ Uuu0r4urtlt:* rlEru*UrJ r:urr:nugppun,,lrr,uuuo uuuj1r,til. , r*roruiorfuffiIt1"u.ra b nunftunpr [u rl N0 ri: LuuuL i- t z i = ,o.rlugl J'uuilr,ul*hrJru .g r ''1
nuuu'&urr,lu.ir.dlrnLu r f urpprnrpnrijjJtrru -r::ff:;r.t:::ji|}.r:r:0u,=uu,un,rurl,tu (.(docsoqcuo.rg) ,,uuguhnuf?t0uuneiislu n[,1
t r*u, tt r o I r
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ilt\i lJ U te uc n rB Ld r Nuruu N nM r urru,*
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Lr^B r [1
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vAAn1rfl-frt?0?I0'lrvr-rlJ'i41tr6uflnnr:r rr ntr nrrfint{rr.orruarrayilr.,a.,rx
?1 -vr + ni ': nrrfinrrrilori r rueiur;flu,rru{uo rror "1i1rlri,irin r: ntt 11CIfl?1nX-l I I ,l - ^ X o r v y tfiti'.:"[!vrlrutrua.:fiur',:tctntrfint{ofln >+ nF.': 'lurr*rr'erurfi'ulrrmerfir,rfiofi, 4v ^ v | .- 1'l
:Jonilo'qrrrfl1ild.idn fio ze,I ,0{n{tt1'[il,tn nalfir,,rfforo.,roiurrfiu,,,.Tu,ira,
rouum*rfn 15.3'fr nrrfin,{urrouilairayfiruft 14.4 udn*iiuvrrrrfiu:Itl.arryilfrrrrrr.uri.*. F,a t,ort doo.r,fiu,,,r,.,rrrr,]fi,ln.rrf,fl',irlr r v oon ,nfl 'a 0n r ra1 r {u6..: nn r rLl u0 0n ili fr ,u,,,.li ;* r rr.uiurd^,y I wl .l! I - inrrfinrfiofi:Jrn',,,,'[nuouurn']riljrunouf, n,rari ue :nu; (rerd and 0thers)u. ^ vl , I o - I-[nrrutrufituilrul,
ri..:qioruurrufio.rd Lfinnrrfinrto'irinryua]afirr r1]J 42 ,1uvuufifiartu0lu1?1nrrrfie,r#ototrjonrfrt 32 11u rlr.r,,funrrFerr.{uroo,,uu,,^,
fiTaritrYu ott t finotn nr mirfi'm,u cuua r finfin r fio 'r,,to r frnrrn u fiauaq*lfilanonffa
r,,r'lra r finflu? r rorfi ruri.: r raa'tafra ( cer ruri ti s ) fi , fiunr r6n r{0,0.:t, 1r
fl Tar"itfr'nLruor 1r1'r rl u r fi nornnr rflu.,urfiru, , r f t r ir r iulafir,nrhnay ,. iruunvl.lsdqillula r urfl a r fi olnu r au uav r fi ernr rfi r'r r
tludu nr rl:nutlfl?ru r.,af euri.u,du,t ir r iuJafio,rnfi,,.lil,ra oer r doernrhfrn rarrLa yfi r,#016, olru
vl 0Ail ,r!dn1Ifln tijfl01J "lytt, t l ., - y l I v z I
t'[uuounit'IuurJrunntfl 'lmrnt o Xs I 7I nl tnn t,ro [u,rrti'lfio'lu'iio.r ilo.,: rr ay orofln1 ru ra
*ul .'*,1,Liuu u irluii.rnu'uf,I
n 0{nr v r }^rl vrra vahlX ,.'Iil, fi*,drrriuo ilo.r ffn ra:..r douiru , rJ.f,r ri,rrr.t '",I a.J r.^rr.ly
rrtudrii,r str6 nrlfin rd1l
trr n t ri or o.t r vuul r vd lyrd 1un0 r.r fr ,,ru'i fl trn"l :JL r urin i'er r r
e'11 ud{ r,ru t 6urfl'u1 r 2
tv
Singer, Kaplan,
2Feld. and Others,
and. Armstrong, 0p.cit. t p.175,
Op.cit., p.1OO.
Copyright by Mahidol UniversityCopyright by Mahidol University
19
yo? I w I tu'onorniiurJ':ufi"[n iunr rilonn ru'[rn r ,nn fifl:Trlzra'rfi'q r f urriunr r
w l * "J :l
^.!a,-!Salfliltx0 t\:u0fl, [ue11t ttav t:dud tf]il (loaey, Bori-var, and Fainstein)"lirruor,.,zuonr rfin:*'liir 'iuil n. fl. 1 979 ili.rr.u.u $ r1u d,ri nr:r
,t.ul
n't ril4n01il"ltn t v nn vrru 11 r fi r'rnr rfin r fio"iun r vudlafin t fl0.:lrn uunfl r i utflntJU7'tvv"?xt'
rrnrilaurrnrrfrOrl r?il 49 nr{ d'rrrrqiru'lunoilfi 55id dr ruqraru'lul}jrfifll, a Y "'
?1niloflrJ1il lt.n,irdtr +: nF.r rraruanrrfinr+r'lufl n.fl.1977 iirruniotl
d5olwlt:tnlofiqrirrl 1oo rrufi'lnvrrmrilanntu'l.rnrrr,n 54 rlu rfinilorrurruay
,, i o, r ^ '{ .^. It ilufriernr':udlruniin.: 34 11u rfrofinuarulr,lig loun'lrlnrrnnrla lrfaI
rravfirl!fidfin trn?"[rr (cytomegaro virus, pneumocystis carinii) 1
o Xof 4tunfl 0 { t I0"r4 t Llu,6i1 t14fl
r{ouunfir?u wuumdarl.ur!ilnyrf,ounruau 1o,,ri frlnlatss a ) a. t I v
alnlutrua ttar tnal traal fi.: rlluf,qrar'lrarg.ro.r1r..ri,lu1u,raff iiJ'lutnryfi!., ,
ili rrl t o r 6 onfrfi ri r do'lun r y udlafinorn rH,run r uau n1 r ilu,rr rr,il r nl,lfi ,,u,lJ
4.y.--- X .! ", A x t w t vilo'qi mfl rud.r t fr oLtn t urrnfi r iluar ru n?o.t n't rfl n t rom nfi rln'[ nirn t fi odttrrul1l11-
filanonfi'a 0ot?uri (staphyrococcus Aureus) 2 'lutr.:fl n.il.1953-X .i- X ,45 v. ,-t . r.,' A A1963 [ ']flrr,n
rt.luln lnut a;,lt y r rod rrnulil tanon 6d 0o t T ud mr"[u r frnnr rmo
E o rl 4 I v I
t i,0 lrru]11 1u:J, I f {fl 1]11}lr t ra6 otlrnfr an
v EAafl11.1 Oflt10l1U?']fl t SdlnAfln..l
I r..: iruurura,l.o . d .,in. r1iu,Jf;ft rurdi,qrdni.o fido r fi nrnr 16. r {oorn
1_'Bodey, Bolivar, and Fainstein,
) .l -4e ^v a'0uol-lt1i .nf funa , r'ru artg,]c-tn1, ,lv9'
alAt ,0{ t elil, U1)1 73.
llvlv za .t e aaq vf'l 0:.J''l t 11 oilf l 1, t 1, t 1tlljutrAlJfl Xl lU 1 { n 11 {
'lrr* rii r * ou n r mu nar u r fl urlqrar d rfrc;1u
Op. cit . , p. 198.
allra v Lrd 'td, ri ?i41 ,
Copyright by Mahidol UniversityCopyright by Mahidol University
20
Zt t vltnrilauil1nf,u | ['llanrteynnl, (I'eld, and 0ttiers ) "[o,tfu.:fufi.]nf r1 '1, 4 4 s ^ r t ,l A ^ X efrnuruilrurv t ; { t fr nl afi ntrr I erunauuu{ rnnnlrnfi rso?1n r 6oaunufil an0n fr'dtlt
c4l^oX<-i1 lloot;ud 6nnaltfrErnrrfrer16oornalnrluuud ff.r 2 nailou'iur;ucilrlflrfirfiult,tijItlAAX.esvolf,^.. lruullnaill/tt nnn1tflfl [t0?lndrLnvlv,l tanonnd CIo t tud $1'.1 t 1a1yt]Jt1floud{nl,l! xn -
-, I ! I e I - r v 7, rA4cle6v^S.l4lvtCrt4v-6.1onnalJuu.t0u''t.tlt1tuttr'tnu tuJl'tn11yu1tnt1^ltuu?y tuernu uon?1nuu.:y!u?,.l lil", a. 4 s A y A ^
I I vl. a I
Qil?u:J, I I.: rrJn inum"iit':un tnnn1rE1flt60?1nalrr]urrua dtuuilruur tilerouUtIUv9rv. 4 va /{
u1 [ 1t0o { unel n t ?J0 ?']n r 6oa rrnrrlfil a non fi'd oo t i uo2
rfiolrfla d*uru, '[i,,n riu (Herpes simplex), gdinr
(tterpes Zoster) trnv'ltlrrrlnnTla'[rin (cytomega]ovirus) r6,I V I v I - t, I I I I
r",a.rrfirJnfiflou[n1'lur 1'lrrlur]iliu rrn'[uilrrnq01n']r rfionurGan'txrro{f ,n4 a .. X X .6 v v I vt te
annlsJn Innnlr et0tt rolu ft']1,1t u.: fl1nvrurrfld',rrr rdl'luurjruson?fiu 1n'u t our:ttrr,lrI I v vl I v I
t fl oau"lur r u r yr lu "'1 fl 0 {1 r nua r ryrJ
ru fi1 or iun 1 r fl 1u i { fi"lu r r u r r r a r'[ uu rufn4, v .4'd- ' 9 s s \4 v
" '?rrllu{d1fl [0r]{r0un, 25 -[rlnrlnnrln"[ria Hu"lurrilrdflyt.tut0{frn
tlvyltt
t sufiu t'n r r r I nru iln6 un r'[ r iatfierfifi ou'lur 1.: n']u1 eril'[u rJ r rn go rn r rl/ 7t
[ fl'], r ur dnyl']urt0 s n?TJnluyt'tul t nuoua.: r6ofilv ana'til"hjilt r,1 t frflrryurGanrutt
d,lu. uu, r flu ru,"lilfi rurlnrr il'l;3, II
tr'eld. and Others, .fu].[., 1l.104.
2Loc. cit .
1 c 4v ^v ^ el-t'tt-toil11, f1I"runn, lnu oqlt1flnlt , [tartt'i{{df u ??11,1''lq/
tr0'ltfi:J, 1,1U1 75.
IAtlJo
a"ivrir [ilur]J{na,
Titrun, r ni{r7l?,lt1td1r,
o"Y^
ry, (trutlntlYt 1
2522), UU1 26,Copyright by Mahidol UniversityCopyright by Mahidol University
21
L
,.nr.nf,,iofllrn 6utr,{nt6ua 1:rluirnrdlofia (rnrectiousI v I el I
mononucrecsis) 6',rtilunrrfie,rfiofi"lt:.r'leruou'lunrrilr; ryrfl iarruqrurlrntX ,.4 e
tqio 0.il. trfd (u.n. virus = Epstein-Barr virus) 1rufi*rlirlaoet A r a s Xl J 'o o'luuilruuv r f .: r fiErlafiqrtrr l nua rl r fierl r nilnou r vu; uflrtror?\::Jo1n1, flo.r', z r A A c 4 z q o t v a s X
lJvtr.ttlJetIauflfl')1 ur0i.r01n1tflo'lul,r.ltilfl[auflt11noil ltnltnntrnllnl!il1
^ o X ' - 4 4 \ ^ 4vlu X- '"
t a I
uf o t nertiutnrolJ Inuur t , 't [:Jn launt trn [n luruu.tou tut;utr.lnltflnl]1?1X " d vl -\ol - " ""'a 4 zs. ' o.lt1Ir0 0.1]. tltdu 3Jd1lrtflu1]11 [uInnil, tt.: [:Jn Ia]lflfl11etluuta tu '
X ^ X ^1", j I v
[5or l .fl1rneltr0tmfretfrrilutq,/lr;fr ttu 'lur]rn 6u rin lfierlrvl
? 1n t 60 u,nu6r' r un; iilc#u"[ er'l :r a']! mla, v I I- 6- A A .l 9 .v
uflct1 t ilunrtnn tsof 1iln r, 1'lu tljyl 1l-t4qi.-tr]'o.rrv4v, 1.: n 1 il riu r r r il urlqu 1fr ',fi fi'q ra, n o' [u t fi n nr u u rn ahu tn' lun 1 t in M r ilu6'u urn
I I A "r'v I I Xa Y.s
rdo.rorn"[r]^.u.rnilr;rrr??,/IU'[;ff{uolurn ita;tdoe,rmru t{ofinrrlrul*a'rI I Trtrl 1, lt -t, vl
r 1,tn1u rfluor traqnhfrqfivrh"lr,rzurJru rdufiiqr nrrfiErrfiorfierrinulerurnluqrJru
dtie.rtltrJ.on.uu.,u,n,,1u,d, aru'lfiotat d1u'dlurlaarx'1I
?1nr ^ru{1u30.1 ldaer ttarm[t (rera and. others) "lufl n. 11, 1g7 4t, I e' I v I V.4,a"AcCCAAA
tfl , 1U':',lU1',tUlJ1UlJ' t I.lgtCIUu1 lUAo{ y,| t dUSffi ?1n n',l tflgt lfl 0 1 04 t 1u
'l o'o^ .. X i I ,. ^ a,s vg/" lroitrjl/rt'dusmild']tltE?mt50rl 1/l?l1j!1nvrdnno ttnuflgl1lta3ntill,flnannd
r I I vl 4 1( cand,iri.a aud cryptococcus ) ttq"r rfio rrJiuu rfiluri'unqlryilruu; r i.: rfrer
Jnfirrtrruuti.l*riuuni. ,u,r.r'lul,]1ulrv r, i.: tfie,lafiq,t1l,,,rtttdurr^rfi'tio' ) a" I
illr'ouav ?o' ?1nriu':1u3o.r r{tno,, ttnilttnu ttntolrlJdftr0{ (singer,
Kaplan, and Armstrong) ", '1 a a < a 4 ' ', aluzuilruu; I r.: t ]rer Iauqrgttttarltr ! r{no]Jui tuao':
1'Fred Rosner and l{ans }/. Grunwald, ilInfectious Mononu-
cleosis and Acute Leukemiar'r The Journal of American Medical
Association, voJ.246, ifo.16 (0ctouer, 1981) r p!.JI.1TII.e4.
'r"ru anrl Others, 9-p,:.S8. , !.104.Copyright by Mahidol UniversityCopyright by Mahidol University
22
lt,C^AAutnetnlr9'lfltt0 rltJ 108 r1u
A44n1tflelIsOr 1yttuttr,:t
IqAnqfl t nn?1n [.rorrod [ 1 t0,
a v q t/l?aad ttariLnufletl (Aspergillus and candida) ?1nn1rnr??Fiiluiltu-tX I o o X f,rt .^"? rnnilu 42 r1u "F[Jl',] 22 r1Urilernlrfrert6olr frllunurtnnrl?l!u"[f]noufivl v l. v I 1
'61^lA{'ivl4u:Jru raurirfl tfrofrqrr??-tnrln unufrnl , uod ri,^roria6'6 trayda]nvioralufia
s) u1,rr1uflr#ortrnrurfirrrrirfir du,flrn,.,rr,lrri..r raill. vsl v v l,
I Id "O , ..1 .la e A Av a vAe)- v A 4 d 4ltllll"l L1,1UIJ1U t d?Jf m n'lr9'10 [ sor lu]Jn t nfln1uud.: li-l,u nf r Inuf ntf frnr t fro ttttnli t r u:t -''
'h,,il1 r#ortrrn uodrl,{0raaffri rfiur#orrfiifidulnurn uirri;ia.,#uai,
Cd{12 rlurrr?,tu{ l rrudeilT;rl*riuudr;rfiufiiqr d,rdurr,tu?lnnlrerr??fl14rvl y I e4,{ A A . d c A < ^- ^.. u -
Xfi flnr r 6cr r 6otn r ilo nr? lnuu nfr r iu r doin url uru n 1 r"l ;iln.i rur"[ iluX rfnfi nr ro x ^uqilrudfifrrJErrft rfiu uay'lilutJflGru;e,iirzuun.*i.:d,tuoftn tflot1fli1ulJ,'t t
ttinrttnilnfi n1rilnil.:1101?tilfi?1nrfrorr rflu tro.dtilarAafrtt uioilrnror"[ulnrfiav7'
(liucornycosis) rrarnrr'lunrlinurnrru rroillv{ryroifiu il. (Ampho-
. *'2ter]-c]-n 5/
(Jameson and others)'[lr,lrorrfi *q,j.ru, ri.,r rfinr]afiErrrr do,r.rrf,!,I vtv 'o s u'r-
d .t^ t .4 t A f,r - A v 7'
nlrf nu10u [uIrtr,rururn uaruil?urdufriarout-hnrerfrn "luiufr I ufr.: rtrllul- ^ I .t/
0{1u1r.:rlu1u1a il4fl1rqu i?F1}firul1f,uua r firr6u"luoir,:;nruludrr.rq li,,rivttvv
ilonr rir'h a1r'[d qi'u rJ1]J '[qr rra;fi?nr6orreonerru eJanlr [fl1r tfiurrnlrt
ttun'il!?1 tflutda'lqrrlnArlorou'[uroa6 (Trichosporon beigerri)j4,Xot.^^qlolr,ojer{ t llu t r0r 1}tOilfl'luilnrtut t 1u I nuililt[a, :tu30\: , 1.:n,]u ilot"lu6utta; d..: ur eraoulr - ---r ---
Singer, Kaplan, and Armstrong, Op.cit. , p.715.
2Ibid., p.740.
.v
^Xyo .l v o X -A v I
uon?'lnuil{ }J t't u.: 1u t nu1 nLn r r Ern tfro r rqt'r6u t er'..: t gu t ?:Jfi',utta, nut
.Y
Copyright by Mahidol UniversityCopyright by Mahidol University
a 23
:-sYl^r",^y,rrrlnt r i rl r ? 1dn1u'iur 1{ n1 ul nun 1r u1 u'h nl rfi n r#ouar ur,\ rn r r?,ru,lilfi,? r 1.:
n1ilr'{,#unquanrto,lruu.,n ;-;;rrr,:rufi..:nrrfir,#uf, ,fiu.., 5,1u ffr,r,.,,.:^rl "11. .l.. ou v I
r nfi [uuil1u frInr r nernfl gurYuour t, ilu, { 1
nrrfin r #a r rri': r flurlrur.,dolo r do,r'lunr r inurfijru1 r n r 6oer n r r.liur::^-..^^l z )v t o. i I ti
flfrru;our': r frlilfr..runurn rilufrrfinrrr; i.rlr,u,o.,.r"luiirudf,r,rrrfierrjnfiso,:
t ^:1-.r.. 1 ,. .u)e o 6 X
nunufurra: d.: r aiumr'tr,l r frernr rfie,rfior rr1!rJ1 ua; r fluar r rflrqdr,.lrljrurfiufiiqr ,,rljrnrrifirfiunrrfi^,#ur.,ffo,,ol*rnrflud.,:rfrxq,,ulirr.-:,rar:a*ir
ur'[e,urn
t#ul,trlrt', d*rr.nli,,,l flrlr6^fr^ runi'[u uaruonJr,raraJufia
(Pneumocystis carinii, Toxoplasmosis) :ino;uru'lurrryila, frdolrnul/l
onau'lillrntrarmuri'uflnrrnr,4liqlrYu ilr]uiada uni"lrr :inl: r iluarr rr,r"lfit!!
rfier:Jonruu,,^rr'',1,iuirurfiufiirr nrrifiofulrnornilrrrfio.,fit,,,.,1iu,,,n,Jrfi.u,
1 *u aq-rtuir r #ufi , flrar, *1 r,',1,1 r fi nrn rrfi n, #uu.n tq, fiu r #oirunfi r iu-9 I y
r o{ a.:ut'[e un'[ ria uar r#o r ror rlarffu ff..: r duuonr r flnur r duti'un 116, rfio^
't d I 1)
'Iuruil':uus rf .:erolurru6o.r j50 rlu do,,rufr,^rru; (rera and Bodey)-el Yl I X o ^ X vX. v r . rrru{'ru trrr ryrhurualilrfronrr6nr6ot,r'.:fru 12 ,1u rlrJ 1Br nri,r dru.tuq
.(, - o .X v A e tu. .t ilunrrfrnr rfrora{.:ornfi rr trrou'lulr,:r,rururaua, [ fiotrur'li r nf,inr+r
1 Beryl Jameson and others, 'An r,expected fungalinfection in a patient 6 leukemiarrr Journar o{ clinic?1Pathdloey I Yot.J{, No. } (March, fgef) r pp. 267 _Z7O .
? .a ,,.rv Ay A-CIuour1r firsuna, rd'u ofrtmrntr ,jo'-,ruorud..:diu
?31,r
-4 <l y i 6l vtr0.: tnu?nil uutrnurilu.Copyright by Mahidol UniversityCopyright by Mahidol University
"lunrrfin,r#e 181 r,t,,fii"vfiae'60 1c3 nf,: 6e,rflX.r -l j o
t "r0 t 1, d ilv\lulJ 1n ilfifii,)0I
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dhrair r#ud*,r,juuua; r flut1r nrnrlr,{n1rd. r#u1uqj2uJ r n r6oer.-i/ 7, l"tE traert"[r'iufl,]r 1..ril 1
- ."! .X A 4, A X I r - t vt0l1t't.:11 1 fiurr3o': t60fr.: t[iudrtuflto{mrfrflrfrofruulroulunEuenJrulrnr6oer2
tll
24
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f-tr1?1tlt rfi0r?lJ 133 nf.r ildr ri,irrtrllnrrunfi tiutrn.lAavlvVtt 77i; n1tflpltt0[1tdl,^lLto\ia{}Jlr1u 24 nt: = ta;;
.,y_ 4 yq y t o X.l'd?pt l,^tU0..l ?1 nr.i [u 24 nt.: tilun,]tfrntfrof fUu
lJacterlaStaphylococcusaureus
Staphylococcusepld.errnidis
?seuci.omonasaeruginosaEscherichi-acoli-KlebsiellaspecS-es
Jii bacteria
L'!ycob acte ria ?arasites
2,
-Herpes simplex
-Varlcellazoster
-Cytomegalovlru.s
-iipstein Barrvirus
-liepatitls .&.
..Ilepatltis B.
-Cardidaalhlcans
-Candidatropicalis
-Torulopsisglabrata
-rispergillus sp
-I.ilucor, iihizo-pus /rbidia
-Tricirosporumcutaneum
-iiis to pl asrnacapsulatam
-Cryptococcu.sneoformans
-liocardia sp.
. Tubercu...l-osis
-i,i. i(ansasii
-lii[. Ilaves-cens
-I'i. Fortui-tum
-I;{.Intraoel-lu1are
-?neumocys-tiscarlnli
-Strongy*loidessterco-1arls
-Toxoplas-magondil
tr
7,
6,
o
cl
'i 0.
Bacilluscercus
Lis teri-amonocytogcnes
legionellapneurnophilalegionellalike organisms
-Ilon-.i. , IIon-B "
hepa-i;i.'bi s
-Influenzavirus
Y 1F"1d rrr.1 Bode;r, 0p.cit, t pr4.
2Bo.Luy, l3o1j-var, and li'ajnstein, op. cit. , p.199,Copyright by Mahidol UniversityCopyright by Mahidol University
\ 25
n myilil rr rfi r rluun; n rrfi * r#u
ilrJsr rfi r iju r fluo.r o',.rr, nurrir.,iqdq.drr,iirfinnr rfi* r#r,,^, r fiufiipr1t'ryit'1 t n t fion ,irr1ri,,Xrfirlrrrfi r fiu r irurro ornnrr,lil r ,rrfiini+r doflqrd
nr'"hnr rerrr urnornryuwu rfin,r*nrzorr, r n r r.,, dl,i^.,u.rnairrflrJo,finl.finr1il
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u? rr ri,r r riu r ruerru d,rr *erru g.rfi .r + oz r do r :,iuu r fi uuryudn nq rrdo d.trlfin., r,firlqrrfirriurfie,nrrfirr#urfiur ++ nt: uovd-nrrnr u ,, r e
fi n r ru0 nr:rnfi , o'r r fi r',r afi qr s, ff..: fi rr n r fl a a r,,it rtur'uJ;rh -ry ffi ;nnn{ ttarhl,t}Jflltrrn"luntryrh.:1t " 7, v t
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lrl :l:':rr:-flrl,rfirfiuururfiu z iuoyr drouiun.rfir,duu.n .iur*r,fir,
;1tt'r fi f,fi ,rl rI r fi uua, oru ruro r fi rrrrrfi aar,a o, duu r nrrfi er, #ur, do,duurn*'lu:i'"':fii:]1'lunrr frnr",xjrr rr r.rdo rflu:.,, r frro.-r rfie,lnfier*r
vvuruilrunqufiiilrlorrfioro6u;1njr roo7u.r3 rfiErnrrfin,#umj..,oru,,ro
)*l] lt: 'lu,irorru. rooo fu rdor:iiuu,nrrnrfrirffi;;#;
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rooo iu fi{rvuc,ru,',d,fierfrr]orlrirfiuuru,ri,,t, ronra,duoulrn,.,,
)r-
Copyright by Mahidol UniversityCopyright by Mahidol University
] 26
nYr<*iXlr.rtfrr'' rfiofrfi,rnfr"rfiu r rriYu uon?1nfld'nrrErrufiti.':6uri'rorurufiil,rfiairu,
dufi,u
:ou nqux,lrufrflr,rrrfidrirfiorirn, rooo/:*rl irr.rrufiflnrfioar,llrrtrfl1n{ t f ou t d'Er*nru = 5e;+ ,,uinqudirir,i^,du6u, d., "t frrrr r'iru32.u,
l.ur:ru.:ililnrfiati'riuurlrn.rinurirumrLflfirur6niru,du lrnr rfinurfil, r nuu,r'[ufiu.,rlgirudar,#ur.n,,u nfi r iurf;'un ril0u xjruiflflr1*r,nuan 0.r ?; e]ouduo'r nron 1 r'lr,ru r r fi u.r : u;
^ iruxjru dflfi r1 n rfi u iofi u*u r^uuo
nonr r'lur rfi r z+ia orn nr rfi n urJ r,u''riiu trfi drur raa ruur.r .ffi'uq1jr un Jufi ilfi':l'rfia,durrnn{. roo/nu3 ?yflouduo.:riun,.,rrnr, ;r,r.rgrllarirrr,It
::rr] rool,^*r3'[,jrur.,ruuoulonrrr-ni, Xirun{udtrnrrgni,i,r^r,J,
n:lr:^rrrr.:og" arofio ,,uru,j'lury141,.r{ rniul:lgnri.,rlrnrrgn le,u,lilurnr,
nfiquri'uto.: m':nrufi r fie,'ilrlorrfi r flu'lirrn,,o, , alruulunrrfin , ;ot o.i^,u ?1n^-- j- ^ X j,n rt fr nilrr,ru tt a6ia ra,: n rrfr er r fiafi r fi *#u1uXirufi dEr r,,1 ufi u, ifu, firdilui
'nll!rtar lur 1{n1ufl lrJrl rusr6iiu t ot 1,2
nrrfinr r#onrr"lul, {fl ulLla
nrr.in,#urroxjrul,ordrrirr1,.,,J,Tn r fi'1uJ, {iiru,rrla (Noso-
comial infecticn) rrnt1u..11u?0{ ,nr^ui,,^rruf, 1r"rd and 30dey)o '1 a I e'luuilruur rf rEronr-n rudotoruru r.r r.ud, fie,nrrfin, r{e nrrfier r#urfiru
Ibid.2phiiip A. pizzo, 'The value of protecti.ve rsolation
in Preventing Nosocomial rnfection in High Risk patientsr,,
, Vo1. JO, No. J (I{arch,rgar) , p.5jz.
Copyright by Mahidol UniversityCopyright by Mahidol University
27
fforr*,fi',#u'lur* f,'t. tt r.-
..^-,. r iLtr,,izu:-r':urt*rrou'luJr..1r/!u1ura1 uantlfinur,o,rfru,nur',
ttnuttaurtarall:Jrlftr0{ (singer, Kaplan, and Armstrong) 6r,.,uoarjazu:Jrulu r f .r r flrrlafifl? 1?uarlr* iorur,l. , 16rod r frn,n rrfir, r#o l oB r;;Bo% tililnrrfinr#rfirfinnrr'lulr{ilu,.)u,)^
6n zo.i,,flu,firdl.rru,.,r,r*un1r':uurura Jr,uuanrr,*,',r,#u nr??vru,#u1iuy,,,,uiiu,,rnj;r.;;;d,,;Jr.:nururo2
l.v
I 1 s nr t uorfinrrfis' rfio1ul r.:lr ururai]d.qr r,.,q,,frr,?, r fi'orn i 6n rr q*ra inur
ul,?urnu'rr.rr rrlr ?mr?1lru1fi1ulr.:Irulula,oduofirrodo.lu do,,rruu,
a1u1,ue,,urdu flaofl?unrr1iurrfrfia, ua,n1,rlontiruduoflu,ura,.uj*X !' a, a. X ).v-. :,
jU:U r fluar rlirJ,l?, flu rAuil* irornnruuon (exogenous ) ,iu r #rdflr,j,,i,[utttnruErurrrurtfi (Endogenous) druiuar,ru,du rniuro.:nrrfir,#u1ulrt, rrrr^rYu orolhrrunounlf,5ofl:,+,r I
1 . r.n, irr,l.fi"lulr{,/rullla|
" t I v. ne wl
a 1{ u0n0uuty r r r [rl"lunr r oua inurXrJr u
' .!r t t -o I
[ ?1r4ulyr Lr t nr,: nin"lu t ior nrru ioqi'r, r.rr,.,;i r o'.r fi n r rfi o, #u u,],,
^,
Feld. and. . Bodey r Op. ci t . r p. 101! .
Singer, Kaplarn, and Arrnstrong, Op. cit. , p.755,3Bodey, Op.cit. , p,)4j.A+*3odey, Boli.var, and tr,ainstein, (Jp.cit. r !!,t97_I98,5.rrrd.,u""
Walters Kirchner and Christine E. Reheis,trrwo serious cornplication of Neoplasia : sepsis and I,seminatedfntravascul_ar Coagulationrrr
,Vo1.17, },io.4 (lecember, tgaz), pp,595_597,
Copyright by Mahidol UniversityCopyright by Mahidol University
28
lv[fll] nrrfin tfi.ruo,rr.J,,,r''r': rfiuuru'io ,,*r,,u,J,6u,rrl.,il1rul,u ,,i,,u1,uo,i., u u, i.ri.i,ldo
^
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91"1.1 "130.:r1{il1tJ?rllhntuntr:-le.:ffuto,tr1{fl1ufli1lttrtttrfi (Natural'
^e ^ Y. u I tt Ibarrier) Ltavt,rh"[tltfinnrrfiorfiofiu n']tdo,ina0{ il1uunoflnl (Bronchoscopy)tltlt
n1, tftrl4014e0flrll.ll'r0 (Enaotracheal intubation) ttaynlrinurrfilrri'u,ruuvr1.r rfiur,rru"lp,,,lu nrr"liuruo.:d1, r14alr,urorar#u (Aerosol and
Ilumirlifier) tiluer triqrlo.mrlrfi. rdu n",r'li,iuraoflalrn0?yuh ror,#uoi.o r,!:.^-'.^.i.^^- - v .o
t r.l
l/ll.JauL,, t1ilnCI ua{ne0d}4d ttnvtllu tdu{ (ctottis ancl vocal ccrds)'rlar..ttri/
rrr"[r]e:Jonr nlrl?1r tfion rorr"[tnrre-,n ror;ETu n1tdo,:n00.:t?11,1,.1\:
rtr rt uiin ( s isrnoid os c opy) , .,'1,i r#u,,rnfi , ir,,rrr'n, , ? iu , i,,in, y udl afirr
d ofin rr m r oifl ofrul, n:r1n nir"[ rl un rndrrfi n, fiufido oou.nt,,,i.ffu n rr"l,i aruI r Aq' d.r'reo \ ur.u ' x ",
1 il Iu'.l.:u1uvl1.:flO..1?ilnttlO luotutrnytr [uqtsrtfrotr-Ln uanqrnfrnrl"iaaruut{ tlt1yt0
t o.^ | v I Ifa',lmv 'lrurrrrunfiriu'lufatrrlr?, rfiilfiu rro;,.j [niu ,,arur'lr1anrr6nrr#arl .s ^ tr .. A ^ .^e I " -it"-"lunr v trd Iafrrr t ilo.,: ornuunil t iu.r;ilnun rrlnu'ler
_9 ll I
j , ornnT r'lr,tnrr ur 'druilr rnoulo\: r 6or,rrovotarr rirnrt r iuA qv "
v . I i, tl ll tttrt 6orr n rr"[',rd tr rfi r'r rnr..: r,ru\0q i 60finh r ilut,rr.': fiur r do r rrai ro n. uu,Jru
-y,-t!'l 1l
lerunlt lofr, lufirrtt[av tiludta']u (loaey, Borivar, and tr,ainstein)"[itru.,rrufi.:unnrrfinrrluXj, t) tr4nud.l rfrnnrrfic]r#o'lunryirdlafinua-.:rrn
a/1 lylvrrruTou'[irlrrnurrra 1/\u1,] 19 rlu (+lit) 1e.rrrnrr1,i,r.u,irr^rc,r6oe,p,rs ..1 ' a. ..e e e tl rruii o:a t ittn r l"lran rr ur r r rroue, t 6onnr dpr l r r riuviro,: n r rfi u, r #o r itud'e,dru
I n uor r t ro{, yu r,, u.;il,,ialu' nrrilu rflou ( contaminate ) orlnlni'lunrr
Y
1rod"r, Bolivar, and. li'ainstei.n, Loc. cit.Copyright by Mahidol UniversityCopyright by Mahidol University
t 29
1/1lratu., ilr^u. r 6oe,r',rirruale,un r oJun. rfi.,,fu ?inr 1u.r ruofur frurriu"lonn*fi
', Xiru1 r n r 6oe' o r.uiifi. r,fl u"lun r r unl nfirrornuu nil r ?urfi *un ruaufi dr *rp.,9r1/
utt mn r rilu r fl0il ( cont aminirte ) "lu,,: nr r'l,rarr irrfi. nrunuili:urrrr(votuirot set),iar^u* t6oe,nr fi.: rfin6rrfi'..:,,ri,flo,,,iuouoE*^.r'lru..
flao0?r-r11fl tt,,niinrjeont#o (sterire fechnique) rrrr.,.r'iinar,la,ia' o 1 "9raur6oer.' nrr'iu rnilinurunrutJflfirur,i.*.,.',,,ru,6u.fi,,i.r ra?u"lra rfrnnrr
fi* r#uo,ru ,unr.nfiii?uil, r f o d1. n0^,r., , i.r.{1,1fi0n r6oer'rhuurltril!rru1",.,1
rfio:JiurJq'rnm,lnrurn,',rlrfifi, fi r finnrrfrn r{0u,.,ufi r iuua y , #r, .r1r dufi.u^vl
nrt'iranrrljrunortot r fioe, (B1ooa compcnents ) , Ju tfin, tdonrtn,r4 4 .*^.1 - ""1 .r.,1
,-_.{- "
Vv1 v 4r4r . qtilfitnon?11Lrn, tntfl[copr tlrr'Lr,r Lnlur.ioorn rfrasrfi'.:lrfa rmnfitiu :JrrroErol.tulvv
ruar I aifln'], urfi, nr v r ru,oon-[:J r ru r fio"lriafira rir,r6'u6'n r au r 6u,rr r a r iu"lrlrrrmnrla'[rfla uaruonfrnar,:rrur ,flr.u (nepatitis B, Non A -Non B hepatitis, I'talaria, cytomegalovirus, Toxoplasma)
4 , ?1n01,11' ?A ':l l {1U 1UlA 01U1' dprrrnn i rleql r {,;rru lrJla.rX4r4roll
orrilr6orrunilriutilerunrilauoil rru 6.1n.1a., alnllrura rru afrert!r'e
v4tC4rrnrrrou r.lo1ltl, vtqt, ro'nlrril r fr oun ruau:lr yl mi r ooo 1 nl afi ln fo 'luorur r
rlr, rn,,rfi nrrlrautt|firu, ,i",rlur6oe,ovio, aiu1fi,firdi,u,],,^r'luJ,,,on.,,
Jnurq,nry"luy'r1{rfiuorurr Jrrfr'u,#udur,.,,iro,r1,11r,,ur,fi.,l.r,,*Jnryrru'[:Jrty]1r'l{n1u
Ibid..
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trrrfirrnrrfi* r{uro"/r1iii z nF,r unyfirr r#u'lun, ;uttrJnrfiei ro rir,r2
I
1 Bodey, Bolivar, and. Fainstein,2 Ibid.. , p,2L5.
9p.cit., pp.2I1-2I!.
Copyright by Mahidol UniversityCopyright by Mahidol University
32
ttnrilnnlrfinur'luqjrrurif.rrflnlnfiqr.rrr +e rrufi'lf;rnirnr+r,du'lrirRd.:r]Yl I vzuilru z-o rrufi'loirrfie,laiinrrr r rrurf;Ernrrfi*,.fuu,l.oruur,:,,r'[iiin.,..J.fi" ^,I^ 1-- l'l - -d 1, , ,l rYr- 1 4t"Iu$1Fl?1fln"lrslrl['ia luttiisiizutl:u zo lrufrr rilun4unrunu"h"lqiutfiertaionr
trrrfinnrrfrr,#.rr].orJ*r.r .,r r.u,,^r,',,irda, ;';.,r r,r.uurn,i..,ruoo X ^
1/1 ! t I
n t rqr fl u r- e [u zur]r u z n nrn r,.: frua u r,r fi iiu n r fi'rg 1
,rrrr, r fiernrrfrer,,fui.,^.u.,rnflr 1?,riu , #ud, flu,,,,,,rq1* r ir r ,,rr,ie,4 ^" ?.aJ^^ ,i .- -.&^t: a X t y ,r.,r,^ ^ un?vft1r-j1ril tr,rrrill,iruviir',a:rtv olrYr r.ic-[n ri.:fiurr,trffu ?.i tfl]rn1, nnpr*r4,r:t1....^....1^q t iq' xru a.llrty:1r r'10 lurl't tirc"[utl1]Jlrnnfro,,nutfio"lririrfiae,'i:rfl n. r.t. 1981
1rijr",u.rrufi,:nrl,r,,.,r,#u,,ru'iri d..,flur.,u,,,luu.'lu,l.rrrrr,6u1ufio 1oo:/;
rr0 rn'rrn0udua'r e rr{ r'iorlo utLflfirur u.n"[i B3/; ,.,unr.nflfinr r'li r r fiTo r lnin4llv
tVlniin (i?ao.iometric Techniclue) 6.:irunur,rrrfie,go,:uur,firiu'liarr,tn_-4^-1 ,,^Aqr_ t o ,. y
riovr1flrirnrrifrfr'lrrYuountr:Jn6 '[unrrr*.rr6ur.,nr6onor:.ronu^"[i:oz6r l-s '" Lo t,"[u re ,irlr,:urn 6oz, '[u z+ r'e]r..r irayron"lifi n go% "lu +e d,rJu,:1^-.rl- X * I t v t t/erruiGnrrrrnrvrfio'trarr irirCIrfiori:ru'lynrrifitfi'ulrr,fiol#o ,.1iu,j.ooniu.,
fv"ilturruuhuasrrn rf rfiu2
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?1n11r,,,,,il,]rul, n r,6oer ?!rJ 1rranlr rn i., s i.inrrfin,#r,,u, irr,,q-|"r ": . A s v ,e I 3
i1.4t?rterutrlvr4gr terud.ttnn.ornrr'[t :ru11d'U nrri].:ntay,rr;i,i nrt"[o
tlddtrva-nrr.lionrrd'nrtudu "irflrrilrvqhnniu 01n1rLrdfi{ln.ln,.lrfi*r#arua1f,qro,rorfi'unr r fi'{ r nflun cnr nir y r fluorn rr qi.,u.,j,.,.: ru , ijuo
1 Ibld.2Ibiq. , p.2O1.
Copyright by Mahidol UniversityCopyright by Mahidol University
qniuflfid{ nitlnfi oulunm dmrt,]r.., fr,, j^,in.,.,fl
t rlt9l _ 1/ v-.-t^--) 4 v
dmil,]r'. r flr, rfi ,.r fl d1 r ,n?m nr r fi rr r #o r am"lilu:hulrnnatrrflor,h'iont lir,,druilrufriloeruy{ufrfififlltl0,1n'ulufio r#u 1"ifitiiar,r,
.yv
33
470% ltu
lq/
and Ana GiiGUras,
ilursine Clinicsrgeo), pp. 46-47.
t, l,
. .4't " 't d L t
?lnut II.t (Tumor Fever) yfllnlou"lur.lilruuy ti..:otouUrn,tfiotlrnrilrt f{1aAf,!-
t irerl nfrrr? rr"lur vu v iil r nn r r ir f,n,,r,rv ro.:"tr'[,i^rr.,, oucn"lir r r fierrrnnrro?/r<e,.:6o r fr eniolrnl r n uonq rni'lur ru r diln..,16r., r#o'lunr y rol afinljruorofion*anfiIt,"]nr1ttnfi (rivpothermia) n.rlrr.,^,r,r*ruu"[iluxrrrrtrtu,,lfitrju',i;:lxrarfiahurnurn nrrfin rf,rd,fiu.,r,.,nr#orr "hiduay,,rufi,iu
rflur#0fi,'',,,rn"liu',1 nrrfllnr{rruio11,]nr.rr.r:,rrruiozunn14fl..rdiloerilnilnfi rruffrn, r firruua**rfi,,rfr r fl,.,,Tqrrrd*rrurlu,liru , r0.,fi,
xjrrdtrtrrfir'uihnrr',ooo tur, . irnrfinrrfir,#uruofi,arirraioyrr.:
,6rr^,r"lriruru ;rrrr-diJl..n. run,^, rnxr ul,r ieur,riofir,ruo.r"[u
,irr*d6'nrdlrrau a1?vrurfiru.:ornrrrjrn,uayfi"liui. r,rirf* n.rdu.n,,,r,,u,01n1rudn{30{n1rfinr#e run,iul, I "[:jlmng1ilrfiu1rUjrufirIqrr.fi
rfiu
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^r, d,o r.nnrrfier ,#rl,hr.nr.rnr.u.n*udrr*r p
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4' ' v J.. tll r t/.1r 6nuou r rrrilu iafi.:'luoruro.: uilru ,r^rf iuil.rnrr'[otra, t drJ14, ,do'lud*r*rr-l 'tlrtnrurnurtlnfi ornrrfinrrov,rufiriiu.:r,rru"loHu r,,^,il"li o,u.r.^iuorrryu,in
1
l,awrence R. Crane, Dehorah R. jlarmer,trPrevention Infection on the Oncology Unitrrrof North America, yo1.1), jilo.4 (December,
I lt 5-l Y eOO
Copyright by Mahidol UniversityCopyright by Mahidol University
1/'l' rtCI,:n'rrfn tau'I.n"[nr tru ?,]nyr1.r rfiuuru'lr nr.': t6u:Idrhry fit,tii,r ,,.,,,rr1ulvrrvfi"lr,rarrurrt,1141{uaont6onrerr'luirrn rou lnrrruun gjrudfiu,.,nlrfl0{n1,o X ,'o ",.- .X . y,.- r-.q-" rA4 Io' or, a v afln tt0n?t lcruntr tl1Jir [froi,tnru tnt:trny ilu"[r,rurrJfrfiluryrur]yrtn11,: teruyluy)
,r.r.r,',1.r:Jrvlfiuo'rn'lt3o.:u,lruu,i.oolu, u.., loilrqrr;rrurda.,#u rlrr1,
34
fi .': nr rrr',1 rffqlo.: n l r tl it u gi r u, r ^.f, 1 r u, o,q r frr] r ufi rJ pr ri;i r fi u fi1y a 1 u r".1-.4
u o " t' u !
vrio t6orr r ?'luaofl r dorrnhuou ",ino.:, ri.1h,Jun-,,drfl iruni.rurrr.du.
A a %n t' I
or o r ilern rr fr er riin'lunr v urrl nfin r :, renrrr 6on,rn, r ludinl i or,yu, fl,,.jo fi
*u.,u.^iu,r rriurrior,,or r,ou.,ilr,,J,du r,,,.o eAEr^--!,- , ^ 4^y.--- X ! " -rlul1 lt, u?,Iin 1 t ilo.,: nun,t, Ei er t ti o yr-.: o m t fr an r u uofl tln, t tan 1u t ufl r ruil ru
v ou ' l .Ja ,1 s 4 n v , 't 0{ uu
. Iuuozuilruirtitn rr nrtr n urjrul r n t 6oer'l'ur ru r n? 1ufli1rJyl1u?11 t nt u ,
4llt6lt uor ttn, tn0rnr'rfr (crane, Emmer, iind. GRGUras; lirruru'rlin'sfi
ffurYrrlrnnrr"ifiur.,ui,,n,i. ' 'J'! ,o* - u^',^^, :..." Jr., .." .^i,-.,," , l.r111yty[J.lun.itunuuil,lu tofuufytt/]unff
fiarrfiodu'r,{filanonfr.a r,rionrnf:Jlr,e,anfrn,,oro,.l"lurruyu"rirrnrrr,.,r,#u 1,1u,1ru,.,,
'lr.,,o u,]ru ,rd.fllu',umo , r.rru.fifi, flu,i*ri, riu'lr n r ?urnrnr rr,,,,i,]rou? lflru tuu Ieru r gr?'r?']n r oruurfrnrl-[0iunilnrryu'tma{rr tur; ,,)ilyh: t:1notnrroXvrve"lerr$ol/l,.lvr1\:?Litr m,:nCIon nrrlufn ?1nt60duflufilanonfra raioarE,irflr,
nonfro nt irr flu r fluiirari,qdq^firnruon'u1,]1, ,r.*.dr.l r n6err#r1rfl,rr,,ri7/t '1' I ' N jl ^
i J - - -, r. t -! r t)
zutJ':u nr r"[rauurar r rioa r':ilonouia ov d'ufrafi'ru]ru,,^, nuufr,,daer r udu..r flo ,, r1u1u#rxiru n. r'iiur.ugtu*.ri,,,i , u..,rr.,dirruuiru, fludo or r iru r*ufl
fbid.
Kirchner and Reheis, 0p.cit. r !p.597-601.
Copyright by Mahidol UniversityCopyright by Mahidol University
35
Y "A t vi?"rlru'vi1lo{r,rulunluqunrrfinr6o (rnfection contror) rflujruarirnuuI t i) .
e-4w ruL,k !
rlru:-lr v'd iu.: ''ru?0{i4u1unu nun rl fier t #o ,.r. r rr1ir,rn-urinfinu,,r,r,i,,r r,,*r,irJruoriru r flurh rr,.,, d,.,,,ufiu nrr:rnrd,q1un rrir,,rfia 1
lu,
nrr"lnarur'',,.: tg","irfi'rui.u,du aruur..:'r#u^,r.,, aruorurTaol.:y.4,- 4 l" q qe eru u v .1/ i) e, t,ttll'ld{vl€10"111?1'0lt htrolnou ntor tfluvro':tlrrfino.,:'lrryinfinrie.:fi'unrlfio,r#o
(aseptic rechnique) nar"linrru,.,,.:'l,lrrrt nlrflnrtluur'iuunoneuvl^trfro.r t,r'lou1\: nn t tl nfrn fi.: ov"rruan:Tqrarnr r drfnuay nrr r fio:-lonrrrr'luiir, , riafi ,
f1 ^...v 4' ,.-.! a, , X j^ r. I y^"n;;tfl tJ114u\: t iluaruarilqviov tilunr.: t rl"rto\: rfiofiireu"lur i{n1ir nrlre u,r^ril,ari.:vqi.At, llrrvl9]lrur,l{ rfru'lilfrn1rat,:fl1uur'ir,turonrludu??{ r lrur:,Tuyrrfird,,fiu uirrnrinui
v4vdoiur vfiu"f,ruflra, vrilrufn n1, nhnllIJn rore,riouni.: n",11i r ndo.r drort*a y urr, {undud'r.rro."[lriuu rTrr1s,flu,,rioru.': r#o]rn ilrrnlrdrriuriuiu1/l I 1,
' 'rvr v cv ".^.y^.:^ v 4-- , o v Auu?r.lyt Lr'tf tJIr]iltnulo1?u.]t1..1 trurtyqyffuEto{etLia}1f,ifiri*y t,.,tutfrurriufiruut
,
ufrtornnruo??')rr:Idrtm; orri,',oflu4nui,,,r.rarjurrl,.,,ff.,,^yn.:rfiuilr,r,o v v 4 4 a.,.!.- q", ' u", oa y .. I v Id11,1r]rtlntaurJ0 r'nLril1 "[r,rdvotntratorruherru
tduqrorffe,ffiurfior]o.:ryu'lut)' I o Yl'lutotruilruff.: zu:Jrutrurirrlnuuurniru rndo..rlnurau.:n'ldfirrfiorr"[i"[:rure,^vYAlVllvilrrari.: fi'.:tot ihnttavill1r,lffn rfluuuarro,r r 6ournfi riudnrryE G,,ryrr"irl rfinr
nrtfiotfiu1uu,l.ufirlqrri ril,, ;tt- ^ Itl
Vvvx u1 rlul t n rrli t r-lu 0r0 { ilh n 1 1il6s 0,.r nr.llnffut,rnn i,: raf.: irrl r y yr rutI
0 11,1 1' rrn c n 0u uou Pr r r"ir rrr.l r ..: 6ffu fr oouu:r r fi 0il0,.: fi'u"[,i1.1, n
lt r
i
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i"I i,l t fi nrrrua'l urot:J rn7' 7t
nrt'lrrnulunge, (Dental Fross;,,^r"[i{ur[unrr.:ntlu fl,]rnr??r41{
u': rr u1in n 1, dluoe?,r, r n,',r'iiu,',r r,tfiur,tflo:Jr ouieryl rt urrlra#noroyir"iilA ,{ X r' v y
t ilnrn rl Erar r fr o'[n .in lr yro\: unun y r,,or r fi ufi , duiu n rr fi^u r, r.,no.,r, fiu
'l'Crane, Emmer, and GRGUras, Op.cit., p.849.
Copyright by Mahidol UniversityCopyright by Mahidol University
t 36
,,.1il r fir,fll0., ,i ,',*dlro. r,1,., , i,.,roor, r 6one,r nr r,,yr r nnoln rr6,n r auyrn iu,?, r*d1,{ n1 uu 1{, i.r^u, r donur,.:, ftu l,, ufl n r.fi ot u-, r, u. ; ;;il^s "r' ^ Xttavillttila Irru [rtmnilnilaoettfro (steri:.e technique) {niu rrnyuharu6'tnn rroon ffufi , duruo'r r ru or r fl,r,,.iuui, ul rndri.u,,r r'u".1ir6n, du,t/-!n.: tl rhlug.rriuiluod'or n rr r fiuuiGn rr ilflr16fi'r1rxjru,,^ rrfir,.,r1rliruua,rgrfr r.a r'i o
1 ,2
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, uilanqrnifinrrg,ruryi.ul,rrr urfirlrmfi riiu,doiuu,i,unrrfig, r#0fi,.:dn
^ rru r,ru r,1 ur tn .r,,r,r,ifi 1 iwu r u u fi eriluifinr r q un in i+r"lru 10., ir{jru
rrnrfi, rdoilo':fi'unrrfi, r#u1rlf;na1sru{e.,r,i.ufi ,u,, ,duiuunu1,l1rfio,#rr.nfitltrnam (protective Environment unit)1,,rr'[i,,,[*rrtmnfin,lunrr
^7rv v 7/
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(Exogenous
1Kir"hrr", and lteheis , Op. cit. r pp,J)l -GOL,
c'Crene, Emmer, and GRGUras, 0p.cit., pp.B{5-B{7.
3_. . -r br.d. , p. 849 .
IL'Bodey, Op. cit. , pp,543-544.-r
Copyright by Mahidol UniversityCopyright by Mahidol University
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+
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3 , io.:n-un r rfir, r#affrlrn ,dun. uu'n ua rfl1u'luJr o nr u lrr u1il
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Environment ) , rpE riuiGnr rto,.:rYunrrfiu, r ffudaur rol,,urd^. , rr. rd
13oduy, Bolivar, and Fainstein,
%irror ep. cj. t . , pp .615-616 .
3e
(.Eindogenous
0p. cit. , p.211.
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in. Hospital to Control Infectionr'rVol.2, No.51rB (September, 1928),
Lidwe11, rrlsolatingBritish Medical
p.585,Copyright by Mahidol UniversityCopyright by Mahidol University
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1Donald. A.
Infection ControlInternal Medicine,
Gold.man, and 0thers, "Quideline forin Intravenous therapyrtr ,Annals of
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.Bod.ey, Bolivar, and. Fainstein, 0p.cit. r p.198.
2Collin J. Mutton, rtl_. The Management of Intravenousfnfusionrrr Nursing lvlirror, VoI.59, No.21 (M.ay 2Q, LgTr),p.67T.
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1^.Singer, Kaplan, and. Armstrong,
2llia. t p,711.
3-..-Kirchner and Reheis, 0p. cit. r
0p,cj.t., p,715,
p,597.Copyright by Mahidol UniversityCopyright by Mahidol University
) 101
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Copyright by Mahidol UniversityCopyright by Mahidol University
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t^103
rvuu141{ r6uuru'lo, irrxurda,',ffqtro.: J.on.u iljrupurfiflqrfi rfiud:^^-r^.&-,. ^.x X yc dl/]iln1tr)fitt03l0{ r vuilu?1n t ijottnrunu:infrornrr I urrr.i rra, t flud,t plrrrornrr r fit.r^'le J " X t , ;; i.-; ';t?ar tn r.l tilaflrrdvLori (nera ,-rnd Bodey) lrutturru:hu, r f rr,orur
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rrocal cordsl rrahq,lu* n,irlilavoo.rdlrruntrnrn,rru#u (Aerosol
and Humid if i er) fi r fluar r ur.r?o {n 1rfifl r#o l rlrf.: n.rr flier r uur r d"[r]oni.o
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Y -. li't,vvAilO\: nUfi\: ttfl?IUUO
Feld and Bodey, 9.p.rji!, , p.1020.
Feld. and. Others, Cp. c j.:E. t p.99.
3Ki""hrr"r and Reheisr Op.cit.r p.597,
Copyright by Mahidol UniversityCopyright by Mahidol University
104+
ANIn 1rRfl t.r01 c{ t yuLlilt y d1ylrtr?iln a 1..1
t, nlranr#u'lrrrrul tr',ri,du,1r^ur,lfnraud**u1r,;iru rfiuu 1 r1rlrror r fl urTqrara rriry r fli, 1v r fi r, J ruriun m, r 6onoo n'lua:ror ( rntracerebralHemorrhage),,rarrflu,rElrl,jrurfiufiiqr
I!
1'I ! t vzurjrrfi'nm,rffrna, 1i,,ri ryjrur.ud, do rflulrnlafiErorr
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fini*ruiruf,li^u,,,^, r fion,y , duilu^uuodn r arJru,iu,6uu.,run1rff ,ur,,rrruur'(Meningitis 6 subarachnoid liemorrhage) ?1u1utnfo,t.iurt,*rrfu
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flo{n1t frnurzu:J':u t fiernrr; t 6oe'oon'lua:rot ( rntracerebral Hemorrhage)
rrnv tfiudiqr ?1u?urnin r6or,"lu{ri re,ooo/u:.r3 ua;fi.:1r,fr a zt6 luu3" '1 t x . .t. , '"LuXrjrunqilfrnr
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1rr.r*u=, Kaplan, and Armstrong, op. cit. t p.715.Copyright by Mahidol UniversityCopyright by Mahidol University
I105
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looi<4fl rta0u''t{ ila0ifi 1ilelildn rray I nu I nunl 1u dlrJ1, 0r1l I i --
tr'eId and 0thers, 9.prgij. r p.102.
)u a-ttytrx\t 0F1t"l{nt il 0utu1 [rn;mu-t, r -,I.v'^
t r0{ t fiulnu uu1[ flu1nu.
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4 th ed ; Saint Louis : The C.V. i{osby Company,
. t967.
Muttonr collin J. rt 1 The Managernent of Intravenous rnfusion."Nursins Mirror , yot,6) , 1[o. 2I (M,ay Z{ , 1971), pp. 5,71_
672.
Copyright by Mahidol UniversityCopyright by Mahidol University
Olson, David n.. and. Others.
NegeLtive Bacillar:y
125
rrSuccessful 'Ireatment of Gram _
Ileningitis 6 l,ioxalactam. rr Annal_s
Yo1.95, I',to., (September, 19g1),
Infections in High Itisk patient"r,
gi-&$_lgfge: Vor./0, No.l (March,
Itlnfecti ous l{ononucleosis
Yol-.2l,5, 1rlo.l5 (October,
of f nternal l;recli.cine.
pp,JOZ-)O\ .
Oremr D.E. . New york:McGraw Hill_, 1964.
Pizzo, Philip A. r[he Value
Preventing iVosocomi al
of Protective Isolation in
tbS_lggr.lan Journal
19Br), pp.61t_617,
Rosner, I'red. and Grunwa1d, Ha.ns l{.
and Acute l,eul<e.mia.rr J4lvlA.
I9B1), pp .LTB1-L784.
Ityan, Peggy. 'rnfection contror : A Rationare for single-patient fterns for IsoLation.il Eospital Topics.VoI.55, i,l-o.) (September/October, tgTT)r pp. 21_25.
Singer, Carol ; Kaplan, liark }i.; and Armstrong, Donald..
'Sacteremi-a a.nd tr'ungeraia complicating NeoplasticDj-sease. * . yo:*.Gz,
tdo.5 (Mry, i-977), !! ,T1t_740,
Copyright by Mahidol UniversityCopyright by Mahidol University
Y, 125
Schneid"er, Ilarriet 1,. Evaluation of Nursinfi Cornpetence.
Boston : Little Brown and Company, L979,
spalding, Eugenia Kennedy and i'rotter, Lucille E. professional_.
Nursini{. B th ed ; philad.etphia : J.il. LippincottCompany, 1970.
Copyright by Mahidol UniversityCopyright by Mahidol University
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