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Appraisal Quality qf Care in Patients with llematclogic Disease

DuringProtectivelsolaticnandLowResistant

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FACI.ILTY OF SCIENCEMAHIDOL 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.;


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.

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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.

Armstrong,

Disease r tl

(m"y, t97T),T


14

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Fainsteinr trrnfection comprications in Leukemic patientsrrrseminar in llematoLogv, vo1.r!, No.] (.lury ? LgBZ), p.L91.


15

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2Honald tr'eId and Gerald p. Bodey, 'rlnfection in

Patient 6 tutatignant Lymphoma Treated 6 combination chemo-therapy, tt Cancer, VoI ,)) , t:[o .) (Marcir , L}TT) , p.lO22 ,

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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.


'pTqr

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,

jf,

3 rurcrgurltnrmu"eugB.l :8r],

unras uuu[ no e ,urrblgrrijf rnr.Grrsr 1 grupuu 1

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Lr-h4purx,*gr ru'

oJL l 1., gt uutd u 1 t4t €ttl]

nt t ru,uutst tt:n't, uttnnntltd 1.0& 1 r

ru[uurfiuyitot Ir

x - - -,. " -- r Lnu L

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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T,nL: ui/ u r B*L -J;;l- il ;-:; I ff l,i:ffi)ilfiIJil

ilt\i lJ U te uc n rB Ld r Nuruu N nM r urru,*

Eu l n g rr

Lr^B r [1

11 . 0 0ri, * gi *gr upniru

LICopyright by Mahidol UniversityCopyright by Mahidol University

1B

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.


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 ,


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


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

Yad45 nt ..: nfl t il1J 3 ,By,'

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

1/4V,.1

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

::,.;:]::::f,, rd,n, n1,a'a\:?0roruruirt*rn1 Iflx6,,;u;;ilr0{n,.,,

:: t

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75%r;rr,,,Jl.rn.,,luJro + r.fi*#urd*

l^':r, ,uavxrJrunqufi 73% (N = ro+) fin,yfirlnrfi,firJrrrrlr1u u03

:rlrr:'.,lrluu:, i.,r rfic,lafirrs, nqrrdodfinr,fi* r#, ro+ nF.r ;;J;;,,r,

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

n r lrJd .,r 1, r, n o r fi rl qr rfi n"r u n r r a.,,,.lli liJl;,, ^ :*':';;

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;;#;

rqfru*nnrr roco/un3 *ri.,,fiernrlfirr,#ur,1.,..,r,],,r0rfiu,: + nirr"[u*t

rooo iu fi{rvuc,ru,',d,fierfrr]orlrirfiuuru,ri,,t, ronra,duoulrn,.,,

)r-


] 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.


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,


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

^

r*,, 6u"[r]u rr r rr . ..: r r ijruoi,.,o r fi ulr r riul r ou.,.juj.ul nun r \:

-.--"11 J o t v, ^, "{ o v I2. n1f i,00 td tnt0.:ltof.t1.t "lttll.ll1.:n,tu nrl"Iatnio,rfiottTrot tflerIt.vt

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..


.+ffi 6fepog

pnlllt LU L0@E

1 14utILUittdg" LtjT t t'J 1 ztrBtFfinL (ur 11tc;re c T r, ) rrug-st,urdlnû1.gu J

(utrrtcruaoJp^\ Hrinrrrrr r,',';"! rrc -!qqr 2 |

\ i L L -- -roqr€c) nv,r,nnnl JttJ[]-ul 2u1r ul ttctjr.{L?1uri1N31:nBtF[N0E

rikru Lplr,

r un Lpû

rr 0u u tg&iriil

p ;i,, *.iw d. i T,

nr ri i*J.. n ;.' i ; ; ;:, J";;nu[[utltlfftuu utruuIBt,rrtrun:mLEI3[uDr.ururu.Gnjhr.p1 @Et(dLriuunuN0[r0r,rl

un,, on*ro, nrfrff un,, rrl*n,, ^:gr ;r ur rui?rdl/r1t.,,*1gi*r;5*;;;;;;;'rl;rJgulrdtil Kl gtu ;nurppunlo[rJt1[E] uc,ut Jr,uNt/ r,tuua -";,';';1""- ,-'"'gurDv,d!v,ovreroIt

"..___a ,."_-Jl/g:it-t$fUn0\rl0[1(dtjjt"U

nuNo[ru sunupkrLrr$1 u@u r u c lnupfiuflu-r suusm!pn:pruu$ytnltul

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rtNu(rn@ I :uBU 3x^ r'

f N! Ng&111t't"Bt'r'4L@[lL4tcJUunu]ofirJitnupfLogr i!tt,usulpzsUtktl ufluÎunIrUusL ali4aaal 6

tnraltitulTk,;nl[ogn1 $ Ntf ,,]: Li1ur.ui t/111:Lt unLulr@tui t nr6r.,u 1 r,r r'u.[lrnng[r 1 ru ur0

t't:ttfll full [LU@OnUuubu3Lll,ll@pl Dslrar-dJr,ur.cIr.rJkrllur,r,.u3ulrrnuggpunn1

J tunu Lti'tui utultsft I t trJtu'.1g r utnupfrnl uunu BMr. J LftLn

E.u uulr.r? :ulrLlr rlkiu o 1

uL&,Grr ullrdI u',,*ru,Eruuo:u,l BrUNUcnluurrhungl5,urnr.r'Er[rrru At^hl'6rtFXa?vmuNBnJl"u euuLrtuBi,{u.stuiJtukil JuLln]^BUitkttIlnriNu uunr,fii;lr luLaJtuOr.dt Bl]1 ^ ,o o ._;__";t"__ t,"_,"..,;,,ai.^" i7 v i,puuol Bntt{.Jt-JIun:n,rni hur{u@utue1nupftu,u]r,ou:(rrlumru\r[*Urn I i

s F, r, l-u.- --t ,"."f,";, s r^ ta6 ? X r i"

TE

I t'@1nLFmBtu['tJn]BUuo["1uLe.Lru1ouLr1t{uonntunouutirNi}uu&,u] 40$1n;11 %Lt

uurTuBt,tt'JLnLUUlt4@6lr,,tiJr,uuLirrr,NltrrNJUB(,Liuunl ulj i1oriililul nt ufiouuttr.n, " r N o , r a_.;;--"..t;, "_

;. ;tn;"lnY,"_n(uotlceg:u1 snoueSopuri pu" uoT+caJu1 snoua8oxn) nruRUUlUfftt ftontf a,b,"f

U$1UL&,:ultU0nBUU[0UULitt t,LrU&,0.[l UUJtUbr]r8riLpt,Jq!, ltrLjU jLNtrj0

0tCopyright by Mahidol UniversityCopyright by Mahidol University

31

'[ierafi'r z:r, r,i.ol rfiu,rrnr rluuufldruy:.rrc rnr,r oyfliuna-.u]n"tnn"

(Amino€rlvcocide ) iuzu:]ru iirlqr rfi r fiurYu"l,]t uJt.uâ ,duu ,,.,n1u'd1:i1rntv 9' l'

^ ., t'-., ,, rjlilf un'lru r ?Irflu'r0{ ur"lu:iiu"iuou'lur,6'rfiqrat n rrl

ûurnou.,1i ?1nn,r r nneorfir,

' oo^ " J 1/

nrr r rufififiu'lurou fifir, rdoale,J:.,rLua ,d.r,r.,u , iuirrro ur"lufii,d.r rhuru r#o^ "^-^-;'-";',trryrrrrru4rr'yrirruBn tlJ?li1?'rlJ[?u?u1J0\:tJ,]turf]Jtt..ltruruttio

f,l^.*qElf,vv[urrt':rui,ifrortfrorcann,i untfion,lr:J[?]J?uto{utonatohirr,#rrrrd,ufi,

o,o,yu

1uuiruiltl*rfi rfiuil],,]tlt,rnridn,.:rJfrfriurrornrrd'n r euoonirr"li rfiu.r,ro n1,

vvvvrnurrvff:rnrru,ruturo,rur:Jfrdtrr'lu6i:r1ra,fiuor.u{r00n[1nl

6..rfinrrurrfrgd*

aT iuurf; rr,'.,1u r tY, ?1n nr, *.û o,n,i rir"ril,,ruJu r r,,oifiu fl J r:rfi.u1v'ri-rlg1o1l"[r1orfiu (5-]'luorocvtosine; rrr,oi.u,n. unufierrun:nirJor

v ,r'^ | v

3.ll^,-[rrinrnrr'luuo:.rluruoi8u firfiu,:qhrfiu.r uunr.nf,lrJirufirlurrfirfiu- .61 a A Ifi1 [t.a tilfitaOnfl,]1 (Granulocyte Transfusion) i,:ruriuufrJflfifurqrfi

.AA^9'y-ltilr;frra6nr,,',1[unrlilo':fi'unrrfinr6orrndu ?,]nr,ru.r.,uruoruf;, lrfirrrirn,tiludtf,iu (loaey, Borivar, and tr'ainstein) 'luijruurr f .: rfir,lnfiqrnrr. 6l t

4,1^1 . ^- y'n' a o ,/t v -l, e y184 r1u tu:lrrvi [r,rtnilinur-lqr"[r,rriertfi,oonrr"[rur.,,rurrior]o..:riunr16r,r#oljt

uL')')'r,l1il1lnrvil'0.:fi'unrr tfiudirrornnrrfin,#u1rl, .-ulrtl 5*l75fi1 ,.ru,:1ullvttv A-1- ' t ",

l'1, a d <tuuuu{ Lnnnrrr r [uu:i':uuv r i,.r r urrl ofirrr rt,tioJ afiErorro yun rd6n un-{ ?mur'- u I 7rr t-[err'unrr:-lannru'hnrrnn

*r,irX,.Jronuuruuuo 29 r1u do1*rr,fir,r6oE:rr.:6]vvlLu zr iuurnuff.:orn:Jgnrrrr'[znr ye,nflnrr6rr,{u,o*.rd, .fo uar"[r]rfic,

Xq s ^ . i r

nrrfrorfro"lunrvutlCIiiqrrnu "luturfina:Jn?Ln:r 40 r1u do1,]1rrrrfie,r6o*

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!.


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

c/l ^

j ", v o Xnrrnrreuilrul, r n r 6on"lur ru rfirJnrfi rfiu rr,1,ro:Jo.:fi'unrlfirrtfro

?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.


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

rn r rrrJf fiiurornnrrdn ,

^r, d,o r.nnrrfier ,#rl,hr.nr.rnr.u.n*udrr*r p

*r1 i t rxirr dflnrr fi r,, #.ruo r v *ryr 1-r r fiurTrra, y ru u r.udrr yrornr r fldo, ;Itrisr nru:Tdnrrcrauraioilrnui r rufiirr nrrfio,#orurrr.r,,llinuirrur1.,lu,ruarf,ilre, u?:r uR{,I,ui..r'[,jfiruro ijru;ii,l..uruocilmnnornrrrfiu.r

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


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.


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

lv l^ j, t

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.


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

Ad va ) e' ,1'nt,trttunililru tr,^roilo,.tfi'unr rfin r 6o

, 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/

o, ria'lr,rn r':mr rduqr ru nh ffu J . u,*',r uu nn ru inn :J l, ^.,

oil rro il

1."1^ ^_- o x j v1. tA0ilo.:nunffqtOrttOtfnfr.:LtfnraOUfilUilOn

source) ifin.rd1, 1f;,,,i3,+

1.1 i;Uiru,o.,r,;1rru.,:uilnfrr*rr.rl (Reverse rsolation,simple Protective fsolation) rluudrru.ryj.u,i.#uofiru,fir*ruurua

(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


r Bnl MrjrjlLnnt[il?

ntlrtlnir@rlrrur uuuurrunLur:uLnlrjn ( u.rng Br[fi ) urungrr.n1.1krtptub1!- -F

| ^ I i 14 o"oo t^' I

:tr:li,,YLIL'ulltd loLBtnng

1 $ tLr t'0n@s l rrgr uuuu,s,L unurl nF: f.ruuonBrugt4iignltLP LUt0 t'0 LttJ f J [trJ U

1 Ugr4sruEmULrU r ] r. rgg Unr s- - f n o i o , n , J1!'ulltllBtluL(LzeulJtut@

PEUntn, $n!tN tLlu0 us@P L ut0u(i: ul] t't] i u No-s u 1 rutu,w r0 r,rl Brdt li tu r,0rr.3[r

sc r u 1 nlr irJ u ur, 0N c r unnru grr

Lr a r 0rjr r e!nu* gil*gtn. nio g *i, gn*p.*y inl Nct4nl BtutJt!^ o u ,ut0u3llstBt4L UIilsLutotnltpn;pgrggngr (uor1e;r111g

rrv a+ETncr+red ,(cuercr,J$ qgTH ""aa ,i"a*"'ro", a^r+ca+ord

elduts) Huurr: r.0.iuN0 JUIENEUnnN@nnl fiounr nunfi "f""i"f*'' ^ *r " ,;lt z'L

Bri4otrfi 1 ntB t"t1g0 J uurtt!lcctlyl0 l Btl'r,-qN0ruuiTsJrs,

]L,.lg r ouuhnosl urnrJ ruuo; unrHtJlrE[J uu$r

un, ro nft suu, r ru nnurm'um r lun u, i*1o rng, I n,, " prn*, r rugunolil, -, nnr-

Inuuu'a1rcu uurTUBM:ur*.,r*rN/uJnftnnun,,nn*nigtgpguurnnolr,t I {r

I

,u *,'*]i.}::ffi}[;, J;;:J;ilffitr alj

erridrrLcM,o.*ur.loJ-rt[rp, -ryJr:r,,;;;;;;t";;;;,"-i5rr"---;

'.,nBrL''rnfi,*uo, u1.ruegGunuupnEp

-urp.r[rru[,1,, onr,u n,ronp,ni.p

onlr"ut 0udnnB 1un1 m unrr lonuun[ ngnuFfiurr,tki] BUnk ^

^^-f ; i ^^ . l',i. -;b'"-''"ltTBlttHtdllll$0t'duBllt'0kt

nt[r]u11.4gutntn]o:]:l.rurTrepr,Lrubgu.ugue,r*n1fiour1nry-ifi*ruiTUBr\r

b0 [nr nu.o nupri uirril-r1 uu r mun[I ^,

r^-*, "-;- nPpngr/t.tntyrnulNUU'*nf Jt0lt,ILlUrjjUUfrp,.ttutlutto t ir,,ufti'I ^

- ; * -"nnp[ lsGueLBtttnul ]ul/'lTtTl ilTûtngtltlt\sju r; unnvu* nry

utltLtlttlJ: uttuftu u' t N0 J llt p?tlt'kttlt'LtTuurTUB[r N J I

N0 r/tu r'r t r10uu url t 0 i nn g[ 1 : u,rln n o

t t o- | - 't auupugunufi u,nltl nbuogrnuu (dros r'prcr;ro+rr*t)

"ns, rnr[ftrnr*

onttusgr.6nupfiunn;riiû*t:oruulcrr,iu,tnuot [rucsi 5 | | ^

'' a o t^ - ,.a r I o o r^LOrigol:u113001urJ0l,tt uL0: ppggl uu.r,rJ uuf uMu l Bl.dt r.skrlJuo;, ptrutur"t/J uur,ûunu l Ukl UJ tUnJULt ord

mu Nnu N0 kull n uungui'tott'' 3 U t : ullnu nNnu 1 Nnntp N0 krnivitllu 1 i ftt t40q,1 urs ^ b x ..u f o E, . a i.rL€

+


.? :^"r{,^^-3. F, x.io r", I2, t i/rl0il0.lnun,trfrfl tiolrn rfrofilou"lur1{n1u

source) lr,uanr.iiofu,',;rd'l,uri1rr'.0n..,u ir,,,1,,,

. 1 }iurlfrfirurfil,i.,r.,fiu,i.i.on,.,u (orar non-absorbabre!-o o'|antibiotic) uril'iuf,Lnlrrnru'lr,un r.auen"irfiu rrrulnffufiuuayfidteffiu

(evu = Gentamicin, vancornycin, Nystatin) uffllyil16l1u,.irdrrllu,rul,vr'r\: tfiuorur,,,Ju aJerl:rrrua, 6.1n.'ie. rrarnnfliL00nrunJ,.,onauso.r o i

!''[ni]nrrfinr+r

rfiurf,'rnrrlurri, lu,ul irurlruirro,iruo,,un rruffodu z nfl.lI v - .. l-s . I r ! tl

ila ilu il n l r rl o,r rYul r n ri,:'l u'i n zu a r fl ufi uuu ou

z.z nrrliluttflfrruvrfinrnrnfiutirl.,,onau (0ra1 absorbabre:J

antibiotic) lr,u1i}il r uult,rrrJ?u ra c6'aylr ruyruonmlra (rrimetro-av

. prim Sul-famethoxazole = TI,IP/SMX) trurf'terzua'l1nlrAngilAn,trnlIo X i ' ^ I Yt .' l'v Ifrertfro tilofrnur"lunauuilrufir]r,rfi rflufi1erir rur/srx ffnrrriornrrfinr*o?1nuLnfr , ? ru r^ o u,|,.rfl,fruartrq ., du, rl? uur fi uufi,m d:ro rruu,,;r, *r^ r-f ;ttt,,'lur/smx r rurYuuTlflfiru rtflnfilunndu inru rrinlr yf vrGnr uflunr njorn-unr rwloilA /i E{ n- I

frnr r ro6n m'[rurrjr r r nyiueit r iru,:ffr r fiur rX.,:ri,,rl,r r finnr rfi. rdulr i.u iAn.,f,fl,.t r, lumi'lunr ru n'l i ann r r fi nr, d uluii., ulit o i, r nil in urrurnn .r

3 , io.:n-un r rfir, r#affrlrn ,dun. uu'n ua rfl1u'luJr o nr u lrr u1il

i6nrrilo'rn-unrrfirr,ilurandu,,r*iuufforr. (npr: = rotar- protective

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.


nMuu03pttutuu.t4t0r-ruuulltutttilBOtnr,E1BtF[@m1 ntuujBtrltotlt nB&,1uG r, a7 a . ut o l^Y' --;;6'-F'--; .-";'--

a'' i - u"

n L

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plngu3 rur0rru 1 slNlr urnr."unurf JFrTs

t

grtLp ri}rur: c FrTiELr : nr$gt',, ^ .-a

t^ l,^l)

rI|3U Z f Un!@[,ltEtBnpEl BU] U-ffiuoN0rJ:&,b N3&,rtLrlrr.J0j

E"d" "'"'X"E'"1"''"r"-:t''=Lyo.-o'o -, ..^ *ln^3U|ltLBtlTlt

G

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^t -p;l^'""r"*"x----x

rtal

oo I r'

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utu.uuJrtruppELnru uJrkrjLU/,Llngng:unto rlBl,4,rn Urionss {lluj sU

lÛtputl snull (auree;r3) nsuurn (.(e.zdg) nsptgrapo:nur,Gptn[L: uil

2rBUut t.snLBUusr,:rdu0r,,r1 ( m.rrc u$r) nru:r,rrrtrryUr5nl,unugp[unnur* jli

tTgkrl :ult r.su 9 trrJsf,tuEtrskru.pruurltlpu.nBtuu"nftwBUt rl0ungtBrFfi ôu fr

A- ' ---i'-*'-, r 4 4 ^ - | r-

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B0'0 uuLlnLrg L G,tr1ilMuull3rsN@nnri, Nnlrf 6', nluJ L oplrrMfe

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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

41

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Prrnciples in rvursing, (5thua

Company, 1966), P,1.

Shirley Hawke Gragg, Scientific; Saint l,ouis : The C.V. MosbYI


44

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1, . r. orem ,

(New York : McGraw

2sue Thomas Hegyrary and 11'K' Dieter Haussmann'

rrMonitoring Nursing Care Qualityr't Journal of"l{ursing

Administration, VoI.9, No.9 (November ' L976) t P'1'

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n r cJr6 r.J'j r u a': fu ',4 fl a:J fl ffi qi 1r r u u fi n 1,j n n fi a,.r u i o'l u n, fid, ffi' r, u,,r rt

G, fionr ru'luu.o.ior yrlry r fir r fiu.Jro r rauJuvvll1)a 1i 'rdt yulJel?utlutll dL,nf r:JFl1 uf orrtulnl

,,i.,oiouff tr.r"o ru fo trruf,, ffiir, t

wl-rtrrou'Iuuo{uunnrr z Tu 6{os:iry rfiu

1Vr{nt{i4u{

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lrarLLIJ{nlllj]1"{?o{nlrftrraocn tflu : r;fi'u fio fi r.Jrunart rrar"[rfi ]ru1,vdd

uii'ntat n''lr rno, (carter) 601

I

1,1X1nil 3

,v

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nvltuutaufwI lo

n vrruunhnrl r cua y

vnrttuuraun1- go -

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n v rruunhn tl r aun ,

IS '- - d .{n 011nl I fittCI uniln 1ilfli.rlJir?{1

0 01 lnitJ'i1 t\nl rettta 0u [u r y euiltunar.tft1r9

Arl"tCI 011nilfl 1 Ulnl t firra [lfi1U

100

BO

BO

?1nufnn1 rfll,ir.*,,,io,irdronruuu fi'rflfi u

100

B9

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I4rj0 al 1 n0ttl "lrint r er tta nr

ttl,,4ctm'tn0n 1ilnt r rrlm iltuna t.:-.tl!t4 q'aft fl 11n0a1 1\n1, R[m [ ]Jf)

Y

Krummel 0p.cit., p.767.Copyright by Mahidol UniversityCopyright by Mahidol University

b

55

z. fionrlu*r,rori.,oirrdorfin1ilr,raru 1r,ir.,r ,r'u ,ur.r,l , iu ,

^l w 1 v v wr ---."--;""-

I'Id \

t 116 uur at nmnou, olruoui.u ^'lun

rfiflo,.tui.ui* rrnrn m ufronu'r. iur^, uoI q .. - I ---"'-ror r ru rufi r fi n6uff':r,ru n brn'oirlr',trnr, *,,u'ii 1 n yuuu n.t orrrr,i.,.r n i.v I l.v lr_,oua y Bo fiomlulnirfionr lurYu ua r'tu'lilnrrmu

3 . u'',uln-,r,dui',u'torurrnfirnr, rJnl, o,,u'lu,,olr, v ium nfinr, firi ouu,-t-r'rtlJlnutm.toon'iuttqtayuill?i,ft lur..: t,riu

44 v v tl -s vilil''ln rlr-n4\:utJn G t0 trayuilru"inilnrrnrLnfftfl

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v o .4o^\ I w v

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5 lJEv

4Mv

100 10

1OOx4

llvfirnrrud"lrlnr,r'rfl , i, r.:.ufimr r#1i,rrriofi'..#u nrrr,,^dli.,rnrrliru'iu iu#ufi > 6o fi.rfuiouu,ro'l J

ruoru:lru"lrfrnrrnuerl?t + ito fin rfluioun,

rlnlmrnrrYu lu;uiiuirrlirunrr.,,^'lurrrfi! + finrfuiouo, eo

I

1,11.1?nYl n?n, rlJfll Iftrr?lli

.(-f

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1,i!1U tfi9tI

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lrrou ts (Ertrur

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l.

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3.

4.,tr

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n'ltti.l1l{

55

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rjfi?u 1

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t l-v i,rrrrYr5'f,ht*LluJuugl ,fl a{ ttfl a ;'i,lil1fr00nrt uhnv rtu'ut u6 ufr'l r,lr r :]? uu rri ur rr n0rr]1i,{?o.i m rn *a 0u

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t .^ r..n, , -{

tulvrl-l ll 'rltrtnert r,ifo'l;rd 'lunrfiiifionrrr'luuurn"ln'i:rlnrrfinrvrniu rm

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olf^vrrarfiou'luuo':rLunvr'r',run r+ {u rilr,ifir,nyuuunru.lu ro iu,1i1ili,rfirnrruf,Lrnr'li ro Trirfiud'rr,rri ff..:ri'roJ.u,Ju

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75+

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fr'.rrTunr rr,,^iiii rul ilr-r'Iu,a u..fi' ou1.,

= 87.0010

Iv4? ol 1'tuntlttl 1vtil1una I {

,urni{ 4 nlTnrr?r rdcilrTqlu,dronrrfin,rdoraiofili

1

2

3

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vlY.r. o 11 ! t- ,tnlLnlrnrra luu:.nnjrr 4 fla0f]r ru, tratfiou,luiaar:rtunllu

frn tilunyrnru rodu

fOuay

87.00

fi on r r unr rn,ua'l nfu iuu*,

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85190195


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57

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rJ'rua1 urnruuuffr 4 .r4:.r?nu1lruyu,,ar'li + rflufrrrarr fior"linrLiuu

4 .i2., -lu ' v

rqduao.:nrrnunr['.:ra:rnfiur]rulr,ru rLaruir"i:rrrJ?uurflum,{a r*a*narr,,^u,l,'luryfi'r"lrr fftttu I 1 u

avnv umr r odri oru v.ir itfim ,r lnr r.,,udiirr'iili',ra ro, ,^.,io,l1uiloo

ttun tm y t yfi'unua,tfln1 rfrlta11

fi',.rrYunrLLu, rod'uroon. re,,uaffru:rndui.ur.ud , inru ne,n r 101

du,j'iuiloo,,un fir,tfir,ioua, er frr'r.*n.*nrrouur;,rrrorr.;;;;'l:J

lsld

t n111Uil 1Uu

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tcl

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II 2 3 4

80 85 BB B7 85


5e

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'4'- I I I e I

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fi'rour r r au

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t

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1nfunr ro,,, iur*

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r

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Ibid .


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llunsLkr:u3u1tJUUt1u

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Iqtl r,t {fi 2

vll,

?iltJart1ufr1?0{nnilfr'?0u1{ S rlu

,

t a?}/lI

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nr r ifild'u'lrn Anl rrlnt_+1

Acu'be Leukemia

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11qJ.:

1l rl],t

l,iq.l

?,1U

11U

, rfr:JFint.,.1

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1B ll I orfir yfinur

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fluirr l,+ ;u

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va.l lvunIru1.ll 14?U

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I

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ly

n, uuln o6' u i uuu g, o,: fi o n r r un r r n*afftru udui rr1o., i,fra,u, 1r-

fla00 t rnrflfinr*r ttu {a0n tilut yerunrrm,l},{fl0{ltlrfltta

i6t

tanylvlruilru!

1

2

3

+

5

66.91

66.76

Bo.5Z

5+.57

,+9.51

97.54

75,59

86.64

7 4.37

53. 18

100

100

100

66.67

67.62

B+.W

76,29

87.85

63.84

{41 .92

tyfiu

nt[fl1ilrt

ilrunnt,:I

trJn

:Iun rrtV r.l

[lJRt9'l

t.ri9)

n?n r rlJftl rnttan vttuu

Id

taau

touey

75.42

78.Q3

8,+. 10

59.73

67.38

Y


..J67

vlr)-AvqAr\"I. IlOilatnu1nln1t9rn tflo oln1f rrnrn.rOilunvnl, t:J6uurr:Jatt0{?huxil

a s a o l'I t

il? lflrTla luzuilrutreiar t tut

iu,,1ur...,nd,rTroJr,rff.r 5 r1u rdurfrunrriflofulrn nrrfinr#or'.fi',u rfinro.:rfio rrnv0lnlrul4rnroufirfierdu'ru,.,:r.:diirnrrfini:rryu lfr*rauu-t6l al

LUn1r1.l14 9

Aa v .< - u I a,rrr'rilofru1rn n1rfifl rfroiirqu rfierro.: r6ouovornrr, f, o X 1,, r ^ I Ium r nno uyi r ri erfr ur a.: urhu rrn a y r ru'lur,:.r fi fi n ur

I nSyt1'I

T.!

Fllt 1{i4 g

Acute

lculcornia

Pneunonia li

Pleural Effusion

Oral iioniliasis

ii ilacter.1a,1

l-nf ect ioi:

CeIIuIi'tis Rigirt

Arms (orntnfl

in:gr )

- cls 1rl*r,6u.tA v

(IU?AU?1n01nlr,

0'ln1f ttdn': t[At UA

:r:ray )

- Candlda albican

- Alpha Strep'bo-

cocci

- Streptococci

Group D.

- c/s l,lrr,#u

Septiceniia

?ln ldon-

IlemoIyti_c

Streptococcl

Group D,

E. Coli,

Dnterobacter

2.

3,

qa vSn1t1u?qu tfh

9tAAcnltfit It0ytl\lu

I


5BI

n1t 1.1!1

t

e (flCI)

t alyt,, I

zuilrutJ

1 . ]riea j-::i; i bis

?. 0ra1 iilonillasis

*3. LIiId. G.ingivitis

4. Parasltic

Infection

1. Oral lloniliasis

6 Bacter:lal

Infection

2. Pneunronia ii

i?espirai;ory

Failure

S1.;1n L:fectionel(:J bleb troc?n

I

uuo{fl"Iilfi1m;.: )

IAAfiUet3o{ tr0

- Iilebsiella

Pneumoniae* l.9l

.. tl [ernt c/ s

ifiofrumnornrr

rrdn{

iloclk worm

Stror6yloides

- Cemdlda Albican

- Klebsiella

Pneumonlae

- Pseud omorras

Aerl4llnosa

- Enterococci

"- ?seudomonas

Aeruginosa

I

- un c/ s 'tuuu7/4

tr0

t)

CI1n't I Ltil tntoil

'1. Septicemi_avA

?ln tt0

Klebsiella

Pneun:onia,eI

r ruffunrr; r 6onr

o00n [udIJO.irrnt

.{ dAt dur?ft

SepticerniaIA

91n t flo

Pseudomonas

Aeruginosa

Septic shoclcAI CA

rta, t dus?fl

Aplastic

Anemia

)-

,}.

Aplastrc

iinemia

2).

nrr ifiqfr'uJ rn?'t I446{

nlrflfit fioyl,i,^{u


6gt

,.1

n11 1\:1,1 9 ( rl0;

t nlnvlzurl':utJ

14il1U tUflI

nrrifrofulrn

:lplastic

/Ireriia

ApJ-ast ic

A-tre:eia

{<*

*l.

*1.

oL.

,r

3,

l, IAAd

n1rqtfl trioyirrru

Abdomiital. l,ior-ud

Infeetron (lost..

0I Append ec-bor:y )

Phlebitis trii:lrt

IIand

L{i-Ii Gingivitis

Peri-coronit is,4( H,1':0n0n t dL?1n

vaA'IUn?j0,: tflo

- t"to "1" "[J,lur#o

- c/s 1:1*r,6u

i'{eiserj-a Species

Alpha Strep-bo-

cocci

- Diptherold

Hook vrorr,i

0plsthorchis

viveri-nia.n

{<

).

u-Tun r rudqnilru.qn I

Urinary lrac.b

lnfection

Parasit i<;

Infect ion

n"rrAn rfiu1usofi r firfiun,.,uu.nl r uurut0 ( cominu.nity

acquired infectioi:.)

n'rrfier r fiuirru;iffu 'lu* uru rn frfrrlru*ririlnrrfirrr #er r*r.,t,t yr'.:o ur,: r fiur fl,rJ16.: r fiern rr fier r #oLrunfi r ?u Jruf,run lrAn r #o;it,il r n do.,ruu ru eron,i'urzrira,r^,ruffu ,,^r* ;. , f,nrrfinr#0fi r fier"lrrIr {mrl1u1a (rlosocomiar infec.biori)


7a

lot/i44ax"l1r ilofrni,fr .rn1 rfr fl r fi o'lur v ur-, 1{,i ./r.u

1 1n 1rfi n r #o'lu,a.: d1n t ff.:X X ^,^i.*- . o!_^ 1^ -.rr ,r, v ^ X?1nIt0r1tt?]y ts0uilntiiiU) trulrnr,iflet 6o :lu"Iuirilrufi{ 5 r1U nlrnntn0t0.rrtuaLrncfil,i',i.,t:,ru'lu,;jru r r.,u irrn,,,rfi*,firororrur-Jyr1\:rfiin,lru'lluas

o uo - t' t I vln1rfrntfr'olrnuuoullu1a :,ru1ufirhuail1.in; 2 r1u zur]rudrfiernr.::ulrrniouu!r-?lnn1ffint60 (sepriceraia, & septic sirock) flururuffof;u : r,ruv^.1fl.ttldn{ iilflI,]t1{t4 1o

Yl I v r46rAAn?'] Lll1J[J1] 1 U ]1 t nofl 1, 9i et t to-[ u r r u]-lft 1 { ..,} r,!,e, 0 1n 1,

vt)AA

ttn rntou?1nn1 rflifli t s0

9yAAn 1rfifi tr0 uar 0 1n1, rril rnt0il

Ilt

2,

3,

4,

5,

6,

't,

I

9"11r1'1Yl 10

- A X q ,y- d ri Xn1rfifl t1t0 lilfc,:il1n (yr{ornLrunfr riurray t6orr)t,AAqv

n'.l, n n t t01J0'.: t[r^la ttn, 0tluu.]w

^4n 1 tfr n t frogot t yuuytl,l t fiuraru'irv

Q4afl 1tnn t fl 0 ?1nuiJcllt1 t u,'t.h

l,AA

n1Ifrn t frora.l,yulli4t.: t fiu:Iaam;ela4

n 1rfl fi t $Oljo.lr rUililt y d lyld lunn1.tvlt

CI1n1rttnf nr0il?1nn,trfifl f 6A (Septiceiaia & Septic Shock)

qhuruilil?u(rruI

5

3

2

2

1

1

3


I

I

-4/ 71

vt ,,! . t v i,

6r r, U"utL'ii,, lrrvurnflu,orruo,,unflnrrfie,r#arrn:loe,rru,,urfl,|

j'' uyrlr:,uff.r orn r ir 1140{ uunue.: nrr6e,,#rffonJ..,1 r a1a{ lurir,,rixiruun 1' $rn r ro.[u'lo.: r]rn rfro r rrn r fi o r run r uunfi r i u r.flu,roli r fi nn r rfi pr, ;uiunrvualafierfiu ?1urlJ pmr'rrr,rr.:,,,,rnulrru,iri,llr,,^r,drfir,flu

+g/uu3-iui,fr 11 *nva':6u l.elur3 1u{ud 14 ryirufi1rruuu,,'iudro rrurdrrh

nrr finur t'J

I

ttuunilyl 1lt Jru,Yunmrfi* r#u

1

tutn{n1r r:l6uuu:larror pr{N

tte, ainl r ,,, ,nirrlr*irur.,ud

600 ?1U1U Pltrv

,,1.u, flu celt/ cmlx

= rhuru pl,nl

1/ I .9 I t vurJlurun u:hufl'lgEraaer 14 iufiau'lurio..:trun oruunf, 37,5,c _ 39. c


ui'u,rufi e lufiliuarl,lilu.,n.rr,dn{?0{nrrfi*,#u"}rdro +t '.

fifinrr urd,r, ,duilrol,.r I ohuru pMN ,orffu tssluu3 iud 10

q'r rfio.r rrn r flu,,ro,ro.:6'n raur'ruri'rf, r 6o.uon'li, fiu{uauu offuur,,rru.r..

TZ

?ut$nv,{vl

u trr

:to/ru3 {rd 14el

d .i^rrn yilillu t dug?0

(Subarachnoid Hemomhage) ?1u?U pMN ae,at tu6otfiernr':v t6oo,oon'luaruct (rntracerebral Hemorrhage)ohuru plm r,*r#u zt6luu3

t

ttilunlJyl 2tt

Iridfi\:n1r ril6uurrila{30.: p}ff Jrufi,unrrrfie.rr#o

va Iruar 01n1r rrn rnrou'luryrJrur rufi e

800

700

500

500

400

300

200

100

?,]U?U PMN

,,lru,flu c"-

= o",.tu?u PlCI{

I=))'C 6 Subarachnoid17aI

I

I

I

I

MeningitistI

Hx

levl d\4, I}J:J i?( _--+

l,lulurun , "ludr.riufi : fr,,riud 14

Intracerebral H'Dead.f

14 oruru{u

1rl a,

zuilruf,"irrrnoer goruqi 37 ,5, c - 39


I

-&7'

t, I

a . " u'l,,ur.ud : finrrfrr,r#o'iuso.r:i.,n,,ioor,.,n,#rr.,,u,

r#ouun,fi riuxirrfiligoffo,,ul,d*i.fiuo,,un ?1ulu pruN luiud 1 ira, z rri,i.u 111

err r,,,u"ru{ud, il,in lffi ' ^:ilil:ffil#:*il,J;-il*,,fl,,j,?rlJi;,6t rfinnrry:Jonruruunrnrruru.h;r,r;;lrr:,r;, ?1u?u pi\ov

ritrrh "[rarurrnriulf,runrrn;m 11 6,,girur6u6iqr

Irudfl{n1, r:i6uuri:Jatrat pM},r

rua ro 1n 1r,,r, niuu'lrxi. u, .ud

olttilufllJyt i

!-

t9

tufi'unm;finrfio

3

ohuru pr{NI 4

uurutilu celt/nn1

I=1y C

= ?11.11U PMN

d Septic ShockA!

= 40. l'cT

a-fneumonia ct

i

i

I

I

I

II

Respiratory tr,ailure

Dead4

I

iI

I

11 siuruiu

3B'C - 4O.7'C

Septic Shock

" ' - A v le ltt .i,uulurug : rurr.: I Tuiirroqr,rlu:lun*rrrli;fl gur,rnirunyr *,1i1{ lufi + fi..:iufi 11 zuiruou"lunrr,

0tn0gl Copyright by Mahidol UniversityCopyright by Mahidol University

74

., xirur.ud o f,nrr6e',#uru.,,,u^drr^,*u.. (r.nn.r,l.,fi'e,'[fi6..:d'nraul"^y-ll rA4 ' o -

e 7/ I I itua.: terur:Jgriru; trrunonrt6ooerrrrarurhu'[:rfl'l:r q]aofi G iurrrnra,.:nrlfinur

?1u1u pl,N iuiud r +Gr /:ru3 {uia t ,duil, ,,r.r*, ?1u.ru pMN

" - j r I y"luiufi B riay g u,rru,iulu1r., orn,Yu,iuauff, ,rar,iuird r+ ro.:nrrfinurpr'tN =:oo/ur3 'ludr.'riufi z-r+ uiruflirrou, q*rnil.,lrrri.o ,r.r'.-3g. e'c

+I

LtilunI]l,l 4! rt?trn{n1r r rlduuurla.itlo.r purr

lrgirurrufi +

lltvaA

t 1lJnufl 1?r nfl t fla

5oo

300

200

190

0

qhuru plnr

,,jru,iu cetl/nn1= thu,:u pMN

17 ,8. C

.t ql

11fl1l+*--"--

14 oruruiu

14:J','lu t uelt

o -ifi..11uyt 14 Xiruilrr^u,^ ' -J: tl.Ifl1.1?1llil 7qc

guuqu 37 . 5'C - 38. 2'C


l

I

75

uirur.ufi r finrrfin r#a'luro.:il..,n , duo ornrflunr 1ilneru^, r r,r$ontr

v 1 v I vr 1/ '--i ---'-"'''"0n rdu n0ur311ro{r,run 2 iuXlJru"terirutJfrfiruy ( rfiufifiGu 6 lrrfiu:r)r t rurt,raoe,r 6on e,r iu,,, nd , i.ur#u r,,unujruf,1, go ,r,.,, *r,,0, fl r 6ou.,'oonui

mnit rfiur (netina:- ir"roirr,*s") ohuru pI,rN tn rffu

=,G7 luu3 'luiuulo:iru,jrrt,]nrdn rau uayohuru plrlr ,liu6rrduu ,cr -J-tu{uil n ?o{nlrfrnilroruru p}tN = rzoe/iluj

, ^,1r,sooJ- tttrunlJl/l 5

t,zoofI

r,eooi ?1u1u pMN

l,z,, , ,oo.{- uur u t ilu celL/nn1

., rOOOl

I

1r30Gl-I

, rroof

I

t rsooJ-

r,zoof

r,eoo-i- ?1u1u plm

, , roof ,,j,u, fl, (

' rOOOl

,ra+,ro+

,ro{ .

,ooGlT = l8'l c

I Retinat H*

roof- t.ool i I

::+ '/.-i

I

ttdar{n1, t:lfiuurrila.ltot priiN

t/l I

tra ro lnl t uu rnrou'iuru:hu t ru fi

ly VAAt lunun,t?rf'ln tro

5

= lhutu Pl{N

1 ,1oo+I

,,ooCr=r8.5'cd

BO

70

50ol--,.-)

Y,

0

1i -'i- ?huruiu


+

Uilfi 5

ofiilmuruanrri,i'u

, ^- ornnrrftnurr durfi'unrrilr; rfluunnilnlilnirn,,u{irrlru r6on ,du

rlo'r fi'un r r fi e, r fi o'lur r * ur.ui, u,, uu, r,yu ila n 1, An,r.n6,o tn rr ilr c r iruuaqrunr*n.rg,,u ijru

"lr _ "lurio.:nrrilr:rfiuuaqrrunrnn.rg,,uiirurrnfionr

rudl.rrrr,r.ri.dundruleru rrJiuu rfiuuryurn*ri,tr, riuzuudai.,ofiu lrnrunnrrifo*ri,.,ndrfi,roJr,:,flrXirru, ri.: rie,lafisr?,, 1,1u,,uriirrJufirr;;;r-;;;il-

"';";';;.,''vX yt

rrufi'rfiu 5 ,1u arrflufirjruur,f ouirr,]. nr6o,r,yu1,jir6.roJrr']unrrftn"rri.rfi

.f, o, -f." 6 I tet .v e s r

-,:J0flnu'rri{n?nrrunlfgrta"iuuoravu:rrEfiu:Jru'iu,rurrn,rar,l,,druo1r.:uururu *rr.1rrrr.d, n.r,*iruiuo,,unuu*ud.otin.rf;r; fiui*| - !.. qr

- ;-^

- lDourrbb€td.llJ u\ [xJl'lu [lJ]4U{ i ,,ufi : rfiurr.,u,6u.il.funrreruaoti'lurr6'u:trunarrfio iur^, uo. ro iiruJ : l^ lrt u u ;-.;

-'."' '\rru d:u.t- o*o lu ,,rruii 1 uar z firoglurru,irur 6urfi'uny*urdtfroqjturr6,u"lJ6r,oioi..nj.,n*ri

,odrl,lu.nrTnfioiaua, 75.42 rra, 78.30 ;jrrr,,rd n ,,u, , ,,;*rr.;;r,t 6urriunvr,rrfilrlno rdu.:frule,uoq11ur ra'u1116

" ,,urol.,.,n j.., ,n*ri,odu;;rt;J;,

A' u

frorouac 59.7:, tLat 67.38 (fi'.:nrlr.:il t) rdoirur.r,i itur.rir,,i,uu r r fi ln: r rfilr rrur,,uu, oduul.nr.iuu ur ro do fi u

j trtro.: :Jfur]q,,: ryufi oxB rlunlrnruriufio (fl1niluln fl. vuj 132)

1.,,uni.,,fie,fiuarutufljrr1*urqu13 figjru r r.udlif,rfirnrruiufiurr,,u, ijru z *utir"lr]trr-rnrnr rrfl ,duor.ri*..rrfi;t i*;,;r,f,

uae\ ' ' - u v

rruilur4.r'IuuCIruonuo\:Lrun lerurJn6fiurunruo,,rn6u lrruxjruryurfluuirrud


.J

77

1,1^ru.,*uu',,i, ,,juur.,nd.,anr,rndfierrrfi'uro,,,r'.,r0 ,,:^"""1î..^ .ir, -^"' ' ,';^,rLrrrrJd rrrrYrlrtrl lllul,U\l tll'l3C{ tOfUUfn4n leJfU, rrffori gilu r o\: uac qrfi d,.,r r fi ,u uun u..,nido rrJ.r r* a,r[j;,, rlu irr,., r,flan'rw fi ,^,1ilfiurlor r :Jr ov, fiuu, fiu,,rdo arauru u,#uJ, .'r..,, di;;., ;rauvVa Yrrlriufi"r"lurravuonuo{riun uonornl;"[,]Jrru.n,,,6o,r#o,rarri.: rfluifid*u.rt #A{,uo rtunlnunl t 6':nrr fnurir,6rfi, r or,,1,

^.rrrruo,,un,,oiurruo,*iouff,':oGu.u'lr,r.ri.dr,n?1:rdroln,iuo,rrlr,do^.r.rn:Jfiilanru.rf,gnru..

z. 1,]nr.o,iu..,,aiof,r.,#u gjruff., r r,.,r,,,lrrt,jtf,rrnu,,oin.rnr,.,,iluo,Yuv,'ru{ r iiurir yor do r,.,1rr]uo,uuoq.,nr,;.,, ;;, +r*-r'ri,;;;;.,rrruqrinr rfi. r #rruol , {?!u1u1ar rurGu6lurr,r ru.{. nrr nh rr,:ru^, u.*firlJorrlilinr., rvir lr r.l,i{r40,,a, r #or, nn, , ?1u or, , 6*orur.rurrl^,,6u

"1:,uli,r'lua'rraflui'rarore,ua,irdn:Jrn,iolri6qy,i;; ;;;;rUiir6*3u,60

1rurqru.u.rl.,#u,,urxfiufirrrirrurJlrûur',,i.'lrul,jr.,rr;r-rr.-

firiu ori*, 6t. nr r or1f, ,,u rui, r., u.ddu r, u.,.,r*, uroilu.,lr, i; ;;;;;r.v),,rua rfurroufinnqro':'lunr lrJfl:ifi.: ru uon?1n?, a*o.,rd,[um ritu,,u.ti,rdrrrlr'r*i,r ?a1 :Jr rufer*r

':.: "ru,,o{ , r ^,r,l.d ff.: ti.: t fi*uufi,rriiirule,urrr.t

3 . mhnrrud vo.*d,,,0 u,.,u fiuuri..,oiuu iua, nFr rjn6o r,r ir,r fior, r fruri rr,rdro.r rr,1',d1,lnru., !ru ?1nn1rir,rfiu urorra,,,.tr..,rtru'^r'-uun,.nfi Xiro,rn, rgr6fi ri,: 1r1 ? 1u irr,,u r,,nrr..,fi ,,,u ru.^.,, d;. - ;r- ld *uirr*fl6o,fir,,rdoarûddruoS6uniu' fi,rflrJr (rizzo) "[ilrrrr.ri.

lnturoun, rlJnlr nrunrl r nfinr#ar-i---''"'

, (?Ir;un,

nu; rrrrrn ufitarrr] r.:uu rurar ru16ud ,vvvlv: onurdu/llJt, 2DZO), 1U1| 35.


7B

a

'luiu',,,rn,,r, Reverse rsolation,Yu nri?,rulmirirruoua or,rir,rfiovv1 aa^a.Jt,

uavdn:Jt ' qgriui{ortflufiqvflo{ilhn?,urd;orer'luri trufi,rrnarrotl,ra:lr roro

v I ' I l'I

4n{u um?1flnrrfftrnflv*r?1 u,huffi.,, l r..,u"lirrfirnrrril,.]ar|ro'0,,^rf,ij.,- ^--.y1".o x o v I t

-]";"*r66rJ-ru bt( ,, -1 r1u trriufronrruilr,Iulnir r6u.:eraoerr,:arfifrnr+r t6rrrfluiou ar r,14), , J r o

t. ta,

r o,rr'rurii d runhn,:rd v 0l nffn es vr lfi un r r uf, iu r iu{ura io z - ) iur,rrni,:r,rd,rX-X v it !

uon ornfirirduo uriu , r,',rrrfirrn11ildyorn,,ol^, urf,ru , i* u,rdr.r nuoy uh nrruavornrorrih4nli.r rdofiurfrfiG.: ru ,,u1u,.,0, rufi,,rr r iJurr..: {u, rl,.,,yu 6oauu6 dd^.

ov rt':ufin t nutt'lttnr r i,ihnr rud v oraiu o,,rn"[i i'en r'rgrlnrr,r'1untr mhnr rud,01n.9^9 v . I'[r"iranrunru Lrn;fitufir1uar,6r.,,,ri,r,rru,tdi",un,]n?1rdyurr"l,i,r.1r*i,,,0fi,rfi0

rraoerrufinrnruJrv r fiurua.: ruu,j,.,o^,1,., ,

^ru,,^rJ.,r,,i"[r,Iqr.d, fi*iu d.r1u, fuofie lll" dt .lo*uafl (rooev)'[n'[r,lnrutffu':rnrlfriGnrlto.: Reverse rsolation

r 1l1 I r v ) v v .ttr Inuo r l,rrfrnrrffu arr raqr:Jrunrrrflrrurr,ln , r.,ri.dd,rirrilu{uunu0, nhnrua, o r oio t u un,r..r 1,11, r, n ",, A r yr n d r u u r y ar 2

4, ilhnrtrdcoarruor^,giruiuarnF,: ?1nn,rrfinr.,*rialirr r r^,,ul'- o X t I ,r ! ;

''----[erirfronr rrfiou1.rd]Jh rdrrouarr^,rtru6n , ,.u"[iirfirnr ruf,,fir.,ud..rd{30{nl,

eruail'run o n rl fiUilr u"[nrfifi on, ,:Jfl0uu0u]J [ ]4flua r ru r glur fi,udliunl, ^,r1r,,0r'lulo :

vlt.5, urunrrilrovrrrJduu4niu :tnfiururfi'lu,,dlrurrflu o.zz,[o]o6u

\u t o'l,,uunu uu^^ 1rn, fidlorrfr j, u u, r 6 ur'luir..: uu nu. r r|1s* d'l Jfi ,r.f, u.,

aleutlarnilrrrln'rn1r rrrduuururrflurln : iu ,,ul'lunrfidnrrur"[,]fl*,,fl. "[oTo6uo,

, v t 1,1u00n r.lrr.u.fi ?1{a{ ulru.,,uunuuunJrr t, r l4u rdu o rrnfi pudufifi r r r uu

Y l Pirror Op. ci-t. r p r 514 .

2Souurr op. cit* p,541,Copyright by Mahidol UniversityCopyright by Mahidol University

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L'Crane, Emmer, and

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p,616 .

GRGUrasr 9.p.*!!. r p.844.


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1 Crane, Emmer, and. GRGUrasr 0p.cit.r p.849,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

VoI./!, No.5 (December, 1971), p.849.Copyright by Mahidol UniversityCopyright by Mahidol University

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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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lDennis G. Maki, rtlifeline Gone Bad.r'r EmerAency

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lGeratd p. Bod.ey, ilOral Complicationliferative Diseasesrrt @,(January, l97t) r p.f]9.

2saro"r Drei-zen, Gerald p. Bodey, and victorio Rodriquez,ItOra1 0ornplication of Cancer Chemotherapyr,, postgrad.uatel'{edicine, Yol.lB, No.2 (;rugust, 197il, p.80.

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_ F o v, X ,.^rh^ ., tf:O'Ou$itiltntttnu.&,t"alllllttJl' T f " , r X ,.^t h^ i l" _tl

Nrn@urps@uunrieuun;:onn nfl 6 nBurBr[rfinrp:u1l r unrJBr[rfirusr NrdIlrlea2.flA I

z ft\4n@n[l nMrU@Et ul.JttUnft 1^ ^ > r x - v'

nrp 5:I

nn 1Ng,hF

lt

l3uurJll

?Copyright by Mahidol UniversityCopyright by Mahidol University

l, I I

'luurjrumrfi +

100

| "

| - A' u I t -.^vjV\lJ 1''illttIJA il 1fl fiyl?lU1140 { t U0..1 ?']nnl, il 10] el I df].:

v v yvl vd'nrau rafi..rETrr"lu'uilnuiln frnrruruuanlrr f fu um z] fir uuaflrdo

fl 1uu'ln ttat 5r t 6oErduo,': nah'[r,lafiurraofl r ial qrurufir]nrfia'lur yu i urn ro.t. 4 X j ^i . t v o X A vnlrFlnu'txt 451 /lurJ ( irilunlJyt 4) drraiunrrfrotfroto..:rtuailnrilrufi.:vlu

a,vv.aXv4.d,vvil1n tluOUOL 3 ?C.:ntrflfitrioyr,t",unr rrar tilud,ttl.ton1Ifl1Uf Ilud'u6'u :

| -1 ^ ' ' '

tguflu ' tit tnot rrnllttnltLtnr'01tudflf 0.':

ru'rruir'iuli.uu, ri.,rsrouirrr,r6ar u; r f r rirnlnfimrmun;

urtr..:30{0?u1r0u v\Ln1f9t0rlrCI?o{ttuailT1firouflv 21.57 nrrfrertfroil.? tf n^*', J^ X s ), -ctnfln,tu tlt 1 - +5 luua{u1nfl t 1a1ylflo IiiCIfl,0.trtua [flu tq-CIu 13"8 iil4

' , 4 ' 1 ll^ ^1 -- c A X o v e dvou1.: Itnfl1iluthu]iiln1rnflniniln-ilLrarilnrrfrntfroro,:rruarla;C1uf{rI,.:ilo'Errrur.t I..^^.1.^:1i.-.-1^..Xq , t I o x^n 1Un1n?1ull1ulllfil0 tso [uilOflOu 1.:]J1n t ua {?1nut t luu:Jn1t I ,U1u ( lrainage )r. r ^ ' ,t tt eAl4 t . e | 4 q- ,^4 A

^ vA a Avlfln11- d11,1tLr-Jillut1uuuon?1n [',aur:J$tirur flo nriunrr:]ufruuayovilnrfru!97rv1t.--------4. -. y-

" cr-v Y ' d ' * v6rt1111A0ntCIOnfl1tta1 [elu']tttJil Lutuav 2 nt{ttFtuu Ro.ttrffltrT.t"lunrr

.l o I s ^ tr Kilhttuailm t ilo { qrn t 6o eroon t rul eru t Dr/r.rr I lnl t flerrrua r ilo tuoqr luaera { un tl, I v7/ t r 7'

tlualtfl{ fi6u '[e,fle,ura'l]leriu' lrulr "rpa r a ( s of ratulr e ) d.:rlt1, r flerrruatrltr'Y' A q'a A -'1, X t" v t

-[0drfl1n1uttn, Iuuta0et0on!1n lhrnounuqillurlui.lou'IuTuuquuarinrJryyrru11., o oX I a s y tu d " ' "1 '1 X t

01141t lnn ttu6]?.tfiguou1,:t1ntr1[nu Ilnottuurtila-LurJ "[uru:Jrur1ufrflu11

d .4 . v A " f, ,l ' , A ^u

'"uuaon In0nfl1on t du]lr t 10lLt1l1t1l119l?u tu0'': ?,tn [ flttyt.l t 3]t t"i]|o [ud1, ultta r u1

.l

r.Jfrfrrururu > Iu Iulrhll. l:lduurr, urarj..r ahuiuzunnm r14r1y r #oqrnilaru r 6Lrl-tc,vVviA

rta v ?1nttiln ularnuu Lll.ilL t t0

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

nlran r6oso.:*rua*ac'ruf..:'rugirur,.,udu rryu *ri,,lirur.ud,,fi*,f,r,dudn rau (cerruritis) *- rfrr^r.nn.i;rnflInrrr uuarflu

:

r:r.r Uriua ril r du.uono'.,uurn 1 f,r..,,,uu"liliuay e uF..,,i.u,,,iu*rr* f,ilnrr rulanu,:yuofi 1r"ra and Bodey) nd.rrr,#urdoo.,nraurflunrrfrerX ^ ! l

^ /r

t rio:rotilrurit frr,''ruou 'lur#Jruur.: r rufiar t ufllJ1?mnrrfie,urnrn.u,roJu* io

,i.rû*r6onoht,oru,.,i.uunuryrhnrufirufrrou,l,du urw.:niuniafiu uacc v a z ^9 Y

ov r erlufufiu,^,luulli rfie,nrrrfl 1 dolumrlrul?1?n r nfi tnu,i.rûrr6a,nrhv!ululanrrrtu'iorrrfilou'lur,rnosrt6oe,e,roi,r "t rra;nrtflrryrua^,ruJrirrttrr6u1r,nju r du,Yun r* drrrql

.uru1fi a, un, i.,, ur* U.rri r;r, -;r U-i;r., .,

flnurqr rn r uud": ffu fi , t^{utrr o fi'un, v un r n iur r., n, #u, du6.n r a,.,6,o n J *

, uonornillux:rrurruil : d..:rfie,ntfirr#u'lunrrrralafioro,male,J'uun,,ruI'r:rfi,r,ior::iTrr,i *uilaruflo:Jaru ,r.fl{uu,,1^,,^,

fr*uu,,'rU.#,, i.,lniu ril..: orn ry:jru'loiuu,Jfrfiru;raa rurfier r,an1, ,*., ,#uu.nil,arilui r.:r,rA 4 o.l t,li t iluuuo,: 6,r"[ unru t 6o

?1nr1u':1urylruffy r r,,ufl ,r,fiulrjrgjru1rnr6o'fi10n,,,nfi*r#o",:.--.^ -ul' o X ^ u/ rj

ur [1ueJ1uu': Ierd': nrlfro tfro tfin'inraaruanuuyrrErnnrrfi,uoon,lil 1riirrd,fio,oX',!nrrfrer t6oro ':rrzuaflo'r r r i.:rTqr,,r r 6uu,uun,.irrf,ru ua, ?lnunnrr finu* dr.,n,fionr runrr.,,^fiijrul.r, *r{. 1rryjrur.,ud o d..r r fir,nrrfi*,#uruo,,un,.lr6.n7'1 j ' t' v I

"Û

er:-lrurrufr r 6'r rfin,rfio rfiod'n rdL?1nn1r1irnfiflnur ut' -r ;,;.-:-"uuu,rL6r!-v,r,-tJ [14*,]uInjjl ttnc tetr:Jn1rfitia?u

nr vfftu,o,aru,Yu xjrufi'o , ,,.,u"[lrrnlrerua rdr,yu,r,ru 6r,flrruuor 1oo

vl

uilrt,^lout

7t

iUlt

I

yl

\

Ield. and. Bod.eyr Op.cit. r p.1022.


+102

(rtnzuutn t. ,.rn,,rd , ,r. 137) .,iirrr.rd , firrr,oyruqrruu.*4 v o ^1 .-v. 1'- ^'!'f,ilrJU1lru\: tnoumn{uuu'[nirJnrle,rra'[uzofrr aila' 72.7) (nlnruu?n fl .

; ; vt rr

trunrrfr r uur r:z) uaru:Jrur.,ud o do rfio,ruu.rdoererrfn,^r,duotyvt'

orn'ludrrurua; ur:Jfr'firururufi.: s ru l^ul,]1. trrduum*ra,iod.,ro r6ura,^7/

l, - I t,

rer"ir,rarruh fi, urr"[r.,i:rnrroLra'lufirnr ruffonJr.: rfiu.: iuuo, 44, +4 uayI v

20. oo ( nlnuuin t. I1un1, fr te , t s 1nu,1 136) ?mlJani, finurd,tnamvaAd av 1 vdvl t,il?r t uullnrr errroytzutlnr u o fi zur.h u'[ rr ir.ifi zu aqro n r r fi e, r #o to .: u u a u n y il r rarirl em rr r .r

nrtfirr tdoro.r, rulryr,.r.r t Guuru'iq

1unrr finurnFofi*ui.,fiqrjrufifi e.,,#rr..., r rrrur41'.r r6uraru"6 2, 1ul!rfiotornrfiniloeruru 1o',r,lirur,.,uri r rfirrnrrr:_roe,rur'run-rf,,I.,lu,du.v vl ..tt I vrlurJorr zurJruf,1t g'.r uutlt!'u raff',:orn'[iiuutJfrfiruv 6o rrrdilrfiffa uay

ovi6u fi*u{rti..rirliq,,rij r flurLrr iu6.: rrduurfi.rrorr'tfldru; r flu uonrrttanttnu (Nloxalactam) lrn#u"[:rf,'[ian ilorl'l:rf, r 6u.'rfin:]nfi :lr snouy. . A s o I X I d t -t v t vnu?'lu?uiJl tntvla uvlurnfru fr.:'[urvuvurnnhouriu'il"louar lfilfiurfiu >Ga luu3

^,1 v I

t uruugfifi r ) r,rrarmqau rai:rff.rnirri.:arurroului.,un..,rfi. r#uif, ntai:rel ! vilil1ur1i]vr l rilnn116rrrGo"tunrvualafinrrnale,huua gj.uflhq.: uurrd,u

flaon oruruflderrfia"luiuurnrfiur r r r /ru3 1uzuuqfid :l {rd + ?.{n,.r,4aa7'tfrn:gr r fiernr rv6onornnr rfier r fiu,,^rru.raru'lr 6,,r1i,,lur^uerailnoria, , uduo J, u

. raru'h ruu.rr,,i111fifirr.nnmrdon'iuiuull,riiruianrr6 n,uffulafirrilnfiuavdTrlr'u1u'101f; ro.r 6oor*,iurnoflailnoocn r.rrufirlErrfia,luiuf,ne,to

-.4 tr'

- A ^ j't

rrro.:ourir'l:r"[rr t*ufi I ?0,:nlrfinr.rurLrrrfienmy:]uu,utrJ,::rryrnrrraru'loi'ou .ll t rtuai i':sro{"[avroua0na)JnCIunv rnfo.:rruraru"lo6n [Jnn1r,r,ar,#ur,.,n rd*iy

v,rr r #oql r,l rruudrra * u6r, uui. iir urio oou,j"irn..,r.iu nnaon ua y ohu.:u

fialnr rlati'r n.: orrou,fu'll'[f, ,,ri.,r11.ruulrflfi.ur rarurfier ,,r]n r,fi. r 6u , in'' I . t -t, e/ I r'[ilourttuttt{tint'[rdrurrnnunl'[0, urLru6..: rfiufiiqr"luiud r r rornrr finurCopyright by Mahidol UniversityCopyright by Mahidol University

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

^ J^ o N ^ v- -l r rlvn0{v1tnfln1rflntrofl}J 125 tltJ nrrfrotfiofi,nrmoufiaEdcrJoerlrl 6o,rflu' , X tr q" I a_ r X I,oUav 31 Lrnr til1.td1tllfln,trqt1Ud..tdft f 60fi,,ruu'[qrrn tr.ln!traa1 Ltn, tfr6o1 "l-Aelldun1ilfi1lolrlunu (ulxed organism) I ztrtutflnetttarnrtut (retd and Others)

^7't 1^:^^1.-.^.1- 4 4a ^ .l A A x,1u.1'luij'iXrhulrti':E'rouuhtufro{tta5ilvri..:rfrnrlafiqrr1?yrrnflnlrgrflitgo mu?ulv

1 oB t lu rur:r rfi n r r fi er t 6o ornrjoflu l rJd { dfl ue r r fJud 1 i 1,lfln1 r r,r 1u:rrn d qrr r duri'u2- trl I v .r/cl ', ' Arrs .A A ct o . ,rl lltlltltll u t ue'tu:J tonrdqinr tfro"Lut v ulJvr't,t t fruuru"[t"[nt ru nr r'l,ilyrounona:Jn0?y

^r^]--.n t .!" | ^ vultoltriooir.: rnnog:rit?uno r,ra"tnaoafiaLrnrdlutAu{ (crottis and

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

nr:r r nnfinilnen r#0il'ru3 r r.ru.ddo n,,oujrul , o , du.di. trn rr rnn. , fiu,!1l

fi r v ul u rt r 6ura r l'l o6 o fi u o r v iler r v i': i d u r riu r n nfi nrjao er r #o milff{ n r r i n rgr

n1lildrCI1firjrnr[u rua r t dorar er n1,ru ?h r fl u uir nr l ur r n do.: r r u"lun r r ra ru'l rul'','., ruuntre,u rf ': ,r'',ru.diilnrrfier,#uruorvr.m4r{r6uraru'lol[,]ur*i."lrt

"r^1^-^- 11. I --o_ x x f, ^ , ,u,,,, 4Iunlfflttailil1utuCI{0rnnrrqierttiotto.lrvuuil tilotfrertrnrrrn'tr'terurn 6rnrr

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,


104+

ANIn 1rRfl t.r01 c{ t yuLlilt y d1ylrtr?iln a 1..1

t, nlranr#u'lrrrrul tr',ri,du,1rûr,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

orilaman ornrrarfrqdu'',]r.:1,,u1uia 6o firhror rfiouoonurnilrr:Jnfi tfi,rui,.,,:

,.nXjrudn + r,',rdu.irunr16*r#u) ?1nn1rnr1rr'.0n.*rj.*,auouun4 A 7tl ' l '1'rirrumfrur x:Jru"[:if,'lt ?,'rulurnir,tdontnrrryu eo,ooo/uu3 unyohu,:u

firlrrrfia zTglur3 ,(uzuunfid

z) fud + mrnrrfrnr,..,ijrr1rtr.,,[u fi.u*urnr,,rJ'4' a - t"te,rernmufiuluuar'14

r flonnrour'[u r rrli riouhr,r.rilt'ulr]1o.,rru rrfrfirurir..ruirtr - | H j o*'l"luiuq..:fiuriufi"l:rnr r 37.5" ,,orfi1ifio,lofruur4niu ird 1o n0{n1,

fini*ruiruf,liû,,,^, r fion,y , duiluûuodn r arJru,iu,6uu.,run1rff ,ur,,rrruur'(Meningitis 6 subarachnoid liemorrhage) ?1u1utnfo,t.iurt,*rrfu

ts,ooo/u:r3 fidnrfia tto luu3 rafr.:rrn"iiu1Jfrfiru; rfinr6or,,,rr ,

(rurrv coat) ,,a, rnf .r6on'riui*rirlinfla\: ,.rnrrfi'rlu6du iud 14rdl"

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

I t fier t floralalo vtn r auo rn uu nfi r iurfiq un rlnurYu:,ru"l*1r]rjou,fnl9.O A -

tuFrnh"lra r ilsrnruarurn'lun rr ffiL*ruayosrr rnrr r fiu6ior4.r , ijrrr ruf,,,i*Yt* o X r I tl

Irirnrrfrnrrfrorrncuun?1nn11yfir]nrfiriluro,rxj.,rr.,1ra*,drlr.i.,u l uayut"

qnau"hlour.:rrn r f r uarorn:-Iqnrr 6rro,:,;jr, fiu, 6uruon,i,.,u,duo ran4 4 l- Y

t n inr r 6orrErhurrnen t,,r'1, r fi nnrr y,,r r nioudr uLu t 6o r 6oooo n.lutro.:

1rr.r*u=, Kaplan, and Armstrong, op. cit. t p.715.Copyright by Mahidol UniversityCopyright by Mahidol University

I105

. .i I ' - J' v 't' ,ri vttat t ilo t frermurYunllt t fiouudilo':on r dufi d{ r a?urYut,rr'lu rril1il r fiufiiEr u:ro;r t ,---v o r^-...q1f i c. c^ - o X ta

"vrul'IlUt1 t n0fl00n.: 1ul'l,t [u uil1u r dufr in r 0{ e\: ]Ji?1nn 1rfi n t6o urrfi r flu1r\

dltuanllflrufinhnq rilnerua vnuy (nera and others) r rurrufi.:iiru.a '

u, o ,l . oo o , - 'Ilt t t.t-l0uln tuc-o,tri tnUfrinlfn tfiOsrOOn ?1u?il 18 ,,tU ,Ttu1tfld1t1,10lu1?m

I4q41-lltaoenan luduornt 5 ,1u' rintul d'ntrrlflr il ou$ul rrarnur na11?1l,t'iul r nlafifl?1.r0rT,CIlafinnrrfi r doeraon rdo,:rttrn r nfn t danrrlou i.r,.,rrurninr6oerer]rrrj.,,,20,ooo - 5o,ooo/nn3 ryflrrdoeroonrdor,raoerrdonfin:rrnt.: lun-.- 4 |

- ' o 4 a l^ I .rtsu tnIuoilflr1ul{flou1fln rrCIrn1?hulutnintdoernrnrr 20,ooo/ilur

orfi r 6oe,oon"[i r e.r}.,udruu. r 6oerrjnfi nrr f, r6onroonluliru rradrfi,riliiuuu,14 .4 u

^z7O unrtiludlrl40lnlrEllufrlrouay 4sI

rrnqi'roJr,rdu.u.fin,r.fl ,, rfirlii.uon?mnr16rr#u,rX, nrrfi

r 6or,oon.irufi rflu:Iqrarahfi'qd, r.ru.dfiurnr vufn n.,, dfi,* rdo' rdufiu,ruIA u 6r.i I

^r^--^1 ^u-.t - v c A AX I ou11lu{ tut u0qto.t:Jrnurouuue"rr t?ilfunlriJt6onoontiiuiu t,ru rdaeroonI

qrtr"[rffu uacohururnf err6onnfld,',uo,fjuarnre t6ouro..rnrlruyrrn;oudo, rfie,

'r-1.4vil1nfl, r,t, tt0 tlJ01n''lf nO.: nttUerU

v- 7rl I4 , .{C 4 e A1ilfl1IrJl ilil1rjyl)J t a0n00nu, t,lut rriut1'

rlso|"a,))uu.l'.t't'"lunr r luanfrt uv d.l t liler1u r :]ufi.r fi r ? 11,1u1ii!rrro.l nu"io rrar'lunrr rrn"tsl nrufi'ufit

El c 4 a 1t 1' - vY I t 1'l Yl

n1tiurf,iiu:.rrn;flt6ogrrn:rruLr,asuhilr'luqlilrulflurirfran uurrmhu:.i1{r1u?,A A dl -v- j . - a, '"' o .lo

t ' ' ' 1o ",,tn0n11t te0fl00n tuo{urlvtdrnq tiluua"[u tdulilrr unr?,]1,1iJ1frilnrrey'[unrr

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.


105

arraiunr16l*,,lurrnrrouuurGil.,r"[uo,]ru 2 r,)u r"fufi*, 1.,,,1-.-.-1r -- :r1.1 ^q..,1 le ,-.' u', u c A XTiu'tmm?0 Ttil1r t,d rflOurrarflur.l [u l:-LlUflu uil,:udn 1 ,1uiln1rfrertfroro.l

A q/. i ! o... r "t,r1.i t 6urTd,i1?, r ilo.r?1n rfrofirlfrrau,.r (Dipthcroia) uar'lururffuuirrfii'- ,A..1 I tl 9,, - L, !

lj

1niuurilfrfi1uv'duu0? ilnn1, rurry r.{oornflnt,hrr nF..:qlarr,,nru,fiu6',.,n.',,rru,l-l

nir 105/rr. our.:'irfiqrrunrrfir,{offo r rfirflrfir,fiu1uqu,,r.,r,,ur"[,],flu

rTrgra.rl,nr r nu 1r0.r uirun,,1udfi n*.

,'vo1n 1r [rilrnto1J?1nnr16n tfio

: A ^ X 9' t o X q s + 40"1fl1t l.tlilr ll'dOuyl t n9t.]u Inrttn nrrqtntiio-lltnr y ttd lafrrrrta yn,]1yton

^r^.!- i .(, ^ x i x ^ e'

? 1nn lrqletteio fr't t iluuaq rnnt tfrnr u'fron lurLr I ru nrr rio r 6o'lun r y ua'[afrnyru- 7rl 1,, I vl ,

t, , v I"luurhu 3 r1u '[e,un ,,]rurrufi r rdofiq,.roru '[i,,n uou-d]u"lafin

arniillqrnonln nqrt6, 6.1n.'[n, r6urvrolr,*r*',,rur' (Non-irernorytic

Streptococci gr.D, E.Co1i, Enterobacter) ujrrr,',r,d , flr1?i,AlU

X 4 vi J t"

tEiotnauttanl ttavzu:hutrufi I nri?yllJrdanlulruud'lunryrrdlafiqr uon_--Z-., 1 --a- Xt " d; da __Ar o^,?lnuil'l tnnnl1vflOn?1nn1tfln ttorltifi?u tilor tnlryr,tii.,r:Io'i'uilnr raiu'lunrr

fl9rltoruttt..:tlu?utnnnllritntn"oouerqnnlllra1 n'nlrt rJofufrarrYq6'ur,ri]t 6oa s 4l Er ? v I I \ lt.

nrrvilrlnt',I tirt lnruzuilrurrufr 1 r vu!fifin rfio'iunr su6lafiflorurufif rrrflerI t ,"

-, '

0urr,i11{er1?ulru,,l1. - +g/uu3 turuu4fid 1) ljrumud z rrurufirlrrrfia!-U

:ro.,r,Yu 27 6 ^ loo /nu3 ( uuuf fld 2 ) ijrur rud r qrurufirJnrflaq.r q.

z+zluu3 1uiufi 2 r0,:n1rfinur rrnffuulrr*fil,]iil ,^.. 11 ;rdfinr.. ^J ) a d '(ttu1Jnilt,l 3) r{ tnru tartrorttnv tnornf 1d (crane, Emmer, and.

tru'GRGUras) nnrrr1 fl'rrafla.ir0{?fl1ufl':lnlfin rfluarrrqa.,ff}iiq.d*.1il{ |

^ X -l I I A s o I t .t du.:flon1rqtfi t tarru nyt t ,u t:to'.,rruruit,: [nr,leou r yu11\: 5oG-1ooo /ilur


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Lymphoma 105 ,1U.,' t_lulruet-!_U$q. flil ,, o,yrd ,(ilJl:lluu - finuruu t z5zz), so _ BT.

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Appraisal quality of care in patients with hematologic...

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